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Specialists' agreement and construct validation of a visual scale for assessing mucosal healing after third molar
Julia Gomes Lucio de Araujo1, Beatriz Campos Pereira1, Lais Albuquerque Fernandes1
1School of Dentistry, Oral Surgery Department, Universidade de São Paulo, Av Prof. Lineu Prestes 2227 Cidade Universitária, CEP: 05508-000, São Paulo, Brazil.
Objective:
To present and validate a digital visual scale for evaluating mucosal wound repair after mandibular third molar extraction. The research seeks to establish a standard-based tool to improve communication in clinical practice and research by reducing subjectivity in postoperative assessments.
Materials And Methods:
A digital image scale using four clinical inflammatory stages (Scores 0 to 3) of recovering oral mucosa of tooth extractions sites was construct. Employing electronic forms (n = 300) were sent to dentists to assess agreement with the consensus score, and construct validity in six tooth extraction mucosal wounds examined by specialists or not. Construct validation involved specialists who evaluated the scale's utility, graphic quality, and clinical significance via a 5-point Likert scale. There was a total of eighty-three responses for the agreement consensus, and sixty-seven for construct validation.
Results:
The scale demonstrated a "fair" inter-rater agreement with a Fleiss' Kappa of 0.3018. The average agreement was 64.3%, with high agreement (> 80%) for advanced repair stages (Score 3) and greater variability for intermediate stages (Scores 1 and 2). Validation results showed high acceptance, with 96.6% of participants agreeing on the tool's utility for standardization. There was agreement between specialists and general practitioners. The initial scores may require further descriptive refinement to reduce interpretive overlap but under observer's calibration it can be used across different dental specialties.
Conclusions:
The proposed digital scale showed high professional acceptance and potential usefulness for standardizing the assessment of mucosal healing after third molar surgery.
Clinical Relevance:
By providing a standardized visual reference, this scale facilitates the early detection of healing deviations or postoperative complications and rationalizes clinical documentation in professional practice.