Bleeding on brushing and slurry hemoglobin for identifying periodontal health/diseases

Abstract

Objectives: Gingival bleeding on brushing (BoB) is an early sign of periodontal diseases (gingivitis and periodontitis) with the potential to be a warning signal for self-detection. This study investigated whether self-reported BoB and hemoglobin level in saliva/toothpaste slurries could be used for identifying periodontal health and diseases. Methods: The BoB test comprising self-assessment of BoB and analysis of hemoglobin level in saliva/toothpaste slurries was conducted in 408 adults, followed by a full-mouth periodontal examination. Periodontal diagnosis was made based on the 2017 classification of periodontal diseases. Gingival inflammation was defined as presence of at least 10% of sites with bleeding on probing (BOP). Sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC) were assessed.. Results: Overall, 37.1% of the participants self-reported BoB, and they had significantly higher values of BOP% (median: 25.0%; interquartile range: 16.0%-37.5%) than those without BoB (median: 13.5%; interquartile range: 8.0%-24.8%). Hemoglobin levels in saliva/toothpaste slurries were positively correlated with BOP% (r=0.401, p<0.001). The BoB test exhibited a sensitivity of 53.6%, moderate specificity of 77.8% and an AUROC value of 0.706 for detecting gingival inflammation. Moreover, the AUROC of the BoB test for identifying periodontal diseases were 0.631, with a sensitivity of 41.3% and a relatively high specificity of 84.8%, respectively. Notably, the combined models incorporating the BoB test with demographic and lifestyle factors yielded a pronounced increase in accuracy value for detecting periodontal diseases (AUROC: 0.815), but a slight improvement in identifying gingival inflammation (AUROC: 0.736). Conclusions: Self-perceived BoB alone or in combination with hemoglobin analysis in saliva/toothpaste slurries enables to distinguish periodontal health from diseases. The self-detectable BoB may be a promising subjective indicator of gingival inflammation and used for increasing public’s awareness of oral/periodontal health as well as promoting disease prevention and early diagnosis of periodontal diseases for appropriate healthcare.