Validity and accuracy of a risk calculator in predicting periodontal disease.
BACKGROUND
Research on the pathobiology of periodontal diseases has increased our knowledge of these diseases and is fostering a transition from the repair model to the medical or wellness model of periodontal care. Successful application of the wellness model depends on an accurate and valid assessment of disease risk, as well as institution of risk reduction as an integral part of prevention and treatment. A computer-based risk assessment tool has been developed.


METHODS
The authors reviewed clinical records and radiographs of 523 subjects enrolled in the Veterans Affairs Dental Longitudinal Study to evaluate the validity of risk prediction using the computer-based tool. Data from baseline examinations was entered into the risk calculator, and a risk score on a scale from 1 (lowest risk) to 5 (highest risk) was calculated for each subject to predict periodontal deterioration. Actual periodontal status in terms of alveolar bone loss (determined from digitized radiographs) and tooth loss (determined from clinical records) was assessed at years 3, 9 and 15. The authors determined the statistical strength of the association between risk prediction and actual outcome.


RESULTS
The risk scores were strong predictors of periodontal status, as measured by alveolar bone loss and loss of periodontally affected teeth. Risk scores consistently ranked risk score groups from least to most bone loss and tooth loss. Compared with a risk score of 2, the relative risk of tooth loss was 3.2 for a risk score of 3, 4.5 for a risk score of 4 and 10.6 for a risk score of 5.


CONCLUSIONS
Use of the risk assessment tool over time may result in more uniform and accurate periodontal clinical decision-making, improved oral health, reduction in the need for complex therapy, reduction in health care costs and a hastening of the transition from a repair model to a wellness model of care.
Page
Roy C
RC
Department of Periodontics, School of Dentistry, University of Washington, Seattle 98195, USA. roypage@u.washington.edu
Krall
Elizabeth A
EA
Martin
John
J
Mancl
Lloyd
L
Garcia
Raul I
RI
D016301:Alveolar Bone Loss / Q000453:epidemiology; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D010510:Periodontal Diseases / Q000453:epidemiology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012986:Software Validation; D018709:Statistics, Nonparametric; D016388:Tooth Loss / Q000453:epidemiology; D014728:Veterans