Clinical Study: Review of Periodontitis Risk Assessment Tools

At Norfolk Dental Specialists, we like to stay abreast of the latest developments in our particular dental specialisms of periodontal disease, endodontics and implantology. We also like to share our knowledge of any developments in these fields with our referring GDPs and patients. In this week’s blog post, the latest in our series of clinical study abstracts, we’ll be looking at a study led by Niklaus P Lang. The eminent periodontist and his team examined the academic dental literature to identify and compare different computerised tools that have been used to assess the risk of periodontitis progression. 

The Questions

This meta-analysis attempted to answer two questions: 

1. What are the characteristics of currently used tools for assessing the risk of periodontitis progression?
   
2. Are results from these tools predictive of periodontitis progression in adults?
   

The Meta-Study Approach

Conducting a meta-analysis involves setting inclusion criteria and then conducting a thorough review of all the relevant scientific literature to find studies that meet these criteria. To avoid bias, it is essential that the criteria are set before the search is conducted. Once all the acceptable studies have been found, their combined results can be analysed. In this instance, conducting a meta-study allowed different tools that have been developed for the measurement of risk in periodontitis progression to be compared.

Characteristics of Five Different Tools

Computerised and manual screening of swathes of dental literature revealed 19 studies that fitted the inclusion criteria. Five different tools for assessing patient-based periodontal risk were identified. Each of them had been analysed in at least one study, but never had the five been compared to one another for efficacy in predicting periodontitis progression. Which would be the best?

• Health Improvement in Dental Practice Model (HIDEP). A computerised tool to assist the dentist in creating an overview of a patient’s oral health situation – including the risk factors for periodontal disease and dental caries.
  
• Periodontal Risk Calculator (PRC). Nine parameters are entered into an algorithm. The output of the algorithm is on a scale of one to five with one being the lowest risk and five being the highest.
  
• Periodontal Risk Assessment Model (PRA). Generates a web-shaped functional diagram that can be used to interpret low, medium and high risk of periodontitis progression.
  
• Dentition Risk System (DRS). A two-level system that identifies risk: first in the patient and then at the tooth level.
  
• Risk Assessment-Based Individualized Treatment (RABIT). This system takes into account additional aspects of oral health – not just periodontitis progression alone.
  

Each of these analysis tools aims to achieve the same result – prediction of periodontitis progression in adults. Each tool has been studied individually. The studies contain patient data that records the prediction being made and how accurate the prediction proved to be. By combining the studies, the authors of the meta-study hoped to prove which tool worked best.

Results  

With the caveat that additional research was needed, the authors concluded that the PRC and PRA models were the most effective at predicting tooth loss. However, Dr Debra M Ferraiolo has questioned the legitimacy of these results. In a commentary for the journal Evidence Based Dentistry, she concluded:

“Despite the authors’ claim that PRC and PRA are the best tools, the evidence does not necessarily indicate which of the tools is ‘best’. Also, there is the potential for a conflict of interests since two of the authors developed the PRA tool.”

Our Approach

At Norfolk Dental Specialists, we pride ourselves on our patient-centred approach. Each of these computer algorithms is a handy tool to call on if necessary, but they can never be a substitute for knowing and understanding patients and their motivations.

You can read our own dental specialists clinical studies in the Norfolk Dental Specialists Journal. Contact our reception on 01603 632525 or email info@ndspecialists.uk for details.

What do you think about these findings? Have you used any of these tools? Let us know on Facebook and Twitter.