Graph representation of the oral cavity as a method for screening the general condition of the patient

Vollständiger Abstract

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AIM. To analyze the ability of the oral cavity, represented as a patient–tooth graph and processed by a graph neural network, to reflect systemic health, using the detection of concomitant cardiovascular disease as an example. MATERIALS AND METHODS. On a large population-based cohort, each patient was represented as a heterogeneous patient – tooth graph encoding periodontal status and dentition configuration, and a Heterogeneous Graph Transformer with attention was trained. The capacity of the structure to carry a systemic signal was probed two ways: ablation of the graph structure while keeping the aggregate DMFT index and the graph contribution in a dental-chair scenario (“age, sex + tooth graph” vs “age and sex only”). The cardiovascular example comprised atherosclerotic cardiovascular disease (ASCVD) and chronic heart failure (CHF); discrimination was assessed by AUC with the DeLong test and applicability by an operating point. RESULTS. The cardiovascular signal resided in the graph structure: removing the tooth structure while keeping the DMFT index significantly reduced AUC for both cardiovascular outcomes – CHF (−0.024; p = 0.026) and ASCVD (−0.011; p = 0.032). In the dental-chair scenario the graph yielded an AUC gain of +0.083 for CHF ( p = 2 × 10 - ⁴) and +0.030 for ASCVD ( p = 1.5 × 10 - ⁵); at ~0.80 sensitivity the model reached 0.70–0.74 specificity and 0.97–0.99 negative predictive value. CONCLUSION. This is the first confirmation that a graph representation of the oral cavity can be “read” as a map of systemic health: the cardiovascular signal lies in the structure of the dentition and is irreducible to aggregate indices. Periodontal examination is applicable as a screening point for concomitant cardiovascular disease with referral to a physician.