Effect of different diagnostic thresholds on dental caries calibration.
OBJECTIVE
(a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values.


METHODS
A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity.


METHODS
Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used.


METHODS
WHO and WHO+IL diagnostic thresholds according to tooth and dental surface.


RESULTS
Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL.


CONCLUSIONS
It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.
Assaf
Andréa Videira
AV
Departamento de Odontologia Social, Avenida Limeira 901, Piracicaba, SP, Brazil.
Meneghim
Marcelo de Castro
Mde C
Zanin
Luciane
L
Cortelazzi
Karine Laura
KL
Pereira
Antonio Carlos
AC
Ambrosano
Gláucia Maria Bovi
GM
D019985:Benchmarking; D002138:Calibration; D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000175:diagnosis*; D003945:Diagnosis, Oral / Q000193:education / Q000592:standards; D006801:Humans; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity