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Discriminant validity of the current gingivitis classification in adolescents: a cohort study

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Abstract

Objectives

To compare the prevalence of gingivitis estimated by the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification with the other case definitions and assess the ability of this classification system in discriminating sociodemographic and clinical factors associated with the presence of gingivitis in a cohort study.

Materials and methods

A multistage random sample of 1134 12-year-old adolescents was submitted to a full-mouth examination according to the Community Periodontal Index. Socioeconomic and clinical variables were collected at baseline. Gingivitis was considered according to the following criteria: (a) ≥ 10% of bleeding sites (the 2018 EFP/AAP criteria); (b) ≥ 15% of bleeding sites; and (c) the mean full-mouth bleeding sites. Adjusted multilevel Poisson regression assessed the association between independent variables at baseline and each definition of gingivitis at 2-year follow-up.

Results

Seven hundred forty-two 14-year-old adolescents were re-revaluated at follow-up. The prevalence of gingivitis was 28.7% according to 10% of bleeding threshold. The 2018 EFP/AAP criteria and other definitions showed higher prevalence and mean of gingivitis for low-household income adolescents and for those with higher levels of dental plaque and untreated dental caries. Nonetheless, the highest strengths of association were observed for the threshold of ≥ 15% of bleeding sites.

Conclusion

The 2018 EFP/AAP case definition of gingivitis showed a similar discriminant validity compared to the 15% threshold and the mean full-mouth bleeding sites.

Clinical relevance

The 2018 EFP/AAP classification allows the discrimination of important risk factors and should be used for the establishment of priorities for large-scale therapeutic programs.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Murakami S, Mealey BL, Mariotti A et al (2018) Dental plaque-induced gingival conditions. J Clin Periodontol 45:17–27. https://doi.org/10.1111/jcpe.12937

    Article  Google Scholar 

  2. Trombelli L, Farina R, Silva CO et al (2018) Plaque-induced gingivitis: case definition and diagnostic considerations. J Clin Periodontol 45:44–67. https://doi.org/10.1111/jcpe.12939

    Article  Google Scholar 

  3. Chapple ILC, Mealey BL, van Dyke TE et al (2018) Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 45:68–77. https://doi.org/10.1111/jcpe.12940

    Article  Google Scholar 

  4. Lang NP, Bartold PM (2018) Periodontal health. J Clin Periodontol 45:9–16. https://doi.org/10.1111/jcpe.12936

    Article  Google Scholar 

  5. Karayiannis A, Lang NP, Joss A et al (1992) Bleeding on probing as it relates to probing pressure and gingival health in patients with a reduced but healthy periodontium. A clinical study J Clin Periodontol 19:471–475. https://doi.org/10.1111/j.1600-051X.1992.tb01159.x

    Article  PubMed  Google Scholar 

  6. Lang NP, Nyman S, Senn C et al (1991) Bleeding on probing as it relates to probing pressure and gingival health. J Clin Periodontol 18:257–261. https://doi.org/10.1111/j.1600-051X.1991.tb00424.x

    Article  PubMed  Google Scholar 

  7. Baser U, Germen M, Erdem Y et al (2014) Evaluation of gingival bleeding awareness by comparison of self-reports and clinical measurements of freshman dental students. Eur J Dent 8:360–365. https://doi.org/10.4103/1305-7456.137649

    Article  PubMed  PubMed Central  Google Scholar 

  8. Botero JE, Rösing CK, Duque A et al (2000) (2015) Periodontal disease in children and adolescents of Latin America. Periodontol 67:34–57. https://doi.org/10.1111/prd.12072

    Article  Google Scholar 

  9. Drummond BK, Brosnan MG (2000) Leichter JW (2017) Management of periodontal health in children: pediatric dentistry and periodontology interface. Periodontol 74:158–167. https://doi.org/10.1111/prd.12195

    Article  Google Scholar 

  10. Elias-Boneta AR, Ramirez K, Rivas-Tumanyan S et al (2018) Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: a cross-sectional study. BMC Oral Health 18:13. https://doi.org/10.1186/s12903-017-0471-5

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kissa J, Albandar JM, El Houari B et al (2022) National survey of periodontal diseases in adolescents and young adults in Morocco. J Clin Periodontol 49:439–447. https://doi.org/10.1111/jcpe.13613

