American Academy Of Periodontology Research Articles

Applying current European periodontitis clinical practice guidelines is not feasible even for the richest countries in the world.

Clinical practice guidelines aim to enhance the quality, equality and consistency of care but often demand more time than is available, rendering adherence impractical and exceeding feasible resources. The 2017 introduction of a new periodontal classification system by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) sought to refine clinical and epidemiological practices by serving as the basis for clinical practice guidelines and epidemiological investigations around the world. Following this classification, the EFP recommends supportive periodontal care visits every 3-12 months for all periodontitis cases. Given that in Norway, approximately 72% of the adult population are identified as periodontitis cases under the current AAP/EFP case definition, this poses a significant demand on healthcare resources. We calculated that between 60% and 70% of all estimated available working hours available for adult dental care provided by dentists and dental hygienists in Norway in 2017 would be spent on supportive periodontal care visits alone if the recommendations were to be met. This situation calls for a reevaluation of disease definitions and clinical practice guidelines to ensure they are practical, financially feasible and patient-outcome relevant.

Estimating disease prevalence from partially-sampled clusters using the conditional linear family for multivariate Bernoulli data

In periodontal disease surveillance in human populations, full-mouth clinical examinations to classify the disease status of individuals are the gold standard for estimating periodontitis prevalence. However, conducting full-mouth exams is resource intensive, time consuming, and costly, especially in studies involving thousands of participants. Partial-recording protocols have been utilized in oral health surveys worldwide to gather correlated binary outcomes of periodontal disease on selected teeth in lieu of full-mouth exams. Since the use of partial-recording protocols tends to underestimate disease prevalence, a statistical distributional approach considering the pattern of tooth-level disease in the mouth was proposed to substantially reduce bias for the estimation of periodontitis prevalence. This approach employed multivariate Bernoulli distributions for observation (tooth)-level disease indicators to define formulae for the prevalence of disease (periodontitis) at the cluster (person)-level for various full-mouth case definitions. In turn, prevalence estimators were based on plug- in estimates of parameters from a conditional linear family for binary data gathered under partial recording protocols. Work in this article extended existing prevalence estimators for simple case definitions based on single clinical measures of tooth-level periodontal disease to a definition of severe periodontitis using two measures as defined by the Centers for Disease Control and Prevention and the American Academy of Periodontology, and later adopted by the 2017 World Workshop in Periodontology. Simulations evaluated the finite-sample performance of the proposed estimators and their confidence intervals for three established partial-recording protocols. In general, the prevalence estimators performed well relative to bias and coverage when tooth-level probabilities of disease and within-mouth correlation structures were correctly specified and even when the pattern of tooth-pair correlations was misspecified. Journal of Statistical Research 2024, Vol. 58, No. 1, pp. 3-31.

Rugoscopic Evaluation of Periodontal Disease: A Cross-Sectional Study.

Introduction Rugoscopy, which is the study of the ridges on the roof of the mouth, or rugae palatinae, is frequently employed to identify individuals. Since these ridges maintain their shape throughout a person's life, their unique patterns are used as a diagnostic aid for periodontal diseases. Objective The aim of this study is to explore the connection between palatal rugae patterns and periodontal diseases. Methodology A study group of 120 patients aged between 18 and 60 was meticulously grouped according to the American Academy of Periodontology (AAP) 1999 classification of periodontal diseases: Group A comprised healthy individuals, Group B had patients diagnosed with gingivitis, Group C included patients diagnosed with chronic periodontitis, and Group D had patients diagnosed with aggressive periodontitis. Maxillary impressions from each group were cast in dental stone and analyzed in detail for rugae patterns. Results Patients with gingivitis and chronic periodontitis predominantly showed a sinuous rugae pattern, while those with aggressive periodontitis exhibited an angular rugae pattern. Using the chi-square test (p < 0.05) to perform statistical analysis confirmed a significant association between rugae patterns and diagnosis, thus supporting the hypothesis of a nuanced relationship between palatal rugae patterns and specific periodontal conditions. Conclusion In summary, palatal rugoscopy provides a sophisticated and precise method for identifying and understanding various periodontal conditions, offering a potential breakthrough in diagnosing and prognosticating these conditions.

