Department of Dental Public Health, School of Dentistry, The University of Manchester, Manchester, UK.
Community Dent Oral Epidemiol. 2012 Jun;40(3):239-46. doi: 10.1111/j.1600-0528.2012.00671.x. Epub 2012 Mar 5.
The use of role substitution, where different levels of practitioner undertake the duties of the most qualified clinician, is common in medicine and dentistry. Proponents argue that role substitution has the potential to increase dentists' efficiency and effectiveness, thereby freeing up resources to improve access and reduce oral health inequalities. Given the current global economic climate, many countries are re-examining models of service provision to utilize role substitution. The objective of this study was to determine whether different members of the dental team could meet the diagnostic threshold set by the World Health Organization, when screening photographs of occlusal surfaces for dental caries.
Participants were sampled purposively and included; final-year dental students, final-year hygiene-therapy students, primary care dentists, hygiene-therapists and dental nurses. Following a brief training package, participants were asked to score 102 clinical photographs of both carious and noncarious extracted teeth and determine whether the tooth was 'healthy' or had 'suspected decay'. The time delay between consecutive photographs was set at 8-s. Judgment decisions were compared against the International Caries Detection and Assessment System as the gold standard, with scores of two or less representing 'healthy'. Sensitivity, specificity and predictive values were determined for each participant and clinical group. Kappa was calculated to determine test-retest reliability.
Dental nurses had the highest median sensitivity (87.9%), although all groups were comparable. The median specificity for the groups was lower than their sensitivity scores, with dentists scoring the highest (71.0%). Dentists also scored the highest median positive predictive value (57.8%), whilst dental nurses scored the highest negative predictive value (91.3%). The median level of agreement was high for all groups; the highest median score was for the final-year dental students (88.9%).
Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.
角色替代在医学和牙科中很常见，不同级别的从业者承担最合格临床医生的职责。支持者认为，角色替代有可能提高牙医的效率和效果，从而腾出资源来改善获得治疗的机会并减少口腔健康方面的不平等。鉴于当前的全球经济形势，许多国家正在重新审视服务提供模式，以利用角色替代。本研究的目的是确定牙科团队的不同成员是否可以满足世界卫生组织（WHO）设定的诊断阈值，即在筛选龋齿的咬合面照片时。
参与者是通过有针对性的抽样选择的，包括：牙科专业的最后一年学生、口腔卫生治疗专业的最后一年学生、初级保健牙医、口腔卫生治疗师和牙科护士。在接受简短的培训包后，参与者被要求对 102 张龋齿和非龋齿的牙列照片进行评分，并确定牙齿是“健康”还是“疑似有蛀蚀”。连续照片之间的时间延迟设置为 8 秒。将判断决策与国际龋齿检测和评估系统（作为金标准）进行比较，得分 2 或以下表示“健康”。为每个参与者和临床组确定了敏感性、特异性和预测值。计算 Kappa 以确定测试 - 重测的可靠性。
牙科护士的中位敏感性最高（87.9%），尽管所有组都相当。各组的中位特异性低于其敏感性评分，牙医的评分最高（71.0%）。牙医的中位阳性预测值也最高（57.8%），而牙科护士的阴性预测值最高（91.3%）。所有组的一致性中位数都很高；最后一年的牙科学生的中位数评分最高（88.9%）。
即使经过最少的培训，牙科团队的不同成员也有可能以与初级保健牙医相似的标准筛查磨牙龋病。这需要进一步的体内测试，但对未来牙科劳动力的生产力和设计具有重要意义。
