Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis

J Periodontol. 2015 Jan;86(1):16-26. doi: 10.1902/jop.2014.140339.


Background: This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis.

Methods: Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored.

Results: Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001).

Conclusions: Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.

Keywords: Arthritis, rheumatoid; osteoarthritis; periodontitis; rheumatoid factor; self report; sensitivity and specificity.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Alveolar Bone Loss / diagnosis
  • Arthritis, Rheumatoid / complications*
  • Educational Status
  • Female
  • Gingival Hemorrhage / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis / complications*
  • Periodontal Pocket / diagnosis
  • Periodontitis / diagnosis*
  • Physical Examination
  • Reference Standards
  • Reproducibility of Results
  • Risk Factors
  • Self Report*
  • Sensitivity and Specificity
  • Sex Factors
  • Smoking
  • Tooth Mobility / diagnosis
  • Young Adult