Diagnostic accuracy of severe periodontitis case definitions: Comparison of the CDC/AAP, EFP/AAP, and CPI criteria.

BACKGROUND: This cross-sectional study aimed to evaluate the diagnostic accuracy of severe periodontitis by three different case definitions. METHODS: Patients aged >35 years (n = 243, mean age = 47.8 ± 9.3 years) were evaluated by periodontal examinations and classified in patients with severe periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Academy of Periodontology (AAP)-CDC/AAP, the new periodontal disease classification proposed jointly by the AAP and the European Federation of Periodontology (EFP/AAP), and the Community Periodontal Index (CPI). The primary outcome was to compare the diagnostic accuracy of severe periodontitis between the three case definitions. Sensitivity (SS), specificity (SP), and area under the receiver operating characteristic (ROC) curve were used to analyze the accuracy. RESULTS: The proportion of subjects presenting the most severe definitions of each classification was: severe periodontitis (CDC/AAP) = 47.3%, type III and IV periodontitis (EFP/AAP) = 43.2% and CPI code 4 = 44.4%. When comparing the CDC/AAP case definitions with the EFP/AAP classification, SS, SP, and ROC of 81.7%, 91.4%, and 0.866 (CI, 95%: 0.816 to 0.916), respectively, were obtained. Similarly, when comparing CDC/AAP to CPI code 4, SS, SP, and ROC of 81.7%, 89.1%, and 0.854 (CI, 95%: 0.802 to 0.906), respectively, were obtained. When type III and IV periodontitis (EFP/AAP) was compared with CPI code 4, the values were 92.4%, 92%, and 0.922 (CI, 95%: 0.883 to 0.961), respectively. CONCLUSIONS: The EFP/AAP classification and the CPI demonstrated high diagnostic accuracy with the CDC/AAP case definition to diagnose severe periodontitis.

Aggressive periodontitis presents a higher degree of bilateral symmetry in comparison with chronic periodontitis.

The purpose of this cross-sectional study was to evaluate the occurrence of bilateral symmetry in the distribution of clinical parameters in subjects with generalized aggressive periodontitis (GAP) and severe chronic periodontitis (SCP). The sample comprised 53 subjects with GAP and 33 with SCP. Probing depth (PD) and clinical attachment loss (CAL) were recorded from both buccal and lingual interproximal sites of incisors and molars. The symmetry of periodontal destruction was analyzed in terms of intraclass coefficient correlations (ICC) for pairs of contralateral sites at which PD and/or CAL was ≥5 mm at one of the sites of the subjects in each group. GAP patients had a higher proportion of both PD and CAL ≥ 5 mm and also a higher mean proportion of subjects having PD and/or CAL ≥ 5 mm at one or both sites. The GAP group had 20 pairs of contralateral sites with PD (ICC = 0.22-0.63) and 26 pairs with CAL (ICC = 0.20-0.63), the correlation being statistically significant, while the SCP group had only 2 pairs (ICC = 0.36-0.48) with PD and 5 pairs with CAL (ICC = 0.33-0.58) showing a significant correlation. It can be concluded that GAP shows more symmetric periodontal destruction than SCP.

Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

BACKGROUND: Little evidence is available regarding the effects of long-term periodontal infection on diabetes mellitus (DM) control. The aim of this retrospective cohort study is to evaluate influence of periodontal status on changes of glycated hemoglobin (HbA1c) levels of patients with type 2 DM (DMt2). METHODS: Eighty patients (mean age: 56.0 ± 8.9 years) with DMt2 were included. Patients were non-smokers, aged ≥40 years, and using antidiabetic drugs. Demographics, health history, and HbA1c levels were retrieved from medical charts. Probing depth and clinical attachment loss (AL) were recorded. RESULTS: Patients were examined at two time points within a mean interval of 38.6 ± 6.6 months. Increase in HbA1c over time was statistically significant when severe periodontitis was diagnosed at baseline (2.32%, 95% confidence interval [CI]: 1.50% to 3.15%), in patients showing at least one tooth with ≥2 mm of AL progression (2.24%, 95% CI: 1.56% to 2.91%), in males (2.75%, 95% CI: 1.72% to 3.78%), and in those with HbA1c <6.5% at baseline (3.08%, 95% CI: 2.47% to 3.69%). After adjusting for baseline HbA1c, significant changes were still observed for severe periodontitis and progression of AL with increases of 0.85% and 0.9%, respectively. After adjusting for sex and HbA1c, AL progression was also statistically significant, with increases of 0.84%. CONCLUSIONS: Periodontitis progression was associated with increase in HbA1c in patients with DMt2. Identification of these risk factors suggests that periodontal treatment may improve glycemic control of patients with DMt2 by eliminating periodontal infection.