Assessing the surveillance use of 2018 EFP/AAP classification of periodontitis: A validation study and clustering analysis.

BACKGROUND: The performance of the 2018 EFP/AAP classification of periodontitis for epidemiology surveillance purposes remains to be investigated. This study assessed the surveillance use of the 2018 EFP/AAP classification and its agreement with the unsupervised clustering method compared with the 2012 CDC/AAP case definition.

METHODS: Participants (n = 9,424) in the National Health and Nutrition Examination Survey were staged by the 2018 EFP/AAP classification and classified into subgroups via k-medoids clustering. Concordance levels between periodontitis definitions and the clustering method were evaluated through the multi-class area under the receiver operating characteristic curve (multi-class AUC) among 'periodontitis cases' and the general population, respectively. The multi-class AUC of the 2012 CDC/AAP definition versus clustering was used as a reference. The associations of periodontitis with chronic diseases were estimated using multivariable logistic regression.

RESULTS: All the participants were identified as 'periodontitis cases' by the 2018 EFP/AAP classification, and the prevalence of stage III-IV was 30%. The optimal numbers of clusters were three and four. The 2012 CDC/AAP definition versus clustering yielded a multi-class AUC of 0.82 and 0.85 among the general population and 'periodontitis cases,' respectively. The multi-class AUC of the 2018 EFP/AAP classification versus clustering was 0.77 and 0.78 for different target populations. Similar patterns prevailed in associations with chronic diseases between the 2018 EFP/AAP classification and clustering.

CONCLUSION: The validity of the 2018 EFP/AAP classification was verified by the unsupervised clustering method, which performed better in distinguishing 'periodontitis cases' than classifying the general population. For surveillance purposes, the 2012 CDC/AAP definition showed a higher agreement level with the clustering method than the 2018 EFP/AAP classification. This article is protected by copyright. All rights reserved.