Medidas de autorrelato para triagem de periodontite severa : avaliação clínica e revisão sistemática

Abstract

Objectives: The aim of this study was to evaluate the predictive performance of a self-reported periodontal questionnaire applied by community health workers (CHA) for screening for severe periodontitis (PSev) and to conduct a systematic review (SR) on the use of self-report questions for the PSev diagnosis. Methodology: For the first study, the CHAs applied the CDC/AAP questionnaire, consisting of 8 questions, in their communities in the city of Sobral, Ceará, Brazil. Participants underwent a clinical examination, consisting of a complete periodontal examination. PSev was evaluated considering three definitions. The performance of the questionnaire was analyzed using the chi-square test and logistic regression with assessment of sensitivity (SS), specificity (SP) and area under the ROC curve (AUROC). For SR, a search was performed in Pubmed, Scopus, Web of Science, VHL and Pro-Quest databases with the descriptors “self-reported” and “periodontitis”. Studies in adults (> 18 years) were selected, using the criteria for definition of severe periodontitis CPITN and CPI, radiographic evaluation or complete periodontal examination, according to the definition proposed by the CDC-AAP, by the AAP/EFP classification, or by the GBD criteria (PIC > 6 mm or PS > 5 mm). Studies that did not establish criteria for PSev classification or that grouped PSev data with other types of periodontitis were excluded. The quality and risk of bias of each article was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Results: 243 individuals answered the questionnaire and were examined. The prevalence of PSev was 47.3% according to the CDC/AAP criteria. Significant differences were observed for the means of interproximal clinical attachment loss (PIC), SEV = 4.6 ± 1.7* mm x NOMMOD = 2.9 ± 0.6 mm) and probing depth (PS), SEV = 3.6 ± 0.8 mm x NOMMOD = 2.7 ± 0.4 mm, and also for the number of teeth with PIC and PS >5 mm and >6 mm (p <0.001). Three of the eight questions, “having gum disease” (odds ratio [OR] = 2.6, 95% confidence interval [CI] = 1.5-4.7), “general health of teeth and gums” (OR = 0.5, 95% CI = 0.2-0.9) and “dental mobility” (OR 2.6, 95% CI = 1.5-4.7) were associated with severe periodontitis (p < 0.05). In the multivariate logistic regression analysis, the best models to predict severe periodontitis were those that included all self-report questions and all sociodemographic variables and that used the CDC/AAP definitions as a parameter (SS=69.7%, SP=80.3, ROC= 0.806) and the presence of two sextants with PS≥ 6mm (SS=82.1%, SP=69.2, ROC=0.861). For RS, 24 studies were included, published between 1988 and 2020. Significant variation in sample size and prevalence of PSev was observed. The form of application of the self-report questionnaires varied, taking place by mail, telephone, face-to-face form filled in by the participants themselves and a personal interview. In the multivariate analysis 11 studies showed excellent ROC value, 4 exceptional, 4 acceptable and only 1 presented a low ROC value (0.67). 10 articles used the eight-question questionnaire proposed by the CDC-AAP to assess self-report. Quality assessment showed a low level of bias in most of the included studies in terms of patient selection, index testing, reference standards, as well as flow and timing. Similar results were also observed regarding concerns about applicability. Conclusions: This analysis identified that self-report is an important promising measure to optimize diagnosis and provide a screening of more severe cases of periodontitis. may be applied by ACS.