To prove that Caries Management by Risk Assessment (CAMBRA) can be successfully implemented in dental practices outside of the university setting, dentists in the San Francisco Bay Area (CA) were approached to participate in a Practice Based Research Network (PBRN) study. The overall goal of the CAMBRA-PBRN study was to recruit 30 dentists to perform a two-year study involving approximately 900 patients. Goal of the calibration study was to standardize and calibrate dentists potentially participating in the CAMBRA-PBRN study.
To minimize inter-examiner variability in data collection, including classification of carious lesions and recording of existing restorations, participating dentists were trained and calibrated in accurate DMFS (decayed, missing, filled surfaces) charting. Dentists were also trained and calibrated to diagnose and differentiate between sound surfaces and non-cavitated caries lesions (International Caries Detection and Assessment - ICDAS scores 1 and 2) for posterior occlusal surfaces.
Thirty dentists were calibrated to a single gold standard examiner (BJ) during 6 calibration sessions, between 2011 and 2014. Kappa statistics were used to determine inter-examiner reliability on 13 or more patients, aged 12–63 (average age 38 ± 15 years), per examiner during each session, resulting in 94 patient encounters over the course of all 6 sessions. To participate in the main study, examiners needed to achieve a minimum required kappa of 0.75. During the calibration process, examiners scored between 1036 and 2220 tooth surfaces.
The kappa values (unweighted kappa) of the participating dentists compared to the gold standard examiner ranged from 0.75 to 0.90, with an average kappa of 0.84 ± 0.03. 90% of the examiners achieved overall kappa values above 0.8. However, separate reliability for assessment of non-cavitated lesions, as in other studies, was lower (0.55 ± 0.15). Multiple subcategories were evaluated. All dentists reached sufficient reliability values to proceed into the study; nevertheless, one dentist discontinued with the study due to scheduling conflicts.
The high inter-examiner reliability results have shown that dentists who work in primarily non-research based practices can be effectively standardized and calibrated in data collection, based on specific guidelines created to anticipate potential research study scenarios.
Brostek AM, Bochenek AJ, Walsh LJ. Minimally invasive dentistry: a review and update. Shanghai Kou Qiang Yi Xue. 2006;15(3):225–49. PubMed
Mertz-Fairhurst EJ, Adair SM, Sams DR, Curtis JW Jr, Ergle JW, Hawkins KI, et al. Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults. ASDC J Dent Child. 1995;62(2):97–107. PubMed
Rechmann P, Domejean S, Rechmann BM, Kinsel R, Featherstone JD. Approximal and occlusal caries lesions: restorative treatment decisions by California dentists. J Am Dent Assoc. 2016;147(5):328–38. doi: https://doi.org/10.1016/j.adaj.2015.10.006. CrossRefPubMed
Featherstone JD, White JM, Hoover CI, Rapozo-Hilo M, Weintraub JA, Wilson RS, et al. A randomized clinical trial of anticaries therapies targeted according to risk assessment (caries management by risk assessment). Caries Res. 2012;46(2):118–29. doi: https://doi.org/10.1159/000337241. CrossRefPubMedPubMedCentral
Pitts NB, Ekstrand KR, Foundation I. International caries detection and assessment system (ICDAS) and its international caries classification and management system (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol. 2013;41(1):e41–52. doi: https://doi.org/10.1111/cdoe.12025. CrossRefPubMed
Featherstone JD, Domejean-Orliaguet S, Jenson L, Wolff M, Young DA. Caries risk assessment in practice for age 6 through adult. J Calif Dent Assoc. 2007;35(10):703–7. 10-3 PubMed
Featherstone JD. The caries balance: contributing factors and early detection. J Calif Dent Assoc. 2003;31(2):129–33. PubMed
Domejean S, White JM, Featherstone JD. Validation of the CDA CAMBRA caries risk assessment--a six-year retrospective study. J Calif Dent Assoc. 2011;39(10):709–15. PubMed
Domejean-Orliaguet S, Gansky SA, Featherstone JD. Caries risk assessment in an educational environment. J Dent Educ. 2006;70(12):1346–54. PubMed
Chaffee BW, Cheng J, Featherstone JD. Baseline caries risk assessment as a predictor of caries incidence. J Dent. 2015;43(5):518–24. doi: https://doi.org/10.1016/j.jdent.2015.02.013. CrossRefPubMedPubMedCentral
ICDAS. Rationale and evidence for the international caries detection and assessment system (ICDAS II) international caries detection and assessment system (ICDAS) coordinating committee. 2005/2012.
Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The international caries detection and assessment system (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35(3):170–8. doi: https://doi.org/10.1111/j.1600-0528.2007.00347.x. CrossRefPubMed
Klein H, Palmer CE, Knutson JW. Studies on dental caries. I. Dental status and dental needs of elementary school children. Pub. Health Rep. 1938;53(19):751–65. CrossRef
World-Health-Organization. Oral health surveys: basic methods. World Health Organization. Geneva: Monograph Series World Health Organization; 2013.
Warren JJ, Weber-Gasparoni K, Tinanoff N, Batliner TS, Jue B, Santo W, et al. Examination criteria and calibration procedures for prevention trials of the early childhood caries collaborating centers. J Public Health Dent. 2015;75(4):317–26. doi: https://doi.org/10.1111/jphd.12102. CrossRefPubMedPubMedCentral
CARIN. CAries Research INstrument Software Package. Tech ID: 19030 / UC Case 2009–035-0 San Francisco: Regents of the University of California; c2009 http://techtransfer.universityofcalifornia.edu/NCD/19030.html.
Nelson S, Eggertsson H, Powell B, Mandelaris J, Ntragatakis M, Richardson T, et al. Dental examiners consistency in applying the ICDAS criteria for a caries prevention community trial. Community Dent Health. 2011;28(3):238–42. PubMed
Sbaraini A, Evans RW. Caries risk reduction in patients attending a caries management clinic. Aust Dent J. 2008;53(4):340–8. doi: https://doi.org/10.1111/j.1834-7819.2008.00076.x. CrossRefPubMed
Deery C, Ellwood R, Gomez J, Kolker J, Manton D, McGrady M et al. ICCMS™ guide for practitioners and educators. 2014. http://www.icdas.org/uploads/ICCMS-Guide.
Imrey PB, Kingman A. Analysis of clinical trials involving non-cavitated caries lesions. J Dent Res. 2004;83 Spec No C:C103-8. PubMed
Braga MM, Oliveira LB, Bonini GA, Bonecker M, Mendes FM. Feasibility of the international caries detection and assessment system (ICDAS-II) in epidemiological surveys and comparability with standard World Health Organization criteria. Caries Res. 2009;43(4):245–9. doi: https://doi.org/10.1159/000217855. CrossRefPubMed
Vollmer WM, Papas AS, Bader JD, Maupome G, Gullion CM, Hollis JF, et al. Design of the Prevention of adult caries study (PACS): a randomized clinical trial assessing the effect of a chlorhexidine dental coating for the prevention of adult caries. BMC Oral Health. 2010;10:23. CrossRefPubMedPubMedCentral
- Calibration of dentists for Caries Management by Risk Assessment Research in a Practice Based Research Network - CAMBRA PBRN
Beate M. T. Rechmann
John D. B. Featherstone
- BioMed Central
Neu im Fachgebiet Zahnmedizin
Mail Icon II