Examiner performance in calibration exercises compared with field conditions when scoring caries experience

Area of Science:

• Oral Health
• Epidemiology
• Biostatistics

Background:

• Accurate caries experience (CE) scoring is crucial for public health surveillance.
• Calibration exercises aim to standardize examiner performance before data collection.
• The validity of pre-survey calibration in reflecting actual field performance requires investigation.

Purpose of the Study:

• To compare the validity of misclassification measurements from pre-survey calibration with those from field conditions.
• To identify factors influencing the accuracy of caries scoring in different settings.

Main Methods:

• Utilized data from the 'Smile for Life' oral health intervention study in Flemish children.
• Conducted a pre-survey calibration exercise with 32 children and 8 examiners.
• Collected validation data in field conditions, with benchmark scorer re-examining screened children.
• Employed generalized estimating equations to analyze sensitivity and specificity, accounting for clustering.

Main Results:

• Sensitivity scores were significantly lower in field conditions compared to pre-survey calibration (p < 0.01).
• Examiner, tooth type (molars lower sensitivity), and tooth position (lower jaw lower sensitivity) influenced sensitivity.
• Examiner, tooth type (molars lower specificity), and surface type (occlusal lower specificity) influenced specificity.
• The validation setting did not significantly influence specificity.

Conclusions:

• Misclassification measurements for caries experience scoring are influenced by multiple factors.
• Pre-survey calibration results should be interpreted cautiously as they may not fully represent field performance.
• Lower sensitivity observed in field conditions highlights potential challenges in accurate caries detection during actual surveys.