Diagnostic performance of the AAP/EFP classification and the CDC/AAP case definition among pregnant women and a practical screening tool for maternal periodontal diseases

Abstract

Background and Objective: There is a limited number of studies on the performance assessment of the 2017 AAP/EFP classification and the CDC/AAP case definition among pregnant females. This study evaluated the agreement between these two systems and explored a practical tool for screening maternal periodontal diseases by general dentists.Materials and Methods: Totally, 204 systemically healthy females at different phases of pregnancy underwent a full-mouth periodontal examination. Demographic characteristics, lifestyles, and systemic conditions were recorded. Referring to the CDC/ AAP definition, the diagnostic performance of the AAP/EFP classification was evaluated by the area under the ROC curve (AUC) and statistical tests (e.g., Youden's index and kappa coefficient). Additionally, a modified scoring system of the FDI Periodontal Diseases Chairside Guide (FDI-CG) was formulated with the addition of pregnancy for testing accordingly.Results: Overall, there were 22.1% of the participants in early phase of pregnancy (7-13 weeks) and 77.9% in late phase (34-36 weeks). The majority of them were below 35 years and non-smokers without gestational diabetes. Notably, 30.9% of subjects presented with Moderate/Severe periodontitis (CDC/AAP), and 35.8% with Stages II-IV periodontitis (AAP/EFP). Referring to the CDC/AAP definition, the AUC, Youden's index, and κ of the AAP/EFP classification were 0.979, 0.890, and 92.9%, respectively.The modified FDI-CG system improved the AUC (0.815), Youden's index (63.0%), and κ (0.544) with reference to the original one. Conclusions:This study shows that the AAP/EFP classification is in high agreement with the CDC/AAP definition among the pregnant women. The phases of pregnancyintegrated FDI scoring system may serve as a convenient screening tool for maternal periodontal diseases in general dental practice.

Systematic review to evaluate accuracy studies of the diagnostic criteria for periodontitis in pregnant women

“…In 2022, a study conducted by Li et al [ 31 ], verified the performance of the classification for diagnosing periodontitis recommended by the AAP/EFP in relation to that stipulated by the CDC/AAP. Furthermore, it explored a practical tool for screening periodontitis in pregnant women.…”

“…For the patient selection domain, there was an uncertain risk of bias in the studies of Kugahara et al [ 28 ] and Micu et al [ 29 ] due to eligibility criteria that were not well defined. The investigations by Conceição et al [ 27 ], Conceição et al [ 32 ], Li et al [ 31 ], and Turton et al [ 30 ] presented an uncertain risk of bias in the index test domain, due to not providing information regarding if the index test results were interpreted without knowledge of the findings of the reference standard test. Micu et al [ 29 ] presented a high risk of bias in the referred domain (index test), because of the use of a self-reported questionnaire and memory bias could be present.…”

“…The studies by Conceição et al [ 27 ], Li et al [ 31 ], and Micu et al [ 29 ] used the criteria recommended by the US CDC/AAP as the gold standard for the diagnosis of periodontitis [ 9 , 10 ]. This is considered an internationally recognized criterion, utilizing probing depth and clinical attachment loss as clinical parameters for disease determination, but not including bleeding on probing.…”

“…Recently, several population-based studies have reported the diagnostic performance and agreement between the CDC/AAP system and the AAP/EFP classification [ 42 – 44 ]. However, only the study of Li et al [ 31 ] compared the aforementioned criteria in the population of pregnant women. This study showed that the AAP/EFP classification is in high agreement with the CDC/AAP definition in this population.…”

A prospective study on maternal periodontal diseases and neonatal adverse outcomes

“…Meanwhile, appropriate preventive measures and in-time periodontal care should be undertaken, along with proactive health education and awareness on upholding healthy lifestyles in the public community. Herein, our recent work on the proposed pregnancy-integrated FDI scoring system could facilitate convenient screening of maternal periodontal diseases in daily practice [54] for promoting oral/periodontal health of mothersto-be and reducing the risk of adverse outcomes of their neonates.…”