RESUMEN
A 3-year-old had spontaneous gingival hemorrhage and bilateral limb weakness with inability to bear weight. He had no preceding oral trauma or recent infection, took no regular medications, and had no recent use of aspirin or nonsteroidal anti-inflammatory drugs; his diet was limited to primarily chicken nuggets and milk. What is the diagnosis and what would you do next?
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Ácido Ascórbico , Hemorragia Gingival , Dolor Musculoesquelético , Escorbuto , Preescolar , Humanos , Masculino , Diagnóstico Diferencial , Hemorragia Gingival/sangre , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/etiología , Dolor Musculoesquelético/sangre , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/etiología , Escorbuto/sangre , Escorbuto/complicaciones , Ácido Ascórbico/sangreRESUMEN
The search for hereditary bleeding disorders (HBD) prior to invasive procedures in children is primarily based on personal and family bleeding history. Although several scores are available, they have only been evaluated in specific situations or in adults. Our monocentric retrospective study aimed to analyze the association between clinical history and four scores (HEMSTOP, PBQ, ISTH-BAT, TOSETTO) and the diagnosis of MHC in children referred to the University Hospital of Montpellier for hemostasis investigations. A total of 117 children were retrospectively included in the study. Of these, 57 (49%) were diagnosed with HBD, with 30 having primary bleeding disorders and 27 having coagulation disorders. The diagnosis of HBD was significantly associated with gingival bleeding, which was present in 30% of HBD patients. In our population, only the HEMSTOP score showed an association with the diagnosis of HBD, but it was positive in only 48% of patients. By including gingival bleeding as a factor, we modified the HEMSTOP score, which increased its sensitivity from 0.45 to 0.53. When examining primary bleeding disorders, the modified HEMSTOP score, with the inclusion of gingival bleeding, enables us to diagnose 63% of patients (see Fig. 1). Conclusion: Therefore, gingival bleeding should be considered a useful factor in bleeding history for HBD diagnosis. Adding this symptom to a screening score such as HEMSTOP improves its sensitivity. To confirm our findings, a prospective study is required. Trial registration: Study registration number: NCT05214300. What is Known: ⢠Screening for hereditary bleeding disorder diseases is a necessity and a challenge in children. ⢠Minor disorders of primary hemostasis are the most common, but often escape standard coagulation tests. What is New: ⢠Gingival bleeding is a frequent symptom that is easy to investigate and may point to a primary hemostasis disorder. ⢠Adding the gingival bleeding item to a routine screening score such as HEMSTOP improves sensitivity.
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Trastornos de la Coagulación Sanguínea Heredados , Hemorragia Gingival , Humanos , Niño , Estudios Retrospectivos , Femenino , Masculino , Preescolar , Adolescente , Trastornos de la Coagulación Sanguínea Heredados/diagnóstico , Trastornos de la Coagulación Sanguínea Heredados/complicaciones , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/etiología , Lactante , Sensibilidad y EspecificidadRESUMEN
AIM: To assess the diagnostic performance of self-reported oral health questions and develop a diagnostic model with additional risk factors to predict clinical gingival inflammation in systemically healthy adults in the United Kingdom. METHODS: Gingival inflammation was measured by trained staff and defined as bleeding on probing (present if bleeding sites ≥ 30%). Sensitivity and specificity of self-reported questions were calculated; a diagnostic model to predict gingival inflammation was developed and its performance (calibration and discrimination) assessed. RESULTS: We included 2853 participants. Self-reported questions about bleeding gums had the best performance: the highest sensitivity was 0.73 (95% CI 0.70, 0.75) for a Likert item and the highest specificity 0.89 (95% CI 0.87, 0.90) for a binary question. The final diagnostic model included self-reported bleeding, oral health behaviour, smoking status, previous scale and polish received. Its area under the curve was 0.65 (95% CI 0.63-0.67). CONCLUSION: This is the largest assessment of diagnostic performance of self-reported oral health questions and the first diagnostic model developed to diagnose gingival inflammation. A self-reported bleeding question or our model could be used to rule in gingival inflammation since they showed good sensitivity, but are limited in identifying healthy individuals and should be externally validated.
