Associations Between Systemic Diseases and Dental Pulp Diagnoses: A Retrospective Chart Study Using a Locally Deployed Large Language Model.

Objectives

The objectives of this study were as follows: (1) statistical investigation of the association between systemic diseases and dental pulp condition; and (2) utilization of locally running large language models (LLMs) to handle a large number of dental charts written in natural languages, while protecting patients' information.

Methods

A total of 5820 endodontic charts, including healthy controls and patients with a history of cancer, HIV, type 1 diabetes mellitus (DM), and type 2 DM, were selected from 15,147 samples. Using a local LLM environment, the dental charts from each group were classified into six categories: normal pulp (NP); reversible pulpitis (RP); asymptomatic irreversible pulpitis (AIP); symptomatic irreversible pulpitis (SIP); pulp necrosis (PN); and "others", including unclear diagnoses. The distributions of these diagnoses across groups were statistically analyzed.

Results

The prompt for the local LLM was repeatedly refined by classifying 400 test cases, resulting in 97.0% agreement with the judgments of three human dentists. The refined prompt was then applied to classify 5820 charts, followed by statistical analyses. Using a generalized linear mixed-effects model (GLMM), the cancer-history group showed a significantly higher NP and a lower AIP proportion, whereas the type 2 DM group showed a significantly lower AIP and a higher SIP proportion.

Conclusions

The findings in the cancer-history group could be attributable to a worsened oral environment in the patients and difficulties in diagnosing AIP. Meanwhile, the lower proportion of AIP and higher proportion of SIP in type 2 DM group may reflect pulpal inflammation associated with the disease. Additional attention may be warranted for caries' prevention and treatment in patients with type 2 DM.