Classification Of Periodontal Diseases Research Articles

Periodontal diseases in Africa.

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.

The association of reproductive health factors with periodontitis in 45-80 years old US women from NHANES 2009-2014.

We investigated the association of female reproductive factors with periodontitis. This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2014 on 2321 women aged 45-80 years who had full-mouth periodontal examination and reproductive questionnaire. The 2018 World Workshop Classification of Periodontal and Peri-implant Diseases was used to classify periodontitis stages. After adjustment, > 3 pregnancies or live births were associated with increased stage III/IV periodontitis but age at first birth (AFB) > 23 years and female hormone use were associated with decreased stage III/IV periodontitis, while there were no associations of oral contraceptive use or menopause status with stage III/IV periodontitis. Stage III/IV periodontitis was more common in women with > 3 pregnancies or live births and AFB ≤ 23 years or never using female hormones but less common in women with ≥ 3 pregnancies or > 3 live births and AFB > 23 years or using female hormones. >3 pregnancies or live births were related with increased stage III/IV periodontitis and increased AFB was related with lowered stage III/IV periodontitis in overweight and smoking subgroups but using female hormone was related with reduced stage III/IV periodontitis in nonsmoking, non-overweight and black subgroups. >3 pregnancies/live births were related with severe periodontitis but AFB > 23 years and female hormone use were related with ameliorating periodontitis. Women with > 3 pregnancies/live births should receive intensive periodontal interventions. Female hormone therapy or AFB > 23 years may be beneficial for periodontal health of > 3 pregnancies/live births women.

Evaluation of Periodontitis and Fusobacterium nucleatum Among Colorectal Cancer Patients: An Observational Cross-Sectional Study.

Periodontitis has been associated with an increased risk of CRC, as well as a worse prognosis due to increased inflammation mediators and carcinogenic factors. Moreover, direct and indirect virulence factors from periodontal pathogens, such as Fusobacterium nucleatum, could play a pivotal role in malignant transformation and progression. This cross-sectional study aims to evaluate the presence and the stage of periodontitis in a cohort of patients with CRC. The secondary aim is to assess the presence of F. nucleatum and its relationship with patients' general characteristics, concomitant pathologies, tumor characteristics, and drug therapy. Patients affected by CRC underwent dental examination and periodontal charting with the "North Carolina" probe to assess the presence and stage of periodontitis, according to the new classification of periodontal diseases of the World Workshop of the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) 2017. F. nucleatum presence was assessed by a dorsal tongue swab and related to the patient's general characteristics, concomitant pathologies, tumor characteristics, and drug therapy. Periodontal disease was found in 94.3% of I/II CRC stage patients and 100% of III/IV CRC stage patients. Severe periodontitis was found in 76% of the advanced CRC stage and 87.9% of patients with initial CRC, while initial periodontitis was found in 12.1% of initial CRC and 24% of late CRC stages, respectively, without significant differences. F. nucleatum presence showed no correlation between the patient's and tumor's characteristics, comorbidities, and drug assumed. Periodontal disease showed a high prevalence among CRC patients. Moreover, severe periodontitis has a higher prevalence in CRC patients compared to initial periodontitis. F. nucleatum presence was unrelated to CRC stage, site, other comorbidities, and drug therapies. With these data, it is not possible to admit a direct relationship between CRC and periodontal disease, but further case-control studies must be carried out to further prove this aspect. Preventive and operative targeted strategies to maintain a healthy oral status are suggested in CRC patients.