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Gingivitis , Adulto , Hemorragia Gingival/diagnóstico , Gingivitis/diagnóstico , Humanos , Inflamación , Salud Bucal , Autoinforme , Reino UnidoRESUMEN
A 12-year-old patient of thalassaemia major developed autoimmune cytopaenia after undergoing haematopoietic stem cell transplantation. She was started on cyclosporine (CsA) in view of poor response to steroids. She developed CsA toxicity manifesting as gum hyperplasia with multiple episodes of gum bleed. During endotracheal intubation for an elective splenectomy, she developed significant bleeding from gums requiring massive transfusion. Postoperatively the gum bleed persisted even after embolisation of facial artery and multiple transfusions. The catastrophic sequelae include transfusion-related lung injury, acute circulatory failure with subsequent cardiac arrest and death. Gum hyperplasia is a commonly reported toxic effect of CsA. Lethal presentations of this toxicity with such severity are limited in the medical literature. Evaluation of the patient's medical and laboratory records, along with a review of literature, was very helpful in understanding more about the toxicity of CsA.
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Ciclosporina/efectos adversos , Hemorragia Gingival/diagnóstico , Hiperplasia Gingival/inducido químicamente , Paro Cardíaco/etiología , Inmunosupresores/efectos adversos , Lesión Pulmonar Aguda Postransfusional/etiología , Transfusión Sanguínea , Niño , Resultado Fatal , Femenino , Hemorragia Gingival/etiología , Hemorragia Gingival/terapia , Hiperplasia Gingival/complicaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Intubación Intratraqueal/efectos adversos , Pancitopenia/tratamiento farmacológico , Pancitopenia/inmunología , Índice de Severidad de la Enfermedad , Choque , Talasemia/terapiaRESUMEN
BACKGROUND: Association between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM). A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were also evaluated in JDM patients. RESULTS: The mean current age was similar in patients and controls (11.5 ± 3.75 vs. 11.2 ± 2.58 years,p = 0.703). Regarding lipid profile, the median triglycerides [80(31-340) vs. 61(19-182)mg/dL,p = 0.011] and VLDL[16(6-68) vs. 13(4-36)mg/dL,p = 0.020] were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%,p = 0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2-69.4) vs. 11.1(0-66.6)%,p = 0.001] and probing pocket depth (PPD) [1.7(0.6-2.4) vs.1.4(0-2.12)mm,p = 0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7-100) vs. 59(25-100)%,p = 0.022], PPD[1.9(0.6-2.4) vs. 1.4(1.2-1.8)mm,p = 0.024] and clinical attachment level (CAL) [1.31(0.7-1.7) vs. 0.8(0.6-1.7)mm,p = 0.005] were significantly higher in patients with dyslipidemia. Further analysis between JDM patients with and without gingivitis revealed that the median of current age [12.4 (8.3-18.4) vs. 9.2 (5.5-17.5) years, p = 0.034] and disease duration [7.09 ± 3.07 vs. 3.95 ± 2.1 years, p = 0.008] were significantly higher in the former group. CONCLUSION: Our study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications.
