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Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys

机译:在流行病学调查中使用视觉龋齿检测系统的检验员的实验室培训

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摘要

Abstract Background In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys. Methods A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces). Results Regarding the reproducibility, the mean (range) of kappa values was 0.781 (0.529–0.927) for occlusal surfaces, 0.568 (0.191–0.881) for smooth surfaces, and 0.844 (0.698–0.971) for proximal surfaces. Considering all lesions, sensitivity and specificity mean values were respectively 0.724 and 0.844 for occlusal, 0.635 and 0.943 for smooth and 0.658 and 0.927 for proximal surfaces. For detecting advanced lesions, sensitivities and specificities were 0.563 and 0.920 for occlusal, 0.670 and 0.985 for smooth, and 0.838 and 0.985 for proximal surfaces. Conclusion The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.
机译:摘要背景在流行病学调查中,检查人员关于龋齿检测方法的良好可靠性至关重要。然而,训练和校准那些检查者是一项艰巨的任务,因为它涉及到许多接受过多次检查的患者。为了促进这一步骤,我们旨在提出一种实验室方法,以模拟在流行病学调查中使用国际龋齿检测和评估系统(ICDAS)检测龋齿病变的检查。方法基准审查员进行了所有培训。在七个牙弓模型中设置了总共67颗脱落的乳牙(从声音到粗大的空化),以模拟整个牙列。 16名检查员(研究生)仅使用ICDAS的冠状初级龋齿评分,两次使用颊镜和球形探头在照明下评估了牙齿的所有表面。作为参考标准,两名不同的检查员通过直接目视检查评估了近端表面,将它们按声音分类,包括非空洞或空洞病变。之后,沿颊舌方向切开牙齿,然后检查者在体视显微镜下对切面进行评估,并根据病变深度对咬合和光滑表面进行分类。使用加权κ评估检查者间的可重复性。在两个阈值处计算敏感性和特异性:所有病变和晚期病变(近端表面的空洞性病变以及在咬合和光滑表面到达牙本质的病变)。结果关于可再现性,咬合面的kappa值的平均值(范围)为0.781(0.529-0.927),光滑面的kappa值的平均值(范围)为0.568(0.191-0.881),而近端的kappa值的平均值为0.844(0.698-0.971)。考虑到所有病变,咬合的敏感性和特异性平均值分别为0.724和0.844,光滑度分别为0.635和0.943,近端表面分别为0.658和0.927。为了检测晚期病变,咬合的敏感性和特异性分别为0.563和0.920,光滑度为0.670和0.985,近端表面为0.838和0.985。结论旨在培训和定标使用ICDAS对学龄前儿童进行龋病流行病学调查的几名检查员的方法是可行的,从而可以在调查发展之前评估检查员的可靠性和准确性。

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