Utilizing Electronic Dental Record Data to Track Periodontal Disease Change

Abstract

Periodontal disease (PD) affects 42% of US population resulting in compromised quality of life, the potential for tooth loss and influence on overall health. Despite significant understanding of PD etiology, limited longitudinal studies have investigated PD change in response to various treatments. A major barrier is the difficulty of conducting randomized controlled trials with adequate numbers of patients over a longer time. Electronic dental record (EDR) data offer the opportunity to study outcomes following various periodontal treatments. However, using EDR data for research has challenges including quality and missing data. In this dissertation, I studied a cohort of patients with PD from EDR to monitor their disease status over time. I studied retrospectively 28,908 patients who received comprehensive oral evaluation at the Indiana University School of Dentistry between January 1st-2009 and December 31st-2014. Using natural language processing and automated approaches, we 1) determined PD diagnoses from periodontal charting based on case definitions for surveillance studies, 2) extracted clinician-recorded diagnoses from clinical notes, 3) determined the number of patients with disease improvement or progression over time from EDR data. We found 100% completeness for age, sex; 72% for race; 80% for periodontal charting findings; and 47% for clinician-recorded diagnoses. The number of visits ranged from 1-14 with an average of two visits. From diagnoses obtained from findings, 37% of patients had gingivitis, 55% had moderate periodontitis, and 28% had severe periodontitis. In clinician-recorded diagnoses, 50% patients had gingivitis, 18% had mild, 14% had moderate, and 4% had severe periodontitis. The concordance between periodontal charting-generated and clinician-recorded diagnoses was 47%. The results indicate that case definitions for PD are underestimating gingivitis and overestimating the prevalence of periodontitis. Expert review of findings identified clinicians relying on visual assessment and radiographic findings in addition to the case definition criteria to document PD diagnosis.