Reasoning behind discrepancies in periodontal diagnosis and classification: A mixed-methods analysis

Area of Science:

• Dentistry
• Periodontology
• Dental Education

Background:

• Discrepancies in periodontal diagnosis and classification exist among dental providers.
• Cognitive reasoning processes behind these diagnostic discrepancies are underexplored.
• The 2017 Classification of Periodontal Conditions has highlighted existing diagnostic challenges.

Purpose of the Study:

• To investigate the underlying reasoning for errors in periodontal assessment and diagnosis among dental students.
• To analyze dental students' cognitive processes in diagnosing periodontal conditions, identifying risk factors, and staging periodontitis.
• To explore how dental students approach real-world periodontal case scenarios.

Main Methods:

• An observational study involving 138 dental students.
• Students responded to three open-ended questions (OEQs) on periodontal diagnosis, risk factors, and staging.
• Mixed-methods approach: quantitative descriptive statistics and qualitative content analysis of OEQ responses, visualized with alluvial plots.

Main Results:

• Only 28% correctly diagnosed gingivitis by integrating clinical and radiographic data.
• 38% identified smoking as the primary risk factor for periodontal disease.
• 72% accurately staged periodontitis as Stage III, with a tendency to overestimate severity by overlooking tooth loss and overemphasizing complexity.

Conclusions:

• Diagnosing gingivitis proved more challenging than staging periodontitis.
• Overreliance on single parameters (e.g., pocket depth) and difficulty integrating clinical-radiographic data led to misdiagnosis.
• Findings highlight the need for structured, case-based training to enhance diagnostic accuracy in periodontology.