Enhancing an AI-Empowered Periodontal CDSS and Comparing with Traditional Perio-risk Assessment Tools

Periodontal disease (PD) is one of the most prevalent dental diseases. Fortunately, it can be prevented if identified early, especially for high-risk patients. Dental electronic health records (EHRs) could help develop a data-driven personalized prediction model using advanced machine learning development of clinical decision support system (CDSS) as in our Phase I, II AMIA-AI showcase. In phase II, we created a CDSS, the Perio-Risk Scoring system (PRSS), to help clinicians generate perio-scores and diagnoses and identify the influential factors. In Phase III (this study), we implemented and compared the patient's risk factors information in five periodontal risk assessment tools [periodontal risk assessment (PRA), PreViser, Sonicare, Cigna, and Periodontal Risk Scoring System (PRSS)]. We examined 1) agreement between the risk scores provided by each of the five risk assessment tools of 20 patients' information and 2) compare the risk scores provided by each tool to the original outcomes (five years outcomes). Fleiss Kappa, Cohen's Kappa, and percentage agreements were performed to determine the agreements between risk scores and original outcomes. We found a -1.24 Kappa value which indicates disagreement between the risk scores provided by five risk assessment tools. Compared to the original outcomes (five-year disease outcomes), PRSS provided the most accurate prediction (70%), followed by Previser (55%), PRA (35%), Phillips (35%), and Cigna (25%). We conclude that using advanced state-of-the-art informatics methods could help us utilize EHR data optimally to represent the current patient populations and their risk factors to provide the most accurate disease risk score. This may promote preventive strategies at the chairside, hoping to reduce PD prevalence, improve quality of life, and reduce healthcare costs.