title: Post-radiation dental index: development and reliability.
abstract: OBJECTIVE
  The aim of this paper was to develop, validate, and assess the reliability of a clinical index for assessing post-radiation dentition breakdown.
  
  
  METHODS
  An expert panel of four dentists with expertise in post-radiation patient care, oral radiology, and mineralized tissues reviewed a series of clinical photographs (n = 60) depicting a wide range of post-radiation lesions varying in size, severity, and location. Based on panel input related to lesion severity rankings and cut-points along a continuum of destruction, a semiquantitative, ordinal lesion scale was developed. A companion scale was developed to account for existing restorations. The index was then reviewed by a separate panel of dental clinician/researchers for confirmation of face and content validity and was refined based on their input. Following index approval by the expert and confirmatory panels, the index was evaluated for test-retest reliability by two educator/clinicians. After a brief calibration session, examiners reviewed and independently scored a second series of lesion images (n = 60). One week later, the same examiners independently scored the same images displayed in a different order. Inter- and intra-rater reliability and agreement were assessed (Spearman r and Kappa statistic).
  
  
  RESULTS
  Respective to sessions 1 and 2, inter-rater reliability values were r = 0.97 and r = 0.98, with Kappa values of kappa = 0.93 and kappa = 0.95. Respective intra-rater reliability and agreement values were 0.99 and 0.98 (rater 1), and 0.98 and 0.95 (rater 2).
  
  
  CONCLUSIONS
  A new index was developed and subsequently demonstrated face validity and excellent inter- and intra-rater reliability for potentially evaluating the severity of post-radiation dentition breakdown.
authors.affiliation: Department of Oral Biology and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA. walkermp@umkc.edu
authors.forename: Mary P
authors.initials: MP
authors.lastname: Walker
authors.forename: Karen B
authors.initials: KB
authors.lastname: Williams
authors.forename: Brian
authors.initials: B
authors.lastname: Wichman
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003753:Dental Health Surveys; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011832:Radiation Injuries / Q000145:classification*; D011859:Radiography; D015203:Reproducibility of Results; D014070:Tooth / Q000473:pathology / Q000528:radiation effects*; D017001:Tooth Demineralization / Q000000981:diagnostic imaging