Adapting to emergent paradigm shifts: A calibration study among graduating dental students using the new classification of periodontal diseases

IntroductionThe World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions introduced the 2018 Classification. Formulating periodontal diagnosis differs from clinician to clinician and depends on the expertise and competence of the clinician. We aimed to assess calibration levels of periodontal diagnosis based on the 2018 classification among senior-year dental interns at Batterjee Medical College in Saudi Arabia preparing for practice and subsequent graduation. Materials and MethodsIn this preapproved study, 52 senior-year dental students received a two-hour presentation on the 2018 classification by a single teacher, followed by a preliminary exam. One week later, the students were subjected to 12 study cases demonstrating a variety of periodontal and peri-implant disorders with gold standard management, followed by a post-test. Case scenarios with photographs, knowledge cognition, knowledge recall, and case scenarios were the four areas of both exams. Kappa statistics were computed to determine agreement. Statistical significance was set at p < 0.05. ResultsThe total examination score was 12.69 ± 2.74 and 15.12 ± 2.99 (p = 0.001) for the pre- and post-tests, respectively. Furthermore, the difficulty factor and discrimination index increased by 12 % (p = 0.007) and 7 % (p = 0.244), respectively. Finally, the kappa statistic showed moderate agreement at 0.427 (p = 0.002). ConclusionInter-rater agreement with the gold standard increased after training, and this improvement was fairly successful in providing graduating dental students with diagnostic abilities simultaneously with the emergence of a new classification system. A calibration procedure based on a simple feedback approach provided beneficial outcomes.

The 2018 Classification of Periodontal Diseases: An Observational Study on Inter-examiner Agreement among Undergraduate Students.

The objective of the present observational study was to assess the inter-examiner agreement for the diagnosis of periodontitis using the 2018 CPD among fourth and fifth year undergraduate students. It is hypothesised that there is no difference in the inter-examiner relaibility between fourth- and fifth-year undergraduate students regarding staging and grading periodontal disease using the 2018 Classification of Periodontal Diseases (CPD). All participants received training on the 2018 CPD scheme through a mandatory periodontics course conducted by a periodontist. Documentation for seven deidentified periodontitis patients, comprising medical history, dental history including tooth loss, intra-oral photographs and radiographs, periodontal charts reporting probing depth, plaque and bleeding on probing scores, furcation involvement and clinical attachment loss, was sent via e-mail to undergraduate students. The cases consisted of one sextant, and the participants were instructed to assume the sextant to be a true representation of the entire dentition. Power analysis was done on pilot data, and the level of significance was set at p0.05. The percentage of undergraduate students in the fourth and fifth year that correctly identified the stage of periodontitis according to the 2018 CPD ranged between 28% and 72% and 18.5% and 77.8%, respectively. The percentage of undergraduate students in the fourth and fifth year that correctly identified the grade of periodontitis ranged between 40% and 88% and 51.8% and 92.5%, respectively. The overall staging and grading ranged between 22.8% and 74.1%, and 45.66% and 87.4%, respectively. There was no statistically significant difference between fourth- and fifth-year undergraduate students with regards to assigning the correct diagnoses to case documentation in terms of either stage or grade. Fourth- and fifth-year undergraduate students demonstrated high inter-examiner agreement using the 2018 CPD.

Periodontitis Treatment by Scaling and Root Planing with Antimicrobial and Anti-Inflammatory Solutions in a Patient with Systemic Lupus Erythematosus

Introduction: Systemic Lupus Erythematosus is a chronic autoimmune disease of unknown cause in which patients regularly consume immunosuppressants, causing a decrease in body fluids of proteins such as mucins, immunoglobulin A and G antibodies, which causes destruction of periodontal tissue. Objective: To report a clinical case on the benefits of scaling and root planing (srp) with solutions based on hypochlorous acid (HOCl) and modified diallyl disulfide oxide (mddo) in the periodontal inflammatory process in a patient with systemic lupus erythematosus patient, tubulointerstitial nephritis and periodontitis. Case presentation: A 32-year-old woman, with systemic lupus erythematosus, tubulointerstitial nephritis and, according to the 2017 global workshop on the classification of periodontal diseases and conditions, was diagnosed with Stage 2 and Grade B periodontitis. Periodontal assessment revealed a high overall dental plaque index, with high-risk plaque being the most prevalent. srp treatment was carried out by quadrants, applying a HOCl solution during periodontal debridement and periodontal pockets were irrigated with mddo solution to disinfect them. Conclusions: The antimicrobial and anti-inflammatory solutions used as adjuvants to srp in this novel periodontal irrigation therapy helped to reduce gingival inflammation and high-risk plaque, which favoured healing of periodontal tissues in a patient with systemic lupus erythematosus.

