Analysis of caries experience taking inter-observer bias and variability into account

In larger oral health surveys, clinical measurements are often obtained using several examiners. This raises the issue of inter-observer variability in measurement. Often, the problem is dealt with by reporting kappa values obtained in a calibration exercise. In the present study, the limitations of this statistic are presented, and an alternative, based on a Bayesian approach, is proposed. When the alternative approach was applied to caries experience data obtained in an oral health screening survey in seven-year-old Flemish children (Signal Tandmobiel study), it could be ruled out that the observed geographic East-West gradient was due to bias induced by variability in scoring of the different dental examiners involved. The proposed method offers an opportunity to refine existing analytical approaches and is relevant to any health outcome study.