Concordance in Diagnosis of Periodontitis in Diabetic Patients Between an Indirect Method Based on a Photograph of the Oral Cavity and a Direct Method Based on the Clinical Examination of This Oral Cavity (Reference).

For the indirect method, two expert dentists will independently analyze the photographs in order to decide whether YES / NO the patient has parodontitis.

For the direct method by clinical examination, an expert dentist different from those involved in the indirect method will decide whether YES / NO the patient has parodontitis.

Positive predictive value = True Positive / (True Positives+False Positives)

Negative predictive value = True Negative / (False Negatives + True Negatives)

Positive predictive value = True Positive / (True Positives+False Positives)

Negative predictive value = True Negative / (False Negatives+True Negatives)

Evaluation of the photograph by two expert dentists who check compliance with the rules established for taking the photo.

During the research or at its conclusion, the data collected on the persons who lend themselves to it and transmitted to the sponsor by the investigators (or any other specialized intervening parties) will be made anonymous. Under no circumstances will the names of the persons concerned or their addresses appear in clear text. The patient will be identified only by a unique seven-digit identification number. A list of subject identifications will be kept in the investigator's file. The investigator will ensure that the anonymity of each individual participating in the study is guaranteed. No identifying information will be given to any third party other than those who are authorized by law to hold such information (and who are bound by professional secrecy).

Two expert dentists will check compliance with the rules established for taking the photo. For sufficient diagnostic quality, the gums must be clearly visible. "Periodontal disease" describes all gingivitis and periodontitis. Gingivitis is characterized by gingival inflammation manifested by redness of the gums, bleeding and localized edema. The inflammatory process only affects the superficial periodontium (gingival epithelium and gingival connective tissue) and is most often due to an accumulation of bacterial plaque. However, it can be reversed with specific oral hygiene measures. When the deep periodontal tissues (alveolar bone, periodontal ligament, cementum) are affected it is called periodontitis. These lesions are clinically characterized by gingival inflammation and a periodontal pocket (space that is created between the tooth and the gum) as well as by bone loss.

Evaluation of the photograph by two expert dentists who check compliance with the rules established for taking the photo. Is the image sharpness good enough to clearly visualize the patient's gums? YES/NO

Evaluation of the photograph by two expert dentists who check compliance with the rules established for taking the photo. Was the flash used ? YES/NO

Evaluation of the photograph by two expert dentists who check compliance with the rules established for taking the photo.Was the zoom used? YES/NO

Evaluation of the photograph by two expert dentists who check compliance with the rules established for taking the photo. Was the photo taken from full front view ? YES/NO

The number of photographs that meet all the above acceptance criteria will be converted into a percentage.

Diabetic findings according to the following criteria recorded for each patient included:

• the type of hospitalization (day or week)

Diabetic findings according to the following criteria recorded for each patient included:

-the type of diabetes (Type I, Type II or other)

Diabetic findings according to the following criteria recorded for each patient included:

• Age of diabetes: <1 year, 1-5 years, 5-10 years, 10-20 years, >20 years

Diabetic findings according to the following criteria recorded for each patient included:

-treatment: insulin therapy yes/no and the drug used (metformin, hypoglycemic sulfonamides, dipeptidyl peptidase IV inhibitors, SGLT2 inhibitors, GLP1 analogues, other) will be recorded.

Diabetic findings according to the following criteria recorded for each patient included:

• the patient's HbA1c level will be recorded in mmol/mol

Diabetic findings according to the following criteria recorded for each patient included:

-Presence of macrovascular complications will be recorded as YES/NO

Diabetic findings according to the following criteria recorded for each patient included:

-The type of macrovascular complication : arteriopathy (cerebral, coronary, lower limbs) will be recorded

Diabetic findings according to the following criteria recorded for each patient included:

-presence of microvascular complications, YES/NO

Diabetic findings according to the following criteria recorded for each patient included:

-The type of microvascular complication (retinopathy, nephropathy, neuropathy) will be recorded

Diabetic findings according to the following criteria recorded for each patient included:

• the patient's smoking status (active/number of cigarettes per day/ex-smoker) will be recorded

Diabetic findings according to the following criteria recorded for each patient included:

Presence of periodontitis (yes/no) according to the reference method, i.e. by odontological examination.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Inflammatory color of the gum The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Root tartar The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Pus The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Bleeding The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Interdental space The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Retraction of the gum The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Gum swelling The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Evaluation of clinical signs visible on the photos of diabetic patients diagnosed with periodontitis according to the gold standard (odontological examination):

-Dental plaque The evaluation will be interpreted by two blinded expert dentists (different from the one who performed the odontological examination) at the end of the inclusion period.

Observation of the photographs by two expert dentists.

Male/female

In years

Inpatients/Outpatients

Periodontitis / gingivitis / healthy

Lives alone / Lives with family or nearby / Homeless

Primary / Secondary / Graduate / Post-graduate

Employed / Full-time/ Part-time/ Unemployed

Type 1 / Type 2 / Unknown / Other

More than 20 years / 10 to 20 years / 5 to 10 years / Less than 5 years / Unknown

YES / NO

YES / NO / Don't know

YES / NO / Don't know

YES / NO / Don't know

GFR between 60 and 89 ml/min/1.73 m² GFR between 45 and 59 ml/min/1.73 m² GFR between 30 and 44 ml/min/1.73 m² GFR between 15 and 29 ml/min/1.73 m² GFR < 15 ml/min/1.73 m²

YES / NO

YES / NO

YES / NO / Don't know

YES / NO / Don't know

YES / NO / Don't know

Biguanides / Glucose-lowering sulfonamides / Glinides / Dipeptidyl Peptidase-IV / A-glucosidase inhibitors / SGLT2 inhibitors / None

Fast/ultra-fast insulin / Slow/ultra-slow insulin / GLP1 analogues / none

Yes / No If yes specify: Corticosteroids / Chemotherapy / Immunosuppressors / Immunomodulators / Targeted therapy

In kilos

In centimeters

Body Mass Index = kg/m2 where kg is the person's weight in kilograms and m2 is their height in metres squared.

Yes/ No < 10 cigarettes per day

≥ 10 cigarettes / day Smoking cessation Yes / No

Yes / No / Withdrawal

Mild liver disease: Yes / No Moderate to severe liver disease: Yes / No Cerebrovascular disease (excluding hemiplegia): Yes / No Venous insufficiency of the lower limbs: Yes / No Mesenteric vascular disease: Yes / No Renal artery vascular disease: Yes / No Aortic aneurysm : Yes / No Peptic ulcer disease : Yes / No Chronic lung disease : Yes / No Connectivitis: Yes / No Non-metastatic solid tumor : Yes / No Metastatic solid tumor : Yes / No Leukemia : Yes / No Lymphoma, Myeloma: Yes / No AIDS : Yes / No Organ transplant / Yes / No