CRA Grid - A preliminary development and calibration of a paper-based objectivization of caries risk assessment in undergraduate dental education

Abstract

Context: Caries risk assessment (CRA) varies between students and faculty due to the subjectivity inherent in the process as well as in the critical thinking skills required for the processing of information. Aims: The aim was to develop a paper-based, grid system, CRA-Grid, to objectivize and standardize risk assessment and to assess its rating agreement with the critical thinking process of the teachers. Settings and Design: The CRA-Grid was developed and tested in a clinical study, in Indira Gandhi Institute of Dental Sciences, Puducherry. Materials and Methods: Based on the currently available evidence, specific weightages were assigned to the risk factors in an existing CRA form. A 10 × 10 paper grid was created incorporating these weightages. Shading and summing up the respective squares in the grid provided a percentage score. The class interval of percentage indicating the risk status was determined using historical clinical data. After training, the students performed CRA of 57 patients by using the CRA-Grid. Six faculties were blinded to these scores and assessed the risk by critical thinking process. Statistical Analysis Used: Cohen's weighted kappa (k) for inter-rater agreement was run using Graph Pad QuickCalcs. Results: Cohen's weighted kappa for agreement at 95% confidence interval, between the CRA-Grid and critical thinking process, ranged from “good” to “very good.” Mean percentage of agreement of the six faculty was 79.6%; and with caries grid, was 80.5%. Conclusions: Risk assessment with the paper-based, objectivized, CRA-Grid matched that done by critical thinking process.

Testing the efficacy of a brief-caries risk assessment form to evaluate the dental health status among preschool children, Bangkok, Thailand

“…Therefore, in order to be more cost-effective, the present study excluded the unchangeable factors, water fluoridation and fluoride supplement and salivary testing for mutans streptococci levels. The results of the present study are consistent with the findings of Intarasompun et al [10] and Ramarao and Sathyanarayanan [13] which also adjusted the full version of caries risk assessment by AAPD by excluding some questions and salivary testing for cost-effectiveness yet also reported effectiveness in preventing dental caries. The IOC index and Cronbach's alpha from the present study registered high values, meaning that the brief-caries risk assessment form was a valid instrument.…”

“…The efficacy of the brief-caries risk assessment form is consistent with a previous research paper in Thailand [10] which also excluded the unchangeable factors, salivary test for mutans streptococci levels and oral examination and found that their form had the effectiveness to prevent dental caries. Furthermore, Ramarao and Sathyanarayanan found that excluding the salivary test in the caries risk assessment-grid for school children also prevented dental caries [13]. However, these previous studies administered the form with 2–5-year-old children [10] and school children [13], respectively.…”

“…Furthermore, Ramarao and Sathyanarayanan found that excluding the salivary test in the caries risk assessment-grid for school children also prevented dental caries [13]. However, these previous studies administered the form with 2–5-year-old children [10] and school children [13], respectively. Whereas the present study measured 6–12-month-old children.…”

“…Whereas the present study measured 6–12-month-old children. The present study selected 6–12-month-old children to assess caries risk because this age group is when an eruption of the dentition begins and is the best time to commence prevention strategies [4, 5, 13]. The present study did not exclude an oral examination in the brief-caries risk assessment form even though the oral examination needed a dentist or dental hygienist as a specialist because the oral examination was an important aspect of the prediction of caries risk [14].…”

“…The results of the present study confirm the effectiveness of caries risk assessment by AAPD. However, the full version of the caries risk assessment by the AAPD took time, used special equipment and a specialist and carried high costs that were not appropriate in public health [10, 13]. Therefore, in order to be more cost-effective, the present study excluded the unchangeable factors, water fluoridation and fluoride supplement and salivary testing for mutans streptococci levels.…”