Who to Be Treated: Nomogram Using Self-Reported Periodontal Screening Instrument among English-Speaking Adults in Multi-Ethnic Singapore

Abstract

Periodontal disease is a major public health problem. This study aimed to develop a nomogram using a self-reported periodontitis screening instrument in predicting severe periodontitis (SP), defined by the World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, and evaluate its utility in clinical setting. An Akaike information criterion selected multivariable model was developed to predict SP using a self-reported questionnaire, with a nomogram developed based on its regression coefficients. Discriminatory capability was evaluated by Receiver-operating characteristic curve. Ability to predict SP of individual patients was evaluated with bootstrapping. Decision curve analysis (DCA) was performed to evaluate its potential clinical utility by evaluating clinical net benefit at different thresholds. 58.1% of 155 participants were classified with SP. Older males without tertiary education, with ‘loose teeth’, ‘bone loss’ and ‘mouth rinse use’ had higher SP risk. The nomogram showed excellent discriminatory capability with Area under Curve of 0.83 (95% CI = (0.76, 0.89)), good calibration (intercept = 0.026) and slight overestimation of high risk and underestimation of low risk (slope = 0.834). DCA showed consistent clinical net benefit across the range of thresholds relative to assumption of ‘no patient’ or ‘all patient’ with SP. Our nomogram using a self-reported periodontitis instrument is useful in SP screening in English-speaking Singaporean adults.

Development of a nomogram for identifying periodontitis cases in Denmark

“…These same factors also hold relevance when considering "Any Periodontitis". Our results align with a previously published study 15 , affirming the suitability of the 8-item questionnaire for identifying individuals with periodontitis.…”

“…While most studies concerning self-reported periodontitis involve the validation of questionnaires 22,23 , our study introduces a tool with clinical utility and applicability. Notably, such a tool has only been previously published in the context of an Asian population of older persons 15 .…”

“…In Singapore, the periodontal questions identified by the authors included selfreported information about bone loss, loose teeth, and the use of mouth rinse, combined with age and education to identify severe periodontitis cases. Notably, the study conducted by Sim and colleagues used a different periodontal classification system, potentially explaining the different variables identified 15 . Leite and coworkers highlighted the impact of classification systems on accuracy in predicting periodontitis occurrence.…”

“…Nevertheless, the use of nomograms in oral health is meager, with this study likely representing one of the initial attempts to assess their performance using a self-reported periodontitis questionnaire in a sample characterized by a broader age range and diverse socioeconomic backgrounds. A previous study by Sim and coworkers constructed a nomogram to screen severe cases of periodontitis among individuals referred to a tertiary specialty center in Singapore, undermining the generalizability of their findings 15 .…”