The diagnosis of periodontal conditions associated with HIV infection
This paper describes the development of a set of diagnostic criteria to be used for the identification of HIV-associated periodontal conditions in large-scale epidemiologic studies where many subjects must be examined quickly. This paper also reports on reliability tests to assess the interexaminer reproducibility of diagnoses made using the criteria. A set of diagnostic criteria for HIV-associated periodontal conditions was devised based on a literature review and on the clinical experience of the authors. These diagnostic criteria distinguish up to eight conditions that may be found in people infected with HlV. The reliability of the criteria was assessed using a formal experimental design involving pre- and post-testing of subjects randomly assigned to study and control groups.
The examiners were nine dentists who were initially shown a series of 20 clinical photographs. Each examiner was asked to identify the clinical signs evident and record a diagnosis by checking one of 14 possible diagnoses. After stage 1, five of the examiners were selected to form a study GrOup. The remaining four became the control group. Each member of the study group received a written set of criteria. One week later, all examiners were shown the original set of photographs again and asked to identify the signs and record diagnoses. The examiners showed only fair reliability in the recognition of clinical signs, made diagnoses intuitively, and had only fair agreement on the diagnosis of periodontal diseases. The article indicates that the proposed criteria will enhance the value of studies of HlV-associated periodontal changes and will contribute to the understanding. [P.W.]
Robinson, P., J.R. Winkler, G. Palmer, J. Westenhouse, J.F. Hilton, and J. S. Greenspan, J Periodont, 65:236, 1994