Protocol for the Training and Calibration of Dental Examiners

OBJECTIVES: To summarize diagnostic criteria and examiner training and
calibration of the National Institute of Dental and Craniofacial
Research-funded Early Childhood Caries Collaborating Centers (EC4) and
report examiner calibration results from 2010 to 2014. The EC4 at Boston
University, University of Colorado, and University of California San
Francisco are performing randomized controlled early childhood caries
(ECC) prevention trials with caries as the main outcome measure. METHODS:
The EC4 with University of Iowa consultants developed standardized tooth
and tooth surface status examination criteria for use in field conditions,
examiner training materials, and examiner calibration and re-calibration
methodologies. Calibration and re-calibration were performed with 1- to
5-year-old children in the San Francisco Mission District in which
assessments from each examiner to be calibrated were compared with those
from a single gold standard examiner from 2010 to 2014. Cohen's kappa
statistic was used to determine inter-examiner agreement. RESULTS: A total
of seven examiners were successfully (re)calibrated during that period,
examining a total of 231 children. Overall unweighted Cohen's kappas
for 10 surface conditions exceeded the criterion of 0.70. However,
separate agreement for assessment of noncavitated lesions, as in other
studies, was lower. CONCLUSIONS: An experienced multidisciplinary and
multi-institutional team was able to develop criteria and training
materials to anticipate situations and field conditions the main trials
would encounter. Examiners were successfully trained and (re)calibrated.