Examiner calibration in caries detection where in vivo calibration is not practical.

Objectives: To study caries diagnostic methods for examiner calibration in populations and settings where clinical in vivo calibration is not practical. Objectives: (1) Can photographs alone be used in the training and calibration of examiners without adversely affecting data quality? This was achieved by assessing examiner reliability in caries diagnosis using: (a) Photographs of caries lesions sourced from the ICDAS e-Learning programme and (b) In vivo community-based examination of children’s teeth. (2) To compare caries diagnosis using intra-oral photographs of selected tooth surfaces with their corresponding in vivo community examination scores – systematic differences
Methods: Study design was cross-sectional and fully-crossed. The units of analysis were 880 tooth surfaces, from ten children ages 3 to 4 years. The study had three data components: (1) Examiner training and calibration using the ICDAS e-Learning programme (2) In vivo community-based visual examination and (3) Intra-oral digital photographs of the same tooth surfaces from the in vivo visual examination. Dental caries was assessed using ICDAS. Kappa and weighted kappa scores were used to study reliability estimates. Systematic differences in caries assessments were determined using the Stuart Maxwell test.
Results: e-Learning photograph Kappa scores for inter-examiner reliability ranged from 0.56 to 0.70 and intra-examiner from 0.74-1.00. In-vivo examination-weighted kappa scores for inter-examiner reliability ranged from 0.50 to 0.64 and intra-examiner from 0.64-0.74.
Conclusions: From this research, it appears that good quality photographs alone may be used for training and calibration among challenging populations or settings, without adversely affecting data quality