Clinical Criteria for the Definition of “Established Periodontitis”

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Abstract
The objective of the present study was to define criteria for the diagnosis of “established periodontitis.” This term will define subjects who have demonstrated clinical attachment loss, and as such can be considered to have periodontitis. Using these criteria, healthy and established periodontitis subjects were compared with respect to gender, race, and age. Five hundred and eight subjects including 248 females and 260 males between the ages of 25 to 73 (mean 44.6 years), were examined in this study. The clinical examination included: plaque assessment index (PAI); gingival assessment index (GAI); probing pocket depth (PPD); and clinical attachment level (CAL). The mean and frequency distribution of these parameters were analyzed by age and gender. CAL (mean 2.12 mm) showed constant and significant increases with age, ranging from a mean of 1.63 mm in subjects 25 to 34 years of age to a mean of 2.65 mm in subjects 65 to 74 years of age. Males exhibited higher mean values than females for all the measured parameters, which were statistically significant for PAI, PPD, and CAL. The frequency distribution of subjects with PPD and CAL beyond certain threshold levels showed an exponential decline and was correlated to both the severity of the most involved site as well as the number of sites beyond threshold levels. The clinical entity of “established periodontitis” is suggested based on the presence of CAL ≥ 6 mm in 2 or more teeth and one or more sites with PPD ≥ 5 mm. In the present study, 30.5% of the subjects fell into this category. African‐Americans, who constituted 5.7% of the subjects, comprised almost 10% of the established periodontitis group. Likewise, males who comprised 51.1% of the subjects constituted over 60% of the established periodontitis group. The aged (65 to 74 years) made up 8.8% of the subjects, but nearly 14% of the established periodontitis group. These higher proportions of the aged, male, and African‐American individuals in the established periodontitis group would suggest that they are at higher risk for this disease. This clinical characterization of established periodontitis may be useful in focusing on the subset of the population which may be at greater risk for periodontal breakdown. J Periodontol 1992; 63:20Z–215