Consistency and conformity in caries assessment among dental nurses in Anguilla, British West Indies

In Anguilla, dental nurses are responsible for providing oral healthcare for children until they reach 18 years of age. This study determined the diagnostic conformity and consistency in caries assessment among dental nurses trained to carry out an oral health survey of 6, 12 and 15-year-old schoolchildren.

Following training in caries diagnosis using slides, extracted teeth and visual-tactile examination, three dental nurses were calibrated by a benchmark examiner (BE) using modified WHO criteria. Conformity and consistency were assessed on four different occasions--on extracted teeth (T0) and in three different groups of children (at C0, D1 and D2) for subject (SB), tooth (TH) and surface (SF) using Kappa statistics.

Perfect agreement (kappa score of 1.0) was attained for all sound, decayed and filled lingual and buccal surfaces at D1 and D2 respectively. Levels of conformity (with and without BE) and consistency increased as the survey progressed. Accuracy level ranges for SB, TH and SF were .770-.935(T0), .895-.951(C0), .947-.989(D1) and .985-.993(D2) respectively. Kappa score of 1.0 was obtained by all three examiners for SB, TH and SF at D2. Identical accuracy levels were attained by all examiners for TH (.985) and SF (.993) at D2. Reliability levels for SB, TH and SF ranged from .972-.999(C0), .977-.996(D1) and was 1.0 at D2.

Substantial and almost perfect inter and intraexaminer agreements were attained at calibration, and maintained throughout the survey. Dental nurses in Anguilla can conduct valid and reliable child oral health surveys when adequate and appropriate training is provided.