Lecture 3: Periodontal Diagnostic Techniques

I. Diagnosis A) Periodontal diagnosis II. Disease progression: Continuous or Episodic? A) Linear progression: a) Problems: 1) many sites do not change over time 2) not all sites progress 3) destruction at a site may arrest and progress no further B) Random burst model: a) certain sites remain free of destruction throughout patients lifetime b) other sites demonstrate brief burst of destruction which may last for an undefined period that site may never demonstrate an active burst again, or could suffer one or more bursts later c) bursts are random with regards to time and previous loss of attachment C) Asynchronous multiple burst model: a) multiple sites show breakdown with a short period, with long periods of remission III. Periodontal destruction is unpredictable, therefore need to be able to identify sites at risk Clinical methods of diagnosis A) Currently available tests: a) tissue color b) tissue contour c) BOP d) probing pocket depth e) attachment levels f) suppuration g) mobility h) radiographic bone loss B) Strengths C) Weaknesses

IV. Accuracy of any test is defined by its sensitivity and specificity: DISEASE Present Absent True positive False positive False negative True negative

TEST

Positive Negative

A) Sensitivity: % of sites/subjects with true disease who give a positive test result =
true positive true positive and false negative

B) Specificity: % of sites/subjects with truly absent disease who give a negative test result =
true negative true negative and false positive

C) Predictive value: % of sites/subjects whose disease or health status is correctly identified by the test =
true positive and true negative true positive and true negative and false positive and false negative

D) Clinical tests are subjective, often descriptive, measure historic disease, poorly reproducible, poor predictors a) As an example, bleeding on probing (BOP) has: 1) sensitivity of 20% in the prediction of 1 mm of attachment loss over following 2 years 2) specificity of almost 100% (i.e. non-bleeding sites suffered no attachment loss) 3) BOP: is poorly sensitive (high incidence of false negatives), but highly specific (low incidence of false positives) predictor of periodontal health

V. New methods of disease diagnosis A) Periodontal probes a) rigid metal probe b) true pressure sensitive probe c) Florida probe: 1) constant force, 2) automated measurement, 3) computerized data collection, 4) resolution 0.1 mm d) Periotest: 1) to determine mobility, taps tooth 16 times in 4 seconds and measures time for tooth to return to original position 2) score from 0-50 3) not site specific B) Radiography a) Conventional radiography: 1) 2D representation of 3D structures 2) problems of exposure geometry, contrast and exposure variables 2) alveolar bone loss is not detectable until 30-50% of bone 3) mineral is destroyed b) Digital subtraction radiography: 1) radiographs are digitized, and subtracted to remove unchanging structures and reveal areas of bone gain or loss need standardized technique

C) Host-derived markers a) Inflammatory mediators b) Enzymes c) Collagenase d) Neutrophil products e) Aspartate aminotransferase (AST) f) -glucoronidase g) Elastase h) Tests 1) PerioGard

2) Periocheck

3) Periodontal susceptibility test

D) Microbial analysis