Periodontitis is a chronic disease of the hard and soft tissue supporting the teeth. It is caused by bacterial plaque resulting in progressive destruction of the periodontal ligament and alveolar bone.48,49 The disease typically has a slow to moderate rate of disease progression, but periods of accelerated attachment loss may be associated with local and/or systemic factors.50-52 Disease severity is classified as mild (1-2 mm), moderate (3-4 mm), or severe (≥ 5mm) based on the amount of clinical attachment loss (CAL).53,54 The prevalence of periodontitis has been estimated to be over 47% of U.S. adults or 64.7 million individuals.55 Of those individuals, 8.7% showed mild disease, 30.0% demonstrated moderate disease, and 8.5% had severe chronic periodontitis.56 Risk indicators for periodontitis include male gender, Hispanic ethnicity, cigarette smoking, uncontrolled or poorly controlled diabetes mellitus, and lower socioeconomic status.57,58 Prevalence of periodontitis varied two-fold between the lowest and the highest levels of socioeconomic status (Figure 2).59
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