Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Disclosing agents provide more effective plaque visualization, aiding evaluation of oral hygiene and improving debridement.

“Disclosing agents provide more effective plaque visualization which aids evaluating oral hygiene and improves effective debridement.24, 25”

• cites [24] sourceNot checked — no full text of the source
• cites [25] sourceSupported

May combine two claims.

Of the 151 children, Rater A indicated at least one clear photo for 133 children, and Rater C indicated at least one clear photo for 138 children.

“Of the 151 children, Rater A indicated there was at least one clear photo for 133 children, while Rater C indicated 138 children had at least one clear photo.”

May combine two claims.

In the CO-OP trial, 151 participants were scored over 9 batches, yielding up to 604 scored photos.

“In the CO-OP trial, 151 participants were scored over 9 batches, yielding up to 604 scored photos.”

• Also stated in: § Results: · plain

  “CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as “clear” (90% and 81%).”

May combine two claims.

In the initial calibration scoring of 30 photos, 29 photos were scorable, with a gold standard mean plaque score of 2.0 (SD 0.52) and rater means ranging from 1.7 (SD 0.68) to 2.2 (SD 0.61).

“Following the initial scoring of 30 photos, including the two CO-OP and one BEECON raters, 29 photos with gold standard mean plaque score of 2.0 (SD = 0.52) were “scorable” with means ranging from 1.7 (SD = 0.68) to 2.2 (SD = 0.61).”

May combine two claims.

There was a slight tendency for raters to score higher than the gold standard consensus, but the difference was not statistically significant.

“While there was a slight tendency for raters to score higher than the gold standard raters’ consensus, this difference was not statistically significant (Table 1 and Figure 1).”

May combine two claims.

Rater C scored six teeth as missing or unreadable (1%), 55 as blurry (9.1%), 542 as clear (89.7%), and 1 data point as missing (<0.1%).

“Among these, Rater C scored six teeth as missing or unreadable (1%), 55 as blurry (9.1%), 542 as clear (89.7%), and 1 data point was missing (<0.1%).”

May combine two claims.

In the initial calibration, LCC ranged from 0.51 to 0.73, and no raters met the required threshold.

“LCC ranged from 0.51 to 0.73, indicating no raters met the required threshold.”

May combine two claims.

At recalibration one year later, scoring 30 photos with a mean plaque score of 2.2 and a gold standard of 2.0, LCC ranged from 0.83 to 0.89, all exceeding the minimum 0.75 threshold.

“Calibration versus gold standard consensus 1 year later included scoring 30 photos with a mean plaque score of 2.2 with the gold standard being 2.0. LCC ranged from 0.83 to 0.89, all exceeding the minimum 0.75 threshold requirement.”

• Also stated in: § Results: · plain

  “All three raters had LCC ≥0.83 at recalibration 1 year later.”

May combine two claims.

When cases with low confidence were excluded, mean Kappa was 0.69 (range 0.41-0.87) and mean Weighted Kappa was 0.75 (range 0.52-0.90).

“When cases with low confidence were excluded, the mean Kappa Coefficient was 0.69 (range: 0.41–0.87) and the mean Weighted Kappa Coefficient was 0.75 (range: 0.52–0.90).”

May combine two claims.

Rater C was very or somewhat confident in more than 92% of ratings, and Rater A was very or somewhat confident in more than 89% of ratings.

“Rater C was “very” (69.5%) or “somewhat confident” (22.4%) in more than 92% of ratings, while Rater A was “very” (56.6%) or “somewhat confident” (32.8%) in more than 89% of ratings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participant cooperation posed a frequent challenge, particularly in the young age group included in these studies.

“Not surprisingly, participant cooperation posed a frequent challenge, particularly with the young age group included in these studies.”

May combine two claims.

Rater C had intra-rater LCCs of 0.83 and 0.95, and Rater A had LCCs of 0.88 and 0.99 for the two batches.

“Rater C had an LCC of 0.83 and 0.95, while Rater A had LCC of 0.88 and 0.99 for the 2 batches.”

May combine two claims.

In the CO-OP trial, Rater A agreed with the adjudicated score 84.5% of the time and Rater C 91.1% of the time.

“In the CO-OP trial, Raters A and C were in agreement with the adjudicated score 84.5% and 91.1% of the time, respectively.”

Classified as probably not a substantial claim. May combine two claims.

Challenges with photo quality included positioning, lighting, blurriness, and adequate retraction, so regular screening of photo quality with timely feedback is needed.

“Some challenges were also seen with scoring related to photo quality, including positioning, lighting, blurriness, and adequate retraction, so regular screening of photo quality with timely feedback is needed to ensure staff collect adequate quality photos.”

May combine two claims.

In the CO-OP trial, when raters were not concordant, the difference in plaque score was usually one category, and there was no directional error by tooth being scored.