Clinical knowledge-guided hybrid classification network for automatic periodontal disease diagnosis in X-ray image

Accurate classification of periodontal disease through panoramic X-ray images carries immense clinical importance for effective diagnosis and treatment. Recent methodologies attempt to classify periodontal diseases from X-ray images by estimating bone loss within these images, supervised by manual radiographic annotations for segmentation or keypoint detection. However, these annotations often lack consistency with the clinical gold standard of probing measurements, potentially causing measurement inaccuracy and leading to unstable classifications. Additionally, the diagnosis of periodontal disease necessitates exceptional sensitivity. To address these challenges, we introduce HC-Net, an innovative hybrid classification framework devised for accurately classifying periodontal disease from X-ray images. This framework comprises three main components: tooth-level classification, patient-level classification, and a learnable adaptive noisy-OR gate. In the tooth-level classification, we initially employ instance segmentation to individually identify each tooth, followed by tooth-level periodontal disease classification. For patient-level classification, we utilize a multi-task strategy to concurrently learn patient-level classification and a Classification Activation Map (CAM) that signifies the confidence of local lesion areas within the panoramic X-ray image. Eventually, our adaptive noisy-OR gate acquires a hybrid classification by amalgamating predictions from both levels. In particular, we incorporate clinical knowledge into the workflows used by professional dentists, targeting the enhanced handling of sensitivity of periodontal disease diagnosis. Extensive empirical testing on a dataset amassed from real-world clinics demonstrates that our proposed HC-Net achieves unparalleled performance in periodontal disease classification, exhibiting substantial potential for practical application.

Classification of apical periodontitis with YOLOv5 and YOLOv8 architectures

Classification of apical periodontitis with YOLOv5 and YOLOv8 architectures

Differences Between Vietnamese Living in Germany and German Periodontitis Patients in Periodontal Conditions and Subgingival Microbiota

Introduction and aimsA number of studies have reported ethnic differences in the prevalence and severity of periodontitis. Such discrepancies could be attributed to disparities in periodontal risk factors, as well as variations in the composition of the subgingival microbiota. Given the substantial Vietnamese population residing in the former German Democratic Republic, the present study aimed to compare the clinical and microbial characteristics of periodontitis patients of Vietnamese Asian origin living in Germany with those of German Caucasian periodontitis patients. MethodsA total of 60 patients with a minimum stage II periodontitis diagnosis were included in the study. Of these, 30 were of Vietnamese origin, with an average age of 55 years and a male prevalence of 33.3%. The remaining 30 patients were of German origin, with an average age of 54.5 years and a male prevalence of 40%. The periodontal diagnosis was made in accordance with the recently revised classification of periodontal disease. The pooled subgingival plaque samples were subjected to next-generation sequencing on the MiSeq platform (Illumina). ResultsThe German patients were significantly more likely to be smokers (56.7% vs 13.3%), had significantly higher body mass index (26 vs 22.6 kg/m²), probing depth (4.1 vs 3.6 mm), and clinical attachment loss (5 vs 4.1 mm). In terms of microbiota, the Vietnamese patients exhibited significantly lower beta diversity compared to the German patients, and smokers demonstrated a significantly higher beta diversity compared to nonsmokers. The microbiota of both groups differed most significantly in the relative abundance of Porphyromonas gingivalis (Vietnamese) and Fusobacteriia (German). ConclusionsGerman patients with periodontitis showed more severe periodontal symptoms and more pronounced periodontal risk factors compared to Vietnamese patients. Both patient groups also showed significant differences in the subgingival microbiota. Clinical relevanceCompared to Vietnamese living in Germany, German patients have a higher need for periodontal treatment and at the same time the risk factors of smoking and obesity should be reduced. More research is needed before the differences in oral microbiota between the two groups can lead to individualised therapeutic approaches.

Do dental students internalized current classification of periodontal diseases?

Do dental students internalized current classification of periodontal diseases?

