title: Accuracy of visible plaque identification by pediatric clinicians during well-child care.
abstract: OBJECTIVE
  Assess pediatric providers' ability to identify visible plaque on children's teeth.
  
  
  METHODS
  Pediatric providers (residents, nurse practitioners, and attendings) conducting well-child care on 15-month to 5-year-olds in an academic practice examined children's maxillary incisors for visible plaque (recorded yes/no). A dental hygienist then examined the children and recorded the degree of visible plaque present.
  
  
  RESULTS
  The children's mean age was 34 months (±15 months), and 50% had visible plaque. Providers (n = 28) identified visible plaque on 39% of children (n = 118), with 55% sensitivity and 80% specificity, and agreement with hygienist measured as a κ score was 0.34. Subgroup analyses (based on provider training level, exam experience, child age, and plaque scores) did not appreciably improve sensitivity, specificity, positive predictive value, negative predictive value, or κ scores.
  
  
  CONCLUSIONS
  Visible plaque exams performed during well-child care may not be accurate. To comply with caries-risk assessment guidelines, providers require further education in oral exams.
authors.affiliation: Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. sarah.dumas@chp.edu
authors.forename: S Amanda
authors.initials: SA
authors.lastname: Dumas
authors.forename: Katelynn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Park
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Polk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weyant
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
mesh_terms: D002662:Child Health Services; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D019140:Dental Care for Children; D003756:Dental Hygienists; D003773:Dental Plaque / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009722:Nurse Practitioners; D010372:Pediatrics; D058007:Physicians, Primary Care; D011320:Primary Health Care; D012680:Sensitivity and Specificity
keywords: caries; child; dental hygienist; oral health; plaque; primary care; risk factors; toothbrushing