“In the CO-OP trial, when raters were not concordant, the difference in plaque score was usually one category, and there was no directional error by tooth being scored (central vs. lateral incisor).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although not statistically significant, greater variance was noted among scores for central incisors for Rater C and lateral incisors for Rater A.

“Although not statistically significant, greater variance was noted among scores for the central incisors for Rater C and lateral incisors for Rater A (Table 3).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Disclosed plaque varied from early plaque to thick debris, reflecting longstanding plaque accumulation.

“Disclosed plaque varied from early plaque to a thick debris, reflecting longstanding plaque accumulation.”

May combine two claims.

Pearson correlation coefficients were greater than 0.90 for all teeth, indicating error was not more prevalent for particular teeth.

“Pearson correlations were calculated to determine if error was more prevalent when scoring particular teeth (central incisors vs. lateral incisors), however correlation coefficients of >0.90 were achieved for all teeth.”

May combine two claims.

Rater A scored 12 teeth as missing or unreadable (2.0%), 100 as blurry (16.6%), 492 as clear (81.5%), and no data as missing.

“Rater A scored 12 teeth as missing or unreadable (2.0%), 100 as blurry (16.6%), 492 as clear (81.5%), and no data as missing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Heavy visible plaque places a patient at very high caries risk.

“heavy visible plaque is consistently agreed to place a patient at very high caries risk.3, 4”

• cites [3] sourceNot checked — no full text of the source
• cites [4]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

Dental plaque biofilm and plaque accumulation are risk factors for dental caries and periodontal disease.

“Dental plaque biofilm and plaque accumulation are risk factors for dental caries and periodontal disease.1, 2”

• cites [1] sourceNot checked — no full text of the source
• cites [2] sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Multiple clinicians can review photographs one or more times without extra participant burden.

“Multiple clinicians can also review photographs one or more times, without extra participant burden.”

Classified as probably not a substantial claim.

The findings suggest potential pragmatic application in the clinical field through teledentistry.

“The findings also suggest potential pragmatic application in the clinical field through teledentistry.”

May combine two claims.

Excluding low quality and/or low confidence photos had minimal effect on overall LCC, so exclusion was not necessary for analysis.

“Excluding low quality and/or low confidence showed minimal effect on the overall LCC, indicating that exclusion was not necessary for analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

A general limitation of using plaque disclosing and measurement to assess oral health is that plaque may not be stable over time.

“A general limitation of using plaque disclosing and measurement to assess oral health is that plaque may not be stable over time.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Photo quality and raters' confidence can be consistently high with proper quality assurance and training.

“Reliability with scoring photograph quality and confidence was not an aim of this study, although data suggest photo quality and raters’ confidence can be consistently high with proper quality assurance and training.”

May combine two claims.

The OHI-MIS protocol can be applied to sites with a single clinician rater as well as sites with more than one clinician rater.

“The OHI-MIS protocol can be applied to sites with a single clinician rater as well as sites with more than one clinician rater.”

May combine two claims.

Excluding low quality and/or low confidence photos had minimal effect on overall Kappa coefficients, so exclusion was not necessary for analysis.

“Excluding low quality and/or low confidence showed minimal effect on the overall Kappa Coefficients, indicating that exclusion was not necessary for analysis (Figure 2).”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The ability for non-clinicians to capture photos could provide a pragmatic and cost-effective means of conducting research and executing oral health screening and promotion strategies.

“Furthermore, the ability for non-clinicians to capture photos could provide a pragmatic and cost-effective means of conducting research and executing oral health screening and promotion strategies such as interventions aimed at increasing tooth brushing and plaque control.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Raters completed three rounds of photo review and adjudication before being allowed to score independently.

“Raters completed three rounds of photo review and adjudication before they were allowed to score independently.”

Classified as probably not a substantial claim.

Clinicians and researchers can use these methods to evaluate plaque index as a proxy for oral health behaviors such as brushing quality.

“Clinicians and researchers can use these methods to evaluate plaque index as a proxy for oral health behaviors, such as brushing quality.”

• AssumptionRests on an assumption: Plaque index is an intermediate variable between brushing behaviors and future caries.

Probably not a substantial claim: may not pass S2 (checkable).

Because families may face geographic and other barriers to care, the ability to capture photos for later clinician review may provide pragmatic screening for high-risk oral health behaviors or conditions.

“Given geographic and other barriers families may face accessing care, the ability to capture photos that clinicians subsequently review may provide pragmatic screening for high-risk oral health behaviors or conditions.”

May combine two claims.

Tooth-level variability was modest, so OHI-MIS provided stable inter- and intra-rater reliability evaluation.

“Our findings suggested tooth level variability was modest, so OHI-MIS provided stable inter- and intra-rater reliability evaluation.”

The quote only partly states this claim.

Non-clinicians can be trained to capture quality photographs in field or clinical settings, including non-clinical environments such as the home.

“Non-clinicians (e.g., research assistants) can be trained to capture quality photos in non-clinical environments, such as the person’s home.”

• Also stated in: § Conclusions: · plain

  “Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.”