Assessment and Comparison of N-Terminal-Probrain Natriuretic Peptide (NT-proBNP) in Saliva and Serum of Healthy Subjects, Periodontitis Patients, and Periodontitis Patients With Myocardial Infarction.

Introduction Periodontitis is a multifactorial oral disease causing destruction of the periodontium. Systemic diseases can exacerbate periodontal inflammation through immune dysregulation. N-terminal-probrain natriuretic peptide (NT-proBNP) a prohormone, released by myocardial cells is a known biomarker for cardiovascular disease (CVD). Existing literature discloses a bidirectional relationship between periodontitis and CVD. NT-proBNP release can be regulated by mediators of the systemic inflammation. Cardiocyte NT-proBNP release might get stimulated through proinflammatory cytokines. NT-proBNP levels can also be influenced by systemic inflammation in the absence of cardiac dysfunction. Accordingly, we postulated that the inflammation of periodontium could aid in increased levels of NT-proBNP in serum and saliva in participants without cardiovascular disorders. Saliva is said to be the mirror of the body. Assessing NT-pro BNP in saliva allows for a non-invasive method. The present research evaluated the salivary and serum concentrations of NT-proBNP in a healthy group, patients suffering from periodontal disease and periodontal disease along with myocardial infarction (MI). Material and method A total of 90 patients, 30 in each group i.e., healthy group, periodontitis patients and patients suffering from periodontitis with myocardial infarction, were enrolled. The periodontitis patients were selected according to the Classification of Periodontal and Peri-implant Diseases and Conditions 2017. Patients clinically diagnosed with MI by the physician were selected following World Health Organization criteria for detection of MI. Case history was recorded and periodontal parameter analysis like plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were measured. Salivary and serum samples were collected from the participants after obtaining informed consent. The samples were subjected to human NT-proBNP sandwich type enzyme-linked immunosorbent assay (ELISA) for quantitative evaluation. The obtained data was analysed and compared using ANOVA, Tukey's post hoc test and Pearson's correlation. The p-value<0.05 was considered statistically significant. Result PI and GI were highest in subjects with periodontitis only (p<0.05). Patients suffering from periodontitis with MI exhibited significantly higher PPD and CAL values (p<0.05). Salivary and serum concentrations of NT-proBNP were significantly higher with p-value=0.000 in subjects suffering from periodontitis with MI. The salivary NT-proBNP levels were significantly higher than serum NT-proBNP levels in periodontitis and periodontitis with MI patients. The levels of NT-proBNP in periodontitis along with MI patients were 1.570 pg/mL in serum and 1.694 pg/mL in saliva. Conclusion Salivary NT-proBNP levels were highest in subjects affected from periodontitis along with MI. Elevated salivary NT-proBNP levels can be due to systemic inflammation and cardiovascular stress linking periodontitis to MI. The positive correlation between periodontal parameters and NT-proBNP levels validates the biomarker's role in reflecting the extent of periodontal destruction and its association with cardiovascular stress. Salivary NT-proBNP can be used as a non-invasive diagnostic marker for diagnosing periodontitis and MI. Future research could explore targeted therapies for the shared inflammatory pathways between periodontitis and MI.

Salivary IL-1β, IL-6, and IL-10 Are Key Biomarkers of Periodontitis Severity.

To explore severity and progression biomarkers, we examined the clinical relevance of multiple cytokines and mediators involved in the inflammatory response in periodontitis. A cohort of 68 patients was enrolled in the study and periodontal status assessed by the current classification of periodontal diseases. Immune mediators present in saliva, of both patients and healthy controls, were quantified using a Legendplex-13 panel. Clinic parameters were significantly higher in PD patients compared with HC, with a strong significant association with the disease severity (stage) (p < 0.001), but not with progression (grade). The panel of immune mediators evidenced elevated levels of pro-inflammatory cytokines IL-6 and IL-1β as disease established (p < 0.01). IL-1β/IL-1RA ratio was increased in PD patients, being associated with disease stage. An anti-inflammatory response was spotted by higher IL-10. Lower levels of IL-23 and IP-10 were associated with disease severity. No significant statistical differences were found by grade classification. Moreover, salivary IL-1β and IL-6 exhibited significant positive correlations with several clinical measurements (PI, BOP, PPD, CAL), while IP-10 showed a statistical negative correlation with BOP, PPD, and CAL. These insights highlight the complexity of the periodontitis inflammatory network and the potential of cytokines as biomarkers for refined diagnostic and therapeutic strategies.

