Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample

Tonello, Aline Sampieri; Silva, Renato Pereira da; Assaf, Andréa Videira; Ambrosano, Gláucia María Bovi; Peres, Silvia Helena de Carvalho Salles; Pereira, Antônio Carlos; Meneghim, Marcelo de Castro

doi:10.1590/1980-5497201600020005

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Another aspect that deserves attention is the caution when interpreting kappa coefficients in some situations. For instance, in the studied sample, the kappa coefficient is influenced by the prevalence of the health condition 23,24 . In the present study, the mean of DMFT was considered low, ranging from 0.98 to 1.68, depending on the examination method and the group of examiners.…”

Section: Discussionmentioning

confidence: 61%

“…For instance, in the studied sample, the kappa coefficient is influenced by the prevalence of the health condition. 23,24 In the present study, the mean of DMFT was considered low, ranging from 0.98 to 1.68, depending on the examination method and the group of examiners. Similarly, the prevalence of severe and very severe malocclusion ranged from 14% to 18%, according to the DAI classification.…”

Section: Discussionmentioning

confidence: 92%

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Reliability analysis using the in‐lux examination method for dental indices in adolescents for use in epidemiological studies

Pinto

Vettore

Abreu

et al. 2022

Comm Dent Oral Epid

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ObjectiveTo evaluate the in‐lux examination method to assess the reliability of examiners for oral health surveys.MethodsA calibration study involving 10 examiners and 27 patients was conducted, and high‐quality photographs of dental epidemiological indices were projected. The latter refers to the in‐lux examination method. Two groups, comprised of five examiners each, were trained to assess dental caries (DMFT index) and malocclusion (DAI). The first group carried out in vivo (clinical) and in‐lux examinations in the same patients. The second group performed in‐lux examinations only. The measurements were repeated to obtain intraexaminer weighted kappa coefficients.ResultsInterexaminer weighted kappa coefficients of the in vivo examination method for DMFT and DAI ranged from 0.597 to 0.851 and from 0.574 to 0.844, respectively. The values for in‐lux examination were between 0.440 and 0.856 (DMFT) and between 0.524 and 0.783 (DAI). The intraexaminer kappa coefficients of the in vivo examination method ranged between 0.569 and 0.851 (DMFT) and between 0.644 and 0.834 (DAI). In the in‐lux method, these values were between 0.426 and 0.831 (DMFT) and between 0.341 and 0.838 (DAI). Three examiners did not reach the minimum acceptable kappa value (k = 0.610) for DMFT, and one for DAI. Of these, one examiner managed to reach the minimum kappa coefficient for DMFT after additional training. The three others maintained the kappa coefficients at lower than acceptable limits.ConclusionsCalibration, using both in vivo and in‐lux examination methods, was able to discriminate the examiners regarding their reliability to reproduce dental indices. The in‐lux examination method was considered reliable and can replace the in vivo examination method. The in‐lux method might be more feasible to evaluate the reliability of examiners when clinical calibration is unrealistic due to logistic issues and when a large number of examiners are involved in the survey.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 92%

Reliability analysis using the in‐lux examination method for dental indices in adolescents for use in epidemiological studies

Pinto

Vettore

Abreu

et al. 2022

Comm Dent Oral Epid

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“…The general percentage of agreement (GPA) and Cohen's Kappa (k) statistics are the most frequently used tests in oral health surveys 1,2 . Cohen's Kappa statistics are calculated from square matrices 2x2, 3x3, 4x4, and so forth, and may be influenced by current development patterns of dental caries in samples [3][4][5][6][7] . Therefore, the prevalence of dental caries in oral health surveys deserves special attention, and a truly representative sample for reproducibility studies must cover the entire spectrum of dental caries 1,7 .…”

Section: Introductionmentioning

confidence: 99%

Dental caries surveys

et al. 2022

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Aim: To evaluate the impact of the recording of teeth whose clinical conditions rarely vary (anterior teeth and third molars) in inter-examiner agreement measurements. Methods: Clinical data from 56 schoolchildren, 12 years of age, previously collected by two examiners, according to the “Oral Health Surveys: basic methods” codes and criteria, were analyzed in the present study. The effects from including/excluding such teeth upon reproducibility were measured by general percentage agreement (GPA) and Kappa statistics (к) performances. Results: The exclusion of anterior teeth associated with the inclusion of third molars produced a decrease in GPA that was simultaneous to an increase in the weighted Kappa (nominal data) and simple (dichotomous data) values. The incorrect inclusion of third molars (GPA = 100%; к = + 1) in the reproducibility measurement artificially increased the inter-examiner Kappa values. Conclusion: The inclusion/exclusion of anterior teeth and third molars, seeking a more reliable agreement among examiners, can have a positive or negative impact on the measured reproducibility values. A clear warning about the impact of including third molars in the reproducibility measurement, in the 12 years old age group, should be performed in “Oral Health Surveys: basic methods” and similar manuals.

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“…The general percentage agreement (GPA) and kappa statistics have been proposed for this task. 2 The extent of agreement between examiners or raters is referred to as "inter-rater reliability (IRR)". IRR is, to a greater or lesser degree, a concern in most large-scale studies due to the fact that multiple individuals collecting data may experience and interpret the phenomena of interest differently.…”

Section: Introductionmentioning

confidence: 99%

Building team agreement on large population surveys through inter-rater reliability among oral health survey examiners

et al. 2018

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Background: Oral health surveys conducted on a very large population involve many examiners who must be consistent in scoring different levels of an oral disease. Prior to the oral health survey implementation, a measurement of inter-rater reliability (IRR) is needed to know the level of agreement among examiners or raters. Purpose: This study aimed to assess the IRR using consensus and consistency estimates in large population oral health surveys. Methods: A total of 58 dentists participated as raters. The benchmarker showed the clinical sample for dental caries and community periodontal index (CPI) score, with the raters being trained to carry out a calibration exercise in dental phantom. The consensus estimate was measured by means of a percent agreement and Cohen’s Kappa statistic. The consistency estimate of IRR was measured by Cronbach’s alpha coefficient and intraclass correlation. Results: The percent agreement is 65.50% for photographic slides of dental caries, 73.13% for photographic slides of CPI and 78.78% for calibration of dental caries using phantom. There were statistically significant differences between dental caries calibration using photographic slides and phantom (p<0.000), while the consistency of IRR between multiple raters is strong (Cronbrach’s Alpha: >0.9). Conclusion: A percent agreement across multiple raters is acceptable for the diagnosis of dental caries. Consistency between multiple raters is reliable when diagnosing dental caries and CPI.

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Interexaminer agreement dental caries epidemiological surveys: the importance of disease prevalence in the sample

Abstract: A virtual sample of 60 individuals, under caries prevalence of 50%, seems feasible to produce a satisfactory interexaminer agreement at epidemiological conditions. However, epidemiological studies to corroborate or refute this assertion are necessary.

Cited by 6 publications

References 7 publications

Reliability analysis using the in‐lux examination method for dental indices in adolescents for use in epidemiological studies

Reliability analysis using the in‐lux examination method for dental indices in adolescents for use in epidemiological studies

Dental caries surveys

Building team agreement on large population surveys through inter-rater reliability among oral health survey examiners

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