IADR Abstract Archives
Measuring Preschool-age Children’s ICDAS-based Caries Experience: Examiners’ Training and Calibration
Objectives: Epidemiological investigations of early childhood oral health rely upon the collection of high-quality clinical measures of health and disease. Preschool-age children have a reduced ability to cope and cooperate with clinical research procedures compared to older children and adults, creating unique challenges for the ascertainment of valid and accurate clinical measures of caries experience in this group. Our objectives were to: a) report the training and calibration procedures and b) determine the performance of clinical examiners in the context of a large-scale genetic epidemiologic study of early childhood oral health.
Methods: The training of examiners included online and in-class didactic modules on the use of ICDAS and study-specific criteria, laboratory and clinical training sessions. Modified ICDAS criteria were used to record caries experience at the surface-level: healthy (ICDAS: 0), early-stage lesion (ICDAS: 1,2), established/severe lesion (ICDAS: 3-6), as well as the presence of sealants, various categories of restorations and missing teeth, and combinations of those. Children ages 3-6 whose guardians provided informed consent participated in the training and calibration. The threshold for calibration was based upon achievement of weighted kappas≥0.65 for inter- and ≥0.75 for intra-examiner agreement.
Results: Between August 2016 and September 2017, 10 clinical examiners (pediatric and general dentists, and dental hygienists) were trained and 9 of them were successfully calibrated. Two hundred thirty-six children contributing 20,317 tooth surfaces were jointly examined by a clinical examiner and the gold standard and 64 children contributing 5,178 surfaces had repeat exams, conducted in community settings. Median weighted kappas were—inter-examiner=0.75 and intra-examiner=0.79. Unsurprisingly, most discordances were between healthy and early-stage lesion diagnoses.
Conclusions: Valid and reliable measurement of dental caries experience in the primary dentition is feasible. Nevertheless, a considerable degree of variation is to be expected in the scoring of early-stage lesions among preschool-age children.
Methods: The training of examiners included online and in-class didactic modules on the use of ICDAS and study-specific criteria, laboratory and clinical training sessions. Modified ICDAS criteria were used to record caries experience at the surface-level: healthy (ICDAS: 0), early-stage lesion (ICDAS: 1,2), established/severe lesion (ICDAS: 3-6), as well as the presence of sealants, various categories of restorations and missing teeth, and combinations of those. Children ages 3-6 whose guardians provided informed consent participated in the training and calibration. The threshold for calibration was based upon achievement of weighted kappas≥0.65 for inter- and ≥0.75 for intra-examiner agreement.
Results: Between August 2016 and September 2017, 10 clinical examiners (pediatric and general dentists, and dental hygienists) were trained and 9 of them were successfully calibrated. Two hundred thirty-six children contributing 20,317 tooth surfaces were jointly examined by a clinical examiner and the gold standard and 64 children contributing 5,178 surfaces had repeat exams, conducted in community settings. Median weighted kappas were—inter-examiner=0.75 and intra-examiner=0.79. Unsurprisingly, most discordances were between healthy and early-stage lesion diagnoses.
Conclusions: Valid and reliable measurement of dental caries experience in the primary dentition is feasible. Nevertheless, a considerable degree of variation is to be expected in the scoring of early-stage lesions among preschool-age children.