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Journal of Clinical Periodontology Aug 2022To evaluate the inter-examiner reliability in classifying periodontitis using the 2018 classification of periodontal diseases, when used by postgraduate students,...
AIM
To evaluate the inter-examiner reliability in classifying periodontitis using the 2018 classification of periodontal diseases, when used by postgraduate students, academics, and specialist clinicians trained in European Federation of Periodontology (EFP) and American Academy of Periodontology (AAP) postgraduate-accredited programmes.
MATERIALS AND METHODS
An online survey including five patients with periodontitis was sent twice to seven specialists in periodontology to provide the staging and grading characteristics. After agreeing on a "gold-standard" classification, the same questionnaire was sent to 16 EFP and 73 AAP postgraduate programmes, to be answered by their faculty, graduates, and students. The responses were compared with the gold-standard classification, and the inter-examiner agreement was calculated.
RESULTS
One-hundred and seventy-four participants completed the survey. The inter-examiner agreement resulted in 68.7% in assigning the stage, 82.4% in assigning the grade, and 75.5% in assigning the extent. The academic position and the experience of the participants did not have any significant influence on classifying periodontitis as the gold standard.
CONCLUSIONS
The use of the 2018 periodontitis classification resulted in high inter-examiner reliability when used by a specialist group of clinicians, postgraduate students, and academicians, irrespective of their current position and experience. Given the low response rate and potential selection bias, results pertaining to the use of this system in classifying periodontitis should be interpreted with caution.
Topics: Humans; Periodontal Diseases; Periodontics; Periodontitis; Reproducibility of Results
PubMed: 35322458
DOI: 10.1111/jcpe.13618 -
Journal of Dental Education Aug 2001In the 1960s and 1970s, data became available indicating that most of the adult population had periodontal disease and that effective bacterial removal prevented and... (Review)
Review
In the 1960s and 1970s, data became available indicating that most of the adult population had periodontal disease and that effective bacterial removal prevented and treated periodontitis. This information led to a systematic approach to the management of periodontal disease and influenced teaching of periodontics in dental schools. We now know that most adults have only gingivitis and very mild localized periodontitis. A small percentage, albeit representing substantial numbers, of adults have generalized severe periodontitis. We also recognize that a few currently known and measurable risk factors, including diabetes, smoking, and genetics, can identify the patients who are at risk for the severe generalized cases that require extensive therapy and intensive prevention, as well as patients at risk for a less-predictable response to treatment. This review will discuss the evidence that supports the change in our knowledge and understanding of periodontal disease. The question now becomes at what point, and how, do we integrate this new knowledge into the dental curriculum?
Topics: Adult; Animals; Curriculum; Dental Plaque; Diabetes Complications; Education, Dental; Genetic Predisposition to Disease; Humans; Interleukin-1; Mice; Periodontics; Periodontitis; Prognosis; Risk Factors; Smoking
PubMed: 11518250
DOI: No ID Found -
Dental Update Oct 2004The emerging worldwide problem of bacterial resistance has resulted from overuse and misuse of systemic antibiotics. It is appropriate therefore to review periodontal...
The emerging worldwide problem of bacterial resistance has resulted from overuse and misuse of systemic antibiotics. It is appropriate therefore to review periodontal treatment strategies to determine whether systemic antibiotics have a role to play in the management of periodontitis. For the great majority of patients presenting with periodontal conditions, systemic antibiotics are not indicated. Instead, treatment should focus on mechanical disruption of plaque biofilms, plaque control and risk factor modification. Systemic antibiotics may be indicated in severe spreading infections, some aggressive forms of periodontitis, and necrotizing periodontal conditions. These conditions present infrequently in general practice, most will require referral to a periodontal specialist and the decision to use systemic antimicrobials as part of periodontal management is more appropriately taken within a specialist centre. Systemic antibiotics are not indicated in the vast majority of periodontal conditions encountered in general dental practice.
Topics: Aggressive Periodontitis; Anti-Bacterial Agents; Biofilms; Chronic Disease; Contraindications; Dental Plaque; Dental Scaling; Drug Resistance, Bacterial; Gingivitis, Necrotizing Ulcerative; Humans; Periodontal Abscess; Periodontics; Periodontitis; Referral and Consultation; Risk Factors; Root Planing
PubMed: 15554049
DOI: 10.12968/denu.2004.31.8.448 -
Journal of Periodontology Feb 2024The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals.
BACKGROUND
The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals.
METHODS
A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity.
RESULTS
Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD).
CONCLUSIONS
The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity.
Topics: United States; Humans; Cross-Sectional Studies; Sleep Quality; Universities; Periodontitis; Periodontics
PubMed: 37477025
DOI: 10.1002/JPER.23-0209 -
Journal of Periodontology Dec 2021A new periodontitis classification was recently introduced involving multidimensional staging and grading. The aim of the study was to assess if individuals well-trained...
