Background: This was a method comparison study. The aim of study was to compare caries information obtained\r\nfrom a full mouth visual examination using the method developed by the British Association for the Study of\r\nCommunity Dentistry (BASCD) for epidemiological surveys with caries data obtained from eight, six and four\r\nintra-oral digital photographs of index teeth in two groups of children aged 5 years and 10/11 years.\r\nMethods: Five trained and calibrated examiners visually examined the whole mouth of 240 5-year-olds and 250\r\n10-/11-year-olds using the BASCD method. The children also had intra-oral digital photographs taken of index\r\nteeth. The same 5 examiners assessed the intra-oral digital photographs (in groups of 8, 6 and 4 intra-oral\r\nphotographs) for caries using the BASCD criteria; dmft/DMFT were used to compute Weighted Kappa Statistic as a\r\nmeasure of intra-examiner reliability and intra-class correlation coefficients as a measure of inter-examiner reliability\r\nfor each method. A method comparison analysis was performed to determine the 95% limits of agreement for all\r\nfive examiners, comparing the visual examination method with the photographic assessment method using 8, 6\r\nand 4 intra-oral photographs.\r\nResults: The intra-rater reliability for the visual examinations ranged from 0.81 to 0.94 in the 5-year-olds and 0.90 to\r\n0.97 in the 10-/11-year-olds. Those for the photographic assessments in the 5-year-olds were for 8 intra-oral\r\nphotographs, 0.86 to 0.94, for 6 intra-oral photographs, 0.85 to 0.98 and for 4 intra-oral photographs, 0.80 to 0.96;\r\nfor the 10-/11-year-olds were for 8 intra-oral photographs 0.84 to 1.00, for 6 intra-oral photographs 0.82 to 1.00 and\r\nfor 4 intra-oral photographs 0.72 to 0.98. The 95% limits of agreement were -1.997 to 1.967, -2.375 to 2.735 and\r\n-2.250 to 2.921 respectively for the 5-year-olds and -2.614 to 2.027, -2.179 to 3.887 and -2.594 to 2.163 respectively\r\nfor the 10-/11-year-olds.\r\nConclusions: The photographic assessment method, particularly assessment of 8 intra-oral digital photographs is\r\ncomparable to the visual examination method in the primary dentition. With the additional benefits of archiving,\r\nremote scoring, allowing multiple scorers to score images and enabling longitudinal analysis, the photographic\r\nassessment method may be used as an alternative caries detection method in the primary dentition in situations\r\nwhere the visual examination method may not be applicable such as when examiner blinding is required and in\r\npractice based randomised controlled trials (RCTs).
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