title: In vitro validity of the Dundee Selectable Threshold Method for caries diagnosis (DSTM).
abstract: OBJECTIVE
  It is not generally possible to assess diagnostic accuracy in dental surveys as no histological 'gold standards' are available, therefore examiner agreement tends to be used as a proxy for accuracy. The aim of this study was to investigate, using extracted teeth in arch models, the in vitro validity of a diagnostic system to assess caries at the D1 (enamel and dentine) and D3 (dentine) diagnostic thresholds, for epidemiological purposes.
  
  
  METHODS
  Two groups of 10 dental examiners trained in the use of the Dundee Selectable Threshold Method for caries diagnosis (DSTM) each examined (on two occasions) 160 extracted permanent molar and premolar teeth set in arch models in phantom heads according to the codes and criteria of the DSTM. The teeth were subsequently radiographed and sectioned to provide validation of the diagnoses.
  
  
  RESULTS
  Intra-examiner agreement according to the kappa statistic was substantial. In general terms the results of the in vitro validation exercise demonstrated significantly higher sensitivity values at the D1 diagnostic threshold than were found at the D3 diagnostic threshold with a consequent loss of specificity.
  
  
  CONCLUSIONS
  The results of this in vitro validation exercise demonstrate that at the D1 diagnostic threshold the sensitivity of the DSTM was greater than at the D3 threshold indicating no loss of diagnostic accuracy at the D1 threshold.
authors.affiliation: Dental Health Services Research Unit, Dental Hospital and School, Dundee, Scotland, UK. h.e.fyffe@dundee.ac.uk
authors.forename: H E
authors.initials: HE
authors.lastname: Fyffe
authors.forename: C
authors.initials: C
authors.lastname: Deery
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Nugent
authors.forename: N M
authors.initials: NM
authors.lastname: Nuttall
authors.forename: N B
authors.initials: NB
authors.lastname: Pitts
mesh_terms: D001641:Bicuspid / Q000000981:diagnostic imaging / Q000473:pathology; D004245:DMF Index; D003731:Dental Caries / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D066298:In Vitro Techniques; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D011861:Radiography, Dental / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012606:Scotland; D018709:Statistics, Nonparametric