Partial-mouth periodontal examination protocol for estimation of prevalence, severity and extent of periodontitis

Aim: The aim of this study is to identify a partial-mouth periodontal examination (PMPE) protocol which closely approximates a full-mouth periodontal examination (FMPE) protocol in estimating prevalence, severity and extent of periodontitis. ^ Methods: First, articles published in English from 1946-2012, which compared PMPE protocols vs. FMPE protocol and used clinical attachment loss (CAL) and pocket depth (PD) ≥4mm were selected. PMPE protocols were evaluated to determine sensitivity for estimates of the percentage of subjects with CAL or PD ≥ 4 mm, and relative difference for the estimates of severity (mean CAL and PD) and extent (mean intraoral percentage of sites with CAL and PD ≥ 4 mm). Second, true periodontitis prevalence according to the Centers of Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) case definition, severity (mean CAL and PD) and extent (mean intraoral percentage of sites with CAL and PD ≥ 4, 6 mm) were determined by FMPE in a sample of 3,737 adults from the National Health and Nutrition Examination Survey (NHANES) 2009-2010 and 35,269 adults sampled from the Consortium for Oral Health Research and Informatics BigMouth Dental Data Repository. Difference, relative difference, McNemar\u27s test, paired t-test, intra-class correlation coefficient (ICC) and Kappa statistics were calculated for each PMPE identified in the first step. The evaluation was performed when the CDC/AAP case definition and adjusted CDC/AAP case definition was applied to the PMPEs. ^ Results: In the first step, a systematic review of the published literature identified three promising PMPE protocols (sensitivities ≥ 85% for prevalence and relative differences ≤ 5% for severity and extent): 1) half-mouth six-sites, 2) quadrant 1and 3 or 2 and 4 six-sites and 3) full-mouth mesiobuccal-midbuccal-distobuccal. Two other PMPE protocols, full-mouth and half-mouth mesiobuccal-midbuccal-distolingual, performed well for prevalence and mean. In the second step, half-mouth six sites PMPE protocol provided the lowest relative difference among five PMPE protocols. True total periodontitis prevalence according to the CDC/AAP case definition was 84.4% (5.6% mild, 49% moderate and 29.8% severe) and 56% (9.5% mild, 34.8% moderate and 11.7% severe) in the BigMouth and NHANES samples, respectively. The corresponding prevalence determined by the half-mouth six sites PMPE protocol was 83.8% (4.7% mild, 49.1% moderate and 30% severe) and 57.4% (9.6% mild, 36.9% moderate and 10.9% severe) for adjusted CDC/AAP case definition; and was 70.6% (2.6% mild, 47.1% moderate and 20.9% severe) and 37.5% (1.8% mild, 27.9% moderate and 7.8% severe), respectively for the CDC/AAP case definition. Regarding the adjusted CDC/AAP case definition, relative difference of this PMPE protocol in prevalence estimates was ≤ 7% for total periodontitis; and ≤ 20% for mild, moderate and severe periodontitis across almost all strata. The McNemar\u27s test showed that the difference between this PMPE and FMPE protocol in estimates of total periodontitis prevalence was not statistically significant (p \u3e 0.001) for all strata in the NHANES but not for all strata in the BigMouth. The PMPE provided good to excellent reproducibility of periodontitis severity (mild, moderate and severe periodontitis) across all strata in both samples. For periodontitis severity, differences between FMPE and this PMPE protocol were ≤ 0.03 mm in absolute value and associated relative differences were ≤ 1.2% across all strata for two samples. For periodontitis extent, differences between FMPE and this PMPE protocol were ≤ 0.006 and associated relative differences were ≤ 10%. Paired t-test showed no significant difference (p\u3e 0.005) between FMPE and this PMPE protocol in estimates of severity and extent. ICCs were ≥ 0.96 for severity and ≥ 0.88 for extent. ^ Conclusions: Half-mouth six sites PMPE protocol in accordance with adjusted CDC/AAP case definition satisfactorily approximates true prevalence, severity and extent of periodontitis in the US population and in patients visiting dental clinics.