Performance of three artificial intelligence (AI)-based large language models in standardized testing; implications for AI-assisted dental education.

The emerging rise in novel computer technologies and automated data analytics has the potential to change the course of dental education. In line with our long-term goal of harnessing the power of AI to augment didactic teaching, the objective of this study was to quantify and compare the accuracy of responses provided by ChatGPT (GPT-4 and GPT-3.5) and Google Gemini, the three primary large language models (LLMs), to human graduate students (control group) to the annual in-service examination questions posed by the American Academy of Periodontology (AAP). Under a comparative cross-sectional study design, a corpus of 1312 questions from the annual in-service examination of AAP administered between 2020 and 2023 were presented to the LLMs. Their responses were analyzed using chi-square tests, and the performance was juxtaposed to the scores of periodontal residents from corresponding years, as the human control group. Additionally, two sub-analyses were performed: one on the performance of the LLMs on each section of the exam; and in answering the most difficult questions. ChatGPT-4 (total average: 79.57%) outperformed all human control groups as well as GPT-3.5 and Google Gemini in all exam years (p < .001). This chatbot showed an accuracy range between 78.80% and 80.98% across the various exam years. Gemini consistently recorded superior performance with scores of 70.65% (p = .01), 73.29% (p = .02), 75.73% (p < .01), and 72.18% (p = .0008) for the exams from 2020 to 2023 compared to ChatGPT-3.5, which achieved 62.5%, 68.24%, 69.83%, and 59.27% respectively. Google Gemini (72.86%) surpassed the average scores achieved by first- (63.48% ± 31.67) and second-year residents (66.25% ± 31.61) when all exam years combined. However, it could not surpass that of third-year residents (69.06% ± 30.45). Within the confines of this analysis, ChatGPT-4 exhibited a robust capability in answering AAP in-service exam questions in terms of accuracy and reliability while Gemini and ChatGPT-3.5 showed a weaker performance. These findings underscore the potential of deploying LLMs as an educational tool in periodontics and oral implantology domains. However, the current limitations of these models such as inability to effectively process image-based inquiries, the propensity for generating inconsistent responses to the same prompts, and achieving high (80% by GPT-4) but not absolute accuracy rates should be considered. An objective comparison of their capability versus their capacity is required to further develop this field of study.

The association between cystic fibrosis-related diabetes and periodontitis in adults: A pilot cross-sectional study.

Periodontitis is a highly prevalent complication of diabetes. However, the association between cystic fibrosis-related diabetes (CFRD) and periodontitis has not yet been evaluated. The objective of this study was to assess if: 1) CFRD is associated with periodontitis among adults with CF, and 2) periodontitis prevalence differs by CF and diabetes status. This was a pilot cross-sectional study of the association between CFRD and periodontitis in adults with cystic fibrosis (CF) (N = 32). Historical non-CF controls (N = 57) from the U.S. National Health and Nutrition Examination Survey (NHANES) dataset were frequency matched to participants with CF on age, sex, diabetes status, and insulin use. We defined periodontitis using the U.S. Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) case definition, as the presence of two or more interproximal sites with CAL ≥3 mm and two or more interproximal sites with PD ≥4 mm (not on the same tooth) or one site with PD ≥5 mm. Because NHANES periodontal data were only available for adults ages ≥30 years, our analysis that included non-CF controls focused on this age group (CF N = 19, non-CF N = 57). Based on CF and diabetes status, we formed four groups: CFRD, CF and no diabetes, non-CF with diabetes, and non-CF and no diabetes (healthy). We used the Fisher's exact test for hypotheses testing. There was no association between CFRD and periodontitis for participants with CF ages 22-63 years (CFRD 67% vs. CF no diabetes 53%, P = 0.49), this was also true for those ages ≥30 years (CFRD 78% vs. CF no diabetes 60%, P = 0.63). For the two CF groups, the prevalence of periodontitis was significantly higher than for healthy controls (CFRD 78% vs. healthy 7%, P<0.001; CF no diabetes 60% vs. healthy 7%, P = 0.001) and not significantly different than the prevalence for non-CF controls with diabetes (CFRD 78% vs. non-CF with diabetes 56%, P = 0.43; CF no diabetes 60% vs. non-CF with diabetes 56%, P = 0.99). Among participants with CF, CFRD was not associated with periodontitis. However, regardless of diabetes status, participants with CF had increased prevalence of periodontitis compared to healthy controls.

