Abstract
BackgroundThe aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient’s age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed.MethodsNine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test.ResultsIncluding the patients’ age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement).ConclusionThese results suggest that knowledge of a patients’ age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.
Highlights
The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient’s age
Within the 1989 classification system, age at onset was a criteria for diagnosis of adult periodontitis, early onset periodontitis, pre-pubertal periodontitis, and juvenile periodontitis
The desire for a re-evaluation of our diagnostic system is in line with a recent publication in reaction the previous mentioned task force report that calls for a profound reconsideration of what is hoped to be achieved with periodontal classification [16]. This pilot study demonstrates a need for further investigation of both the effect of patients’ age in the diagnosis of aggressive verses chronic periodontitis and the need for consideration of a patient’s age during the update to our current classification
Summary
The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient’s age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. An age of 30 years was used to distinguish between juvenile or Aggressive Periodontitis and Adult or Chronic Periodontitis in the 1989 classification system [3,4,5]. In 1999 the age criteria that had previously distinguished aggressive and chronic periodontal disease was removed, leaving diagnosis of these forms of periodontitis to be based solely on clinical features such as; rate of disease progression; amount of periodontal destruction relative to local factors such as plaque and calculus; and a specific disease pattern of greater destruction surrounding first molars and central incisors [6,7,8]. The use of microbiologic testing as a means to distinguish between the two forms of disease has been explored but currently microbial findings have not been shown to aid diagnostic capability [4, 9]
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