Influence of examiner experience on clinical performance of visual inspection in detecting and assessing the activity status of caries lesions

Oper Dent. Nov-Dec 2013;38(6):583-90. doi: 10.2341/12-067-C. Epub 2013 Apr 25.


Our hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy.

MeSH terms

  • Child
  • Child, Preschool
  • Clinical Competence*
  • Dental Caries / diagnosis*
  • Dental Caries Activity Tests
  • Dentists / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Observer Variation
  • Pediatric Dentistry / statistics & numerical data
  • Students, Dental / statistics & numerical data