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Dermatomiositis/complicaciones , Dislipidemias/complicaciones , Enfermedades Periodontales/complicaciones , Adolescente , Estudios de Casos y Controles , Niño , Estudios Transversales , Índice de Placa Dental , Dermatomiositis/sangre , Dislipidemias/sangre , Femenino , Hemorragia Gingival/sangre , Hemorragia Gingival/complicaciones , Hemorragia Gingival/diagnóstico , Bolsa Gingival/sangre , Bolsa Gingival/diagnóstico , Gingivitis/sangre , Gingivitis/complicaciones , Gingivitis/diagnóstico , Humanos , Lipoproteína Lipasa/antagonistas & inhibidores , Lipoproteínas VLDL/sangre , Masculino , Enfermedades Periodontales/sangre , Enfermedades Periodontales/diagnóstico , Triglicéridos/sangreAsunto(s)
Hemorragia Gingival/terapia , Mucosa Bucal/fisiopatología , Púrpura Trombocitopénica Idiopática/diagnóstico , Púrpura Trombocitopénica Idiopática/terapia , Corticoesteroides/uso terapéutico , Vesícula/diagnóstico , Vesícula/etiología , Análisis Químico de la Sangre , Terapia Combinada , Danazol/uso terapéutico , Femenino , Estudios de Seguimiento , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/etiología , Humanos , Inmunización Pasiva/métodos , Persona de Mediana Edad , Recuento de Plaquetas , Transfusión de Plaquetas/métodos , Púrpura Trombocitopénica Idiopática/complicaciones , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P<.001) and primary diagnosis of cholestatic disease (P=.04). Gingival inflammation was associated with plaque (P<.001), use of immunosuppressive medication (P=.04), and was more pronounced in children with cholestatic disease (P=.007). Children and young adults with liver transplants presented a rather poor oral health status. Liver transplant physicians should counsel patients for regular dental follow-up in order to avoid serious dental infections.
Asunto(s)
Caries Dental/etiología , Hemorragia Gingival/etiología , Sobrecrecimiento Gingival/etiología , Gingivitis/etiología , Trasplante de Hígado , Salud Bucal/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Adolescente , Niño , Preescolar , Estudios Transversales , Caries Dental/diagnóstico , Caries Dental/epidemiología , Femenino , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/epidemiología , Sobrecrecimiento Gingival/diagnóstico , Sobrecrecimiento Gingival/epidemiología , Gingivitis/diagnóstico , Gingivitis/epidemiología , Humanos , Masculino , Higiene Bucal , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To compare the performance of partial-mouth periodontal examination (PMPE) protocols with different cut-off points to the full-mouth examination (FME) in the assessment of the prevalence and extent of gingival bleeding in adolescents. METHODS: A cross-sectional study was conducted involving 12-year-old adolescents. Following a systematic two-stage cluster sampling process, 1134 individuals were evaluated. Different PMPE protocols were compared to the FME with six sites per tooth. Sensitivity, specificity, area under the ROC curve (AUC), intraclass correlation coefficient (ICC), relative and absolute biases and the inflation factor were assessed for each PMPE protocol with different cut-off points for the severity of gingival bleeding. RESULTS: The highest AUC values were found for the six-site two-diagonal quadrant (2-4) (0.97), six-site random half-mouth (0.95) and Community Periodontal Index (0.95) protocols. The assessment of three sites [mesiobuccal (MB), buccal (B) and distolingual (DL)] in two diagonal quadrants and the random half-mouth protocol had higher sensitivity and lower specificity than the same protocols with distobuccal (DB) sites. However, the use of DB sites led to better specificity and improved the balance between sensitivity and specificity, except for the two-diagonal quadrant (1-3) protocol. The ≥1 cut-off point led to the most discrepant results from the FME. CONCLUSION: Six-site two-diagonal quadrant (2-4) and random half-mouth assessments perform better in the evaluation of gingival bleeding in adolescents. However, when a faster protocol is needed, a two-diagonal quadrant assessment using only MB, B and DL sites can be used with no important loss of information.
Asunto(s)
Diagnóstico Bucal/métodos , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/epidemiología , Índice Periodontal , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Sensibilidad y EspecificidadRESUMEN
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that can affect all aspects of life, including nutrition. This case reports a patient with ASD in which gingival bleeding was the key finding that led to a diagnosis of scurvy. The literature review discusses behavioral food aversions in patients with ASD that lead to significant nutritional deficiencies, such as scurvy. Through this case report, the objective is to raise clinical awareness to consider relatively rare diseases in patients with ASD who have atypical feeding patterns.
