Clinical calibration of ICDAS visual examination in two geographical locations

Objectives: The purpose of this study was to calibrate clinical examiners in the use of the ICDAS (International Caries Detection and Assessment System) visual caries criteria. Methods: Previous calibration was done by the same examiners few months prior to the current study [Eggertsson et al: Caries Res 2005;39:299]. To further improve inter- and intra-examiner agreement additional training and calibration was undertaken separately at two different locations. Two examiners were trained by a senior examiner at each location. At the first location there were 59 subjects examined, and 16 repeated exams. At the second location 85 subjects were examined, and 21repeated (all age ranges 10-55 years). The second trainee examiner at the second location examined 56 subjects and repeated 7. Following brushing, the occlusal surfaces were examined, using the ICDAS criteria for lesion severity (0-6). Lesion activity was assessed as either active or non-active. Intra- and inter-examiner repeatability was assessed using Weighted Kappa (WK) statistics for severity and Kappa (K) statistics for activity assessment. Results: At the first location, intra-examiner repeatability (WK) was 0.84, 0.83, and 0.78 for the senior examiner and the two examiner, respectively, while at the second location the repeatability was 0.91, 0.91, 0.69, respectively. For activity the scores for Kappa were 0.89, 0.72, and 0.71 at the first location, but at the second location they were 0.75, and 0.86 for senior and first trainee examiner. Inter-examiner agreement of the trainees compared with senior examiner for severity was (WK) 0.70 and 0.65 at first location, but 0.81, and 0.72 at second location. For activity the inter-examiner agreement was (K) 0.69, 0.71, and 0.69, 0.67 at each location, respectively. Conclusions: Agreement within and between examiners was good for severity scoring as well as assessment of lesion activity. Supported by Curozone USA Inc.