Natural progression of periodontal diseases in Chinese villagers based on the 2018 classification

Based on the 2018 classification, we aimed to determine the prevalence, distribution, and progression of periodontitis in the rural Chinese population without access to dental care.

In all, 404 subjects (28.7 ± 8.9 years, M:F = 182:222) were randomly enrolled in 1992 and re-called in 1996. With the new classification, the prevalence and distribution of stage, grade, and extent were characterized. Stage progression was compared with the progression of clinical attachment loss (CAL) and radiographic bone loss (RBL).

At baseline, 94.1% villagers suffered from periodontitis, of whom 53.7% were in Stage III/IV. The prevalence of Stage III/IV increased from 18.2% in the age group of 15 to 24 years to 60.9% in 25 to 34-year-old group and 88.7% in the 35 to 44-year-old group. Significantly more Stage III/IV, generalized, and Grade C periodontitis were found in male villagers than female villagers. In 1996, the prevalence rate of periodontitis increased to 98.5%, with 80.0% in Stage III/IV. Further, 84.2% villagers presented with Grade C periodontitis based on longitudinal ΔCAL. The rate of progression (≥1 site with ΔCAL ≥3 mm) was 63.7%. Stage progression correlated significantly with CAL and RBL progression in Stage I/II, but this association was not found in Stage III/IV. Among subjects with disease progression in Stage III/IV, 90.4% shifted from localized to generalized cases. Furthermore, ceiling effects were observed in Stage III/IV.

In villagers without access to dental care, 94.1% suffered from periodontitis, with more than half having Stage III/IV disease based on the 2018 classification. The majority cases presented with rapid periodontal progression. Although stage progression correlated significantly with CAL and RBL progression in Stage I/II, ceiling effects existed in Stage III/IV.