Occurrence of periodontal diseases according to the ACES 2018 Classification Framework and the CDC/AAP definition: A cross-sectional study in a major Brazilian city.

The occurrence of periodontal diseases is still to be determined in large samples of major Brazilian cities. This study aimed to assess the periodontal status of adults from Curitiba, Paraná, Brazil, using periodontitis definitions by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) and the recently published ACES 2018 Classification Framework. A multi-stage probability sampling technique was applied to draw individuals aged 18 or older. A total of 566 individuals underwent a full-mouth periodontal examination. Periodontitis cases were defined according to the CDC/AAP and the ACES 2018 Classification Framework. Non-periodontitis cases were classified as healthy or gingivitis. The agreement between the two definitions was calculated. Periodontal health was present in 33.6% and 13.8% of individuals, and gingivitis was found in 11.7% and 7.5%, according to CDC/AAP and ACES, respectively. Mild, moderate and severe periodontitis (CDC/AAP) were present in 2.1%, 33.4% and 19.1% of individuals, respectively. Using ACES, 34.3% had Stages I/II and 43.3% had Stages III/IV. The occurrence of periodontitis was higher when a subgroup of individuals aged 30+ were analysed, ranging from 69.6% (CDC/AAP) to 90.1% (ACES). CDC/AAP and ACES agreement for health, gingivitis and periodontitis accounted for 68.8% of the observations. Periodontal diseases affect more than 66% of the population aged 18+ years. Classic definition by the CDC/AAP and the recently published ACES Framework yielded moderate agreement.

The Severity of Periodontitis in Elderly Patients with Type 2 Diabetes Mellitus: A Community-Based Study

Abstract Objective Indonesia is one of the top five countries with the highest prevalence of diabetes mellitus (DM). There were 18 million DM patients in 2020, and this number has doubled in has doubled in 2022. The main complication of DM in the oral cavity is periodontitis. Periodontitis and DM have a bidirectional relationship. Controlling the severity of both diseases can improve the quality of life of DM patients. The aim of this study is to determine the severity of periodontitis in older people with type 2 DM. Material and Methods This research is observational with a cross-sectional design. The research subjects were 263 patients aged ≥ 60 years, taken using a purposive sampling technique. The diagnosis and severity of periodontitis were based on the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) with the Centers for Disease Control and Prevention (CDC), using the clinical attachment loss (CAL) and probing depth (PD) clinical parameters. The diagnosis of DM was established by measuring HbA1c. Descriptive statistics was used to describe the distribution of severity of periodontitis. Results In total, 42 people (16%) in this study did not experience periodontitis, and 221 people (84%) experienced periodontitis with 4.5% of the study population suffering from mild periodontitis, 21.3% moderate periodontitis, and 74.2% severe periodontitis. The results of this study indicated that severe periodontitis was the most common category in patients with type 2 DM. Severe periodontitis is the most common type of periodontitis at all levels of age, occupation, and education. It was found most commonly among those aged 60 to 65 years, housewives, and those with elementary education level with moderate or poor oral hygiene. Conclusion Almost all respondents who suffered from type 2 DM experienced periodontitis, severe periodontitis being most common category at all age levels, occupations, education, and oral hygiene status. The severity of periodontitis in this study tended to be due to high HbA1c levels.

