Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada.
J Public Health Dent. 2011 Fall;71(4):335-44. doi: 10.1111/j.1752-7325.2011.00278.x. Epub 2011 Aug 17.
This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra-examiner reliability scores from the initial standardization sessions.
Study examiners were trained to use a modified International Caries Detection and Assessment System II system to detect the visual signs of non-cavitated and cavitated dental caries in adult subjects. Dental caries was classified as no caries (S), non-cavitated caries (D1), enamel caries (D2), and dentine caries (D3). Three standardization sessions involving 60 subjects and 3,604 tooth surface calls were used to calculate several measures of examiner reliability.
The prevalence of dental caries observed in the standardization sessions ranged from 1.4 percent to 13.5 percent of the coronal tooth surfaces examined. Overall agreement between pairs of examiners ranged from 0.88 to 0.99. An intra-class coefficient threshold of 0.60 was surpassed for all but one examiner. Inter-examiner unweighted kappa values were low (0.23-0.35), but weighted kappas and the ratio of observed to maximum kappas were more encouraging (0.42-0.83). The highest kappa values occurred for the S/D1 versus D2/D3 two-level classification of dental caries, for which seven of the eight examiners achieved observed to maximum kappa values over 0.90. Intra-examiner reliability was notably higher than inter-examiner reliability for all measures and dental caries classifications employed.
The methods and results for the initial examiner training and standardization sessions for two large clinical trials are reported. Recommendations for others planning examiner training and standardization sessions are offered.
本报告介绍了参与两项龋齿临床研究的口腔检查者的培训情况，并报告了初始标准化阶段的组内和组间检查者可靠性评分。
研究检查者接受了使用改良的国际龋齿检测和评估系统 II 系统来检测成年受试者中非龋性和龋性龋齿的视觉征象的培训。龋齿分为无龋齿（S）、非龋性龋齿（D1）、釉质龋齿（D2）和牙本质龋齿（D3）。三个标准化阶段涉及 60 名受试者和 3604 个牙面检查，用于计算几项检查者可靠性测量指标。
标准化阶段观察到的龋齿患病率范围为被检查牙冠表面的 1.4%至 13.5%。两位检查者之间的总体一致性范围为 0.88 至 0.99。除一位检查者外，所有检查者的组内系数阈值均超过 0.60。组间未加权 Kappa 值较低（0.23-0.35），但加权 Kappa 值和观察到的最大 Kappa 值之比更令人鼓舞（0.42-0.83）。S/D1 与 D2/D3 两级龋齿分类的 Kappa 值最高，其中 8 位检查者中有 7 位的观察到的最大 Kappa 值超过 0.90。所有测量指标和龋齿分类的组内可靠性明显高于组间可靠性。
报告了两项大型临床试验初始检查者培训和标准化阶段的方法和结果。为计划检查者培训和标准化阶段的其他人提供了建议。