BACKGROUND
A new periodontitis classification was recently introduced involving multidimensional staging and grading. The aim of the study was to assess if individuals well-trained in periodontics consistently used the new classification for patients with severe periodontitis. The secondary goal was to identify "gray zones" related to classifications.
METHODS
Participants (raters) individually classified 10 pre-selected severe periodontitis cases using the 2017 World Workshop classification. An internet case-based study was conducted after inviting members from American Academy of Periodontology and European Federation of Periodontology. Gold-standard diagnoses were determined by five experts who developed the new periodontitis classification. Inter-reliability agreement among raters was assessed using Fleiss Kappa index with the jackknife method for linearly weighted kappa calculations. McNemar test was used to determine symmetry between raters and gold-standard panel.
RESULTS
A total of 103 raters participated and classified nine clinical cases. Fleiss Kappa values showed moderate inter-examiner consistency among raters for stage (K value: 0.49; 95% CI, 0.19 to 0.79), grade (K value: 0.50; 95% CI, 0.30 to 0.70) and extent (K value: 0.51; 95% CI, 0.23 to 0.77). When analyzed as composite (stage, grade, extent) a moderate inter-reliability was present among raters, k = 0.479 (K value: 0.47; 95% CI, 0.442 to 0.515). Agreement between raters and gold-standard panel was staging 76.6%; grading 82%; and extent 84.8%. In six of nine cases 77% to 99% of raters consistently agreed with gold-standard panel, and the other three cases had gray zone factors that reduced rater consistency.
CONCLUSIONS
Clinicians trained in the 2017 World Workshop periodontitis classification demonstrated moderate concordance in classifying nine severe periodontitis cases, and in six of nine cases raters consistently agreed with the gold-standard panel.
Topics: Humans; Periodontics; Periodontitis; Reproducibility of Results
PubMed: 34545953
DOI: 10.1002/JPER.20-0825 -
Journal of Clinical Periodontology Oct 2022To evaluate the effects of an at-home artificial intelligence (AI)-assisted dental monitoring application on treatment outcomes in patients with periodontitis. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To evaluate the effects of an at-home artificial intelligence (AI)-assisted dental monitoring application on treatment outcomes in patients with periodontitis.
MATERIALS AND METHODS
Participants with periodontitis were recruited and randomly assigned to an AI (n = 16), AI and human counselling (AIHC; n = 17), or control (CG; n = 20) group. All participants received non-surgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intra-oral scanning and assessment. Patients in the AI and AIHC groups received additional (a) DM or (b) DM, respectively, with real-person counselling over 3 months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analysed the follow-up effects over time.
RESULTS
The AI and AIHC groups, respectively, exhibited greater improvement in probing pocket depth (PPD) (mean diff = -0.9 ± 0.4 and -1.4 ± 0.3, effect size [ES] = 0.76 and 1.98), clinical attachment level (mean diff = -0.8 ± 0.3 and -1.4 ± 0.3, ES = 0.84 and 1.77), and plaque index (mean diff = -0.5 ± 0.2 and - 0.7 ± 0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in PPD (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group.
CONCLUSIONS
Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients who received AI-assisted health counselling exhibited better treatment outcomes than did patients who received AI monitoring alone.
Topics: Artificial Intelligence; Chronic Periodontitis; Dental Scaling; Follow-Up Studies; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Periodontitis
PubMed: 35713224
DOI: 10.1111/jcpe.13675 -
Clinical Oral Investigations Jul 2021This study aimed to answer the PICO question: in adults with periodontitis, does subgingival delivery of natural products (NP) after scaling and root planing (SRP)... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to answer the PICO question: in adults with periodontitis, does subgingival delivery of natural products (NP) after scaling and root planing (SRP) results in a better reduction of probing pocket depth (PPD) when compared with SRP alone or SRP plus placebo?
MATERIAL AND METHODS
A search for trials was carried out in eight databases. Two independent investigators performed all steps of this review. PPD reduction, clinical attachment level (CAL) gain, gingival inflammation, and biofilm accumulation reduction were investigated. We conducted meta-analyses where data could be pooled.
RESULTS
Searches yielded 4771 records, in which 27 trials fulfilled the eligibility. There was a large heterogeneity among trials (I > 0.69, χ < 0.000). Only four studies were at low risk of bias. The evidence quality was very low. The effectiveness of NP was demonstrated in a follow-up of 3-6 months considering PPD reduction (8 trials: 0.72 mm [95%CI: 0.23, 1.22]) and CAL gain (5 trials: 1.07 mm [95%CI: 0.36, 1.78]). A significant reduction in periodontal inflammation favors the use of NP. The biofilm accumulation reduction effect of NP was very weak or non-significant.
CONCLUSION
Although the high risk of bias and large heterogeneity of trials impose some restrictions on the validity of effect estimate, this review indicates that adjunctive NP better reduced the PPD when compared to SRP alone or SRP plus placebo in a follow-up of 3-6 months.
