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Eficácia de uma nova estratégia de screening periodontal : estudo piloto
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Abstract(s)
Objetivos: Analisar a eficácia de diagnóstico da nova metodologia de triagem epidemiológico proposto. A eficácia será analisada através do número de pacientes com periodontite que não seriam sinalizados pela estratégia baseada sobre a analise de perda óssea medida radiograficamente sobre a ortopantomografia.
Materiais e Métodos: O estudo teve como população alvo os doentes que se dirigiram à Clinica dentária Egas Moniz (CDEM) para a sua primeira consulta de triagem. Foram estabelecidos os seguintes critérios de inclusão para este estudo: pacientes a realizar a primeira consulta de triagem na CDEM com idade superior à 20 anos e não desdentados totais. O estudo baseia-se sobre a realização do diagnóstico periodontal com o método Radiographic based Periodontal Bone Loss (R-PBL) e seguido de exame periodontal completo, utilizado como referência padrão. Foram utilizados métodos estatísticos descritivos para resumir as propriedades da recolha de dados e métodos estatísticos inferenciais.
Resultados: Os pacientes com doença periodontal tinham uma média de idade de 47,4 anos (±15.1) e 27,2 anos (±29) para os pacientes saudáveis. 52% dos doentes eram mulheres, 50% das quais com doença periodontal, e 48% eram homens, 50% dos quais com doença periodontal. Quanto aos hábitos tabágicos, 28% nunca fumaram, 40% eram fumadores e 32% eram ex-fumadores. Comparamos 4 estratégias diferentes, na primeira o rácio de probabilidades (RP) era de 0,9 < 1, os erros de diagnóstico são mais frequentes
no método auto-reportado em comparação com o método R-PBL. Na segunda o RP era de 0,43 < 1, os erros são presentes no método de diagnóstico auto-reportado em comparação com o diagnóstico clínico gold standard. Na tercera o RP era de 1,01, existem erros de diagnóstico mas na globalidade o método R-PBL é parecido ao método gold standard. Na quarta o RP era de 1,2, existem erros de diagnóstico no método autoreportado quando confirmado pelo método R-PBL.
Conclusão: O método de triagem periodontal testado demonstrou capacidade para detetar pacientes periodontais de extensão generalizada. No entanto, revelou-se ser incapaz de detetar casos de periodontite localizada. As investigações futuras deverão aumentar a dimensão amostral e explorar uma metodologia aprimorada para casos de extensão localizada e de gravidade inicial.
Aim : To analyze the diagnostic effectiveness of the proposed new epidemiological screening methodology. The effectiveness will be analyzed through the number of patients with periodontitis who would not have been flagged by the strategy based on the analysis of bone loss measured radiographically on orthopantomography. Material & Methods: The target population for this study was patients who came to the Egas Moniz Dental Clinic (CDEM) for their first screening appointment. We included patients attending their first screening appointment at CDEM, non-edentulous and aged over 20. The study was based on periodontal diagnosis using the Radiographic based Periodontal Bone Loss (R-PBL) method and a complete periodontal examination. Fullmouth periodontal diagnosis was used as the standard reference for each case definition. Descriptive statistical methods were used to summarise the properties of the data collection and inferential statistical methods. Results: The patients with periodontal disease had a mean age of 47.4 years (±15.1) and 27.2 years (±29) for the healthy patients. 52% of the patients were women, 50% of whom had periodontal disease, and 48% were men, 50% of whom had periodontal disease. In terms of smoking habits, 28 % never smoked, 40 % were smokers and % were exsmokers. We compared 4 different strategies, in the first the odds ratio (OR) was 0.9 < 1, diagnostic errors are more frequent in the self-reported method compared to the R-PBL method. In the second, the PR was 0.43 < 1, errors are present in the self-reported diagnostic method compared to the gold standard clinical diagnosis. In the third, the PR was 1.01, there are diagnostic errors but overall the R-PBL method is similar to the gold standard method. In the fourth the PR was 1.2, there are diagnostic errors in the selfreported method when confirmed by the R-PBL method. Conclusion: The periodontal screening method tested demontrated ability to detect periodontal patients of generelized extension. However, it was found to be unable to detect cases of localized periodontitis. Future investigations should increase the sample size and explore an improved methodology for cases of localized extension and initial severity.
Aim : To analyze the diagnostic effectiveness of the proposed new epidemiological screening methodology. The effectiveness will be analyzed through the number of patients with periodontitis who would not have been flagged by the strategy based on the analysis of bone loss measured radiographically on orthopantomography. Material & Methods: The target population for this study was patients who came to the Egas Moniz Dental Clinic (CDEM) for their first screening appointment. We included patients attending their first screening appointment at CDEM, non-edentulous and aged over 20. The study was based on periodontal diagnosis using the Radiographic based Periodontal Bone Loss (R-PBL) method and a complete periodontal examination. Fullmouth periodontal diagnosis was used as the standard reference for each case definition. Descriptive statistical methods were used to summarise the properties of the data collection and inferential statistical methods. Results: The patients with periodontal disease had a mean age of 47.4 years (±15.1) and 27.2 years (±29) for the healthy patients. 52% of the patients were women, 50% of whom had periodontal disease, and 48% were men, 50% of whom had periodontal disease. In terms of smoking habits, 28 % never smoked, 40 % were smokers and % were exsmokers. We compared 4 different strategies, in the first the odds ratio (OR) was 0.9 < 1, diagnostic errors are more frequent in the self-reported method compared to the R-PBL method. In the second, the PR was 0.43 < 1, errors are present in the self-reported diagnostic method compared to the gold standard clinical diagnosis. In the third, the PR was 1.01, there are diagnostic errors but overall the R-PBL method is similar to the gold standard method. In the fourth the PR was 1.2, there are diagnostic errors in the selfreported method when confirmed by the R-PBL method. Conclusion: The periodontal screening method tested demontrated ability to detect periodontal patients of generelized extension. However, it was found to be unable to detect cases of localized periodontitis. Future investigations should increase the sample size and explore an improved methodology for cases of localized extension and initial severity.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Periodontite Diagnóstico periodontal Screening Epidemiologia Saúde pública