    Article  PubMed  Google Scholar 

  12. Leroy R, Jara A, Martens L et al (2011) Oral hygiene and gingival health in Flemish pre-school children. Community Dent Health 28:75–81

    PubMed  Google Scholar 

  13. Tomazoni F, Vettore MV, Zanatta FB et al (2017) The associations of socioeconomic status and social capital with gingival bleeding among schoolchildren. J Public Health Dent 77:21–29. https://doi.org/10.1111/jphd.12166

    Article  PubMed  Google Scholar 

  14. Chiapinotto FA, Vargas-Ferreira F, Demarco FF et al (2013) Risk factors for gingivitis in a group of Brazilian schoolchildren. J Public Health Dent 73:9–17. https://doi.org/10.1111/jphd.12001

    Article  PubMed  Google Scholar 

  15. Erdemir EO, Sönmez IS, Oba AA et al (2010) Periodontal health in children exposed to passive smoking. J Clin Periodontol 37:160–164. https://doi.org/10.1111/j.1600-051X.2009.01510.x

    Article  PubMed  Google Scholar 

  16. Machado ME, Tomazoni F, Ortiz FR et al (2017) Impact of partial-mouth periodontal examination protocols on the association between gingival bleeding and oral health–related quality of life in adolescents. J Periodontol 88:693–701. https://doi.org/10.1902/jop.2017.160622

    Article  Google Scholar 

  17. Tomazoni F, Zanatta FB, Tuchtenhagen S et al (2014) Association of gingivitis with child oral health–related quality of life. J Periodontol 85:1557–1565. https://doi.org/10.1902/jop.2014.140026

    Article  PubMed  Google Scholar 

  18. Diamanti I, Berdouses ED, Kavvadia K et al (2021) Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self-rated oral health and changes in 10 years. Eur J Paediatr Dent 22:98–106. https://doi.org/10.23804/ejpd.2021.22.02.3

    Article  PubMed  Google Scholar 

  19. Ortiz FR, Sfreddo CS, Coradini AGM et al (2020) Gingivitis influences oral health-related quality of life in adolescents: findings from a cohort study. Rev Bras Epidemiol 23:e200051. https://doi.org/10.1590/1980-549720200051

    Article  PubMed  Google Scholar 

  20. Sfreddo CS, Moreira CHC, Celeste RK et al (2019) Pathways of socioeconomic inequalities in gingival bleeding among adolescents. Community Dent Oral Epidemiol 47:177–184. https://doi.org/10.1111/cdoe.12441

    Article  PubMed  Google Scholar 

  21. Instituto Brasileiro de Geografia e Estatística (2010). Sinopse do censo demográfico 2010. https://censo2010.ibge.gov.br/sinopse/index.php?dados=8. Acessed 20 February 2023

  22. Nascimento GG, Seerig LM, Vargas-Ferreira F et al (2013) Are obesity and overweight associated with gingivitis occurrence in Brazilian schoolchildren? J Clin Periodontol 40:1072–1078. https://doi.org/10.1111/jcpe.12163

    Article  PubMed  Google Scholar 

  23. World Health Organization (2013) Oral health surveys: basic methods. WHO Press, Geneva

    Google Scholar 

  24. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent 25:229–235

    Google Scholar 

  25. Jin LJ, Armitage GC, Klinge B et al (2011) Global oral health inequalities: task group—periodontal disease. Adv Dent Res 23:221–226. https://doi.org/10.1177/0022034511402080

    Article  PubMed  Google Scholar 

  26. Lang NP, Schätzle MA, Löe H (2009) Gingivitis as a risk factor in periodontal disease. J Clin Periodontol 36:3–8. https://doi.org/10.1111/j.1600-051X.2009.01415.x

    Article  PubMed  Google Scholar 

  27. Chaves ES, Wood RC, Jones AA et al (1993) Relationship of “bleeding on probing” and “gingival index bleeding” as clinical parameters of gingival inflammation. J Clin Periodontol 20:139–143. https://doi.org/10.1111/j.1600-051x.1993.tb00328.x

    Article  PubMed  Google Scholar 

  28. Haubek D, Ennibi OK, Poulsen K et al (2008) Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study. Lancet 371:237–242. https://doi.org/10.1016/S0140-6736(08)60135-X

