title: Performance of a quality assurance program for assessing dental health in methamphetamine users.
abstract: BACKGROUND
  Systematic characterization of the dental consequences of methamphetamine (MA) abuse presupposes a rigorous quality assurance (QA) program to ensure the credibility of the data collected and the scientific integrity and validity of the clinical study. In this report we describe and evaluate the performance of a quality assurance program implemented in a large cross-sectional study of the dental consequences of MA use.
  
  
  METHODS
  A large community sample of MA users was recruited over a 30 month period during 2011-13 and received comprehensive oral examinations and psychosocial assessments by site examiners based at two large community health centers in Los Angeles. National Health and Nutrition Examination Survey (NHANES) protocols for oral health assessments were utilized to characterize dental disease. Using NHANES oral health quality assurance guidelines, examiner reliability statistics such as Cohen's Kappa coefficients and inter-class correlation coefficients were calculated to assess the magnitude of agreement between the site examiners and a reference examiner to ensure conformance and comparability with NHANES practices.
  
  
  RESULTS
  Approximately 9% (n = 49) of the enrolled 574 MA users received a repeat dental caries and periodontal examination conducted by the reference examiner. There was high concordance between the reference examiner and the site examiners for identification of untreated dental disease (Kappa statistic values: 0.57-0.75, percent agreement 83-88%). For identification of untreated caries on at least 5 surfaces of anterior teeth, the Kappas ranged from 0.77 to 0.87, and percent agreement from 94 to 97%. The intra-class coefficients (ICCs) ranged from 0.87 to 89 for attachment loss across all periodontal sites assessed and the ICCs ranged from 0.79 to 0.81 for pocket depth. For overall gingival recession, the ICCs ranged from 0.88 to 0.91. When Kappa was calculated based on the CDC/AAP case definitions for severe periodontitis, inter-examiner reliability for site examiners was low (Kappa 0.27-0.67).
  
  
  CONCLUSIONS
  Overall, the quality assurance program confirmed the procedural adherence of the quality of the data collected on the distribution of dental caries and periodontal disease in MA-users. Examiner concordance was higher for dental caries but lower for specific periodontal assessments.
authors.affiliation: National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, MD, USA. bruce.dye@nih.gov.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Dye
authors.affiliation: Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. laurenharrell@ucla.edu.|Oral & Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA. laurenharrell@ucla.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Harrell
authors.affiliation: Integrated Substance Abuse Programs, University of California Los Angeles, Los Angeles, CA, USA. DMurphy@mednet.ucla.edu.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Murphy
authors.affiliation: Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. tbelin@mednet.ucla.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Belin
authors.affiliation: Oral & Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA. vshetty@ucla.edu.
authors.forename: Vivek
authors.initials: V
authors.lastname: Shetty
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000453:epidemiology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D009749:Nutrition Surveys; D009909:Oral Health / Q000706:statistics & numerical data*; D017622:Periodontal Attachment Loss / Q000453:epidemiology; D010514:Periodontal Pocket / Q000453:epidemiology; D010518:Periodontitis / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000592:standards; D016388:Tooth Loss / Q000453:epidemiology
chemical_list: D008694:Methamphetamine