title: The quantification of dental plaque using an image analysis system: reliability and validation.
abstract: OBJECTIVE
  Established clinical indices used to measure dental plaque have limitations. The aim of this study was to develop and evaluate a new method of quantitative plaque measurement, with increased sensitivity and reproducibility, using a purpose designed image analysis system.
  
  
  METHODS
  After plaque disclosure, the patient was positioned in a cephalometric head holder mounted in a custom-built frame with standard lighting and camera position. A 32-bit Digital Camera grabbed the image of the patient's teeth, which was analysed using Adobe Photoshop (V5.02, Adobe Systems Ltd, Europe) and Image Pro Plus software (V4.0, Media Cybernetics, USA). Measurements were made on 120 incisors in 15 patients and reproducibility was assessed using Fliess' Coefficient of Reliability. Sensitivity was assessed by comparison of results of treatment effects from a clinical trial involving 30 patients. Analysis of covariance was used to compare the image analysis system with the Turesky modification of the Quigley and Hein plaque index and the Addy plaque area index.
  
  
  RESULTS
  The results were within the 'Excellent Reliability' category, for inter-operator reproducibility and intra-operator repeatability.
  
  
  CONCLUSIONS
  This new system provided accurate quantitative measurements of dental plaque and labial tooth surfaces and was shown to have increased sensitivity when compared with the Turesky modification of the Quigley and Hein plaque index and the Addy plaque area index. The stored images can be re-measured for reliability and comparability between studies.
authors.affiliation: Department of Child Dental Health, University of Sheffield, School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK. R.Smith@Sheffield.ac.uk
authors.forename: R N
authors.initials: RN
authors.lastname: Smith
authors.forename: A H
authors.initials: AH
authors.lastname: Brook
authors.forename: C
authors.initials: C
authors.lastname: Elcock
mesh_terms: D000704:Analysis of Variance; D003773:Dental Plaque / Q000175:diagnosis*; D003774:Dental Plaque Index; D004311:Double-Blind Method; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D007180:Incisor; D015588:Observer Variation; D023861:Photography, Dental; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity