Epidemiology of periodontal diseases in the study of health in Pomerania

Aim: The aim of this study was to assess the prevalence and extent of periodontal diseases among adults in a province in Eastern Germany.
Material and Methods: The Study of Health in Pomerania is a population-based study conducted during 1997–2001. The net random sample comprised 4310 20–81-year-old subjects. Periodontal status was assessed at four surfaces using a half-mouth recording protocol.
Results: The prevalence of attachment loss 3 mm was 89.7%, with 62.8% of teeth being affected. Probing depths 4 mm were prevalent in 69.7% of subjects, and 29.6% of teeth were affected. 25.3% of all subjects had severe pockets (6 mm). Periodontitis was significantly more prevalent in males. For attachment loss, the prevalence and extent increased significantly with increasing age, whereas probing depth values levelled off after the age of 40. In older subjects, increased recession and attachment loss were found, while the probing depth remained constant. According to the recent CDC classification, 17.6% and 33.3% of persons had severe and moderate periodontitis, respectively. The prevalence of periodontitis increased significantly with age and remained constant after the age of 50–59.
Conclusions: Periodontitis is more prevalent in Pomerania than in the United States or Western Europe. In older subjects, attachment loss steadily increased, while the probing depth remained constant.     

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

Background: This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009 to 2010 and 2011 to 2012 cycles of the National Health and Nutrition Examination Survey (NHANES). Methods: Estimates were derived for dentate adults, aged ≥30 years, from the US civilian non‐institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (AL) and periodontal probing depth (PD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of non‐Hispanic Asians were sampled in 2011 to 2012 to provide reliable estimates of their periodontitis prevalence. Results: In 2009 to 2012, 46% of US adults, representing 64.7 million people, had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PD ≥4 mm, and 19.3% of sites (37.4% teeth) had AL ≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and non‐Hispanic blacks (59.1%), followed by non‐Hispanic Asian Americans (50.0%), and lowest in non‐Hispanic whites (40.8%). Prevalence varied two‐fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education. Conclusions: This study confirms a high prevalence of periodontitis in US adults aged ≥30 years, with almost fifty‐percent affected. The prevalence was greater in non‐Hispanic Asians than non‐Hispanic whites, although lower than other minorities. The distribution provides valuable information for population‐based action to prevent or manage periodontitis in US adults.     

Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014

Background

This report presents weighted average estimates of the prevalence of periodontitis in the adult US population during the 6 years 2009-2014 and highlights key findings of a national periodontitis surveillance project.

Occurrence of periodontitis in an urban adolescent population

The presence of periodontitis in 307 black, Hispanic, and Asian students age 12 to 15 years was evaluated by calibrated examiners in a Los Angeles inner city junior high school. The periodontal status of maxillary and mandibular incisors and permanent first molars was evaluated using the Plaque Index, probing depth, attachment loss, bleeding on probing, tooth mobility, presence of calculus, and caries. Thirty-nine (12.7%) of 307 students had 5 mm or deeper probing depths and associated attachment loss of at least 2 mm and were considered to have periodontitis (PD). The PD group had significantly more bleeding, calculus, and missing teeth than the non-PD group, but both groups had moderate to severe plaque accumulation. The distribution and severity of disease increased with age. Deeper probing depths were associated with the molar teeth and six (15.4%) of the 39 subjects in the PD group had furcation involvement. Clinical screening alone was not sufficient to determine if the periodontitis seen was localized juvenile periodontitis; however, the program detected a high occurrence of periodontitis in this population group.     

