title: Accuracy of NHANES periodontal examination protocols.
abstract: This study evaluates the accuracy of periodontitis prevalence determined by the National Health and Nutrition Examination Survey (NHANES) partial-mouth periodontal examination protocols. True periodontitis prevalence was determined in a new convenience sample of 454 adults ≥ 35 years old, by a full-mouth "gold standard" periodontal examination. This actual prevalence was compared with prevalence resulting from analysis of the data according to the protocols of NHANES III and NHANES 2001-2004, respectively. Both NHANES protocols substantially underestimated the prevalence of periodontitis by 50% or more, depending on the periodontitis case definition used, and thus performed below threshold levels for moderate-to-high levels of validity for surveillance. Adding measurements from lingual or interproximal sites to the NHANES 2001-2004 protocol did not improve the accuracy sufficiently to reach acceptable sensitivity thresholds. These findings suggest that NHANES protocols produce high levels of misclassification of periodontitis cases and thus have low validity for surveillance and research.
authors.affiliation: Division of Oral Health, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention (CDC), Rhodes Bldg, Mail Stop F-10, Atlanta, GA 30341, USA. peke@cdc.gov
authors.forename: P I
authors.initials: PI
authors.lastname: Eke
authors.forename: G O
authors.initials: GO
authors.lastname: Thornton-Evans
authors.forename: L
authors.initials: L
authors.lastname: Wei
authors.forename: W S
authors.initials: WS
authors.lastname: Borgnakke
authors.forename: B A
authors.initials: BA
authors.lastname: Dye
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005889:Gingival Recession / Q000453:epidemiology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009749:Nutrition Surveys; D017622:Periodontal Attachment Loss / Q000453:epidemiology; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000453:epidemiology; D010518:Periodontitis / Q000145:classification / Q000453:epidemiology*; D011159:Population Surveillance; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D016388:Tooth Loss / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data