Assessing the surveillance use of 2018 EFP/AAP classification of periodontitis: A validation study and clustering analysis

Abstract

BackgroundThe performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification of periodontitis for epidemiology surveillance purposes remains to be investigated. This study assessed the surveillance use of the 2018 EFP/AAP classification and its agreement with the unsupervised clustering method compared with the 2012 Centers for Disease Control and Prevention(CDC)/AAP case definition.MethodsParticipants (n = 9424) in the National Health and Nutrition Examination Survey (NHANES) were staged by the 2018 EFP/AAP classification and classified into subgroups via k‐medoids clustering. Concordance levels between periodontitis definitions and the clustering method were evaluated through the multiclass area under the receiver operating characteristic curve (multiclass AUC) among “periodontitis cases” and the general population, respectively. The multiclass AUC of the 2012 CDC/AAP definition versus clustering was used as a reference. The associations of periodontitis with chronic diseases were estimated using multivariable logistic regression.ResultsAll the participants were identified as “periodontitis cases” by the 2018 EFP/AAP classification, and the prevalence of stage III–IV was 30%. The optimal numbers of clusters were three and four. The 2012 CDC/AAP definition versus clustering yielded a multiclass AUC of 0.82 and 0.85 among the general population and “periodontitis cases,” respectively. The multiclass AUC of the 2018 EFP/AAP classification versus clustering was 0.77 and 0.78 for different target populations. Similar patterns prevailed in associations with chronic diseases between the 2018 EFP/AAP classification and clustering.ConclusionsThe validity of the 2018 EFP/AAP classification was verified by the unsupervised clustering method, which performed better in distinguishing “periodontitis cases” than classifying the general population. For surveillance purposes, the 2012 CDC/AAP definition showed a higher agreement level with the clustering method than the 2018 EFP/AAP classification.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and prevalence of periodontitis among US adults: a cross-sectional NHANES study

“…The NHANES examination data includes a file named “OHXPER.Doc” that encompasses data on periodontal examinations involving clinical attachment loss (CAL) and probing depth (PD). This data classified participants as periodontitis or not based on criteria provided by the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) 30 .…”

Contesting the conventional wisdom of periodontal risk assessment

“…55 As an example, implementation of the 2017 World Workshop in Periodontology criteria 10 for the diagnosis of periodontitis has resulted in a situation where 72.4% of adult Norwegians are now thought to have some form of periodontitis 60 while all (100%) US adults over age of 30 present with periodontitis to some degree. 61 Thus, for most people, periodontitis is so mild that there is no room for any patient-important changes resulting from actions taken by the individual or by their health care providers, even after consulting periodontal risk assessment tool. Instead, in our view, risk prediction in such circumstances will not be useful for other purposes than disease mongering 55 and boosting business.…”