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Trastorno del Espectro Autista/complicaciones , Hemorragia Gingival/diagnóstico , Escorbuto/diagnóstico , Niño , Diagnóstico Diferencial , Humanos , Masculino , Factores de RiesgoRESUMEN
BACKGROUND: It is not clear how using partial-mouth periodontal examination (PMPE) protocols affects estimates of the association between gingival bleeding (GB) and oral health-related quality of life (OHRQoL). The aim of the present study is to assess impact of different PMPEs on the association between GB and OHRQoL in 12-year-old adolescents. METHODS: A total of 1,134 adolescents were evaluated for clinical and subjective variables. GB was determined by full-mouth examination (FME) of six sites (disto-buccal [DB], mid-buccal [B], mesio-buccal [MB], disto-lingual [DL], mid-lingual, and mesio-lingual [ML]) and different PMPEs were calculated using a 15% cut-off point: 1) full-mouth (MB-B-DB/MB-B-DL); 2) two diagonal quadrants (six sites/MB-B-DB/MB-B-DL); 3) two randomly selected half-mouth quadrants (six sites/MB-B-DB/ MB-B-DL/MB-DB-ML-DL); and 4) the community periodontal index. OHRQoL was assessed using the Child Perceptions Questionnaire (CPQ11-14). Adjusted negative binomial regression models were used to calculate the rate ratio of CPQ11-14 scores for each PMPE. RESULTS: Adolescents with GB showed significantly poorer OHRQoL than their counterparts when FME was used. In contrast, more than half of PMPE protocols did not detect significant associations between GB and CPQ11-14 scores in the adjusted analysis. CONCLUSIONS: Using PMPE to assess GB in adolescents significantly affects associations with OHRQoL outcomes, depending on the protocol used. PMPEs that evaluated MB-B-DL sites of randomly selected half-mouth quadrants (1 or 2 and 3 or 4) achieved results closer to those obtained with FME.
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Atención Dental para Niños/métodos , Hemorragia Gingival/diagnóstico , Salud Bucal , Enfermedades Periodontales/diagnóstico , Calidad de Vida , Brasil , Niño , Femenino , Hemorragia Gingival/etiología , Humanos , Masculino , Enfermedades Periodontales/complicacionesRESUMEN
The focus on oral manifestations of dengue fever (DF) is not common in the scientific literature and the patient affected can present signs and symptoms that may not be noticed by dental professionals. This systematic review article was conducted to identify and discuss the oral manifestations related to DF. The electronic databases PubMed, Latin American and Caribbean Literature in Sciences (LILACS), Web of Science and Scopus were searched from November to December 2016 by two authors, simultaneously, using the search terms 'dengue and oral manifestation' combined. We included complete original articles, clinical trials and clinical case reports published in Portuguese, Spanish and English. No limits were applied to the year of publication. Review articles and those with no health outcomes were removed. A limited number of studies aimed to investigate the oral manifestations of DF (N = 25). However, several manifestations were identified in the oral cavity of patients diagnosed with DF such as acute gingival and palate bleeding, dryness of the mouth, taste changes, and erythematous plaque and vesicles on the tongue and palate. Osteonecrosis of jaw associated with DF was also reported. In conclusion, oral manifestations may represent a relevant contributory factor to identify DF disease among patients undergoing dental procedures in general practise.