CLINICAL RELEVANCE
The evidence of non-responsive patients to conventional periodontal therapy highlights the need for therapeutic alternatives to treat periodontitis.
Topics: Adult; Biological Products; Chronic Periodontitis; Dental Scaling; Humans; Periodontitis; Root Planing
PubMed: 33527193
DOI: 10.1007/s00784-021-03774-2 -
Oral Health & Preventive Dentistry Jun 2022This randomized, controlled clinical trial aimed to evaluate the clinical, adjunctive effects of an approved botanical barrier device or patch on probing parameters in... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
This randomized, controlled clinical trial aimed to evaluate the clinical, adjunctive effects of an approved botanical barrier device or patch on probing parameters in patients with periodontitis.
MATERIALS AND METHODS
Eighty patients with periodontitis were recruited for this single-blinded trial. Patient demographic data, including gender, age, self-reported smoking status, and history of diabetes or cardiovascular disease, were collected. At baseline, all patients received a full-mouth probing examination followed by scaling and root planing (SRP). Thereafter, patients were randomized to receive either adjunctive botanical patch applications (i.e. at 2-4 treatment sites with baseline pocket depth PD ≥6 mm) or no additional therapy (SRP alone, control). Patients applied botanical patch devices per randomization to treatment sites three times on day 0 and once daily on days 1-6. Study devices were spontaneously shed or removed by the patient at 2-2.5 h after each application. Patients were recalled for probing reexaminations at 1, 2 and 3 months. Statistical analyses focused on intergroup differences in probing parameters and included ANOVA for baseline measures and ANCOVA controlling for baseline measures at 1, 2 and 3 months in the overall population and in subpopulations (e.g. smokers vs nonsmokers).
RESULTS
Randomized patient groups were balanced with respect to baseline periodontal status (mean and extent PD) but not smoking, with statistically significantly more smokers clustering in the control group (p = 0.002). For the overall population and the non-smoking subpopulation, statistically significantly improved PD and clinical attachment levels (CAL) were observed with adjunctive botanical patch therapy vs control at 1 and 2 months (p < 0.05) but not 3 months (p = 0.08 for PD). For smokers, no statistically significant intergroup differences in PD or CAL were detected with botanical patch treatment.
CONCLUSIONS
The data from this trial indicate short-term improvements in probing parameters with the botanical patch device when used adjunctively with SRP, especially with non-smoking periodontitis patients.
Topics: Dental Scaling; Humans; Periodontitis; Root Planing
PubMed: 35723714
DOI: 10.3290/j.ohpd.b3147141 -
Evidence-based Dentistry Mar 2023The electronic databases Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, LILACS BIREME... (Meta-Analysis)
Meta-Analysis
DATA SOURCES
The electronic databases Cochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, LILACS BIREME Virtual Health Library from inception to September 2021, along with trial registers and journals (hand searching) were searched to identify the randomized controlled trials (RCTs).
STUDY SELECTION
Two reviewers independently identified and selected RCTs of at least three months' duration, comparing the effectiveness of subgingival instrumentation relative to no active intervention or usual care (oral hygiene instruction, education, or supportive interventions, and/or supragingival scaling) in the reduction of glycated haemoglobin (HbA1c) in periodontitis patients with type 1 or 2 diabetes mellitus.
DATA EXTRACTION AND SYNTHESIS
Data extraction and risk of bias assessment were performed by two reviewers independently. Data were synthesized quantitatively with meta-analyses using a random-effects model, and pooled outcomes were expressed as mean differences with 95% confidence intervals. In addition, subgroup analysis, heterogeneity assessment, sensitivity analyses, summary of findings, and assessment of the certainty of the evidence were performed.
RESULTS
Out of 3109 identified records, 35 RCTs were included for qualitative synthesis, and amongst them, 33 studies were included for meta-analysis. Meta-analyses showed that periodontal treatment with subgingival instrumentation, compared to usual care or no treatment, led to a mean absolute reduction of 0.43% in HbA1c at 3 to 4 months, 0.30% at six months, and 0.50% at 12 months. The certainty of the evidence was assessed to be moderate.
CONCLUSIONS
The authors concluded that periodontitis treatment by subgingival instrumentation improves glycaemic control in diabetic patients. However, there is insufficient evidence about the effect of periodontal treatment on quality of life or diabetic complications.
Topics: Humans; Glycemic Control; Glycated Hemoglobin; Periodontitis; Dental Scaling; Diabetes Mellitus
PubMed: 36890247
DOI: 10.1038/s41432-023-00863-x -
Journal of the Formosan Medical... Dec 2021Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology...
BACKGROUND/PURPOSE
Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population.
METHODS
The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions.
RESULTS
The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population.
CONCLUSION
The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.
Topics: Asian People; Consensus; Humans; Periodontics; Periodontitis; Taiwan
PubMed: 34294496
DOI: 10.1016/j.jfma.2021.06.029