Accuracy of NHANES Periodontal Examination Protocols

TLDR

The study assesses how accurately NHANES partial‑mouth protocols estimate periodontitis prevalence. The authors compared full‑mouth gold‑standard examinations of 454 adults with prevalence estimates derived from NHANES III and NHANES 2001‑2004 partial‑mouth protocols. Both NHANES protocols underestimated periodontitis prevalence by over 50 % and failed to meet validity thresholds; adding lingual or interproximal sites did not improve sensitivity, indicating low validity for surveillance and research.

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.