Validity of Self‐Reported Periodontal Disease: A Systematic Review and Meta‐Analysis

Background: Periodontal disease (PdD) has been shown to be related to other systemic diseases. However, to assess this relationship, large epidemiologic studies are required. Such studies need validated self‐report measures. The aim of this systematic review is to assess the validity of self‐reported measures in the diagnosis of PdD. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Medline, Embase, and Google Scholar were searched up to January 2016. Two periodontal journals were searched manually. Two reviewers independently made selected studies and extracted data. All disagreements were resolved after discussion with a third reviewer. Risk of bias was evaluated. Sensitivity, specificity, diagnostic odds ratio, and 95% confidence interval (CI) were calculated. Of 933 papers found, 11 were selected for the review. All studies, except two, had acceptable quality. Four comparable studies were selected for meta‐analysis. Results: Study size ranged from 114 to 1,426 participants. Sensitivity and specificity ranged from 4% to 93% and 58% to 94%, respectively. Diagnostic odds ratio was 1.4 (95% CI: 0.9 to 2.2) for the question on bleeding gums and 11.7 (95% CI: 4.1 to 33.4) for the question on tooth mobility. Heterogeneity was low for most questions except those on painful gums and tooth mobility. Conclusions: Self‐reported PdD has acceptable validity and can be used for surveillance of PdD in large epidemiologic studies. However, there is a need for large, well‐designed diagnostic studies.     

Validity of the self‐reported number of natural teeth in Japanese adults

Aim: The aims of this research were to assess the validity of self‐reporting of the number of teeth by comparing the number with that obtained through clinical dental examinations, and to investigate factors affecting the discordance between the two measures. Methods: Self‐administered questionnaires and dental examinations were conducted among 1152 dentate community residents in Japan. The validity of the patients’ reports of the number of teeth was assessed by comparing the self‐reported number with that determined at the clinical examination. Factors affecting the absolute value of the difference between the self‐reported number of teeth and the number at clinical examination were investigated using a multivariate analysis. Results: Overall, 47.5% of participants had perfect agreement in their self‐report with the clinical examination. There was a slight tendency toward underestimation of the number of natural teeth by self‐reporting. Pearson’s correlation coefficient was 0.80, and the intraclass correlation coefficient was 0.78 for all patients. Decayed, filled, sound teeth, and fixed prosthetic pontics were significantly associated with the absolute value of the difference between self‐reports and clinical examinations. Conclusions: Patients’ reported number of remaining teeth, the data for which were collected via the questionnaire, provided reasonably valid data on the actual number of teeth within a population group.     

Correlation between self‐reported and clinically based diagnoses of bruxism in temporomandibular disorders patients

The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self‐reported questionnaire‐based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One‐hundred‐fifty‐nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism‐related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of φ coefficient. The highest correlations were achieved for the sleep grinding referral item (φ = 0·932) and for the awake clenching item (φ = 0·811), whilst lower correlation values were found for the other items (φ values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self‐reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep‐time activities.     

Validity of CPITN''s hierarchical scoring method for describing the prevalence of periodontal conditions

Abstract CPITN has been a frequently used index in periodontal epidemiology during the last decade. It was originally designed to describe treatment needs in populations. For this purpose, it was decided to record only the worst periodontal condition around each index tooth. Such a recording procedure can be regarded as a hierarchical scoring method. Recently, CPITN has been used and recommended for describing the prevalence of periodontal conditions. For this purpose, the index should give a valid estimate of the true periodontal conditions of the index tooth, and not only a recording of the worst condition. The aim of the present study was to test whether the hierarchical assumption of CPITN concerning treatment needs was valid for describing the prevalence of periodontal conditions in a Scandinavian population. The study population comprised 3330 persons from a rural and an urban area in the county of Trondelag, Norway. The clinical recording was carried out so that it was possible to analyze the indicators both hierarchically and non-hierarchically. The results showed that nearly all the CPITN indicators scored hierarchically gave a correct estimate of the prevalence of bleeding in the population. CPITN codes 3 and 4 overestimated the prevalence of calculus. The degree of overestimation varied by age and tooth type. Most overestimation of calculus occurred on molar teeth with pockets 3.5-5.5 mm and for individuals 13–14 yr of age. There was almost no overestimation of calculus for those aged 65 yr and above. The distribution of the different combinations of the indicators was fairly similar for all index teeth for codes 2, 3, and 4, with the exception of the mandibular incisor.     