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Dengue/diagnóstico , Enfermedades de la Boca/diagnóstico , Placa Dental/diagnóstico , Hemorragia Gingival/diagnóstico , Humanos , Hueso Paladar/patología , Trastornos del Gusto/diagnóstico , Xerostomía/diagnósticoRESUMEN
OBJECTIVE: This observational study aimed to compare the estimation of clinical attachment loss (CAL) as measured by direct (CALD ) and indirect (CALI ) methods. METHODS: Periodontitis patients (n = 75; mean age: 50.9 ± 8.02 years; 72.2% women; 50.6% smokers) received a periodontal examination (six sites/tooth) to determine the presence of visible plaque and calculus, the gingival bleeding index (GBI), periodontal probing depth (PPD), bleeding on probing (BOP), CALD and gingival recession (GR). CALI values resulted from the sum of PPD and GR values. Statistical analysis considered only data from sites with visible GR (e.g. the gingival margin apical to the cemento-enamel junction; n = 4,757 sites) and determined the mean difference between CALI and CALD measurements. Based on the mean difference, univariate and multivariate analyses were also performed. RESULTS: Mean CALD and CALI values were 3.96 ± 2.07 mm and 4.47 ± 2.03 mm, respectively. The indirect method overestimated CAL compared with the direct method (mean difference: 0.51 ± 1.23 mm; P < 0.001). On uni- and multivariate analyses, absence of GBI and BOP, PPD and proximal site location had significant influences on the overestimation of CAL by the indirect method (all P ≤ 0.01). The indirect method increased the CAL value by 0.38 mm for each additional 1 mm in PPD. CONCLUSIONS: To decrease the number of probing errors in daily practice it is suggested that direct examination is more appropriate than the indirect method for estimating CAL.
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Pérdida de la Inserción Periodontal/diagnóstico , Placa Dental/diagnóstico , Índice de Placa Dental , Femenino , Hemorragia Gingival/diagnóstico , Recesión Gingival/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Índice PeriodontalAsunto(s)
Conjuntivitis/diagnóstico , Periodontitis/diagnóstico , Plasminógeno/deficiencia , Enfermedades Cutáneas Genéticas/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Fibrina/análisis , Hemorragia Gingival/diagnóstico , Hiperplasia Gingival/diagnóstico , Granulomatosis con Poliangitis/diagnóstico , Humanos , Hialina/química , Masculino , Sarcoidosis/diagnósticoRESUMEN
The authors present a case study of a 13-year-old female with a past medical history of tuberous sclerosis complex (TSC), an autosomal dominant disorder. It usually presents with a triad of epilepsy, mental deficiency and facial angiofibromas that are often distributed around the nose, cheek and chin, and are frequently shaped like butterfly wings. In addition, oral manifestations include gingival enlargement and developmental enamel pitting on the facial aspect of the anterior permanent dentition in 50% to 100% of patients. The patient's chief complaint was gingival enlargement and gingival bleeding. The histology of the excised gingival tissue revealed epithelial and fibrous hyperplasia, consistent with TSC.
Asunto(s)
Hiperplasia Gingival/diagnóstico , Esclerosis Tuberosa/diagnóstico , Adolescente , Esmalte Dental/anomalías , Femenino , Hemorragia Gingival/diagnóstico , Hiperplasia Gingival/cirugía , Gingivectomía/métodos , HumanosRESUMEN
BACKGROUND: The development of self-reported measures of periodontal disease would be of great benefit to facilitate epidemiological studies of periodontal disease on a larger scale, and to allow for surveillance of the periodontal condition of populations over time. OBJECTIVES: To develop a culturally adapted self-reported measure of periodontal disease, test its predictive and discriminative validity and establish a cut-off value for this measure to diagnose periodontal disease. METHODS: A total of 288 Jordanian adults completed the questionnaire assessing self-reported periodontal health (18 questions) and underwent periodontal examination. Of the 18 questions, six were significantly associated with at least one clinical definition of periodontitis and were used to constitute the self-reported periodontal disease measure. Receiver-operating characteristics (ROC) curve analyses were used to examine the overall discriminatory power, sensitivity and specificity, and corresponding cut-off points of the self-reported periodontal disease measure. RESULTS: ROC analysis showed that the self-reported periodontal disease measure had an excellent performance to discriminate between those with and without periodontal disease, regardless of the clinical definition used. A score of 2, on a scale of 0 to 6, had the highest sensitivity and specificity to detect periodontal disease when defined by all study criteria. Significant associations were observed between self-reported periodontal disease measures and all clinical definitions in the regression analysis (the odds ratio ranged from 8.31 to 18.96), according to the clinical definition to be predicted. CONCLUSION: Self-reported periodontal disease measures have excellent predictive and discriminative validity when tested against clinical definitions, and severity and extent of periodontal disease.
