Global cases of severe periodontitis have risen sharply over the past three decades, according to an analysis of Global Burden of Disease 2021 data covering 204 countries.
The study found that incident cases increased by more than 76% between 1990 and 2021, climbing from about 50.8 million to nearly 89.6 million worldwide. Over the same period, disability-adjusted life years (DALYs) linked to severe periodontitis rose by roughly 91%, reaching 6.9 million in 2021.
Despite the growth in absolute numbers, the global age-standardised incidence and DALY rates remained broadly stable. Researchers reported only small annual percentage changes, suggesting that population growth and ageing, rather than a major rise in individual disease risk, are the main factors behind the expanding burden.
The analysis also revealed strong regional differences. South Asia had the highest age-standardised incidence and DALY rates in 2021, while Oceania consistently recorded the lowest. In absolute terms, the biggest increases in cases and DALYs were seen in India, China and the United States, reflecting large populations, demographic change and improved detection.
Socioeconomic development was closely linked to outcomes. Countries with a high socio-demographic index generally showed lower incidence and DALY rates. In contrast, low and low-middle index regions carried a disproportionate share of the burden, highlighting the influence of access to preventive care, oral health awareness and overall health system capacity.
Incidence increased with age, peaking in middle adulthood. Men had higher rates at younger ages, but after about 45 years women showed higher incidence. Similar age and sex patterns were observed for DALYs, particularly among older adults.
While stable age-standardised rates point to some progress in managing disease risk, the continuing rise in absolute burden underscores the need for stronger prevention and control strategies. The findings emphasise the importance of integrating periodontal care into broader non-communicable disease policies and addressing shared risk factors such as smoking, vaping, poor oral hygiene and diabetes.