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Multiple Imputation for Partial Recording Periodontal Examination Protocols
J S Preisser1, T Shing1, B F Qaqish1
1Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
JDR Clinical and Translational Research
|January 16, 2023
Summary
Partial-mouth sampling underestimates periodontitis. Multiple imputation of missing data for periodontal sites can reduce bias in prevalence and extent estimates, offering a more accurate assessment of oral health.
Area of Science:
- Periodontology
- Biostatistics
- Dental Public Health
Background:
- Partial-mouth recording protocols are resource-efficient but often underestimate periodontitis prevalence and extent.
- Accurate estimation of periodontitis is crucial for public health surveillance and clinical decision-making.
Purpose of the Study:
- To evaluate the effectiveness of multiple imputation in reducing bias in periodontitis estimates derived from partial-mouth samples.
- To assess the impact of multiple imputation on periodontitis prevalence and extent using a large national dataset.
Main Methods:
- Utilized a generalized estimating equations framework for multiple imputation of clinical attachment loss data at non-selected tooth sites.
- Applied periodontitis case definitions to imputed "complete" dentitions.
- Employed a multiple imputation-bootstrap procedure for point and variance estimation.
- Evaluated the method using pseudo-partial-mouth samples from the 2013-2014 National Health and Nutrition Examination Survey (NHANES).
Main Results:
- Multiple imputation, when applied to partial-mouth samples, showed a tendency to overestimate periodontitis mean extent (9.5% for 84 sites) and prevalence (5-10%).
- Despite overestimation in specific scenarios, the method provided less biased estimates compared to direct application of full-mouth definitions to partial-mouth samples.
Conclusions:
- Multiple imputation offers a promising statistical approach to mitigate estimation bias inherent in partial-mouth recording for periodontitis.
- This method has broad applicability for various periodontitis measures and sampling protocols, enhancing the accuracy of oral disease surveillance.
