Evaluating Interfaculty Agreement in ICDAS Coding Between Restorative and Nonrestorative Dentists Using Photographic and Extracted Carious Samples: A Pilot Study.

Abstract

Introduction: The International Caries Detection and Assessment System (ICDAS) is a standardised method for recording caries severity. Effective training in ICDAS is essential for dental faculty and students. This pilot study aimed to compare the effectiveness of photographic images versus extracted teeth in ICDAS training and to assess whether restorative and nonrestorative dental faculty achieve similar accuracy in ICDAS coding.

Methods: Following comprehensive ICDAS training, dental faculty participated in a rotation through diagnostic stations, where they assigned ICDAS codes to tooth surfaces. The specimens consisted of either extracted adult teeth or their corresponding photographic images, each was preassigned a gold standard ICDAS code. Faculty members were categorised as belonging to either restorative or nonrestorative disciplines. After each rotation, individual performance was assessed by calculating linearly weighted Kappa (k_w) values comparing each participant's coding to the gold standard. Data were analysed using nonpaired, nonparametric, statistical methods. The study was completed over two end-of-training sessions, one of which included a repeat circuit of stations following a 1 h rest period.

Results: With k_w scores as measures of ability, dental faculty coded more accurately with extracted teeth carious surfaces than with photographic images (p = 0.0005). When grouped by specialities, there were nearly identical median k_w scores (p = 0.482), with extracted teeth suggesting that dental faculty of all types of speciality can use ICDAS effectively.

Conclusions: Extracted teeth appear to have value in training ICDAS as well as photographic images. Dental faculty of all types of specialities can use ICDAS effectively after similar amounts of training.

Clinical relevance: This study contributes to the refinement of training strategies for the ICDAS caries detection system, an important component of the dental curriculum and a system which is widely recognised as facilitating effective early reversal of dental caries lesions. Specifically, in this pilot study, the use of extracted teeth as teaching tools appeared to offer additional diagnostic value compared to photographic images, possibly by improving the correct identification of ICDAS codes for early lesions. Also, the study demonstrates that dentists from both restorative and nonrestorative disciplines should be able to successfully adopt, apply and teach ICDAS coding, thereby promoting interdisciplinary collaboration and fostering uniformity in caries management practices.