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Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers

  • Joon Soo Park
  • Estie Kruger
  • Wendy Nicholls
  • Mohamed Estai
  • John Winters
  • Marc Tennant
Original Article
  • 61 Downloads

Abstract

Objectives

To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners.

Materials and methods

As part of a quality assurance program, intra-oral photographs were obtained from 77 patients (2–18 years) as part of a CDE before undertaking dental treatment under general anaesthesia. A DSLR camera was utilised to acquire images which were subsequently uploaded to a cloud-based server. The baseline for each participant was established during the CDE, utilising both visual and radiographic examination, which was then compared to the assessment made by a mid-level dental practitioners (MLDP). The evaluation was based on utilising an odontogram where the teeth were charted either as decayed or filled.

Results

Specificity (95%) was higher than sensitivity (61.5%) when comparing the photographic assessment with the benchmark CDE assessment. The inter-rater reliability between the two methods of assessment was substantial, with a kappa score of 0.62. The photographic assessment method underestimated the decayed and filled teeth, as observed by the caries experience (dft/DFT scores) (CDE = 7.01 vs. photographic assessment = 5.22). There were lower levels of diagnostic detection in the posterior teeth as compared to the anterior teeth assessments.

Conclusions

Although the CDE is still considered to be the gold-standard, this study found that the photographic caries assessment by MLDP produced an acceptable diagnostic level of detection particularly for the anterior teeth.

Clinical relevance

The photographic method could offer a potential cost-saving and user-friendly screening.

Keywords

Caries Radiography Photograph Dental screening Paediatric oral health 

Notes

Acknowledgements

We want to thank the staff at the Dental Department, Princess Margaret Hospital, Australia, for their kind assistance. Furthermore, we would like to acknowledge Dr. Matthew Payne for his assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This quality activity-based study was approved by the Princess Margaret Hospital for Children (Clinical Governance Number - 14107).

