Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification

Germen, Meliha; Başer, Ülkü; Lacin, Cagdas Caglar; Fıratlı, Erhan; İşsever, Halim; Yalçın, Funda

doi:10.3390/ijerph18073459

Cited by 53 publications

(53 citation statements)

References 33 publications

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“…However, these were not designed for research purposes and impose very low thresholds for CAL and PD, rendering its use and value in this analysis questionable. In fact, we did calculate the prevalence using this data and found that approximately 99% were found to have periodontitis, similar to findings based on another study (Germen et al, 2021; Ghassib et al, 2021; Stødle et al, 2021).…”

Section: Discussionsupporting

confidence: 87%

Exploring periodontitis misclassification mechanisms under partial‐mouth protocols

Alshihayb

Sharma

Thränhardt

et al. 2022

J Clinic Periodontology

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Aim To investigate the sources of periodontitis misclassification under partial‐mouth protocols (PMPs) and to explore possible approaches to enhancing protocol validity. Materials and Methods Using data from 10,680 adults with 244,999 teeth from the National Health and Nutrition Examination Survey, we compared tooth‐, site‐, and quadrant‐specific periodontal parameters and case identification under full‐mouth protocols and PMPs. Separately, we utilized population measures of tooth‐specific periodontal severity to generate PMPs with tooth selection based on the population ranking of clinical severity and assessed the sensitivity of case identification. Results Symmetry of clinical severity was generally confirmed, with the exception of lingual inter‐proximal sites, which yielded greater sensitivity in identifying periodontitis compared to buccal sites due to more severe pocketing and attachment loss on average. Misclassification of severe periodontitis occurred more frequently under commonly implemented PMPs compared to ranking‐based selection of teeth, which yielded sensitivity estimates of 70.1%–79.4% with the selection of 8 teeth and reached 90% with the selection of only 14 teeth. Conclusions Clinical symmetry and sources of periodontitis misclassification were confirmed. The proposed selection of teeth based on population rankings of clinical severity yielded optimal sensitivity estimates for the detection of severe periodontitis and may present a favourable alternative to current options.

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Section: Discussionsupporting

confidence: 87%

Exploring periodontitis misclassification mechanisms under partial‐mouth protocols

Alshihayb

Sharma

Thränhardt

et al. 2022

J Clinic Periodontology

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“…To our knowledge, no other agreement analysis between the two case definitions is currently available although other recent studies reported on periodontitis in relation to the two classification systems [64,65]. This point highlights one main strength of our study, which lies in the validity assessment of the 2018 EFP/AAP classification of periodontal conditions in a specific group of IS patients.…”

Section: Discussionmentioning

confidence: 64%

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

Costea

Christodorescu

Şoancă

et al. 2022

JCM

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The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

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“…did not describe an appropriate diagnostic test for comparison, presenting only descriptive data on the prevalence of severe periodontitis according to the two definitions—being 16.8% (CDC/AAP) and 34% (EFP/AAP). However, it was reported that patients with PD ≥6 mm, although not presenting with clinical AL ≥5 mm, were classified as EFP/AAP Stages III and IV 33 . Therefore, these data must be observed with caution since a larger number of subjects may have been classified as severe periodontitis according to the EFP/AAP definition, which may explain why the prevalence of these cases is twice the prevalence of cases according to the CDC/AAP case definitions.…”

Section: Discussionmentioning

confidence: 96%

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

Brito

Taboza

Silveira

et al. 2021

Journal of Periodontology

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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.

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Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification

Cited by 53 publications

References 33 publications

Exploring periodontitis misclassification mechanisms under partial‐mouth protocols

Exploring periodontitis misclassification mechanisms under partial‐mouth protocols

Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

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

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