Competence of the assessment method using Q-Ray™ system in dental hygiene process

Abstract

Dental hygiene assessment of tooth lesions, restorations, and periodontal conditions has been performed by visual inspection, a conventional assessment method. However, distinguishing tooth lesions, restorations, periodontal conditions, and dental plaque with visual inspection alone is a great challenge for dental hygiene students without much experience. As an assessment tool, the recently developed Quantitative Light-induced Fluorescence-Digital Biluminator™ (Q-Ray™ system) can not only detect tooth lesions such as incipient caries and dental caries, but also distinguish natural tooth-like porcelain or ceramic crowns and detect and quantify red autofluorescent dental plaque emitted by the endogenous porphyrins generated by intraoral bacteria.Therefore, integrating such a reliable diagnostic tool in theoretical education and practical training of dental hygiene students would greatly enhance students’ diagnostic accuracy and assessment performances.This study was conducted with approval from the Institutional Review Board of the Yonsei University Dental Hospital (IRB No: 2-2014-0023). In this study, a performance comparison in the assessment of tooth lesions, restorations, and periodontal conditions was performed between visual inspection alone and visual inspection assisted by the Q-Ray™ system. The assessment results of both methods were checked against the gold standard in order to compare their assessment accuracy and check whether different results had been yielded by the two methods.The subject population of this study was 110 dental hygiene students, of whom 92 and 18 students were enrolled as assessors and simulated patients, respectively. The 92 assessors were randomly assigned to the experimental or control group, 46 each, and the 18 simulated patients were assigned to the experimental or control group, 9 each, with attention paid to equitable

distribution of lesions and restorations.Based on the assessment results of the experimental and control groups, Cohen’s kappa values were calculated for each group, whereupon each group was subdivided into upper (30%), middle (40%), and lower (30%) grade subgroups. The tooth lesions, restorations, and periodontal conditions were then compared for each subgroup using kappa values and percent agreements.In the intergroup comparison of the assessment accuracy for tooth lesions, a significant difference was found only in the image test results of the middle grade subgroups, whereby the experimental group showed a higher percent agreement than the control group (64% vs. 62%; p = 0.043).In the assessment of restoration, the experimental group students of all three grades outperformed their control group counterparts in terms of kappa values and percent agreements in both the image and simulated patient tests, thus demonstrating that the application of the Q-Ray™ system enhances the detection accuracy.By type of restoration, the experimental group using the Q-Ray™ system showed higher percent agreements in the image test with 62.6% for composite resin (p = 0.006) and 78.3% for porcelain crown (p < 0.001) than the control group with 56.0% and 52.9%, respectively. Also, the percent agreements of the experimental group in the simulated patient test was higher with 66.0% than the control group with 42.9% for composite resin (p < 0.001).The comparison of the performance in discriminating periodontal conditions by grade revealed that middle and lower grade students in the experimental group showed higher kappa values and percent agreements in both the image and simulated student tests compared to their counterparts in the control group. This means that the use of the Q-Ray™ system enhanced the performance of middle and lower grade students in detecting periodontal

anomalies and dental plaque, while higher grade students’ performance was less influenced by the use of the Q-Ray™ system.The results of this study allow the conclusion that the use of the Q-Ray™ system as an aid in distinguishing dental and periodontal conditions in dental hygiene assessment can be expected to contribute to improving the assessment accuracy in dental hygiene process of care and enhancing students’ assessment performance.