title: Relative performance of different dental professional groups in screening for occlusal caries.
abstract: OBJECTIVE
  The use of role substitution, where different levels of practitioner undertake the duties of the most qualified clinician, is common in medicine and dentistry. Proponents argue that role substitution has the potential to increase dentists' efficiency and effectiveness, thereby freeing up resources to improve access and reduce oral health inequalities. Given the current global economic climate, many countries are re-examining models of service provision to utilize role substitution. The objective of this study was to determine whether different members of the dental team could meet the diagnostic threshold set by the World Health Organization, when screening photographs of occlusal surfaces for dental caries.
  
  
  METHODS
  Participants were sampled purposively and included; final-year dental students, final-year hygiene-therapy students, primary care dentists, hygiene-therapists and dental nurses. Following a brief training package, participants were asked to score 102 clinical photographs of both carious and noncarious extracted teeth and determine whether the tooth was 'healthy' or had 'suspected decay'. The time delay between consecutive photographs was set at 8-s. Judgment decisions were compared against the International Caries Detection and Assessment System as the gold standard, with scores of two or less representing 'healthy'. Sensitivity, specificity and predictive values were determined for each participant and clinical group. Kappa was calculated to determine test-retest reliability.
  
  
  RESULTS
  Dental nurses had the highest median sensitivity (87.9%), although all groups were comparable. The median specificity for the groups was lower than their sensitivity scores, with dentists scoring the highest (71.0%). Dentists also scored the highest median positive predictive value (57.8%), whilst dental nurses scored the highest negative predictive value (91.3%). The median level of agreement was high for all groups; the highest median score was for the final-year dental students (88.9%).
  
  
  CONCLUSIONS
  Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.
authors.affiliation: Department of Dental Public Health, School of Dentistry, The University of Manchester, Manchester, UK. paul.brocklehurst@manchester.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: James
authors.initials: J
authors.lastname: Ashley
authors.forename: Tanya
authors.initials: T
authors.lastname: Walsh
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data; D003726:Dental Assistants / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000175:diagnosis; D003756:Dental Hygienists / Q000706:statistics & numerical data*; D003815:Dentists / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013335:Students, Dental / Q000706:statistics & numerical data*; D055815:Young Adult