Assessment of Students’ Performance on Caries Detection

Objective: This IRB approved retrospective study aimed to assess the performance of freshman dental students at Indiana University School of Dentistry (IUSD) on detection of dental caries following their initial exposure to the IUSD cariology curriculum activities. Methods: All students received a lecture and then attended a hands-on lab where they experienced detecting caries on natural teeth using the ICDAS criteria. In addition students were required to complete the ICDAS and an in-house e-learning on caries detection. Students from DDS classes of 2007, 2008, and 2010 had a practical exam and assessed 26 teeth as sound, with incipient (ICDAS 1 or 2) lesions, or with cavitated (ICDAS 3-5) lesions. Teeth assessed in the practical exams were scored by two independent faculty examiners, sectioned and examined under a stereomicroscope (Nikon SM 1500) for presence of caries using Ekstand et al (2007) criteria. Additionally, the class of 2010 assessed a set of 50 clinical images for caries, before and after both lecture and hands-on lab, and their assessments compared to the faculty. Results: According to histological scores 3 (12%) were sound, 8 (31%) had lesion in outer enamel, 3 (12%) had lesion in inner enamel outer dentin, 5 (19%) had a lesion in middle third of dentin and 7 (27%) had a lesion in inner dentin.  Spearman correlation of faculty ICDAS scores with histology was 0.92. Spearman correlation of DDS classes with histology ranged from 0.65-0.72; weighted Kappa scores of DDS classes with faculty ICDAS scores ranged from 0.56-0.67. Comparison of clinical image assessments revealed a significant improvement (p<0.001) between their assessment prior to lecture and after hands-on labs. Conclusion: The results indicate that this limited exposure to ICDAS and practical experience is a good introductory experience for students to differentiate sound surfaces from incipient and cavitated lesions.