The periodontal condition of regular dental attenders in Northern Ireland

The aim of this study was to assess the prevalence and severity of periodontal destruction in regular dental attenders in Northern Ireland. 132 individuals aged between 20 and 49 years who had recently had a course of routine treatment in the General Dental Service completed a questionnaire and had a periodontal examination. Measurements of plaque, subgingival calculus, bleeding, probing pocket depth and periodontal attachment level were made at 4 proximal sites per tooth. Plaque was present at an average of 17%, subgingival calculus at 13%, and bleeding on probing at 34% of interproximal surfaces examined. The mean probing pocket depth was 2.7 mm and the mean probing attachment level was 1.0 mm. Incipient periodontal destruction was common with all subjects having at least 1 pocket of greater than or equal to 3 mm and 90% having at least 1 site with greater than or equal to 2 mm attachment loss. Only 24 (18%) of those examined had deep pocketing or severe loss of periodontal attachment (greater than or equal to 6 mm). The extent of deep pocketing and severe attachment loss was low at only 0.2% and 0.6%, respectively, of the sites examined. It was concluded that gingivitis and incipient periodontitis were prevalent and extensive in the regular dental attenders investigated, but that severe periodontal destruction was uncommon.     

Periodontal status of older Floridians attending senior activity centers

Older adults attending senior activity centers in Florida cooperated for a questionnaire and an oral examination. The 671 ambulatory dentate seniors in this report had a mean of 17.0 teeth. The mean attachment loss was 3.5 mm from the cementoenamel junction (CEJ), and the mean pocket depth was 2.1 mm. 24% of the sample had at least 1 site with attachment loss of 7 or more mm; the majority of these persons had only 1 or 2 severely-involved sites. The extent and severity index of attachment loss (2 mm or more threshold) was (88%, 3.7 mm). Use of pocket depths alone would have substantially underestimated prevalence of periodontitis in this older sample. Sites with severe attachment loss were typically not accompanied by severe pockets. Evidence of a history of moderate disease in this cross-sectional study was prevalent (62% of persons had a maximum attachment loss of 4-6 mm), as was evidence of a history of severe disease (24% had at least 1 site with attachment loss of 7 mm or more).     

Epidemiology of periodontal status in dentate adults in France, 2002-2003

BACKGROUND AND OBJECTIVE: Few recent nationwide studies of the periodontal landscape in European countries have been developed from the point of view of attachment loss and pocket depth. Decision makers are not always in a position to estimate the burden of periodontal disease. The purpose of this study was to investigate the prevalence and the oral distribution of periodontal status among dentate adults in the general population of France. MATERIAL AND METHODS: In 2002-2003, a National Periodontal and Systemic Examination Survey was organized to a stratified quota sample of 2144 adults, aged 35-64 years, nationwide. Participants with six or more teeth were selected from the Health Examination Centers of the National Health Insurance. Measurement of periodontal health was assessed by clinical attachment level and probing depth. RESULTS: A total of 95.40% and 82.23% of adults were found to have clinical attachment loss and periodontal pockets, respectively. Population prevalence estimates indicated that loss of attachment > or = 5 mm is 46.68% and probing depth (> 5 mm) is 10.21%. However, clinical attachment loss of > or = 5 mm occurred in only 0.88 sites in an individual. Periodontal depth pocket generalized forms were as follows: 78% slight, 18% moderate and 4% severe. Multiple logistic regression analyses showed significant differences of attachment loss values between types of tooth (molar, incisors, canines, or premolars). CONCLUSION: Based on the International Classification of Periodontal Diseases, approximately 50% of adults in France may suffer from a severe attachment loss problem. Periodontal pockets are an uncommon condition in France. Significant differences in the prevalence of loss of attachment and probing depth with respect to location of attack have implications in the purchase and development of screening and treatment services.     

The effect of plaque control and root debridement in molar teeth

The healing response of non-molar sites, molar flat surface sites, and molar furcation sites was investigated in 19 adult periodontitis patients following a periodontal therapy of plaque control and root debridement. A total of 2472 sites were monitored by recordings of dental plaque, bleeding on probing, probing depth, and probing attachment levels every 3rd month for 24 months. The results demonstrated that in sites with initial probing depth of 4.0 mm or greater, molar furcation sites responded less favorably to the therapy as compared to molar flat surface sites or non-molar sites. This was demonstrated by higher mean scores for bleeding on probing, less reduction in probing depth, and a mean loss of probing attachment of 0.5 mm over 24 months. Site analyses using linear regression showed a higher % of deeper sites with probing attachment loss for the molar furcations than either molar flat surface or non-molar sites. Among sites initially 7.0 mm or deeper, 21% of molar furcations were identified as showing probing attachment loss as compared to 7% of the molar flat surface sites and 11% of the non-molar sites.     

