Assessment of masticatory function in the differential diagnosis of Stage IV periodontitis: A pilot diagnostic accuracy study

Abstract

Background After diagnosis of periodontitis is made, detection of Stage IV cases is critical for appropriate management that may call for interdisciplinary care. This study aims to identify and assess the accuracy of a simple screening approach for practice and surveillance of Stage IV periodontitis. Methods Masticatory function assessments by both validated self‐reported masticatory dysfunction questionnaire and dual‐color chewing gum mixing ability test (index test) were conducted in 214 consecutive patients, followed by a full‐mouth periodontal examination. Periodontal diagnosis was based on the 2017 World Workshop classification of periodontal diseases (reference standard). Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed. Results Overall, the individual patient‐reported masticatory dysfunction questions showed low to moderate accuracy for predicting Stage IV periodontitis. The objective measures of masticatory function by calculating the variance of hue from the chewing gum test performed better with an AUROC of 0.840. A diagnostic approach based on age, self‐report of altered food type intake, and chewing gum test results exhibited excellent performance for predicting Stage IV periodontitis (sensitivity: 89.7%; specificity:76.3%; AUROC:0.912). Conclusions Once the presence of periodontitis has been established, a simple diagnostic approach that does not require specialized workforce, complex, or lengthy assessment allows identification of patients with Stage IV periodontitis. This is important as these patients require specific case work up and interdisciplinary care pathways. Additional studies are required to validate the findings in multiple populations.

Implementation of a software application in staging and grading of periodontitis cases

“…In fact, periodontal probing is known to require training and calibration to provide accurate measurements (Grossi et al, 1996). Similarly, reliable methods for masticatory function assessment in patients with periodontitis are not yet implemented in daily practice (Deng et al, 2022). Moreover, clinical judgment on the implications of previous tooth loss and the near-term risk of losing additional teeth could affect the staging (Sirinirund et al, 2021), just as an incomprehensive collection of medical history could impact the grading (Steigmann et al, 2021).…”

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function

“…A two‐colour chewing gum (Hue‐check Gum, University of Bern, Switzerland) was used to test masticatory function, as previously described (Deng et al, 2022; Schimmel et al, 2015). Two pieces of chewing gums (azure and pink) were wetted and adhered together.…”