Diagnostic performance of the AAP/EFP classification and the CDC/AAP case definition among pregnant women and a practical screening tool for maternal periodontal diseases

Abstract

Background and objective: There is a limited number of studies on the performance assessment of the 2017 AAP/EFP classification and the CDC/AAP case definition among pregnant females. This study evaluated the agreement between these two systems and explored a practical tool for screening maternal periodontal diseases by general dentists.

Materials and methods: Totally, 204 systemically healthy females at different phases of pregnancy underwent a full-mouth periodontal examination. Demographic characteristics, lifestyles, and systemic conditions were recorded. Referring to the CDC/AAP definition, the diagnostic performance of the AAP/EFP classification was evaluated by the area under the ROC curve (AUC) and statistical tests (e.g., Youden's index and kappa coefficient). Additionally, a modified scoring system of the FDI Periodontal Diseases Chairside Guide (FDI-CG) was formulated with the addition of pregnancy for testing accordingly.

Results: Overall, there were 22.1% of the participants in early phase of pregnancy (7-13 weeks) and 77.9% in late phase (34-36 weeks). The majority of them were below 35 years and non-smokers without gestational diabetes. Notably, 30.9% of subjects presented with Moderate/Severe periodontitis (CDC/AAP), and 35.8% with Stages II-IV periodontitis (AAP/EFP). Referring to the CDC/AAP definition, the AUC, Youden's index, and κ of the AAP/EFP classification were 0.979, 0.890, and 92.9%, respectively. The modified FDI-CG system improved the AUC (0.815), Youden's index (63.0%), and κ (0.544) with reference to the original one.

Conclusions: This study shows that the AAP/EFP classification is in high agreement with the CDC/AAP definition among the pregnant women. The phases of pregnancy-integrated FDI scoring system may serve as a convenient screening tool for maternal periodontal diseases in general dental practice.

Keywords: assessment; case definitions; periodontal status; pregnant women; screening.

FIGURE 1

Flow chart of subject recruitment. SZMCH, Shenzhen Maternity and Child Healthcare Hospital

FIGURE 2

ROC curves for discriminating subjects with or without Moderate/Severe periodontitis with reference to CDC/AAP case definition. Model 1 (red line): AAP/EFP classification; Model 2 (green line): FDI‐CG scoring system (FDI‐CG original model); Model 3 (blue line): FDI‐CG scoring system with two scores added for pregnancy (FDI‐CG all +2); and Model 4 (pink line): FDI‐CG scoring system with one score added for early phase of pregnancy and two scores added for late phase of pregnancy (FDI‐CG early +1 and late phase +2). Significant difference was detected by pairwise comparison except for Model 3 versus Model 4 (p < .001). ROC, receiver operating characteristic; FDI‐CG, FDI periodontal diseases chairside guide