Untreated periodontal disease in Indonesian adolescents

Abstract. At present, several risk factors for the initiation and progression of periodontitis have been identified. In order to investigate the role of various potential clinical and microbiological risk factors and indicators, a longitudinal study was initiated in a young population deprived from regular dental care. The present communication describes the baseline cross-sectional data obtained in 1987 in terms of the clinical periodontal condition and prevalence of periodontal bacteria in the oral cavity. All inhabitants in the age range 15 25 years of a village with approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 255 adolescents, comprising 130 males and 125 females participated in the study. Samples for bacteriological examination were taken from the gingiva, the dorsum of the tongue, and the saliva. Plaque index, bleeding upon probing, pocket depth, and attachment loss (AL) were scored on the approximal surfaces from the vestibular aspect of all teeth as well as the mid-vestibular and mid-lingual aspects of the Ramfjord teeth. Calculus was scored only on the 4 surfaces of the Ramtjord teeth. Following the clinical measurements, the deepest bleeding pocket with no clinical loss of attachment was sampled for microbiological examination. In addition, in 37 subjects a deep bleeding (≥4 mm) with at least 4 mm of attachment loss was sampled. Moderate periodontitis (max. AL 3–4 mm) was found in 26% of the population, advanced periodontitis (max. AL ≥ 5 mm) in 8%, whereas 66% of the population showed no or minor periodontitis (max. AL 0–2 mm), Actinobacillus actinomycetetmcomitans was found in 57% of the population. Porphyromonas gingivalis in 87%. Prevotella intermedia and motile rods in all cases and spirochetes in 89%. P. gingivalis (66%), A. actinomycetemcomitans (37%) and spirochetes (63%) were, of all the sampled sites of the oral cavity, most frequently detected in pockets without attachment loss. Motile rods were most prevalent on the tongue and in the saliva (92% and 89%. respectively). A high prevalence of the investigated periodontal bacteria was detected both in the pockets without and with attachment loss. No significant association between the clinical periodontal parameters and the prevalence of the microorganisms was observed at a patient level. At a site level, both P. gingivalis and spirochetes were more prevalent in sites with attachment loss. The actual role of these putative periodontal pathogens may be elucidated more extensively, when longitudinal data on the present population become available.     

Radiographic periodontal attachment loss as an indicator of death risk in the elderly

OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly.     

The Prevalence of Periodontal Attachment Loss in an Iowa Population Aged 70 and Older

Survey dental examinations were conducted in 262 dentate elderly people aged 70 and older and residing in two rural Iowa counties. Over 60 percent of the elderly in these countries were dentate. Buccal and mesial sites of all teeth were assessed for gingival recession, pocket depth, and attachment loss. Mean loss of periodontal attachment was 2.1 mm, and was slightly greater in older age groups and in men. More gingival recession was found on buccal sites and deeper pocketing was found on mesial sites regardless of age group, sex, or tooth type. However, the clinical magnitude of these differences was small. The prevalence of advanced periodontal breakdown was relatively low, with less than 15 percent of the subjects having at least one site with attachment loss of 7 mm or more. However, moderate periodontal breakdown was highly prevalent in this older population.     

Risk indicators for future clinical attachment loss in adult periodontitis. Tooth and site variables.