Navigating Discordance: Assessing Varied Applications of the American Academy of Periodontology In-Service Examination in Postdoctoral Programs

Introduction The American Academy of Periodontology (AAP) In-Service Examination (ISE) is offered annually to residents in postdoctoral periodontal programs across the United States and Canada. The language in AAP published guidance supports both formative and summative uses of the exam, presenting discordance in how to use and interpret the AAPISE. It is important to clarify how programs use data, as formative assessments are low-stakes and aim to provide feedback to learners for improving their learning. On the other hand, summative assessments are used to make high-stakes decisions, such as program admission, graduation, and licensure. These two types of assessments serve different purposes and have distinct outcomes. This study aimed to explore and characterize how stakeholders utilize the AAPISE and its associated score reports. Methods Semi-structured interviews of periodontology program directors, department chairs, and residents were conducted in 2022. Data from these interviews were explored, coded, and thematically analyzed. Results A total of 16 interviews were conducted and analyzed: four chairs, eight program directors, and four residents representing the experience at 20 postdoctoral periodontal programs. Five major themes were identified regarding the use of the AAPISE: formative assessment, board preparation, program development, promoting a culture of achievement, and summative assessment. Conclusion This study's findings suggest varied uses of the AAPISE amongst postdoctoral periodontal program stakeholders, reflecting the variance within the AAP guidance. The discordant uses and guidance jeopardize the AAPISE’s potential to align with the 2018 Consensus Framework for Good Assessment elements. The authors propose recommendations to the AAP and stakeholders for future use.

Association between life's essential 8 and periodontitis: a study based on NHANES 2009-2014.

This research aims to investigate the relationship between Life's Essentials 8 (LE8), the American Heart Association's latest indicator, and periodontitis. The purpose is to provide guidance on preventative measures. Data for our investigation were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, with a total of 8,784 participants eligible. LE8 scores were compiled from 8 index scores (the score for each component of diet, physical activity, nicotine exposure, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure). Periodontitis was classified by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). The study utilized multivariable logistic analyses to investigate the potential correlation. After controlling for all covariates, LE8 was discovered to have a significant negative correlation with periodontitis prevalence [0.91 (0.88, 0.94)]. This trend continued to hold statistical significance even after converting LE8 into a categorical variable. Furthermore, a noteworthy adverse correlation was discovered across both genders, specifically males [0.35 (0.22, 0.55)] and females [0.39 (0.25, 0.60)], as well as for the majority of categorical classifications, namely ethnicity, age, education level, and marital status. However, only the age subgroups displayed some degree of significant difference from each other. Life's essential 8 was negatively associated with periodontitis, but more prospective trails are needed to confirm our findings.

The Association of Maternal Periodontal Diseases in the Postpartum Period with Preterm Low Birth Weight.

Preterm birth is the most adverse effect of pregnancy, commonly leading to low birth weight. Our study aimed to assess the relationship between maternal periodontal status and adverse pregnancy outcomes by immediate postpartum periodontal examination and diagnosis. 125 mothers were divided into four groups based on gestational day (GD) and newborns' birth weight (BW); the mothers with GD ≥ 259 days and BW ≥ 2500 gm (Control), the mothers with GD <259 days and BW ≥ 2500 gm (PT group), the mothers with GD ≥ 259 days and BW <2500 gm (LBW group), and the mothers with GD <259 days and BW <2500 gm (PT-LBW group). The maternal periodontal assessment was carried out within 3 days after delivery. The bleeding on probing (BOP) of the PT-LBW group was significantly higher than the control (P = 0.027). The correlation test revealed a mild inverse relationship between BOP and BW (R = -0.23, P = 0.044). According to the new 2018 American Academy of Periodontology (AAP) periodontal classification, there was no significant difference between periodontal status within groups. The present study suggests that BOP, an early sign of gingival inflammation, is involved in adverse pregnancy outcomes. This study is the first of its kind to use immediate postpartum periodontal examination and diagnosis by the new 2018 AAP periodontal classification. The findings demonstrate that signs of gingival inflammation may be associated with adverse pregnancy outcomes. How to cite this article: Yanaranci S, Laosrisin N, Sriprasertsuk A, et al. The Association of Maternal Periodontal Diseases in the Postpartum Period with Preterm Low Birth Weight. J Contemp Dent Pract 2024;25(2):99-106.

Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study.

Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Predictors of standardized in-service examination performance and residency outcomes in a graduate periodontics program.

