Yamal Jose-Miguel, Mofleh Dania, Chuang Ru-Jye, Wang Mengxi, Johnson Kila, Garcia-Quintana Alejandra, Titiloye Tolulope, Nelson Suchitra, Sharma Shreela V
Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA.
Department of Epidemiology, Center for Health Equity, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA.
J Public Health Dent. 2025 Mar;85(1):13-20. doi: 10.1111/jphd.12648. Epub 2024 Dec 8.
This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting.
ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6-8 years old) in grades 1-2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0-6), lesion activity (active/inactive), and filling material (0-9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the "gold standard" trainer was evaluated using Kappa statistics.
For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71-0.82) and 0.82 (95% CI 0.77-0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58).
ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.
本文展示了国际龋病检测与评估系统（ICDAS）在小学环境中针对病变严重程度、活动情况及充填标准的培训程序以及检查者间/检查者内的可靠性。
在一项基于学校的整群随机对照试验之前，于2021年12月开展了ICDAS培训。从德克萨斯州休斯顿的一所学校招募了59名1 - 2年级的儿童（6 - 8岁）。两名持牌牙医在参与学校接受了来自ICDAS培训师的为期5天的培训。每名牙科实习生至少对38名儿童进行了一次评估，其中18名儿童接受了重复检查。使用ICDAS标准对所有可见的乳牙和恒牙表面的龋病病变严重程度（0 - 6）、病变活动情况（活跃/不活跃）及充填材料（0 - 9）进行分类。使用Kappa统计量评估每名牙科实习生与“金标准”培训师之间的检查者间及检查者内可靠性。
对于病变严重程度，与金标准检查者相比，每名实习检查者的检查者间加权Kappa值分别为0.77（95%置信区间0.71 - 0.82）和0.82（95%置信区间0.77 - 0.87）。Kappa值从第一次检查到第二次检查略有增加（病变加权Kappa值：从0.76增至0.84以及从0.82增至0.84）。检查者内可靠性显示，病变和充填方面具有出色的可靠性（0.83至0.94），活动情况方面为中等可靠性（0.58）。
ICDAS培训/校准对于确保龋病测量的准确性和可靠性至关重要。该研究表明，在社区环境中对没有先前标准经验的牙医进行ICDAS培训是可行的，并且可以实现高可靠性和可重复性。
