{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:16:37Z","timestamp":1788434197694,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: A parsimonious multivariable model was engineered and externally validated using dental electronic health records to screen for a clinician-evaluated \u201cgum disease or related problem\u201d status. Designed for seamless electronic integration, a positive screening result triggers a targeted referral\u2014and the model is well-suited for dental hygienist use\u2014 while providing clinical decision support for dentists during definitive diagnoses. This automated support standardises workflows, maximises team efficiency, and supports data-driven clinical decision-making. Methods: This cross-sectional study developed the model using the US National Health and Nutrition Examination Survey (NHANES) 2011\u20132012 cohort (n = 1732) and independently validated it on the 2013\u20132014 replication cycle (n = 1855) for the high-risk 30\u201350-year-old demographic. Survey-weighted logistic regression incorporated age, gender, and eight targeted molar probing depth (PD) measurements paired with binary indicators for tooth presence to predict whether an individual has a gum disease or related problem. Results: External validation demonstrated high parameter generalisability, yielding a pooled population-level AUC of 0.859 (95% CI: 0.828\u20130.885). At the prevalence-matched threshold of Pt = 0.367, the framework yielded a sensitivity of 78.39% (95% CI: 69.48\u201385.29%) and a specificity of 79.10% (95% CI: 74.55\u201383.04%). Demonstrating public health utility via Decision Curve Analysis, the model avoided approximately 39 unnecessary clinical examinations by a dentist per 100 individuals at a practical clinical decision threshold of 0.33, achieving a substantial pooled net benefit compared with a treat-all strategy without compromising case-detection metrics. Conclusions: This scalable screening model offers a highly practical pathway for gum disease and related problem interception. Optimised for seamless software integration, the framework facilitates rapid, hygienist-led risk stratification without increasing chairside burden, and delivers objective data streams to reinforce the dentist\u2019s definitive diagnostic workflow.<\/jats:p>","DOI":"10.3390\/dj14090560","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Screening \u2018Gum Disease or Problem\u2019 Status Using Molar Probing Depths: Model Development and Validation in NHANES Young to Middle-Aged Adults"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9532-8829","authenticated-orcid":false,"given":"Miika","family":"Penttala","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/eje.12501","article-title":"A common European curriculum for dental hygiene","volume":"24","author":"Nyblom","year":"2020","journal-title":"Eur. J. Dent. Educ."},{"key":"ref_2","first-page":"e85062","article-title":"Artificial intelligence tools in dentistry: A systematic review on their application and outcomes","volume":"17","author":"Tyagi","year":"2025","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/0022034512457373","article-title":"Prevalence of Periodontitis in Adults in the United States: 2009 and 2010","volume":"91","author":"Eke","year":"2012","journal-title":"J. Dent. Res."},{"key":"ref_4","first-page":"S173","article-title":"Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions","volume":"89","author":"Papapanou","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/10454411970080030601","article-title":"Periodontal probing","volume":"8","author":"Hefti","year":"1997","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1038\/s41577-020-00488-6","article-title":"Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities","volume":"21","author":"Hajishengallis","year":"2021","journal-title":"Nat. Rev. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dye, B.A., Afful, J., Thornton-Evans, G., and Iafolla, T. (2019). Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011\u20132014. BMC Oral Health, 19.","DOI":"10.1186\/s12903-019-0777-6"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Penttala, M. (2026). Predicting the Need to Visit a Dentist in Young to Middle-Aged Adults: A Development and External Validation. Dent. J., 14.","DOI":"10.3390\/dj14070398"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6653","DOI":"10.1038\/s41598-025-88249-0","article-title":"Burden of periodontal diseases in young adults","volume":"15","author":"Wang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1111\/jcpe.12944","article-title":"Age-dependent distribution of periodontitis in two countries: Findings from NHANES 2009 to 2014 and SHIP-TREND 2008 to 2012","volume":"45","author":"Billings","year":"2018","journal-title":"J. Clin. Periodontol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"b605","DOI":"10.1136\/bmj.b605","article-title":"Prognosis and prognostic research: Validating a prognostic model","volume":"338","author":"Altman","year":"2009","journal-title":"BMJ"},{"key":"ref_12","unstructured":"National Center for Health Statistics (2014). NHANES 2011\u20132012 Oral Health\u2014Recommendation of Care (OHXREF_G) Data Documentation, Codebook, and Frequencies."},{"key":"ref_13","unstructured":"National Center for Health Statistics (2011). NHANES Oral Health Examiners Manual, 2011\u20132012."},{"key":"ref_14","unstructured":"National Center for Health Statistics (2013). NHANES Oral Health Examiners Manual, 2013\u20132014."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1902\/jop.2015.140520","article-title":"Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012","volume":"86","author":"Eke","year":"2015","journal-title":"J. Periodontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.adaj.2018.04.023","article-title":"Periodontitis in US adults: National health and nutrition examination survey 2009\u20132014","volume":"149","author":"Eke","year":"2018","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_17","first-page":"S159","article-title":"Staging and grading of periodontitis: Framework and proposal of a new classification and case definition","volume":"89","author":"Tonetti","year":"2018","journal-title":"J. Periodontol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Millsap, R.E., and Maydeu-Olivares, A. (2009). Missing data. The SAGE Handbook of Quantitative Methods in Psychology, SAGE Publications.","DOI":"10.4135\/9780857020994"},{"key":"ref_21","unstructured":"Chen, T.C., Parker, J.D., Clark, J., Shin, H.C., Rammon, J.R., and Burt, V.L. (2018). National Health and Nutrition Examination Survey: Estimation Procedures, 2011\u20132014."