1. Performance of dental faculty members and undergraduates in caries detection after ICDAS training Parolia A, Bhatia S, Smales F, Toh CG, Pau A Presenter: Shekhar Bhatia School of Dentistry, International Medical University, Kuala Lumpur, Malaysia 28/7/20151

2. Introduction There is increasing agreement that the traditional measurement of caries at the stage of cavitation, is no longer sufficient to reflect changes in the incidence of caries in present-day populations exhibiting an overall slower rate of caries progression. Furthermore, it has been shown that the diagnosis of caries at the cavitation level results in a significant underestimation of the actual caries experience in populations. Several new visual criteria have been promoted, and the new visual criteria known as the International Caries Detection and Assessment System (ICDAS) has received considerable attention. ICDAS was developed to provide an international system for caries detection that would allow for comparison of data collected in different locations as well as at different points in time, and to bring forward the current understanding of the process of initiation and progression of dental caries to the fields of epidemiological and clinical research. 28/7/20152

3. ICDAS (the International Caries Detection and Assessment System) is a new approach for coding and recording the six stages of caries severity, varying from initial changes visible in enamel to frank cavitation in dentine. International Caries Detection and Assessment System (ICDAS) – Codes 0-6 of caries extension in teeth through visual inspection of clean, plaque-free wet and dry teeth. Peer-reviewed and evidence-based Code 3Code 0Code 1Code 2 Code 4 Code 5 Code 6 Ahlawat.P Comprehensive Implementation of the International Caries Detection and Assessment System (ICDAS) in a Dental School and University Oral Health Centre: A Stepwise Framework Dent. J. 2014, 2, 41-51. 28/7/20153

4. Review of literature 28/7/20154

5. Study was done to evaluate the effect of a Digital learning tool(DLT) on undergraduate dental students' performance in detecting dental caries using ICDAS. Result: statistically significant difference between the values obtained before and after learning strategies, increase the sensitivity of ICDAS used by undergraduate dental students. The DLT appeared to improve dental students' ability to use ICDAS. LuzPB Eur J Dent Educ 2014 Dec 12. Study was done to evaluate Performance of experienced dentists in Switzerland after an e- learning program on ICDAS occlusal caries detection A Wilcoxon test showed a statistically significant difference between before and after the e-learning program. Rodrigues JA J Dent Educ 2013 Aug;77(8):1086-91. Study was done to compare three groups of participants with different levels of clinical experience in using the International Caries and Detection System (ICDAS) on occlusal surfaces. Thirty participants (faculty, graduate and undergraduate students), after a lecture and hands-on training session on two occasions, examined 60 occlusal surfaces previously examined by two criteria expert examiners. There were no significant differences between the groups for intra-and inter-examiner agreement for ICDAS severity or activity on occlusal surfaces as measured by kappa. Previous clinical dental experience does not seem to play a significant role in learning ICDAS. A. G. F. Zandona, Operative Dentistry: September 2009, Vol. 34, No. 5, pp. 598-604. 28/7/20155

6. Aims and objective To assess and compare the inter-examiner accuracy of the International Caries Detection and Assessment System (ICDAS) among dental faculty members and undergraduates after ICDAS training for dental caries detection. 28/7/20156

7. Materials and methodology 28/7/20157

8. Twenty permanent human teeth, without sealants or restorations and with a range of ICDAS codes between 0 and 6, were selected from a pool of extracted teeth and cleaned. Digital images of selected surfaces were taken using the Shofu (Eye special C-II) Camera Three dental faculty members examined the teeth and the details of each code were discussed based on a published paper concerning ICDAS until a consensus was reached Thereafter the reference set was developed and validated by the international expert of ICDAS before initiating the training session ICDAS training using E-learning program, extracted teeth exercise and photograph discussion was given to dental faculty members of different specializations and dental undergraduates. After the training the participants were requested to code the carious lesion using ICDAS on the selected extracted teeth The teeth were kept hydrated between exams. Examinations were conducted using a clinical light and air/water-syringe, and a ball ended probe 28/7/20158

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10. Reference set Ahlawat.P Comprehensive Implementation of the International Caries Detection and Assessment System (ICDAS) in a Dental School and University Oral Health Centre: A Stepwise Framework Dent. J. 2014, 2, 41-51. 28/7/201510

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12. Statistical analysis these codes were compared with the reference set coding, Kappa (weighted: Wkappa) statistics and Yates corrected Chi Square were used using SPSS 17.0. 28/7/201512

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14. For detection of caries the calibration indicated an inter-rater Wkappa ranging from 0.67-0.85 among dental faculty members and 0.57-0.75 among dental undergraduates. 28/7/201514

15. GroupsNo of correct identification of codes Mean percentage of correct identification of carious lesions P value Undergraduates students(n=59) 558 47.05% 0.5435 This result is not significant at p < 0.05. Faculty members (n=7)70 50.0% 28/7/201515

16. Groups Percentage of Responses that Correspond to Reference Codes Code 0 (n=5) Code 1 (n=1) Code 2 (n=2) Code 3 (n=7) Code 4 (n=2) Code 5 (n=1) Code 6 (n=2) Undergraduate students N = 59 14.9% 22.03% 48.3% 60.04% 35.60% 91.5% 82.2% Faculty members N = 7 17.14% 28.57% 50.0% 61.22% 42.85% 100% 85.71% P value0.7280.6960.9040.873 0.593 0.4230.743 This result is not significant at p < 0.05. 28/7/201516

17. DISCUSSION 28/7/201517

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19. There is less agreement with coding of initial caries lesions (Codes 0-1) ranging from 14.9-28.6% agreement and higher agreements for more advanced lesions (Codes 5 and 6) ranging from 82.2%-100%. Positive –good agreement with code 2 and code 3-ranging from 48.3- 61.2%. In using only digital images, lack of information as to whether tooth is dry or wet, difficult to detect break in enamel integrity,therefore both extracted tooth as well as digital images were kept together. 28/7/201519

20. Conclusion The ICDAS can be learned and practiced by dentist of any specialization and dental undergraduates. However, it could be suggested that more time prac­ticing and training could help the study participants in developing their skills in the caries detection process. 28/7/201520

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22. I Acknowledge Dr. Abhishek Parolia and Professor F. Smales in implementation of this project. 28/7/201522

23. References 1. Ahlawat.P Comprehensive Implementation of the International Caries Detection and Assessment System (ICDAS) in a Dental School and University Oral Health Centre: A Stepwise Framework Dent. J. 2014, 2, 41-51. 2.Pitts NB. Modern Concepts of Caries Measurement. J Dent Res 83(Spec Iss C):C43- C47, 2004. 3.ICDAS Coordinating Committee. Rationale and Evidence for the International Caries Detection and Assessment System (ICDAS II) in http://www.icdas.org/uploads/Rationale%20and%20Evidence%20ICDAS%20II%2 0September%2011-1.pdf 4.Ismail AI. Visual and Visuo-tactile Detection of Dental Caries. J Dent Res 2004a;83(Spec Iss C):C56-C66. 5.Ismail AI, Tellez M, Sohn W, Sen A. Reliability of the International Caries Detection and Assessment System (ICDAS). Community Dent Oral Epidemiol, 2005. 28/7/201523

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