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ORIGINAL RESEARCH Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 3  |  Page : 243-246
Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India


Department of Preventive and Community Dentistry, MS Ramaiah Dental College, Bangalore - 560 054, Karnataka, India

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Date of Submission16-Mar-2007
Date of Decision10-Jul-2007
Date of Acceptance20-Jul-2007
 

   Abstract 

Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India.
Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively.
Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

Keywords: Clinical assessment, periodontal health, subjective perceptions

How to cite this article:
Nagarajan S, Pushpanjali K. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India. Indian J Dent Res 2008;19:243-6

How to cite this URL:
Nagarajan S, Pushpanjali K. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India. Indian J Dent Res [serial online] 2008 [cited 2019 Jun 25];19:243-6. Available from: http://www.ijdr.in/text.asp?2008/19/3/243/42958
Epidemiological research indicates that periodontal diseases are widespread throughout the world and evidence exists to show that their extent and severity increases with age. The prevention and management of periodontal diseases is accomplished primarily by maintaining tooth surfaces which are free of dental plaque. [1]

The maintenance of periodontal health requires an informed patient. Treatment will fail and in fact not even start, if individuals are not aware of the differences between periodontal health and disease; the significance of these differences and the part they can play in prevention and control.

Self-awareness begins the process, with self-care and professional care following. Thus, the recognition of health and disease by a person, the knowledge of what to do when a problem occurs and the appropriate response from the health professional are the major factors in prevention and control of chronic inflammatory periodontal diseases.

To accomplish an adequate level of periodontal health, the individual must be aware of disease symptoms, perceive a need to do something about the symptoms, be motivated to do something about them, know what to do about them and finally adopt the appropriate behavior.

Comparisons of oral health normative versus self-perceived assessments could demonstrate the efficacy of the individual to evaluate personal health status and highlight fields in which self-perceived assessment is precise or imprecise. Studies comparing questionnaires and interviews with clinical examinations have demonstrated the efficacy of self-perceived assessment concerning the number of teeth and presence of dentures. Self-perceived assessment data have been found as neither useful nor successful in the assessment of individual dental and periodontal health status. Kallio et al. suggested that self-reporting of gingival health lacks sufficient validity in the screening of individuals for gingivitis. [2] Gilbert et al. compared questionnaires and clinical assessment of periodontal health status, and the results yielded sensitivity and specificity values of below 50%. [3] Tervonen and Knuttila reported that people tend to underestimate their dental treatment needs, mainly in the field of periodontology. [4]

Very few studies in India have assessed the efficacy of self-reported periodontal health status and compared it to the clinically evaluated periodontal status. Hence this study was undertaken to compare the self-assessed and clinically diagnosed periodontal health status among patients attending M.S. Ramaiah Dental College.


   Materials and Methods Top


Ethical approval was sought and given by ethical committee of M.S Ramaiah Dental College. A target was set to obtain 216 patients with at least 20 teeth and no complicating medical histories from adults who were attending as casual patients (i.e., were not referred) at M.S. Ramaiah Dental College, Bangalore. The patients were asked to give informed consent to taking part, after being told that the experiment would consist of them answering a questionnaire and then having a periodontal examination.

The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, sensitivity of teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. The assessment of the periodontal status carried out by using Community Periodontal Index. [5] The Gingival Index (GI) was developed by Loe and Sillness in 1963 was used for the purpose of assessing the severity of gingivitis. [6] Mobility was elicited with the help of blunt end of 2-mouth mirrors. The mobility of the tooth recorded under the following codes:

Code 1: No mobility present

Code 2: Mobility elicited

The data were entered into the computer database and analyzed using the Statistical Package, SPSS/Version 10. Frequency distributions, sensitivity, and specificity analysis were performed to assess the relationship between subjective and objective perceived periodontal treatment needs. The results are presented as the sensitivity and specificity of particular responses to questions as a predictor of clinically derived scores of gingivitis, bleeding, deposits, recession, pocketing, and mobility. The cut-off points were chosen as they were listed as significant stages in periodontal disease assessment in a recent article in the British Dental Journal. [7]


   Results Top


A total of 216 patients participated in the study. All the patients completed the questionnaires and underwent clinical examination. There were 96 females and 120 males. The mean age group in males was 27.23 whereas in females it was 23.43.

The self-assessed versus clinically diagnosed gingival bleeding showed a sensitivity of 18% and a specificity of 75.75%. The table showed a large number of false negative cases (81.9%) and a few false positive cases (24.2). There was a marked disparity between the self-assessed and clinically diagnosed bleeding [Table 1].

Self-assessed versus clinically diagnosed deposits on teeth showed a sensitivity of 22.7% and a specificity of 87.5% that is there was an agreement of 87.5% that there were no deposits between teeth when it was absent. The table showed a false negative value of 77% that is, most of the patients were unable to self-assess presence of deposits on the teeth [Table 2].

Self-assessed versus clinically diagnosed gingival swelling showed a very low sensitivity of 1.6% and a specificity of 65.7%, that is, there was an agreement of 65.7% that there was no gingival swelling when it was absent [Table 3]. The table showed a false negative value of 98% that is, most of the patients were unable to self-assess gingivitis.

Self-assessed versus clinically diagnosed recession showed a sensitivity of only 0% and a specificity of 100% that is, there was an agreement of 100% that there was no recession when it was absent [Table 4].

