Discussion: Natural history of periodontal disease in man

The periodontal disease problem. A comparison between industrialised and developing countries

There is no reason to believe that periodontal diseases in industrialised and developing countries are in principle different. That is, not in the sense that the problem is caused by a different set of periodontal diseases, with different micro-organisms and a different natural history, needing a different approach towards prevention and treatment. Indeed, from a public health perspective the relative similarities in periodontal conditions around the world are far more striking than the differences. The view that periodontal diseases are a much more prevalent and a severe problem in the developing countries seems to be true only in terms of poorer oral hygiene and considerably greater calculus retention, already at a young age, but not so clear for periodontal destruction in adults.

Trends in the prevalence and severity of periodontal diseases in the US: a public health problem?

This article reviews trends in the prevalence and severity of periodontal diseases in US adults and examines the implications of these trends regarding the recognition of periodontal disease as a public health problem. Data from the National Center for Health Statistics (NCHS) examination surveys, 1960-62 and 1971-74, and the National Institute of Dental Research (NIDR) 1985-86 Survey of Employed and Senior Adults are examined. Issues of comparability and generalizability are discussed. Changes in the prevalence and severity of gingivitis and periodontitis are presented for the time periods 1960-62 to 1971-74 and 1971-74 to 1985-86. We concluded (1) it is difficult to document the changes occurring in the prevalence of gingivitis; however, given the available evidence, the prevalence and severity of gingivitis have probably declined; (2) it appears that periodontitis continues to affect approximately the same proportions of the overall US adult population; but with those affected, the extent and severity of the disease have declined; and (3) older adults continue to exhibit more disease and greater levels of severe disease than the younger age groups. Renewed efforts to clarify the epidemiologic confusion concerning trends in the prevalence and severity of periodontal disease should remain high on the agenda for public health dentistry.