Application of the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) Framework to Estimate the Periodontitis Prevalence in the United States

ABSTRACT Aims To compare periodontitis prevalence estimates based on the Application of the 2018 periodontal status Classification to Epidemiological Survey data (ACES) and the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) classification. Materials and Methods National Health and Nutrition Examination Survey data for the years 2009/2010, 2011/2012 and 2013/2014 were survey‐weighted and post‐stratified to estimate the prevalence of periodontitis. Estimates based on ACES and CDC/AAP were cross‐classified and stratified by age group. Prevalence estimates using different partial recording protocols were examined. Results Using the ACES framework, the prevalence of adults with periodontitis was 93.1% (95% CI: 91.9–94.2) (Stage I: 17.9%; Stage II: 46.2%; Stage III: 16.7%; Stage IV: 12.4%). Complexity factors did not alter Stage II prevalence. The CDC/AAP classification yielded a periodontitis prevalence of 38.9% (95% CI: 36.4–41.4) (Mild: 3.5%; Moderate: 28.1%; Severe: 7.3%). Partial recording protocols resulted in increased prevalence in the lower stages of periodontitis. Conclusions The European Federation of Periodontology/American Academy of Periodontology Classification (using the ACES framework) overestimates periodontitis cases compared with the CDC/AAP classification. Including complexity factors in the ACES framework provides limited benefits in staging periodontitis. Partial‐mouth recording protocols overestimate health and early disease stages while underestimating more severe disease.