Self-assessed versus clinically diagnosed sensitivity showed there was an agreement of only 8% between self-assessed and clinically diagnosed sensitivity whereas there was a specificity of 100%. The table showed a false negative value of 90.9% [Table 5].

Self-assessed versus clinically diagnosed loose teeth showed a sensitivity of 35.2% and a specificity of 98% that is there was a 98% agreement between the self-assessed and clinically diagnosed absenteeism of loose teeth. However, the ability to assess loose teeth when present was 35% which showed a better predictive value than the other self-reported items. The table showed a false negative score of 64.7 and a false positive score of 1% [Table 6].

The percentages of self-assessed and clinically diagnosed periodontal health status showed marked discrepancy between the two values showing that self-assessed periodontal tool was a poor indicator of the periodontal health status [Table 7].


   Discussion Top


Epidemiological research indicates that periodontal diseases are widespread throughout the world and evidence exists to show that their extent and severity increases with age. The prevention and management of periodontal diseases are accomplished primarily by maintaining tooth surfaces which are free of dental plaque.

The maintenance of periodontal health requires an informed patient. Treatment will fail and in fact will not even start, if individuals are not aware of the differences between periodontal health and disease; the significance of these differences and the part they can play in prevention and control. The present study was undertaken to determine the periodontal awareness among patients visiting M.S. Ramaiah Dental College and compare it with the clinically assessed periodontal health status. A total of 216 dental patients were subjected to a self-administered questionnaire followed by a periodontal examination to assess their periodontal status.

The self-reporting of bleeding gums was only 18%. When this was compared with the clinically diagnosed bleeding gums, it showed very low sensitivity but a high specificity. Most of the patients were unaware of the presence of bleeding gums. A marked disparity between the self-assessed and clinically diagnosed bleeding gums was seen. This is in contrast to the studies of Gilbert et al. [3] and Buhlin et al., [8] who showed that self-reported bleeding gums had a good validity. This study is in agreement with the studies of Tervonen and Knuttila [4] and Kallio et al., [2] who showed that most of the patients did not notice bleeding from gums and was poorly perceived by the patient.

The present study showed that the self-perceived score for the presence of deposits was markedly different from clinically diagnosed scores. The self-assessed versus clinically diagnosed score showed low sensitivity of 22.7% and good specificity of 87.5% which was in coherence with most of the previous studies.

The study of Gilbert et al. [3] showed a low sensitivity for self-assessed swelling of gums. This study is also in agreement with the study as most subjects were unable to perceive swollen gums. Self-assessment of recession showed low sensitivity which is in agreement with the study of Pitiphat et al. [9] Self-assessment of loose teeth showed good sensitivity which is in agreement to the study of Gilbert et al. [2] and Glavind and Attstrom. [10] Patients were able to perceive periodontitis as the severity increased and as irreversible changes set in.

Overall, the results of the study showed marked disparity between the self-assessed and clinically diagnosed periodontal health status stressing on the urgent need for patient education and motivation for the maintenance of periodontal health.


   Conclusion Top


In conclusion, the present study that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs were very distinct. In spite of the high prevalence of periodontal disease, the awareness of the people is very low. This is mainly due to the relatively asymptomatic course of the disease at least in the early stages.

The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in. Utilization of dental services in this country should, therefore, be improved not only by improving the availability and accessibility by manpower arrangements, but also to a great extent by increasing peoples awareness and knowledge of their own dental disorders and by attempting to change their attitudes and behavior in relation to oral health care.

 
   References Top

1.Hel φe LA. Comparison of dental health data obtained from questionnaires, interviews and clinical examination. Scand J Dent Res 1972;80:495-9.  Back to cited text no. 1    
2.Kallio P, Nordblad A, Croucher R, Ainamo J. Self-reported gingivitis and bleeding gums among adolescents in Helsinki. Community Dent Oral Epidemiol 1994;22:277-82.  Back to cited text no. 2    
3.Gilbert AD, Nuttal NM. Self reporting of periodontal health status. Br Dent J 1999;186:241-4.  Back to cited text no. 3    
4.Tervonen T, Knuttila M. Awareness of dental disorders and discrepancy between objective and subjective dental treatment needs. Community Dent Oral Epidemiol 1988;34:345-8.  Back to cited text no. 4    
5.Oral Health Surveys: Basic Methods WHO; Geneva:1987.  Back to cited text no. 5    
6.L φe H, Silness J. Periodontal disease in pregnancy, I: Prevalence and severity. Acta Odont Scand 1963;21:533-51.  Back to cited text no. 6    
7.Palmer RM, Floyd PD. Periodontology a clinical approach. 3 Non-surgical treatment and maintenance. Br Dent J 1995;178:263-8.  Back to cited text no. 7    
8.Buhlin K, Gustaffon A, Anderson K, Hakansson K, Klinge B. Validity and limitations of self reported periodontal health. Community Dent Oral Epidemiol 2002;30:431-7.  Back to cited text no. 8    
9.Pitiphat W, Garcia R, Douglass CW, Joshipura KJ. Validation of self reported oral health measures. J Public Health Dent 2002;62:122-8.  Back to cited text no. 9    
10.Glavind L, Attstrom R. Periodontal self-examination: A motivational tool in periodontics. J Clin Periodontol 1979;63:238-51.  Back to cited text no. 10    

Top
Correspondence Address:
Sripriya Nagarajan
Department of Preventive and Community Dentistry, MS Ramaiah Dental College, Bangalore - 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.42958

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]

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