Mojon P, Favre P, Chung J P, Budtz-Jörgensen E
Division of Gerodontology and Removable Prosthodontics, University of Geneva, Switzerland.
Gerodontology. 1995 Jul;12(1):49-55. doi: 10.1111/j.1741-2358.1995.tb00130.x.
Indices used to evaluate plaque accumulation and coronal caries have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of clinical criteria used in coronal and root caries diagnosis and oral hygiene evaluation as applied in elders. Nineteen elderly subjects, 73 years old on average, were examined at a first appointment by two independent examiners. They were re-examined two weeks later. Plaque accumulation was evaluated using the Plaque Index (PI) and coronal and root caries were detected according to the WHO criteria and Fejerskov et al. (1991), respectively. Recurrent caries was recorded as recommended by WHO and by probing at the interface tooth-restoration. Inter- and intra-examiner agreement was evaluated using kappa statistics. The PI score showed good reliability except for examiner b, for whom a simplification of the 4-point scale in 3-point scale improved significantly the reliability. The prevalence of coronal caries was very low and intra- and inter-examiner agreement was poor. Most of the root caries lesions were covered by plaque and the kappa values indicated only poor agreement. Recurrent caries were found with good agreement using WHO criteria but the detection with the probe was not reliable. In conclusion, it seems that examiners should be trained carefully to maximise their reliability and that plaque should be removed to obtain reliable diagnoses of caries. Retraining and calibration may be necessary for surveys continuing over a long period.
用于评估菌斑堆积和冠龋的指数在流行病学研究中已被广泛接受，但其可靠性无法得到保证。本研究的目的是评估用于老年人冠龋和根龋诊断及口腔卫生评估的临床标准的可靠性。19名平均年龄为73岁的老年受试者在首次就诊时由两名独立检查者进行检查。两周后对他们进行复查。使用菌斑指数（PI）评估菌斑堆积情况，并分别根据世界卫生组织（WHO）标准和费耶斯科夫等人（1991年）的标准检测冠龋和根龋。按照WHO的建议并通过探查牙齿修复体界面记录继发龋。使用kappa统计量评估检查者间和检查者内的一致性。PI评分显示出良好的可靠性，但检查者b除外，对于该检查者，将4分制简化为3分制可显著提高可靠性。冠龋的患病率非常低，检查者内和检查者间的一致性较差。大多数根龋损害被菌斑覆盖，kappa值表明一致性仅为差。按照WHO标准，继发龋的发现具有良好的一致性，但用探针检测不可靠。总之，似乎应该对检查者进行仔细培训以使其可靠性最大化，并且应该去除菌斑以获得可靠的龋病诊断。对于长期持续的调查，可能需要重新培训和校准。
