The Effect of Calibration on Caries Risk Assessment Performance by Students and Clinical Faculty

Abstract

Caries management requires a complete oral examination and an accurate caries risk assessment (CRA). Performing Caries Management by Risk Assessment (CAMBRA) is inefficient when the caries risk level assignment is incorrect. The aim of this study was to evaluate the ability of faculty members and students at one U.S. dental school to correctly assign caries risk levels for 22 CRA cases, followed by calibration with guidelines on how to use the CRA form and a post-calibration test two months after calibration. Inter-examiner reliability to a gold standard (consensus of three experts) was assessed as poor, fair, moderate, good, and very good. Of the 162 students and 125 faculty members invited to participate, 13 students and 20 faculty members returned pre-calibration tests, for response rates of 8% and 16%, respectively. On the post-calibration test, eight students and 13 faculty members participated for response rates of 5% and 10%, respectively. Without guidelines and calibration, both faculty members and students when evaluated as one group performed only poor to fair in assigning correct caries risk levels. After calibration, levels improved to good and very good agreements with the gold standard. When faculty and students were evaluated separately, in the pre-calibration test they correctly assigned the caries risk level on average in only one-quarter of the cases (students 24.1%±13.3%; faculty 23.6%±17.5%). After calibration, both groups significantly improved their correct assignment rate. Faculty members (73.8% correct assignments) showed even significantly higher correct assignment rates than students (47.7% correct assignments). These findings suggest that calibration with a specific set of guidelines improved CRA outcomes for both the faculty members and students. Improved guidelines on how to use a CRA form should lead to improved caries risk assessment and proper treatment strategy for patients.

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

“…Students tend to conclude directly without understanding the process or the significance of every risk factor. [89] It is vital that they are trained in critical thinking skills and clinical reasoning so that they can emulate the thought process of an expert in decision making. [92324] Such training is best provided in a staged manner as per the Dreyfus skill acquisition model.…”

“…[7] Without calibration, the faculty and the students tend to assign caries risk inconsistently. [8] Critical thinking skills required are not similar between an expert and a novice. [9] The variation can also be attributed to the inherent subjectivity and to the multifactorial nature of the disease.…”

Conceptualization of dental caries by dental students is related to their preventive oral care routine

“…Also, a higher percentage of clinical students, compared to preclinical students, reported brushing at school. All students (first through fourth year) learned and tested the same cariology concepts in their first year including how to determine and classify caries risk using a standardized form based on CAMBRA 33 . The standard of care in the dental clinic includes a CRA on the patient electronic records, thus, CRA is part of everyday practice for third‐year and fourth‐year students.…”

“…Students were instructed to “ conceptualize (define) dental caries in your own words (Minimum 2 sentences) .” Multiple choice questions regarding daily oral care habits were based on previously published surveys 31,32 (Tables 3−5). Self‐risk determination was determined by the caries risk assessment (CRA) chart implemented at MWU‐CDMI, which is based on CAMBRA (Caries Management by Risk Assessment) form 33 . This method centers on disease indicators, caries risk, and protective factors.…”

Determinación del riesgo de caries en niños menores de 5 años en escuelas del sector norte de Quito, Ecuador

“…Estos, en general, demuestran resultados similares al da presente investigación (7,13,17) . Sin embargo, es fundamental contar con un personal evaluador capacitado en presentar esas preguntas a los padres y con conocimiento para la identificación de ciertos aspectos básicos cuando se trata de considerar preguntas sobre la morfología de las superficies dentales (18,19) , presentando algunos problemas en la subestimación del riesgo, sobre todo en la evaluación clínica (20) .…”