慢性牙周炎和侵犯性牙周炎的診斷一致性評估

Assessment of Agreement on Diagnoses of Chronic and Aggressive Periodontitis

魏郁如(Yu-Ju Wei) ； 賴玉敏(Yu-Min Lai) ； 林怡君(Yi-Chun Lin) ； 李士元(Shyh-Yuan Lee) ； 季麟揚(Lin-Yang Chi)

《中華牙醫學雜誌（中文版）》 26卷2期 (2007/12) Pp. 114-124

https://doi.org/10.7106/CJD.200712.0114

摘要

牙醫界對於牙周病的分類長期以來存在著分歧的意見，即使是1999年由美國牙周病學會所提出之最新的牙周疾病分類系統也仍然受到各界質疑。本研究目的為評估牙醫師對於慢性牙周炎和侵犯性牙周炎診斷的一致性，並分析在前述之新分類系統中慢性牙周炎和侵犯性牙周炎的診斷依據的可用性。共16位不同訓練資歷的牙醫師參與本研究，他們分析了86位於某醫學中心接受全口牙周治療病患的臨床資料，包括病患基本資料、全口臨床相片及牙根尖放射片、全口牙周檢查記錄等，本研究以問卷記錄醫師對每一位病患牙周病的診斷名稱及所採用的診斷依據。以Kappa analysis分析一致性，結果顯示牙周病專科醫師組別診斷最具有一致性，而實習醫師組和全科訓練住院醫師組對於牙周病的診斷則未顯示有一致性。本研究結果顯示現行牙周疾病分類系統仍然未臻完善，須在新知識繼續發展下，修訂更符合臨床診斷需求之牙周疾病分類系統。

關鍵字

牙周病診斷 ； 牙周炎分類 ； 慢性牙周炎 ； 侵犯性芽周炎 ； 一致性

並列摘要

There has been long-standing confusion with the classification of periodontal diseases among dentists, The latest revised classification system was proposed by the American Academy of Periodontology (AAP) in 1999 (AAP99), and divergent viewpoints still exist. The purpose of this study was to evaluate the extent of agreement among dentists on diagnoses of chronic and aggressive periodontitis and to further assess the reliabilily of determinate factors for the 2 diagnoses as stipulated in the AAP99. In total, 16 dentists with different professional training backgrounds participated in the study, They reviewed the clinical data of 86 study subjects, including the patients' basic information, full-mouth clinical photographs and radiographs, as well as periodontal charts kept in a medical center. They then answered a brief questionnaire which focused on the diagnosis of periodontal disease and recorded the determinate factors which they used to arrive at the diagnosis for each patient. The kappa statistic revealed that the periodontal specialists demonstrated the highest level of agreement in the disease diagnosis while more inter-examiner variation was observed among the groups of intern-doctors and rotating residents. Our findings suggest that the AAP99 classification of periodontal diseases is unsatisfactory, and practical guidelines including operational definitions for the disease diagnosis need to be developed once there is sufficient new knowledge to justify revisions.

並列關鍵字

periodontal diagnosis ； classification of periodontitis ； chronic periodontitis ； aggressive periodontitis ； agreement