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.

Structure, governance and delivery of specialist training programs in periodontology and implant dentistry.

To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Fermented foods and probiotic consumption frequency as protective indicators for peri-implant diseases – a cross-sectional study

BackgroundDue to their modulatory effect on biofilm growth, bacterial gene expressions, and host-modulation effects, fermented foods and probiotic products could potentially have a protective role against peri-implant diseases. This cross-sectional study aimed to examine the association of consumption of fermented foods and products containing probiotics, with peri-implant health and diseases.MethodsA total of 126 implants were included. The peri-implant health status (peri-implantitis, peri-implant mucositis, and peri-implant health) was assessed through Chicago’s Classification of periodontal and peri-implant Diseases and Conditions. A questionnaire was used to evaluate the consumption patterns of fermented and probiotic foods and product. One-way ANOVA was employed to compare the 3 peri-implant conditions categories in terms of fermented food and probiotic consumption.ResultsThere were significant differences in the daily and general consumption of yogurt, probiotic yogurt, kefir, ayran, vinegar, pomegranate syrup, whole meal bread, and homemade butter among peri-implantitis, peri-implant mucositis and peri-implant health (p < 0.05). The peri-implant health group consumed significantly more yogurt, kefir, ayran, vinegar, whole wheat bread, and homemade butter than peri-implant mucositis and peri-implantitis.ConclusionA higher consumption of fermented and probiotic foods may be associated with peri-implant health. Fermented and probiotic products may be useful for prevention of peri-implant diseases in patients with implants.

An apically positioned flap and free gingival graft around an implant

Following the ‘2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions,’ hard and soft tissue deficiencies have been debated in the literature with keratinized mucosa at the forefront. In this case report, the present author investigated whether an apically positioned flap and free gingival graft to increase keratinized mucosa and vestibular depth improved oral hygiene and patient comfort around an implant-retained upper complete denture. Using an apically positioned flap in combination with free gingival graft to augment the soft tissues around implants with hard and soft tissue deficiencies, increased both the keratinized mucosa and vestibular depth to correct the soft tissue deficiencies. This case report highlights the importance keratinized mucosa and vestibular depth has at the patient and site level in improving oral hygiene and patient comfort. This case report also supports the growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm. CPD/Clinical Relevance: This case report supports growing evidence that the ideal periodontal phenotype around implants is to have keratinized mucosa ≥2 mm and vestibular depth ≥4 mm.

Performance of ChatGPT in classifying periodontitis according to the 2018 classification of periodontal diseases

ObjectivesThis study assessed the ability of ChatGPT, an artificial intelligence(AI) language model, to determine the stage, grade, and extent of periodontitis based on the 2018 classification.Materials and methodsThis study used baseline digital data of 200 untreated periodontitis patients to compare standardized reference diagnoses (RDs) with ChatGPT findings and determine the best criteria for assessing stage and grade. RDs were provided by four experts who examined each case. Standardized texts containing the relevant information for each situation were constructed to query ChatGPT. RDs were compared to ChatGPT's responses. Variables influencing the responses of ChatGPT were evaluated.ResultsChatGPT successfully identified the periodontitis stage, grade, and extent in 59.5%, 50.5%, and 84.0% of cases, respectively. Cohen’s kappa values for stage, grade and extent were respectively 0.447, 0.284, and 0.652. A multiple correspondence analysis showed high variance between ChatGPT’s staging and the variables affecting the stage (64.08%) and low variance between ChatGPT’s grading and the variables affecting the grade (42.71%).ConclusionsThe present performance of ChatGPT in the classification of periodontitis exhibited a reasonable level. However, it is expected that additional improvements would increase its effectiveness and broaden its range of functionalities (NCT05926999).Clinical relevanceDespite ChatGPT's current limitations in accurately classifying periodontitis, it is important to note that the model has not been specifically trained for this task. However, it is expected that with additional improvements, the effectiveness and capabilities of ChatGPT might be enhanced.