The objectives of this study were to assess the influence of learner- and education-related factors on standardized in-service examination performance and determine whether in-service examination scores predict residency outcomes. American Academy of Periodontology (AAP) In-service Examination (AIE) scores from 10 periodontics residency classes at a single center were recorded and compared against a panel of learner- and education-related variables using multiple linear regression models. Defined residency outcome measures were analyzed against AIE scores using binomial logistic regression. No evaluated learner- or education-related variable was a statistically significant predictor of AIE score in this study sample. Likewise, AIE score was not a statistically significant predictor of any assessed residency outcome. The AAP has performed a tremendous service to periodontics residents and programs by marshaling the leadership and expertise necessary to offer a professionally constructed assessment instrument. However, in the current study, no relationship could be identified between AIE score and any outcome, including first-attempt board certification. The AAP In-service Committee appears well situated to provide additional leadership focusing on exam implementation, which may enhance AIE value in competency decision making.

Artificial intelligence in dental education: ChatGPT's performance on the periodontic in-service examination.

ChatGPT's (Chat Generative Pre-Trained Transformer) remarkable capacity to generate human-like output makes it an appealing learning tool for healthcare students worldwide. Nevertheless, the chatbot's responses may be subject to inaccuracies, putting forth an intense risk of misinformation. ChatGPT's capabilities should be examined in every corner of healthcare education, including dentistry and its specialties, to understand the potential of misinformation associated with the chatbot's use as a learning tool. Our investigation aims to explore ChatGPT's foundation of knowledge in the field of periodontology by evaluating the chatbot's performance on questions obtained from an in-service examination administered by the American Academy of Periodontology (AAP). ChatGPT3.5 and ChatGPT4 were evaluated on 311 multiple-choice questions obtained from the 2023 in-service examination administered by the AAP. The dataset of in-service examination questions was accessed through Nova Southeastern University's Department of Periodontology. Our study excluded questions containing an image as ChatGPT does not accept image inputs. ChatGPT3.5 and ChatGPT4 answered 57.9% and 73.6% of in-service questions correctly on the 2023 Periodontics In-Service Written Examination, respectively. A two-tailed t test was incorporated to compare independent sample means, and sample proportions were compared using a two-tailed χ2 test. A p value below the threshold of 0.05 was deemed statistically significant. While ChatGPT4 showed a higher proficiency compared to ChatGPT3.5, both chatbot models leave considerable room for misinformation with their responses relating to periodontology. The findings of the study encourage residents to scrutinize the periodontic information generated by ChatGPT to account for the chatbot's current limitations.

Validity of individual self-report oral health measures in assessing periodontitis for causal research applications.

Self-reported measures of periodontitis developed for use in population surveillance are increasingly used in causal research. Numerous studies evaluate the validity of these measures against clinical parameters of periodontitis, yet few include validation parameters outside of multivariable models. Individual item validity is necessary to adequately inform use of these measures in causal research. We used data from the National Health and Nutrition Examination Survey 2011-2014 in which dentate participants completed full-mouth periodontal examinations (N=6966). We evaluated six self-report questionnaire items related to periodontal disease status against periodontitis case definitions developed by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP). We estimated the sensitivity and specificity of individual items using severe and moderate-to-severe periodontitis classifications. We additionally combined items to evaluate the validity of joint measures. Sensitivity was highest when measures were evaluated against severe periodontitis. Self-rated oral health of fair/poor demonstrated the highest sensitivity for severe (0.60) and moderate-to-severe periodontitis (0.48). Specificity was highest when evaluated against moderate-to-severe periodontitis, with self-reported history of tooth mobility as the most specific measure (0.87 for severe disease; 0.92 for moderate-to-severe) followed by a history of bone loss (0.88 for severe; 0.91 for moderate-to-severe). Combining questions generally improved specificity at the expense of sensitivity. Our findings related to item-specific validity and the associated clinical profiles facilitate needed considerations for the use of self-reported measures of periodontitis in causal research. Additionally, item-specific validity can be used to inform assessments of misclassification bias within such investigations.