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Enfermedades Periodontales/diagnóstico , Índice Periodontal , Autoinforme , Adulto , Estudios Transversales , Autoevaluación Diagnóstica , Femenino , Hemorragia Gingival/diagnóstico , Recesión Gingival/diagnóstico , Humanos , Jordania , Masculino , Pérdida de la Inserción Periodontal/diagnóstico , Bolsa Periodontal/diagnóstico , Periodontitis/diagnóstico , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Leukaemia is the most common malignancy in children and one of the most common malignancies in young adults. Acute myeloid leukaemia is often associated with early oral manifestations. The purpose of this study is to report the case of a 49-year-old male with spontaneous gingival bleeding for over two years with undiagnosed leukaemia. Haematological investigation was instigated and on referral to the Haematology Department at Dunedin Public Hospital, the diagnosis of an acute myeloid leukaemia was confirmed. Since oral lesions can be one of the early events of acute myeloid leukaemia, they may be considered as an important diagnostic indicator for oral health practitioners, and their roles in diagnosing and treating such patients.
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Hemorragia Gingival/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Diagnóstico Diferencial , Detección Precoz del Cáncer , Humanos , Masculino , Persona de Mediana Edad , Pancitopenia/diagnósticoRESUMEN
AIM: There are reported links between periodontal disease (PD) and cardiovascular (CV) risk but data are lacking, especially from populations with established coronary heart disease (CHD). This study describes self-reported indicators of PD and associations with CV risk factors in a global stable CHD population. METHODS AND RESULTS: A total of 15,828 participants in the global STABILITY trial underwent a physical examination, blood sampling, and completed a lifestyle questionnaire. They reported remaining number of teeth (none, 1-14, 15-20, 21-25 or 26-32 (all)) and frequency of gum bleeding (never/rarely, sometimes, often or always). Adjusted linear and logistic regression models assessed associations between tooth loss, gum bleeding, and socioeconomic and CV risk factors. A total of 40.9% of participants had <15 remaining teeth; 16.4% had no teeth; and 25.6% reported gum bleeding with large differences in prevalence among countries, regions and ethnic groups. Less tooth loss was associated with lower levels of glucose, low-density lipoprotein (LDL) cholesterol, systolic blood pressure, waist circumference and hs-CRP; higher estimated glomerular filtration rate; decreased odds for diabetes and smoking, and increased odds for higher education, alcohol consumption and work stress. Gum bleeding was associated with higher LDL cholesterol and systolic blood pressure; decreased odds for smoking, but increased odds for higher education, alcohol consumption and stress. CONCLUSION: Self-reported indicators of PD were common in this chronic CHD population and were associated with an increasing socioeconomic and CV risk factor burden. However, causality between self-reported PD and CV risk and outcome needs further investigation.
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Enfermedad Coronaria/epidemiología , Enfermedades Periodontales/epidemiología , Anciano , Enfermedad Coronaria/diagnóstico , Femenino , Hemorragia Gingival/diagnóstico , Hemorragia Gingival/epidemiología , Encuestas Epidemiológicas , Humanos , Estilo de Vida , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Enfermedades Periodontales/diagnóstico , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Pérdida de Diente/diagnóstico , Pérdida de Diente/epidemiologíaRESUMEN
BACKGROUND: This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis. METHODS: Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored. RESULTS: Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001). CONCLUSIONS: Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.