Examiner reliability of fluorosis scoring: a comparison of photographic and clinical examination findings

Abstract

Objective To assess and compare examiner reliability of clinical and photographic fluorosis examinations using the Fluorosis Risk Index (FRI) among children in the Iowa Fluoride Study (IFS). Methods The IFS examined 538 children for fluorosis and dental caries at age 13 and obtained intra-oral photographs from nearly all of them. To assess examiner reliability, duplicate clinical examinations were conducted for 40 of the subjects. In addition, 200 of the photographs were scored independently for fluorosis by two examiners in a standardized manner. Fluorosis data were compared between examiners for the clinical exams and separately for the photographic exams, and a comparison was made between clinical and photographic exams. For all 3 comparisons, examiner reliability was assessed using kappa statistics at the tooth level. Results Inter-examiner reliability for the duplicate clinical exams on the sample of 40 subjects as measured by kappa was 0.59, while the repeat exams of the 200 photographs yielded a kappa of 0.64. For the comparison of photographic and clinical exams, inter-examiner reliability, as measured by weighted kappa, was 0.46. FRI scores obtained using the photographs were higher on average than those obtained from the clinical exams. Fluorosis prevalence was higher for photographs (33%) than found for clinical exam (18%). Conclusion Results suggest inter-examiner reliability is greater and fluorosis scores higher when using photographic compared to clinical examinations.

Agreement between photographic and clinical examinations in detecting developmental defects of enamel in infants

“… and Cruz‐Orcutt et al . found only moderate agreement (Kappa = 0.48 and 0.46, respectively) between two methods suggesting that the photographic method detects significantly more DDE than the clinical examination method.…”

“…The photographic method may facilitate blinded examinations to avoid observer bias and enable repeated examinations by multiple researchers even remote from the study site . Most studies have demonstrated a high reliability of photographic methods for assessing DDE with high intra‐ and inter‐examiner reliability although one study reported a relatively lower inter‐examiner reliability .…”

Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal

“…21 New research has been developed out in order to establish new methodologies and protocols in epidemiological surveys, 23 aiming to improve diagnosis using photographs. Some studies 6,18 conclude that the method using photographs is more reproducible and reliable than clinical examinations and can be used to diagnose dental fluorosis.…”

Validation of ICMR index for identification of dental fluorosis in epidemiological studies

“…In another study conducted to assess dental fluorosis by digital photography using T-F index criteria, inter-examiner reliability ranged between 0.4-0.713. In other studies, investigators have tried to compare different indices for assessment of dental fluorosis or to develop different methods for assessment of dental fluorosis and the kappa values were found to range between 0.5 to 11415.…”