An educational method for learning and assessing interproximal dental caries diagnosis in children's radiographs

Abstract

<h3>Background</h3> Dental caries is common in children, and intraoral bitewing radiographs are the gold standard for diagnosing interproximal caries. Accurate interpretation of radiographs is a key competency for dentists treating children to minimize the consequences of misdiagnosis. There are currently no validated methods for assessment of this important competency for Canadian dental trainees. <h3>Objective</h3> We developed an interactive computer-assisted learning (CAL) tool designed to permit the deliberate practice of pediatric bitewing radiograph interpretation. The main objective of this study was to measure the amount and rate of skill acquisition in the diagnosis of interproximal dental caries amongst dental trainees, and to determine the effect size of our education intervention. <h3>Study Design</h3> This multi-center prospective cohort study used a convenience sample of Canadian dental trainees ranging in experience from undergraduate dental education to graduate pediatric dentistry. Reference standard caries diagnosis was determined by consensus between three dental specialists. Study participants learned to interpret children's bitewing radiographs on a web-based platform by deliberately practicing 193 cases with the goal of achieving a performance benchmark of 75% accuracy, sensitivity, and specificity. Participants identified the presence/absence of interproximal dental caries, and if present, identified the specific location of all lesions. <h3>Results</h3> To date, 60 participants have completed all 193 cases, and 10 participants have achieved the performance benchmark. There was a significant increase of 17.8% (95% CI 14.6, 21.0) from mean initial to maximal accuracy amongst participants. The median number of cases to achieve competency was 180 (min 84, max 550). The effect size of the education intervention was large, with a Cohen's d=1.6 (95% CI 1.2-2.10). <h3>Conclusion</h3> The learning intervention evaluated in this study has led to effective and feasible skill improvement in the interpretation of interproximal dental caries on bitewing radiographs amongst dental trainees and may be a valuable adjunct to existing educational methods in dental radiology. <b>Statement of Ethical Review</b> Human/Animal subjects were used and this study was approved by an institutional ethics panel