Prevalence of Periodontitis Based on the American Academy of Periodontology and European Federation of Periodontology 2017 Classification Scheme in Patients Visiting a Tertiary Care Center in New Delhi – An Epidemiological Study

Introduction: Periodontitis is one of the major reasons for tooth loss in adults. Therefore, it is important to know the true prevalence of the disease. Aim: This study was designed to find out the prevalence of periodontitis in Delhi state based on the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) 2017 classification scheme. Materials and Methods: It was a descriptive cross-sectional study involving 2200 patients. Periodontal data were collected using the Community Periodontal Index of Treatment Needs-Epidemiological probe. Periodontal disease was diagnosed with the 2017 AAP and EFP definitions and classifications. Results: Of the study population, 93.2% had no detectable clinical attachment loss (CAL), 34.8% (n = 52) were classified with Stage I, 34.8% (n = 52) with Stage II, 16.8% (n = 25) with Stage III, and none with Stage IV periodontitis. Grade A was the predominant grade, being diagnosed in 50% of the periodontitis cases. The majority of cases (62%) demonstrated generalized periodontitis. Conclusion: The new periodontal disease classification system introduced in 2017 has provided a comprehensive description of periodontal disease which can classify the periodontal disease on the basis of various factors. Based on this, our study reported a maximum number of Stage I and II periodontitis patients.

Prevalence and social determinants of periodontal disease in Colombian pregnant women.

The objective of the study was to identify the prevalence of periodontal disease in pregnant women in the Colombian population and its association with social determinants and medical history based on data from the Fourth National Oral Health Survey (ENSAB IV). A total of 1012 pregnant women from different areas of Colombia were evaluated. A periodontal evaluation was performed using a North Carolina periodontal probe. The following data were recorded: number of teeth, probing depth (PD), the position of the gingival margin (GM) and clinical attachment level (CAL). An ordinal logistic regression analysis was performed for the association between social determinants and the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) classification and logistic regression between social determinants and the European Federation of Periodontology (EFP) classification. The prevalence of periodontitis was 37.1% using the CDC/AAP criteria and 41.2% according to the criteria of EFP distributed in sensitive (40.2%) and specific cases (0.9%). Age, belonging to a subsidized regime, living in a rural area, having an intermittent water supply and bleeding in medical records were found to be positively associated with periodontitis (mild, moderate, severe). The findings of this national study of pregnant women show a high prevalence of periodontitis-using the CDC/AAP and EFP criteria-associated with age, living in rural areas, subsidized regime, intermittent water supply and bleeding in medical records.

Diagnostic accuracy of severe periodontitis for Ramfjord teeth based on different classifications.

To evaluate the accuracy of Ramfjord teeth (RT) protocol for the diagnosis of severe periodontitis based on different classifications and explore the misclassification bias such as teeth loss. Patients (n = 435) receiving full-mouth periodontal examination (FMPE) were included. Patients were classified as severe (stage III/IV) periodontitis and no/mild/moderate (no/stage I/II) periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP)-(CDC/AAP), a new classification introduced by AAP and the European Federation of Periodontology (EFP)-(AAP/EFP), and consensus of Chinese experts (CCE). Sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, and area under the receiver operating characteristic curve (AUROC) compared with FMPE were evaluated. The specificity of RT was 86.8%, 92.2%, and 77.1% when compared with FMPE protocol based on CDC/AAP, AAP/EFP, and CCE classifications, while the AUROC value was 0.934, 0.961, and 0.886 specifically. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis. RT showed the highest specificity based on the new AAP/EFP classification. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis.

J-shaped association between systemic immune-inflammation index and periodontitis: Results from NHANES 2009-2014.

