Periodontal Health Disparities among Adults in Rural North Carolina

Objectives: To measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic clinical practice network (CPN) in rural North Carolina (NC).
Methods: This observational study used deidentified electronic health record (EHR) data from adult patients (≥30 years) of record (2011-2017) who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using standard case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on self-reported tobacco use and diabetes status, gender, age, race and ethnicity.
Results: EHR data for 10,544 adult patients (61% female) indicated 80% having some form of periodontitis. This patient population was diverse: 23% African Americans, 4% American Indians and 54% Whites, with 5% self-identified as Hispanic or Latino. Overall, middle aged participants (35-49 and 50-64 years), males, African Americans and Other race group, and Hispanic or Latino showed significantly (p<0.01) greater periodontitis prevalence than their counterparts. Those using tobacco also showed significantly (p<0.01) greater periodontitis prevalence than nonusers; however, there was no evidence (p>0.2) that self-reported type 2 diabetes had any effect on periodontitis prevalence. A multiple logistic regression analysis of periodontitis prevalence confirmed these findings. As secondary analyses, patient demographics, tobacco use and type 2 diabetes affected % pocket depth ≥4, 5 or 6mm and % clinical attachment level ≥3, 4 or 5mm. Higher age, race/ethnicity minority status, tobacco use and type 2 diabetes also negatively affected % bleeding on probing.
Conclusions: The data from this academic CPN confirm that periodontal health disparities occur in rural NC adults from underrepresented minority populations, and demonstrate the effective use of an EHR system to conduct population and patient oriented research.