ICDAS Training and Calibration Exercise in Adolescents and Young Adults

Objectives: To train and calibrate two dental examiners in the International Caries Detection and Assessment System (ICDAS), as preparation for a clinical study in dental caries.
Methods: Prior to the training and calibration exercise, 18-25 year-old Dominicans (N=111) were consented and screened by a reference examiner (UPR-IRB, protocol 0360114). A total of 74 individuals were selected: 26 for training and 48 for calibration. The first phase of training consisted of completion of the 90-min ICDAS eLearning Program, a 90-min lecture, assessment of clinical images and scoring of 100 coronal surfaces of posterior extracted teeth representing all ICDAS scores (Codes 0-6). During training and calibration, all visual examinations were conducted using optimal clinical facility/equipment including lighted dental mirrors, magnified dental loupes, headlights, and blunt WHO probes. All subjects received a dental prophylaxis by study personnel immediately prior to the examination. The second phase of the training session (2½-day) consisted of an examination of selected quadrants on 26 patients. During the training, trainee examiners were allowed discussion of the scores with the reference examiner. Intra-oral images were obtained to discuss surfaces with disagreements. Live data was entered using digital i-pads equipped with ICDAS Application Tool. Calibration was done on 48 patients following the same protocol, except that examiners were not allowed further discussion of scores. Weighted kappa coefficient was used to assess inter- and intra-examiner reproducibility. Approximately, 20% of the calibration participants were re-examined to determine intra-examiner reproducibility.
Results: Inter-examiner reliability (Cohen’s weighted Kappa) was 0.80-0.82. Intra-examiner reproducibility ranged from 0.81-0.87 (Wt Kappa) for the novice examiners and 0.97 (Wt Kappa) for the reference examiner.
Conclusions: Using this protocol novice trainees achieved substantial agreement (inter- and intra-examiner) using ICDAS to detect caries severity.