Accuracy of visible plaque identification by pediatric clinicians during well-child care

Abstract

Objectives: Assess pediatric providers' ability to identify visible plaque on children's teeth.

Methods: Pediatric providers (residents, nurse practitioners, and attendings) conducting well-child care on 15-month to 5-year-olds in an academic practice examined children's maxillary incisors for visible plaque (recorded yes/no). A dental hygienist then examined the children and recorded the degree of visible plaque present.

Results: The children's mean age was 34 months (±15 months), and 50% had visible plaque. Providers (n = 28) identified visible plaque on 39% of children (n = 118), with 55% sensitivity and 80% specificity, and agreement with hygienist measured as a κ score was 0.34. Subgroup analyses (based on provider training level, exam experience, child age, and plaque scores) did not appreciably improve sensitivity, specificity, positive predictive value, negative predictive value, or κ scores.

Conclusions: Visible plaque exams performed during well-child care may not be accurate. To comply with caries-risk assessment guidelines, providers require further education in oral exams.

Keywords: caries; child; dental hygienist; oral health; plaque; primary care; risk factors; toothbrushing.

Figure 1

Flow chart of screening protocol and enrollment. Abbreviations: WCC, well-child care; PCP, primary care provider. ^a The dental hygienist was often unavailable because she was occupied examining a different child.