title: Quality assurance study of caries risk assessment performance by clinical faculty members in a school of dentistry.
abstract: The goal of this quality assurance study was to explore the decision making of clinical faculty members at the University of California, San Francisco School of Dentistry predoctoral dental clinic in terms of caries risk level assignment using the caries risk assessment (CRA) as part of the Caries Management by Risk Assessment (CAMBRA) concept. This research was done in part to determine if additional training and calibration were needed for these faculty members. The study tested the reliability and reproducibility of the caries risk levels assigned by different clinical teachers who completed CRA forms for simulated patients. In the first step, five clinical teachers assigned caries risk levels for thirteen simulated patients. Six months later, the same five plus an additional nine faculty members assigned caries risk levels to the same thirteen simulated and nine additional cases. While the intra-examiner reliability with weighted kappa strength of agreement was very high, the inter-examiner agreements with a gold standard were on average only moderate. In total, 20 percent of the presented high caries risk cases were underestimated at caries levels too low, even when obvious caries disease indicators were present. This study suggests that more consistent training and calibration of clinical faculty members as well as students are needed.
authors.affiliation: Dr. Rechmann is Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Featherstone is Professor, Department of Preventive and Restorative Dental Sciences, and Dean, School of Dentistry, University of California, San Francisco. Peter.Rechmann@ucsf.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Rechmann
authors.affiliation: Dr. Rechmann is Professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Featherstone is Professor, Department of Preventive and Restorative Dental Sciences, and Dean, School of Dentistry, University of California, San Francisco.
authors.forename: John D B
authors.initials: JD
authors.lastname: Featherstone
mesh_terms: D058491:Bacterial Load; D002138:Calibration; D003657:Decision Making; D003731:Dental Caries / Q000145:classification / Q000209:etiology*; D003733:Dental Caries Susceptibility; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000473:pathology; D003750:Dental Fissures / Q000145:classification; D003773:Dental Plaque / Q000145:classification; D003793:Dental Restoration, Permanent / Q000145:classification; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology; D004498:Education, Dental, Continuing; D005179:Faculty, Dental; D005247:Feeding Behavior; D006305:Health Status Indicators; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification; D015588:Observer Variation; D011785:Quality Assurance, Health Care; D011859:Radiography; D015203:Reproducibility of Results; D018570:Risk Assessment; D012463:Saliva / Q000378:metabolism; D012575:Schools, Dental; D013295:Streptococcus mutans / Q000302:isolation & purification
keywords: CAMBRA; caries; caries risk assessment; clinical faculty; dental education; dental faculty; quality assurance