In an earlier report, we examined the relationship of patient-derived clinical and epidemiological variables to the risk for future clinical attachment loss (CAL) in chronic adult periodontitis. We determined that the extent of the patient's existing periodontal disease as measured by mean attachment loss (MAL) and the patient's age were the most important patient-derived risk indicators for CAL among those factors evaluated. In this study, we examined the tooth and site variables that were associated with CAL. Seventy-five patients with chronic adult periodontitis were followed for 6 months. Clinical data at baseline, including attachment level and probing depth, were obtained from six sites per tooth. The hazard rate for CAL at all sites was 2.0%, and 4.1% of teeth displayed at least one site with CAL. Mandibular and maxillary molars and maxillary premolars displayed the highest incidence of CAL (6.1%, 5.6%, 5.5%, respectively), while maxillary anterior teeth (1.8%) and mandibular premolar teeth (2.1%) demonstrated the lowest incidence. The greatest number of sites demonstrating CAL had an existing attachment level of 4 to 7 mm and a probing depth of less than or equal to 5 mm. When the data were converted to hazard rates, however, an increase in hazard rate was seen with increasing existing attachment loss or probing depth. When MAL was considered, patients with mild and moderate periodontitis demonstrated a relatively low incidence of CAL at sites with less than or equal to 7 mm of existing attachment loss. Patients with severe periodontitis exhibited greater hazard rates for sites with 0 to 3, 4 to 5 and 6 to 7 mm of existing attachment loss.(ABSTRACT TRUNCATED AT 250 WORDS)     

Follow-up study of periodontal tissues around the abutment teeth in Konus telescope denture

The purpose of this study was to evaluate the periodontal tissues around the 47 abutment teeth in patients with advanced periodontitis for 5 years maintenance periods. The periodontal and prosthetic treatment were carried out and 16 Konus telescope dentures were applied for 11 patients. During 5 years maintenance therapy, periodontal conditions were observed once a year assessing probing depth, attachment level, tooth mobility index, gingival index, marginal alveolar bone height, width of periodontal ligament and loss of lamina dura. The results showed that increase of probing depth in 0.61 mm and attachment loss in 0.78 mm were observed for 5 years. A slight gingival inflammation occurred and tooth mobility increased in some extent. Enlargement of periodontal ligament space and loss of lamina dura in 40% of abutment teeth were observed for 5 years. There were six decayed teeth, six teeth, from which a intracoronal crown was removed, and two extracted teeth in 47 abutment teeth. In conclusion, the periodontal tissues around abutment teeth in Konus telescope denture changed slightly at one year after denture placement, after which, the periodontal tissues were well maintained.     

Periodontal conditions among adults in Southern Thailand

OBJECTIVE: To describe the periodontal conditions among 30-39- and 50-59-year-old rural Thais from the Province of Songkhla, Southern Thailand. METHODS: A total of 359 dentate persons were given a clinical examination comprising recordings of plaque and calculus in six teeth, and bleeding on probing, attachment level and pocket depth in six sites of all teeth present, except third molars. The same examiner carried out all examinations. Information on religious faith, smoking habits and use of betel was obtained by interview. A subset consisting of 60 persons was reexamined for attachment level 6 months later by another examiner. RESULTS: The oral hygiene conditions were poor with abundant amounts of both plaque and calculus. Gingival bleeding was essentially ubiquitous. The prevalence of attachment loss > or = 4 mm was 92% among 30-39-year-olds and 100% among 50-59-year-olds. The average percentage of sites affected in the two age groups was 23.9% and 63.9%. Pockets > or = 4 mm were seen in 84% of the 30-39-year-olds and in 93% of the 50-59-year-olds. Older age, Thai Buddhist faith and a high percentage of sites with calculus were significant positive predictors of a high percentage of sites with attachment loss > or = 4 mm, whereas older age and Thai Buddhist faith were the only statistically significant predictors of a high percentage of sites with attachment loss > or = 7 mm. CONCLUSION: The results indicate that this Thai population may have more widespread and severe periodontal destruction than other Asian populations, but failed to confirm the contention that Muslim faith is associated with more severe periodontal destruction.     

