Espelid I, Tveit A B
Faculty of Dentistry, Department of Odontology-Pedodontics, University of Bergen, Norway.
Acta Odontol Scand. 2001 Oct;59(5):285-9. doi: 10.1080/000163501750541147.
Radiographs of occlusal (n = 20) and approximal (n = 24) surfaces of extracted teeth were examined by 240 dentists before participating in continuing education courses dealing with caries diagnosis and treatment decisions. The radiographic caries diagnoses were treated in accordance with the receiver operating characteristic (ROC) technique, in which the area beneath the ROC curve (A, value) indicates the quality of the observations. The frequencies of false positives made in dentin radiographically were higher for approximal (20.7%) than for occlusal caries (12.3%). The quality of pooled radiographic diagnoses of occlusal dentin lesions for all observers was significantly better than diagnoses of approximal caries in dentin. A statistically significant relationship between the observer's qualities of diagnosis of caries on approximal and occlusal surfaces (P = 0.045) was found. For diagnosis of dentin caries on approximal surfaces the mean Cohen kappa was 0.74 (standard deviation (s), 0.12; range, 0.39-0.95), and the corresponding values for occlusal surfaces were 0.70 (s, 0.14; range, 0.25-0.98). In the material under study the dentists were at least as good at diagnosing dentin caries occlusally as approximally. To avoid overtreatment, the observer's diagnostic threshold should ideally be adjusted towards strict criteria when a positive diagnosis is synonymous with a filling. The diagnostic thresholds were stricter in diagnosing occlusal surfaces than for approximal surfaces, indicating a more optimal strategy among dentists while diagnosing occlusal dentin lesions in a population with low caries prevalence.
240名牙医在参加有关龋齿诊断和治疗决策的继续教育课程之前，对拔除牙齿的咬合面（n = 20）和邻面（n = 24）的X光片进行了检查。X光片龋齿诊断采用接受者操作特征（ROC）技术进行处理，其中ROC曲线下面积（A值）表明观察的质量。邻面龋齿在X光片上牙本质出现假阳性的频率（20.7%）高于咬合面龋齿（12.3%）。所有观察者对咬合面牙本质病变的X光片综合诊断质量明显优于邻面龋齿诊断。发现观察者对邻面和咬合面龋齿的诊断质量之间存在统计学显著关系（P = 0.045）。对于邻面牙本质龋齿的诊断，平均Cohen kappa为0.74（标准差（s），0.12；范围，0.39 - 0.95），咬合面的相应值为0.70（s，0.14；范围，0.25 - 0.98）。在所研究的材料中，牙医对咬合面牙本质龋齿的诊断能力至少与邻面诊断能力一样好。为避免过度治疗，当阳性诊断等同于补牙时，理想情况下观察者的诊断阈值应调整为严格标准。诊断咬合面时的阈值比邻面更严格，这表明在龋齿患病率低的人群中，牙医在诊断咬合面牙本质病变时采用了更优化的策略。
