Examiner agreement on periodontal indices during dental surveys of elders

Abstract

Indices used to evaluate periodontal health have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of periodontal indices applied on elders. 19 elderly subjects, 73-years-old on average, were examined at a 1st appointment by 2 independent examiners. They were re-examined 2 weeks later during a 2nd session. The examinations were performed in a dental chair with good illumination. Periodontal health was evaluated using the community periodontal index of treatment need, and tooth mobility was evaluated using 2 different indices. Inter and intra-examiner agreements were evaluated using kappa statistics. Taken as an overall measurement, the CPITN was a reliable assessment of periodontal treatment need in elders. Disagreement occurred mainly on the evaluation of bleeding and shallow pockets. The detection of fairly mobile teeth was reliable; however, the performance of the more sensitive scale was deceptive. it seems that, in the case of tooth mobility, a choice has to be made between sensitivity or reproducibility. It can be concluded that examiners should be trained carefully since the reliability of the CPITN and tooth mobility evaluation were good but close to a critical level for which an agreement is classified as poor.

Oral Disease, Impairment, and Illness: Congruence Between Clinical and Questionnaire Findings

“…Despite the low prevalence of that perception, the model showed good predictive ability for those reporting such migration. Our result is in accordance with other studies, in which CPI is regarded as a reliable assessment of periodontal disease (21).…”

The oral cleanliness and periodontal health of UK adults in 1998

“…Even with very simple indices, there are still difficulties for survey examiners. 4,5 Plaque and calculus can be difficult to see against a similarly coloured tooth surface, while measuring both periodontal pockets and loss of attachment simultaneously is a tiring and back straining process for the examiner. The pattern of the diseases is also complicated and makes reporting the data difficult, there being no simple indicator of disease experience and activity.…”

Quantitative tooth mobility evaluation based on intraoral scanner measurements

“…An excellent reliability was obtained testing different mobility as demonstrated by a high Cronbach alpha >0.9, and an inter‐examiner correlation between 0.75 ˃ x ˂ 0.9 (good) or >0.9 (excellent). Previous evaluation of mobility data were obtained based on a categorical data using 5 or 2 scores. The data were reported lower Cohen k varying from poor (0.4) to moderate (0.6) between two examiners with 19 patients .…”

“…Previous evaluation of mobility data were obtained based on a categorical data using 5 or 2 scores. The data were reported lower Cohen k varying from poor (0.4) to moderate (0.6) between two examiners with 19 patients . Higher values between two examiners based on the Pearson correlation coefficient of 0.86 was obtained with the first set of 26 patients and 0.98 with 24 patients after recalibration .…”

“…The agreement of the data reported by the analysis of correlation should be done with caution, since the coefficient shows the magnitude of the relationship, not the agreement. The reliability of the measurement depends on 1) the clarity of the criteria, 2) number of categories, and 3) training of the examiners . We here propose a process based on an objective measurement excluding the factors 1 and 2 that will generate an outcome restricted to the magnitude and the direction of the force applied by the operator.…”