Validation of Self-reported Periodontal Disease: A Systematic Review

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Validation of Self-reported Periodontal Disease: A Systematic Review
2005
B. Blicher1, K. Joshipura1,*,2, and P. Eke3
Journal of Dental Research

© 2005 International and American Associations for Dental Research

1 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA;
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; and 3 Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA;

* corresponding author, kjoshipura@hsdm.harvard.edu

ABSTRACT

Self-report is an efficient and accepted means of assessing many population characteristics, risk factors, and diseases, but has rarely been used for periodontal disease (chronic periodontitis). The availability of valid self-reported measures of periodontal disease would facilitate epidemiologic studies on a much larger scale, allow for integration of new studies of periodontal disease within large ongoing studies, and facilitate lower-cost population surveillance of periodontitis. Several studies have been conducted to validate self-reported measures for periodontal disease, but results have been inconsistent. In this report, we conducted a systematic review of the validation studies. We reviewed the 16 studies that assessed the validity of self-reported periodontal and gingivitis measures against clinical gold standards. Seven of the studies included self-reported measures specific to gingivitis, four included measures only for periodontitis, and five included both gingivitis and periodontal measures. Three of the studies used a self-assessment method where they provided the patient with a detailed manual for performing a self-exam. The remaining 13 studies asked participants to self-report symptoms, presence of periodontal disease itself, or their recollection of a dental health professional diagnosing them or providing treatment for periodontal disease. The review indicates that some measures showed promise, but results varied across populations and self-reported measures. One example of a good measure is, "Has any dentist/hygienist told you that you have deep pockets?", which had a sensitivity of 55%, a specificity of 90%, positive predictive value of 77%, and negative predictive value of 75% against clinical pocket depth. Higher validity could be potentially obtained by the use of combinations of several self-reported questions and other predictors of periodontal disease.


KEY WORDS: Systematic review Ô self-report Ô validity Ô periodontal disease Ô gingivitis.

INTRODUCTION

Self-report is an efficient and accepted means of assessing many diseases, such as cancer, cardiovascular disease (Newell et al., 1999), and juvenile rheumatoid arthritis (Wright et al., 1994), as well as risk factors for disease, such as diet (Willett, 1990; Rimm et al., 1992), physical activity (Wolf et al., 1994), high blood pressure (Tormo et al., 2000), and general health (Sheridan et al., 1998). In the United States, The Behavioral Risk Factor Surveillance System (BRFSS), a self-report survey system established in 1984 by the Centers for Disease Control and Prevention (CDC), is used extensively at the state and local levels to survey and track trends in diseases such as heart disease, cancer, stroke, and diabetes, and risk factors such as obesity, and has been used in recent years to monitor trends in dental visits, dental cleanings, and tooth loss (Battelle Memorial Institute, 1999). Self-report is used for overall oral health in other studies as well. For example, the Geriatric Oral Health Assessment Index (GOHAI) has been validated for use in populations diverse in ethnicity and age (Atchison and Dolan, 1990; Atchison et al., 1998; Tubert-Jeannin et al., 2003). Nonetheless, self-report has rarely been used for periodontal disease (chronic periodontitis). Investigators have questioned whether self-report can be used for this purpose. Studies evaluating the validity of self-reported measures for periodontal disease and gingivitis have reported inconsistent results.

The development, implementation, and evaluation of public health interventions for periodontal disease will require that the diseases be monitored at several levels of the population. Current measures of periodontal disease are extremely resource-intensive and cannot be used in several state-based surveillance systems. The existence and use of valid, low-cost, and low-resource self-reported measures of periodontal disease would be beneficial in a variety of ways. It would facilitate epidemiological studies of periodontal disease on a much larger scale than is feasible with the present clinical measures, since much larger study populations could be reached by surveys rather than by clinical examination. Additionally, questions regarding periodontal disease could easily be added to ongoing studies to evaluate associations with other diseases and conditions. The use of self-report would allow for an easier and low-cost method of obtaining data for research and would support the creation of oral health programs (Siegal et al., 1988; Kallio, 1996). Self-assessment can additionally serve as a motivational tool for good oral hygiene (Kallio, 1996). Finally, self-reported measures would allow for surveillance of the periodontal condition of populations over time, in national, state, or regional surveillance programs.

To date, no comprehensive review of the field has been published. In this report, we have reviewed all of the studies validating self-report of periodontal or gingival diseases. We did not necessarily expect to find a clear "yes" or "no" answer as to whether self-reported periodontal measures were valid. Our objective was not only to summarize the validity of different self-reported measures in different populations, but also to identify methods and measures which show promise for use and/or further development, testing, and refinement.

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