The relationship between selected measures of periodontal status and demographic and behavioural risk factors

OBJECTIVE: To assess differences between selected periodontal measures by demographic and behavioural factors in a nationally representative sample of the United States. METHODS: Data for 11,347 person's ages 20-79 years from the third National Health and Nutrition Examination Survey (NHANES III) were used. Indices and measures constructed from NHANES III data used for this study were: derived community periodontal index (dCPI), attachment loss extent index (ALEI), attachment loss (AL) scores, and a Periodontal Status Measure (PSM) developed for this study. RESULTS: The influence of demographic and behavioural factors varied across the four indices examined in multivariate cumulative logistic models. Moreover, there was significant effect modification by cigarette smoking with age in the ALEI and AL models. The odds ratio (OR) of increasing periodontal disease status among 20-39 year olds as measured by AL or ALEI for current smokers compared with non-smokers were OR=6.2 (95% confidence interval (CI)=4.1, 8.7) and OR=5.6 (95% CI=3.7, 8.7), respectively. In a similar comparison, the OR for dCPI was 2.6 (95% CI=1.7, 3.8). Furthermore, Mexican American ethnicity was generally not significant in any models using dCPI, PSM, AL, or ALEI and prior dental visit was more likely to be significant only in the dCPI and PSM models. DISCUSSION: Among the well-known demographic and behavioural influences on periodontal health status, some, such as race/ethnicity and prior dental visit status have different relationships with differing periodontal measures employed to assess periodontal status. Moreover, potential interactions among cofactors also are dependent upon the measure selected. Periodontal research findings may be influenced significantly by periodontal measure selection and its affect on measurement validity. This may have particular relevance to issues concerning disease surveillance and assessing reduction of disparities in oral health. Consequently, a renewed approach to developing appropriate measures for periodontal epidemiology is needed.     

Validity of self‐reported tooth counts and masticatory status study of a Japanese adult population

Self‐reported measures of oral health are often used to assess oral health in populations or groups, but their validity or reliability needs repeated confirmation. The objective of this cross‐sectional study was to evaluate the validity of self‐reported tooth counts and masticatory status, using data obtained from a sample of Japanese adults. A total of 2356 adults aged 40 to 75 years participated in a questionnaire survey and a clinical oral examination from 2013 through 2016. Self‐reported measures were compared with clinically measured values. For tooth counts, mean clinical and self‐reported tooth counts in all participants were 23.68 and 23.78 teeth, and no significant difference was detected. Spearman's, Pearson's and intra‐class correlation coefficients between clinical and self‐reported tooth counts were 0.771, 0.845 and 0.843, respectively. According to the Bland‐Altman analysis, the mean difference between clinical and self‐reported tooth counts was ?0.098 (95% CI : ?0.242, 0.047). The upper limit of agreement was 6.919 (95% CI : 6.669, 7.169), and the lower limit of agreement was ?7.115 (95% CI : ?7.365, ?6.865). No significant fixed or proportional bias was observed. For masticatory status, the crude or age‐ and gender‐adjusted mean numbers of total teeth, posterior teeth and 3 kinds of functional tooth units significantly decreased with the deterioration of masticatory status. This study indicated that self‐reports were within an acceptable range of clinical measures. Therefore, self‐reports were considered valid alternatives to clinical measures to estimate tooth counts and masticatory status in a current Japanese adult population.     

Application of self‐efficacy theory in dental clinical practice

Oral Diseases (2010) 16 , 747–752 In clinical practice, self‐efficacy refers to how certain a patient feels about his or her ability to take the necessary action to improve the indicators and maintenance of health. It is assumed that the prognosis for patient behaviour can be improved by assessing the proficiency of their self‐efficacy through providing psychoeducational instructions adapted for individual patients, and promoting behavioural change for self‐care. Therefore, accurate assessment of self‐efficacy is an important key in daily clinical preventive care. The previous research showed that the self‐efficacy scale scores predicted patient behaviour in periodontal patients and mother’s behaviour in paediatric dental practice. Self‐efficacy belief is constructed from four principal sources of information: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states. Thus, self‐efficacy can be enhanced by the intervention exploiting these sources. The previous studies revealed that behavioural interventions to enhance self‐efficacy improved oral‐care behaviour of patients. Therefore, assessment and enhancement of oral‐care specific self‐efficacy is important to promote behaviour modification in clinical dental practice. However, more researches are needed to evaluate the suitability of the intervention method.     

Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro‐facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time‐consuming, most research testing this belief has relied on patient self‐report of SB. The current case–control study examined the accuracy of those self‐reports relative to laboratory‐based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self‐reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self‐report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self‐reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self‐report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self‐report to assess SB must be viewed with extreme caution.     

Periodontal conditions in 35–44-year-old factory workers in Shanghai

Abstract A periodontal survey applying CPITN was carried out in almost 500 male and female factory workers, 35–44 yr of age, in Shanghai, P.R. China. Calculus and shallow pockets were most frequent. Deep pockets of 6 mm and over were seldom found. The mean number of missing teeth was only 2.7 (out of 32). Problems associated with third molars seem to provide the largest immediate oral health problem