},{"key":"ref_22","unstructured":"Johnson, C.L., Paulose-Ram, R., Ogden, C.L., Carroll, M.D., Kruszon-Moran, D., Dohrmann, S.M., and Curtin, L.R. (2013). National Health and Nutrition Examination Survey: Analytic Guidelines, 1999\u20132010, Vital and Health Statistics Series 2."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1034\/j.1600-0757.2002.290102.x","article-title":"Methodological aspects of epidemiological studies of periodontal diseases","volume":"29","author":"Kingman","year":"2000","journal-title":"Periodontology"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Leroy, R., Eaton, K.A., and Savage, A. (2010). Methodological issues in epidemiological studies of periodontitis-how can it be improved?. BMC Oral Health, 10.","DOI":"10.1186\/1472-6831-10-8"},{"key":"ref_25","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R","volume":"45","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Morris, T.P., White, I.R., and Royston, P. (2014). Tuning multiple imputation by predictive mean matching and local residual draws. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-75"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lumley, T. (2011). Complex Surveys: A Guide to Analysis Using R, Wiley.","DOI":"10.1002\/9780470580066"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Harrell, F.E. (2001). Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis, Springer.","DOI":"10.1007\/978-1-4757-3462-1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1177\/0272989X06295361","article-title":"Decision curve analysis: A novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med. Decis. Mak."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_31","first-page":"7","article-title":"Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT)","volume":"1","author":"Lang","year":"2003","journal-title":"Oral Health Prev. Dent."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1902\/jop.2012.110676","article-title":"Advances in surveillance of periodontitis: The Centers for Disease Control and Prevention periodontal disease surveillance project","volume":"83","author":"Eke","year":"2012","journal-title":"J. Periodontol."},{"key":"ref_33","first-page":"347","article-title":"Screening for Periodontitis Using Blood Biomarkers and Demographic Data: A Machine Learning Study","volume":"24","author":"Choi","year":"2026","journal-title":"Oral Health Prev. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1177\/0022034520915714","article-title":"Artificial Intelligence in Dentistry: Chances and Challenges","volume":"99","author":"Schwendicke","year":"2020","journal-title":"J. Dent. Res."},{"key":"ref_35","first-page":"69","article-title":"Artificial Intelligence in Dentistry: Current Evidence, Clinical Utility, and Challenges","volume":"12","author":"Rajan","year":"2026","journal-title":"J. Appl. Dent. Oral Sci."},{"key":"ref_36","first-page":"257","article-title":"Caries management by risk assessment: Consensus statement, April 2002","volume":"31","author":"Featherstone","year":"2003","journal-title":"J. Calif. Dent. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1034\/j.1600-051X.2003.00370.x","article-title":"Longitudinal validation of a risk calculator for periodontal disease","volume":"30","author":"Page","year":"2003","journal-title":"J. Clin. Periodontol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ballester, B., Bukiet, F., and Dufour, J.-C. (2022). Current state of dental informatics in the field of health information systems: A scoping review. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02221-2"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/00220345211020265","article-title":"Data dentistry: How data are changing clinical care and research","volume":"101","author":"Schwendicke","year":"2022","journal-title":"J. Dent. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1038\/s41415-024-7462-0","article-title":"Voice-activated charting systems","volume":"236","author":"Lister","year":"2024","journal-title":"Br. Dent. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/idh.12796","article-title":"The employment of dental hygienists in European countries: Report of a European Dental Hygienists Federation\/European Association of Dental Public Health survey in 2021","volume":"22","author":"Rederiene","year":"2024","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/s41415-025-9222-1","article-title":"Using mouth rinse samples for screening periodontitis","volume":"239","author":"Penttala","year":"2025","journal-title":"Br. Dent. J."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Penttala, M., R\u00e4is\u00e4nen, I.T., Sakellari, D., Grigoriadis, A., and Sorsa, T. (2025). Statistical method for dental clinics for determining presence and stage of periodontitis with aMMP-8 mouth rinse point-of-care test and digital reader. Dent. J., 13.","DOI":"10.3390\/dj13110508"},{"key":"ref_44","unstructured":"World Health Organization (2024). Global Strategy and Action Plan on Oral Health 2023\u20132030, World Health Organization."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: A global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1080\/01621459.2013.795487","article-title":"A nonparametric spatial model for periodontal data with nonrandom missingness","volume":"108","author":"Reich","year":"2013","journal-title":"J. Am. Stat. Assoc."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/560\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:35:20Z","timestamp":1788431720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["dj14090560"],"URL":"https:\/\/doi.org\/10.3390\/dj14090560","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}