Validity and Accuracy of A Risk Calculator for Future Periodontal Disease

Research on the pathobiology of periodontal diseases has greatly increased our knowledge of these diseases and is fostering a transition from the repair to the medical or wellness model of periodontal care. Successful application of the wellness model is dependent upon accurate and valid assessment of risk, and institution of risk reduction as an integral part of prevention and treatment. A computer-based risk assessment tool has been developed. Clinical records and radiographs of 523 subjects enrolled in the VA Dental Longitudinal Study were used to evaluate the validity and accuracy of risk prediction using the computer-based tool. Information from baseline examinations was entered into the risk calculator and a risk score on a scale of 1 to 5 was calculated for each subject for future periodontal deterioration. Actual periodontal status in terms of alveolar bone loss, determined using digitized radiographs and tooth loss, determined from the clinical records, was assessed at years 3, 9 and 15. The strength of the association between the risk prediction and actual outcome was determined statistically. The risk scores were strong predictors of future periodontal status measured by alveolar bone loss and loss of periodontally affected teeth (p<0.0001). Risk scores consistently ranked risk score groups from least to most bone loss and tooth loss, and generally, the amounts of actual bone and tooth loss by year 3 observed in the highest risk score group were not observed until year 15 in the lowest risk score group. Use of the risk assessment tool over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy, reduction in health care cost and to hasten the transition to the wellness model of care. Supported by VA Med Kes. Service, NIH Grant K24 DE00419 and Dent. Med. Internat'l., Inc.