We used epidemiologic data of clinical periodontal status from two population-based samples in two countries, USA and Germany, to examine (i) the impact of age on the relative contribution of recession and pocketing on the distribution of clinical attachment loss, and (ii) whether it is feasible to define age-dependent thresholds for severe periodontitis.
The analytical sample was based on persons age 30 and older and included 10,713 individuals in the US, participants in NHANES 2009-2014, and 3,071 individuals in Pomerania, Germany, participants in the SHIP-Trend 2008-2012. NHANES used a full-mouth examination protocol to collect data on recession (R), pocket depth (PD) and clinical attachment loss (CAL) for 6 sites/tooth on a maximum of 28 teeth; SHIP-Trend used a half-mouth examination at 4 sites/tooth. In both samples, percentile distributions of mean CAL/person were generated for each 5-year age interval. Age-dependent thresholds defining the upper quintile of mean CAL were calculated for both samples. The topographic intraoral distribution of CAL and the relative contribution of R and PD on CAL was assessed.
Mean CAL increased linearly with age in both samples and was higher in SHIP-Trend than NHANES across the age spectrum. In contrast, mean PD was constant across age groups in both populations. R contributed increasingly to CAL with age, especially after 45-49 years. Upper quintile mean CAL thresholds in NHANES were under 3 mm for ages up to 39 years, and under 3.58 mm in all other age groups. Corresponding values in SHIP-Trend were also under 3 mm in ages up to 39 years, but increased linearly with age up to 7.21 mm for ages ≥ 75 years.
Despite substantial differences in the overall severity of attachment loss between the two samples, common patterns of CAL and of the relative contribution of R and PD to CAL with increasing age were identified. Although periodontitis severity may vary in different populations, empirical evidence-driven definitions of CAL thresholds signifying disproportionate severity of periodontitis by age are feasible.
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