Training protocol and calibration of the International Caries Detection and Assessment System in a school-based clinical trial of elementary school-age children

Objectives

This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting.

Methods

ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6–8 years old) in grades 1–2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0–6), lesion activity (active/inactive), and filling material (0–9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the “gold standard” trainer was evaluated using Kappa statistics.

Results

For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71–0.82) and 0.82 (95% CI 0.77–0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58).

Conclusions

ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.