Predictive value of tooth loss risk with 2018 new classification of periodontitis:a literature review

The occurrence, progression and treatment efficacy of periodontitis are affected by many factors. Development on accurate estimation of prognosis is essential for treatment plan determination. The application of the 2018 new classification of periodontitis is one of the most important advances in the prognosis and risk assessment of periodontitis. The predictive value of the new classification on tooth loss risk had been evaluated by several latest researches, however, consensus still lacks. This review focused on the predictive efficacy of the 2018 new classification of periodontitis on tooth loss risk in periodontitis patients, in order to provide scientific evidence for clinical application and further improvement of the new classification system.

Ease and practicability of the 2017 classification of periodontal diseases and conditions: a study of dental electronic health records

BackgroundA new classification for Periodontal and Peri-implant Diseases and Conditions was introduced in the 2017 World Workshop. In the past the 1999 Armitage Classification was commonly used in practice. This study aimed to assess the ease and practicability of retroactively diagnosing a subset of patients formerly diagnosed using the 1999 AAP/CDC classification with the 2017 AAP/EFP disease classification.MethodsA random subset of 10% of all patients referred over a 7-year period (2011–2018) to the Post-Doctoral Periodontics Clinic at Columbia University College of Dental Medicine were reviewed by accessing the Electronic Health Records (EHRs) on axiUm. Patients diagnosed with periodontal disease based on the 1999 AAP/CDC classification (including chronic and aggressive Periodontitis) were reclassified using the 2017 classification (stage: I, II, III and grade: A, B, C).ResultsA sample of 336 patient records were examined. 132 were diagnosed with gingivitis, and 204 with periodontitis. Of these 204 patients, 68 (33.3%) were diagnosed with aggressive and 136 (66.7%) with chronic periodontitis. Patients diagnosed with aggressive periodontitis, 10% were reclassified as stage II, 47% as stage III, and 43% as stage IV periodontitis, and 100% were reclassified as grade C. Among patients with chronic periodontitis, 7% were reclassified as stage I, 65% as stage II, 21% as stage III, and 7% as stage IV; 11% of these were reclassified as grade A, 63% grade B, and 26% grade C.ConclusionsThe majority of those originally diagnosed with aggressive (90%) and chronic (80%) periodontitis were reclassified as either molar/incisor pattern stage III grade C or stage IV grade C periodontitis, and stage II or III periodontitis, respectively. The study demonstrated that it is practical to retroactively reassign a diagnosis according to the new 2017 classification using available information included in dental EHRs.

The new system for classification of periodontal and peri-implant disease: A questionnaire study of implementation by Swedish dental hygienists.

To what extent do dental hygienists (DH) employed by the Public Dental Health Service (PDHS) in Sweden use the new classification system, their knowledge of it and their attitudes towards it. A web-based questionnaire was distributed to DHs in the PDHS in different regions of Sweden. A total of 197 registered DHs responded. The questions covered their knowledge, attitudes and possible barriers to implementation of the new classification system of periodontal and peri-implant diseases, and a question about their perceived need for a complementary digital tool to facilitate its implementation. Seventy per cent of the DHs stated that they used the new classification system. Twenty-nine per cent of the participants were confident in classifying periodontitis under the new system. Furthermore, 36% of the participants considered their knowledge of the new system to be good and 33% to be poor or non-existent. Several DHs stated that the new system was too time-consuming, that it caused stress, that their knowledge was inadequate and that they, therefore, considered it too difficult to use. Eighty per cent of the participants were positive to a digital tool as a complement and support to classify periodontitis and peri-implantitis. The present study showed that most of the DHs used the new classification system and one-third considered their knowledge to be good, although it was difficult and time-consuming. Furthermore, in general, the DHs were positive to a digital tool to facilitate application of the new classification system.