To examine the relationship between the systemic immune-inflammation index (SII) and periodontitis and to investigate possible effect modifiers. Data used in the present cross-sectional study are from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 (N=10,301). The SII was calculated using the following formula: (neutrophils count × platelet count)/lymphocytes count. The category of periodontitis was defined by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC/AAP) classification. We employed natural cubic spline and multivariable logistic regression analyses to evaluate the associations of the SII with periodontitis. The associations between SII and periodontal health followed a J-shape (p<0.001). The risk of periodontitis tended to reduce with the increment of log2(SII) in participants with log2(SII)≤8.66 (odds radio [OR]=0.83; 95% CI: 0.69-0.999), especially among non-Hispanic Whites (OR=0.70; 95% CI: 0.52-0.95), and increased with the increment of log2(SII) in participants with log2(SII)>8.66 (OR=1.19; 95% CI: 1.02-1.38). A similar trend was also observed between the SII and the number of sites with probing pocket depth (PPD)≥4mm and clinical attachment loss (CAL)≥3 or 5mm. Furthermore, we found a significantly stronger correlation between lymphocytes and either neutrophils or platelets in individuals with log2(SII)>8.66, as opposed to those with log2(SII)≤8.66. There is a J-shaped association between SII and periodontitis in US adults, with an inflection point of log2(SII) at 8.66, which may provide potential adjunctive treatment strategies for periodontitis with different immune response states. Further prospective trials are still required to confirm our findings.

EFEK ANTIBAKTERIAL CUKA SARI APEL DALAM BERBAGAI KONSENTRASI TERHADAP PORPHYROMONAS GINGIVALIS

Background: periodontal disease is a disease that can affect the supporting tissues of the teeth. The American Academy of Periodontology (AAP) classifies it into two, namely chronic periodontitis and aggressive periodontitis. Periodontitis is usually caused by bacteria, one of which is Porphyromonas gingivalis. One of the ingredients that can be used as mouthwash and has an antibacterial effect is chlorhexidine, but the use of this mouthwash has side effects so people turn to herbal medicines, namely apple cider vinegar which contains phenols, flavonoids, saponins, and alkaloids as antibacterial. This study aims to determine whether or not there is an antibacterial effect of apple cider vinegar on Porphyromonas gingivalis bacteria. Methods: the material in the form of fermented apple cider vinegar has a pH value of 3.13 and the remaining sugar content is 1.5% Brix. The research sample was Porphyromonas gingivalis ATCC 33277, obtained from the Aretha Medika Utama Biomolecular and Biomedical Research Center (BBRC) Laboratory in Bandung. The research method is the disc diffusion method (Kirby-Bauer), which is the method on disc paper with various concentrations of apple cider vinegar. Results: based on laboratory experimental research on the antibacterial effect of apple cider vinegar with a concentration of 1.56% and 3.12%, the criteria are weak because they have a value of 0, at concentrations of 6.25% and 50%, have moderate criteria because they have a value of 6.18 mm and 8.33 mm, and at a concentration of 100% has strong criteria because it has a value of 13.93 mm. Conclusion: apple cider vinegar has an antibacterial effect that can inhibit the growth of Porphyromonas gingivalis bacteria, the largest inhibition zone is at a concentration of 100% and decreases as the concentration of apple cider vinegar decreases.

Isolated periodontal pockets: a clinical review

An isolated periodontal pocket is a perplexing clinical entity that usually poses a diagnostic challenge to the oral health professional. Although periodontal pockets are easy to detect, they can be easily missed during a routine clinical examination. The broad range of aetiological factors that can result in an isolated periodontal pocket makes identifying the cause difficult. The aetiology can be as simple as an overhanging restoration or food impaction due to open interproximal contacts, to more complex and uncommonly occurring presentations, such a palato-radicular groove or cemental tears. Although previous classifications proposed by the American Academy of Periodontology and European Federation of Periodontology have discussed this topic under different headings, an explicit classification on isolated periodontal pockets based on aetiology is currently missing. Isolated periodontal pockets are easily undiagnosed, with associated cases presenting with substantial destruction necessitating complex multidisciplinary treatment. This article highlights the various causes of an isolated periodontal pocket, and provides a systematic and easy clinical aetiology-based classification. The proposed classification categorizes isolated periodontal pockets into those occurring due to: (1) developmental anomalies of the teeth; (2) iatrogenic causes; and (3) pathological conditions. Further studies are essential to validate this classification. CPD/Clinical Relevance: Early detection of easily missed isolated periodontal pockets is of clinical value during initial screening to avoid delayed diagnosis and treatment.