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Tennant M, Kruger E (2014) Turning Australia into a ‘flat-land’: what are the implications for workforce supply of addressing the disparity in rural-city dentist distribution? Int Dent J 64:29–33CrossRefGoogle Scholar
  2. 2.
    Spencer AJ (2004) Narrowing the inequality gap in oral health and dental care in Australia. Australian Health Policy Institute, University of SydneyGoogle Scholar
  3. 3.
    Tennant M, Kruger E (2013) A national audit of Australian dental practice distribution: do all Australians get a fair deal? Int Dent J 63:177–182CrossRefGoogle Scholar
  4. 4.
    Australian Institute of Health and Welfare (AIHW) (2016) Oral health and dental care in Australia: key facts and figures 2015. AIHW. https://www.aihw.gov.au/getmedia/57922dca-62f3-4bf7-9ddc-6d8e550c7c58/19000.pdf.aspx?inline=true. Accessed 18 Jan 2018
  5. 5.
    Brocklehurst PR, Ashley JR, Tickle M (2011) Patient assessment in general dental practice - risk assessment or clinical monitoring? Br Dent J 210:351–354CrossRefGoogle Scholar
  6. 6.
    Brocklehurst P, Ashley J, Walsh T, Tickle M (2012) Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol 40:239–246CrossRefGoogle Scholar
  7. 7.
    Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P (2015) The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res 94:70s–78sCrossRefGoogle Scholar
  8. 8.
    Watt RG, Williams DM, Sheiham A (2014) The role of the dental team in promoting health equity. Br Dent J 216:11–14CrossRefGoogle Scholar
  9. 9.
    Sigal A, Sigal MJ, Lam EW (2014) The importance of the initial comprehensive dental examination. J Can Dent Assoc 80:e45PubMedGoogle Scholar
  10. 10.
    Estai M, Kruger E, Tennant M (2016) Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia. Int Dent J 66:195–200CrossRefGoogle Scholar
  11. 11.
    Fricton J, Chen H (2009) Using teledentistry to improve access to dental care for the underserved. Dent Clin N Am 53:537–548CrossRefGoogle Scholar
  12. 12.
    Estai M, Kanagasingam Y, Huang B, Checker H, Steele L, Kruger E, Tennant M (2016) The efficacy of remote screening for dental caries by mid-level dental providers using a mobile teledentistry model. Community Dent Oral Epidemiol 44:435–441CrossRefGoogle Scholar
  13. 13.
    Estai M, Winters J, Kanagasingam Y, Shiikha J, Checker H, Kruger E, Tennant M (2016) Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model. Br Dent J 221:411–414CrossRefGoogle Scholar
  14. 14.
    Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Bunt S, Kruger E, Tennant M (2017) End-user acceptance of a cloud-based teledentistry system and android phone app for remote screening for oral diseases. J Telemed Telecare 23:44–52CrossRefGoogle Scholar
  15. 15.
    Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, Tennant M (2016) A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases. J Telemed Telecare 22:319–325CrossRefGoogle Scholar
  16. 16.
    World Health Organization (WHO) (2013) Oral health surveys : basic methods. http://www.who.int/oral_health/publications/9789241548649/en/. Accessed 18 Jan 2018
  17. 17.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  18. 18.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRefGoogle Scholar
  19. 19.
    Boye U, Willasey A, Walsh T, Tickle M, Pretty IA (2013) Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children. Community Dent Oral Epidemiol 41:526–533CrossRefGoogle Scholar
  20. 20.
    Elfrink ME, Veerkamp JS, Aartman IH, Moll HA, Ten Cate JM (2009) Validity of scoring caries and primary molar hypomineralization (DMH) on intraoral photographs. Eur Arch Paediatr Dent 10:5–10CrossRefGoogle Scholar
  21. 21.
    Gomez J, Zakian C, Salsone S, Pinto SC, Taylor A, Pretty IA, Ellwood R (2013) In vitro performance of different methods in detecting occlusal caries lesions. J Dent 41:180–186CrossRefGoogle Scholar
  22. 22.
    Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM (2007) Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent 29:209–213PubMedGoogle Scholar
  23. 23.
    Hoskin ER, Keenan AV (2016) Can we trust visual methods alone for detecting caries in teeth? Evid Based Dent 17:41–42CrossRefGoogle Scholar
  24. 24.
    Keenan JR, Keenan AV (2016) Accuracy of dental radiographs for caries detection. Evid Based Dent 17:43CrossRefGoogle Scholar
  25. 25.
    Pereira AC, Eggertsson H, Martinez-Mier EA, Mialhe FL, Eckert GJ, Zero DT (2009) Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries-detection methods. Eur J Oral Sci 117:51–57CrossRefGoogle Scholar
  26. 26.
    Mialhe FL, Pereira AC, Meneghim Mde C, Tagliaferro EP, Pardi V (2009) Occlusal tooth surface treatment plans and their possible effects on oral health care costs. Oral Health Prev Dent 7:211–216PubMedGoogle Scholar
  27. 27.
    Estai M, Bunt S, Kanagasingam Y, Kruger E, Tennant M (2016) Diagnostic accuracy of teledentistry in the detection of dental caries: a systematic review. J Evid Based Dent Pract 16:161–172CrossRefGoogle Scholar
  28. 28.
    World Health Organization (WHO) (2012) Oral health. http://www.who.int/mediacentre/factsheets/fs318/en/. Accessed 18 Jan 2018
  29. 29.
    Wong HM, McGrath CP, King NM, Lo EC (2011) Oral health-related quality of life in Hong Kong preschool children. Caries Res 45:370–376CrossRefGoogle Scholar
  30. 30.
    Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bonecker M, Raggio DP (2011) Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol 39(2):105–114CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Paediatric Oral Health Research Group, UWA Dental SchoolThe University of Western AustraliaCrawleyAustralia
  2. 2.International Research Collaborative - Oral Health and EquityThe University of Western AustraliaCrawleyAustralia
  3. 3.Dental DepartmentPrincess Margaret Hospital for ChildrenSubiacoAustralia

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