Recent studies implicating periodontitis as a cause of systemic diseases have reported that the surface area of periodontal pockets exposed to bacterial biofilm ranges from 50 cm2 to 200 cm2. Since the root surface area of the typical human dentition (excluding 3rd molars) is 75 cm2, these estimates appear too large. The goal of this study was to relate linear periodontal probing measurements to the dentogingival surface area (DGES). The DGES comprises both the sulcular and junctional epithelium, present in health, as well as any intervening pocket epithelium present in periodontitis. Formulas to estimate the DGES from clinical measures were derived from a meta-analysis of root surface areas, published values of root length, and a study that related the percent remaining root surface area to the percent remaining root length. These formulas were applied to a survey of the adult US population, the Veterans Affairs (VA) Dental Longitudinal Study, and a population of individuals visiting a periodontist. Individuals without periodontitis had a typical DGES of 5 cm2. Among individuals with periodontitis, the mean DGES in the three samples ranged from 8 cm2 (ranging from 1 cm2 to 29 cm2) to 20 cm2 (ranging from 2 cm2 to 44 cm2). It was concluded that the mean DGES among individuals with periodontitis ranges from 8 cm2 to 20 cm2, considerably smaller than the range of 50 cm2 to 200 cm2 currently assumed.

This article reviews trends in dental caries, periodontal disease, and tooth loss for the United States along with population dynamics and risk factors that might influence these trends going forward. Dental caries experience remains high in the primary dentition. Caries severity in permanent teeth of children has declined to historically low levels, and long-standing inequalities in untreated caries appear to be narrowing. Declines in caries severity of children's permanent teeth have stabilized at a low level, but likely will contribute to future reductions in dental caries severity in adults. The prevalence of periodontal disease is high in adults, and only a small percentage have severe forms of the disease. Countervailing trends in determinants would suggest little change in the prevalence of periodontal disease in the future, but the lack of an obvious trend over the last two decades makes projections uncertain. Tooth loss as a consequence of dental disease has declined markedly over the last half century and has been all but eliminated in high-income groups. However, notable exceptions to these favorable trends are evident. Progress in prevention policies and programs that affect disease experience appears slower than progress in meeting population-level caries treatment needs. Clearly, long-standing inequities related to political and social determinants remain for all dental diseases, and income disparities in dental disease are widening for some indicators. Growing inequalities raise ethical and public health concerns that should be prominent in discussions of dental workforce needs and strategies for the next 25 years. This article was written as part of the project "Advancing Dental Education in the 21 Century."

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