A novel strategy and integrated approach to periodontal screening and diagnosis : self-reported periodontal status, lifestyle behaviours & oral biomarkers

Abstract

Effective management of periodontal diseases, one of the major components of the burden of disease in mankind, requires considerable attention to health promotion, prevention, early diagnosis and effective care in both professional and public communities. The present study investigated a self-detection strategy for tackling disease, and further assessed the diagnostic accuracy of several approaches to differentiating periodontal health, gingivitis and different stages of periodontitis in a cohort of dental hospital attendees. A cross-sectional study on a convenience sample of 408 consecutive subjects was conducted with periodontal screening tools for assessing diagnostic accuracy (i.e., questionnaire, lifestyle behaviours and oral biomarkers), followed by a full-mouth periodontal examination. Periodontal diagnosis was made based on the current classification of periodontal diseases and conditions (2017). Firstly, the validation of an 8-item questionnaire (Chinese) initially proposed by the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) showed different utilities for case diagnoses, notably with moderate to high accuracy for Stages III/IV periodontitis. Next, an oral rinse active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) indicated a significant association of aMMP-8 with probing depth and increased levels of this biomarker in periodontitis, in spite of limited diagnostic accuracy for periodontitis. The supervised, video-filmed bleeding on brushing (BoB) test revealed that BoB could represent a sentinel sign of gingival inflammation. Indeed, absence of BoB had high predictive value for periodontal health, while presence of BoB had increased diagnostic odds ratio for gingival inflammation. Interestingly, visual qualitative detection of BoB could be undertaken even after minor blood loss (hemoglobin concentration: 90.58 µg/ml corresponding to a blood volume of 0.51 µL). The subsequent video analysis on 324 subjects explored the association of toothbrushing behaviours with periodontal status and self-detection of BoB. Crucially, systematic and adequate toothbrushing was independently associated with periodontal health. The observation on significantly decreased brushing systematics in periodontal patients without self-reported BoB suggested that brushing behaviour may be one of the factors affecting the accuracy of BoB. Using the tests in combination provided added value for differentiating various periodontal case diagnoses. The joint use of the questionnaire, aMMP-8 POCT and BoB test enabled to effectively differentiate periodontal health (high accuracy), gingivitis (moderate accuracy) and periodontitis (moderate accuracy). Moreover, the questionnaire in conjunction with age and tobacco smoking indicated excellent performance for the detection of Stages III/IV periodontitis. The present study highlights initial evidence on the integrated self-detection approach to periodontal screening and diagnosis, allowing individuals with periodontal diseases (gingivitis, Stages I/II and Stages III/IV periodontitis) for early self-care and individualized professional treatments. Furthermore, the current work provides new evidence on BoB as a promising sentinel sign of gingival inflammation and the role of toothbrushing in periodontal healthcare in a real-time video monitoring diagnostic trial. After validation in an independent population, implementation of the present findings may promote better self-awareness of the individual periodontal health status that could translate into better prevention, early disease detection and timely treatment, thereby eventually reducing the global burden of periodontal diseases.