Prevalence of aggressive periodontitis in school attendees in Uganda

AIM: The prevalence and severity of early onset periodontitis (EOP) among students attending secondary schools in two regions of Uganda was studied. MATERIAL AND METHODS: 690 students (393 males and 297 females) aged 12-25 years (mean 17 years), representing a range of tribal groups, were recruited from six schools in the peri-urban Central and rural Western regions of Uganda. The study subjects were clinically examined in field conditions by a single calibrated examiner to measure gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Subjects exhibiting >or= 4 mm of clinical periodontal attachment loss at approximal surfaces of one or more teeth were classified with EOP. A structured written questionnaire obtained demographic characteristics of the study subjects. RESULTS: 199 (28.8%) study subjects showed clinical features of EOP, of which 16 (2.3%) subjects exhibited generalized EOP, 29 (4.2%) localized EOP, and 154 (22.3%) incidental EOP. The percentage of EOP-affected males was significantly higher than females (33.8% vs. 22.2%, P < 0.001). EOP prevalence tended to increase with increasing age, but no association was found between EOP prevalence and socioeconomic status or residency in urban vs. rural areas of Uganda. Molars and mandibular incisors generally demonstrated the highest occurrence of >or= 4 mm attachment loss. Clinical periodontal attachment loss of >or= 5 mm was mainly seen at first molars and incisors, suggesting that these two tooth types are first affected with attachment loss. Approximal tooth surfaces showed greater probing depth and attachment loss than buccal and lingual surfaces. Gingival recession was most prevalent at mandibular anterior teeth, whereas gingival margin coronal to CEJ was most frequently observed at second molars and maxillary incisors. CONCLUSION: A relatively high prevalence of EOP (28.8%) was found in young Ugandan school attendees, with 6.5% of these showing severe disease. EOP in Uganda was significantly more prevalent in males than females, and most frequently characterized by approximal involvement of molars and mandibular incisors. Etiologic and predisposing factors associated with the high occurrence of EOP in Uganda, as well as therapeutic and preventive measures of the disease in this population, remain to be delineated.     

The prevalence of periodontal disease measures in elderly adults, aged 79 and older

From 1996-98, we examined 449 adults (mean age 85 years) from the 1982 Iowa 65⁺ Rural Health Study, in the field using headlight, mirror, and periodontal probe. Ninety-six of the 342 dentate subjects were excluded from the follow-up examination due to contraindications to probing, and 10 could not be assessed due to refusals, fatigue or other reasons. For all remaining subjects (n=236), attachment loss, defined as recession plus probing depth, was determined at four sites per tooth. Ninety-one percent of the subjects had at least one site with 4⁺ mm of attachment loss, 45% had one or more sites with attachment loss of 6⁺ mm, and 15% had 8⁺ mm of attachment loss. Moderate periodontal disease is prevalent among very old dentate adults while advanced periodontal disease is much less prevalent, suggesting that most periodontal treatment needed by this age group can be provided by general dentists and dental hygienists rather than periodontists.     

Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey

BACKGROUND: The principal objectives of this study were to examine the relationship between cigarette smoking and periodontitis and to estimate the proportion of periodontitis in the United States adult population that is attributable to cigarette smoking. METHODS: Data were derived from the Third National Health and Nutrition Examination Survey, a nationally representative multipurpose health survey conducted in 1988 to 1994. Participants were interviewed about tobacco use and examined by dentists trained to use standardized clinical criteria. Analysis was limited to dentate persons aged > or =18 years with complete clinical periodontal data and information on tobacco use and important covariates (n = 12,329). Data were weighted to provide U.S. national estimates, and analyses accounted for the complex sample design. We defined periodontitis as the presence of > or =1 site with clinical periodontal attachment level > or =4 mm apical to the cemento-enamel junction and probing depth > or =4 mm. Current cigarette smokers were those who had smoked > or =100 cigarettes over their lifetime and smoked at the time of the interview; former smokers had smoked > or =100 cigarettes but did not currently smoke; and never smokers had not smoked > or =100 cigarettes in their lifetime. RESULTS: We found that 27.9% (95% confidence interval [CI]: +/-1.8%) of dentate adults were current smokers and 23.3% (95% CI: +/-1.2%) were former smokers. Overall, 9.2% (95% CI: +/-1.4%) of dentate adults met our case definition for periodontitis, which projects to about 15 million cases of periodontitis among U.S. adults. Modeling with multiple logistic regression revealed that current smokers were about 4 times as likely as persons who had never smoked to have periodontitis (prevalence odds ratio [ORp] = 3.97; 95% CI, 3.20-4.93), after adjusting for age, gender, race/ethnicity, education, and income:poverty ratio. Former smokers were more likely than persons who had never smoked to have periodontitis (ORp = 1.68; 95% CI, 1.31-2.17). Among current smokers, there was a dose-response relationship between cigarettes smoked per day and the odds of periodontitis (P <0.000001), ranging from ORp = 2.79 (95% CI, 1.90-4.10) for < or =9 cigarettes per day to ORp = 5.88 (95% CI, 4.03-8.58) for > or =31 cigarettes per day. Among former smokers, the odds of periodontitis declined with the number of years since quitting, from ORp = 3.22 (95% CI, 2.18-4.76) for 0 to 2 years to ORp = 1.15 (95% CI, 0.83-1.60) for > or =11 years. Applying standard epidemiologic formulas for the attributable fraction for the population, we calculated that 41.9% of periodontitis cases (6.4 million cases) in the U.S. adult population were attributable to current cigarette smoking and 10.9% (1.7 million cases) to former smoking. Among current smokers, 74.8% of their periodontitis was attributable to smoking. CONCLUSIONS: Based on findings from this study and numerous other reports, we conclude that smoking is a major risk factor for periodontitis and may be responsible for more than half of periodontitis cases among adults in the United States. A large proportion of adult periodontitis may be preventable through prevention and cessation of cigarette smoking.     

Periodontal conditions in a randomly selected population in Switzerland

The aim of the present study was to evaluate the periodontal conditions of a randomly selected population in the Canton of Berne, Switzerland. From a total of 350 selected persons, 206 (59%) attended the examinations. The Plaque Index (PlI), Gingival Index (GI) and Retention Index (RI), the width of the keratinized gingiva, pocket probing depth (PD) and loss of probing attachment (LA) were recorded on four surfaces per tooth in the entire dentition of the subjects. The statistical analyses were performed using the Statistical Analysis System (SAS). A total of 4253 teeth were scored. On average the patients had 20.7 teeth. The mean PlI of this population was 1.16, the mean GI was 1.34 and the mean RI was 0.81. All three indices were higher in older age groups. 72% of all measurements for pocket probing depths were less than or equal to 3 mm, 26% were between 4 and 6 mm, and only 2% were more than 6 mm. 76% of all sites had lost less than or equal to 3 mm of probing attachment, 21% of the sites had lost between 4 and 6 mm and only 3% had lost more than 6 mm. There were no statistically significant differences either between females and males or between the rural and the urban populations. These results indicate that only a relatively small percentage of the sample representative for the respective area in Switzerland suffered from advanced periodontitis, while the great majority may be treated by rather conservative approaches to periodontal therapy.     

Prevalence of HIV-associated Periodontitis and Chronic Periodontitis in a Southeastern US Study Group

OBJECTIVES: This study estimates factors associated with the prevalence of HIV-associated periodontal diseases (HIV-P) and the severity and extent of periodontitis in HIV-infected adults from North Carolina (NC). METHODS: Data are derived from a cross-sectional study of HIV-infected adults (total n = 326, dentate n = 316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV-P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3. RESULTS: In addition to persons with HIV (non-AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range = 19-67); 78 percent were male and 60 percent were black. Sixty-two percent of persons had a probing pocket depth > or = 5 mm; 46% had recession > or = 3 mm, and 66 percent had attachment level > or = 5 mm in one or more sites. Cases of HIV-P (n = 15) were rare. Persons taking HIV-antiretroviral medication were one-fifth (OR = 0.20; 95% CI = 0.07, 0.63) as likely to have HIV-P as those not taking those medications, controlling for CD4+ cell counts. CONCLUSIONS: HIV-infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV-P, which was attenuated by antiretroviral therapy.