    Article  PubMed  Google Scholar 

  29. Paula JS, Cruz JND, Ramires TG et al (2017) Longitudinal impact of clinical and socioenvironmental variables on oral health related quality of life in adolescents. Braz Oral Res 31:e70. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0070

    Article  PubMed  Google Scholar 

  30. Celentano DC, Szklo M (2018) Gordis epidemiology. Elsevier, Philadelphia

    Google Scholar 

  31. Ortigara GB, Ferreira TG, Tatsch KF et al (2021) The 2018 EFP/AAP periodontitis case classification demonstrates high agreement with the 2012 CDC/AAP criteria. J Clin Periodontol 48:886–895. https://doi.org/10.1111/jcpe.13462

    Article  PubMed  Google Scholar 

  32. Brito LF, Taboza ZA, Silveira VR et al (2022) Diagnostic accuracy of severe periodontitis case definitions: comparison of the CDC/AAP, EFP/AAP, and CPI criteria. Journal Periodontol 93:867–876. https://doi.org/10.1002/JPER.21-0365

    Article  Google Scholar 

  33. Morales A, Strauss FJ, Hämmerle CHF et al (2021) Performance of the 2017 AAP/EFP case definition compared with the CDC/AAP definition in population-based studies. J Periodontol 93:1003–1013. https://doi.org/10.1002/JPER.21-0276

    Article  PubMed  Google Scholar 

  34. Koga R, Herkrath APCQ, Vettore MV et al (2020) The role of socioeconomic status and psychosocial factors on gingivitis in socially disadvantaged adolescents. J Periodontol 91:223–231. https://doi.org/10.1002/JPER.19-0129

    Article  PubMed  Google Scholar 

  35. Solar O, Irwin A (2010) A conceptual framework for action on the social determinants of health. WHO Press, Geneva, Social determinants of health discussion

    Google Scholar 

  36. American Dental Association (1998) Acceptance program guidelines: toothbrushes. American Dental Association, Chicago

    Google Scholar 

  37. Bastos JL, Boing AF, Peres KG et al (2011) Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008. Cader Saude Publica 27:141–153. https://doi.org/10.1590/S0102-311X2011001400003

    Article  Google Scholar 

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Acknowledgements

The authors thank all adolescents, their parents, and schools for participating in this study, as well as the Municipal Education Authorities from Santa Maria, Rio Grande do Sul.

Funding

This study was funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (process 310482/2015–1) and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (process 2381–2551/14–0).

Author information

Authors and Affiliations

  1. Department of Semiology and Clinic, Faculty of Dentistry, Graduate Program in Dentistry, Federal University of Pelotas, Gonçalves Chaves Street, 457, 509 Room, Centro, Pelotas, RS, 96015-560, Brazil

    Camila S. Sfreddo

  2. Post-Graduate Program in Oral Science, Federal University of Santa Maria, Roraima Avenue, 1000, 26F Building, Santa Maria, Camobi, RS, 97105-900, Brazil

    Leandro M. Oliveira & Thiago M. Ardenghi

  3. Faculty of Dentistry, Federal University of Pelotas, Gonçalves Chaves Street, 457, Centro, Pelotas, RS, 96015-560, Brazil

    Bruna Z. Gomes

Authors
  1. Camila S. Sfreddo
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  2. Leandro M. Oliveira
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  3. Bruna Z. Gomes
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  4. Thiago M. Ardenghi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Camila S. Sfreddo, Leandro M. Oliveira, Bruna Z. Gomes, and Thiago M. Ardenghi. The first draft of the manuscript was written by Camila S. Sfreddo and Leandro M. Oliveira, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Camila S. Sfreddo.

Ethics declarations

Ethics approval

All procedures were conducted according to the principles expressed in the Declaration of Helsinki. The prospective analysis was approved by our institutional review board (Committee of Ethics in Research of Federal University of Santa Maria; Ethics proposal number CAEE: 30613714.0.0000.5421).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Competing interests

The authors declare no competing interests.

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Sfreddo, C.S., Oliveira, L.M., Gomes, B.Z. et al. Discriminant validity of the current gingivitis classification in adolescents: a cohort study. Clin Oral Invest 27, 6513–6521 (2023). https://doi.org/10.1007/s00784-023-05256-z

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