Can patients self-report their periodontal health status?

Key Points

• People seem generally unable to report signs and symptoms related to their periodontal condition.

• This means that patients affected by periodontal disease depend on their dentists to inform them about it.

• Most people who have clinically detectable indications of periodontal disease appear unable to recall having been informed of this by their dentist.

Abstract

Objective The objective was to develop a self-reporting questionnaire for use as an epidemiological measure of periodontal status.

Design Oral survey.

Subjects and methods 100 (out of 102 who were approached) non-referred patients attending Dundee Dental Hospital and School agreed to complete a questionnaire concerning factors related to periodontal disease and then undergo a standardised periodontal examination in which four indicators were measured: the percentage of sites with plaque, the percentage of sites which showed bleeding on probing, tooth mobility and Community Index of Periodontal Treatment Needs scores.

Main outcome measure Sensitivity and specificity of questionnaire items to predict clinically measured periodontal disease indicators. Acceptable levels for sensitivity and specificity are largely dependent on the context of the test being evaluated, and many tests currently used in dentistry have very low sensitivity or specificity values. Nevertheless, in this case it was felt that any items which had a sensitivity and specificity greater than 0.80 would be reasonable predictors.

Results Only four items were weakly predictive of the periodontal status indicators (sensitivity and specificity > 0.5). These concerned noticing gaps between teeth getting bigger, noticing tooth roots becoming more visible, experiencing pain when consuming hot, cold or sweet things and smoking. Other items, concerned with whether a dentist had told the patient they had periodontal disease or whether the person was aware of being treated for it, had very low sensitivities suggesting that people with periodontal disease indicators are failing to be informed of, or treated for it, by their dentist.

Conclusions Self-reporting of periodontal health was not successful as many people who had some indications of the periodontal diseases appeared to be unaware of their condition and also appeared not to have been informed nor were being treated for it.

Main

Self-reporting of periodontal health status A D Gilbert and N M Nuttall Br Dent J 1999; 186: 241–244

Comment

In an ideal world a patient would present at their dentist or doctor when they had early symptoms or even sub-clinical manifestations of disease. This would enable early treatment of the problem or in some diseases early prevention of the more severe consequences associated with the diagnosis. Clearly early detection of neoplasias, for example by self-detection and reporting of breast lumps, would be a good example of where this process could be crucial to treatment outcome. Finland and Scandinavia have a long tradition of research into dental self-reporting and diagnosis using questionnaires and various diagnostic test kits for caries and other oral lesions. Early studies reported the success of questionnaires in self-reporting of caries and periodontal disease.¹ Further work on self-reporting and self-assessment of gingival health has been extensively studied among Finnish adolescents by Kallio in his doctoral thesis on this subject.² Self-assessment is the process whereby gingival health is assessed and the subjects interpret their findings and are thus motivated to improve their oral hygiene. Self-reporting appears to have only a weak association with clinical indices although self-assessment is generally reported to promote gingival health.

The current study raises several concerns, not only in the fact that self-reporting appears not to be successful in this Scottish population, but that patients who have signs and symptoms of periodontal disease are not being informed of, nor treated for, this disease by their dentist. The findings of this study suggest that the main key to patients realising they suffer from gum disease is the fact that they have been so informed by their dentist. Furthermore if scaling and polishing is provided based on the dentists' convenience rather than the patients' need then clearly the patients could be forgiven for being confused as to whether they have gum disease or not. A previous study reported that Scottish dentists were confident of their ability to detect periodontal disease, but not to treat the problem.³ The current study suggests that if these dentists are able to detect the disease (as they believe), then they may not be successful in educating their patients on this matter. This could be related to their admitted lack of confidence in treating the disease and rather worryingly they then may prefer not to inform the patient of their gum disease. The present study serves a useful purpose in highlighting how little patients know about their periodontal health and provides plausible reasons for why this might be so.