The Development of a Deep Learning Model based on Textual

Longitudinal Electronic Health Records to Detect Periodontal

Disease

Swinckels, L.1,2,3,4, Bijwaard, H.3,5, Kalenderian, E.6,7,8 Keijzer, de A.4,9 Bruers, J.J.M. 1,10
1. Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije
Universiteit Amsterdam, the Netherlands
2. Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences,
Amsterdam, the Netherlands
3. Medical Technology Research Group, Inholland University of Applied Sciences
4. Data Driven Smart Society Research Group, Inholland University of Applied Sciences,
Alkmaar, the Netherlands.
5. National Institute for Public Health and the Environment, Bilthoven, The Netherlands
6. University of California at San Francisco (UCSF), San Francisco, CA, USA
7. Harvard School of Dental Medicine (HSDM), Boston, MA, USA
8. University of Pretoria School of Dentistry, Pretoria, South Africa
9. Data Science and ICT Research Group, Avans University of Applied Sciences, Breda, the
Netherlands
10. Royal Dutch Dental Association (KNMT), Utrecht, the Netherlands
Abstract
Background: Periodontal disease (PD) is a preventable disease with early screening and targeted
interventions. Screening for PD is a returning diagnostic task for dental professionals and requires
patient information, clinical signs, causal- and risk factors. Due to individual variation in clinical
manifestation and the fact that many patients seem clinically asymptomatic until it has become severe,
screening for periodontitis can be challenging for dental professionals. Electronic dental records (EDR)
include relevant factors and have the potential to support PD screening. However, the dramatic increase
in the amount of available data, hinders clinicians from reviewing and therefore, information can be
missed. Deep learning is able to analyze large-scale textual EDRs. In our preliminary review, deep
learning attempts on EHRs in other health areas are scoped. Deep learning yields a high detecting
accuracy, is able to detect diseases earlier than diagnosed, and generates the most important features. A
detection based on textual EHRs can support preliminary screening, without additional impact on the
patient and clinician by using existing data, and thus reducing the workflow. As far as we know, deep
learning has not yet been applied to textual EDRs for the early detection of PD.
Objective: The aim of this research is to develop a deep learning model to detect periodontal disease in
textual, longitudinal EDRs in dentistry.
Methods: This retrospective case-control study will use de-identified EDR data from patients who
received oral healthcare at dental schools in the United States. Patients are defined as cases or controls,
based on diagnosis- and treatment registrations. Their full EDRs will be extracted to trace the
evolvement of the disease over time. Input variables (i.e., possible predictors) include demographics,
vitals, dental procedures, dental diagnoses, medical state, periodontal data and medication, collected in
the Bigmouth repository. By learning from patterns in the data, a neural network is developed (80%
training set), by combining technical engineering and dental expertise. The ability of the developed
model to detect PD in EDRs (outcome), will be evaluated with a 20% test set by performance metrics
AUROC, sensitivity and specificity. The full process from EDR extraction to personalized risk
predictions will be presented.
Results: Preliminary results from our neural network will be presented. The most recent performance
metrics for PD detection and the top most important predictors will be shown.
Conclusion: Deep learning on EDRs will provide insights into the development of the disease and may
provide an earlier detection. Applying this developed model to new data, a personalized risk assessment
can be generated for the concerned patient to support dental professionals. Due to the use of imperfect
data in dental EHR, this work is of practical relevance because it highlights the value of the currently
registered data.

Keywords: artificial intelligence, digital support, dentistry, early detection, prevention.

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