Accurate Calculus Detection: Is it Possible?

Abstract

An important goal of dental hygiene education is graduating clinically competent practitioners. Much of the clinical curriculum includes process and product evaluations that monitor and assess dental hygiene students' clinical abilities, especially related to the detection and removal of subgingival calculus. The purpose of this study was to determine if dental hygiene faculty were consistent in detecting “clickable” subgingival calculus that remained after the administration of a mock clinical board (MCB). A MCB was administered to 24 dental hygiene students during their last semester before graduation. The patient criteria for the MCB matched that of the regional board, including: a quadrant with at least 6 natural teeth, including one permanent molar with a proximal contact; a minimum of 12 surfaces with heavy, subgingival calculus; a maximum of 6 deposits on anterior teeth; and no gross decay, probing depths greater than 6 mm, or other dental conditions that would interfere with calculus detection or removal. Five dental hygiene faculty members were assigned with 3 faculty in the morning MCB and three in the afternoon. The faculty members were required to attend an orientation to calibrate the procedures used during the MCB. One faculty member was assigned as a “chief examiner” for each of the 3 sections of the clinic, with 4 dental hygiene students taking the MCB. The “chief examiner” recorded the 12 areas that were evaluated for calculus upon completion of the MCB. Students were not privy to the areas being examined. Upon completion of the procedures, each patient was examined by 3 examiners. The faculty members did not have access to the other instructors' evaluations. The 12 specified areas were examined with an 11/12 ODU explorer, and any surface that exhibited “clickable” calculus was recorded. The results were tallied to track the surfaces marked by each examiner. Two hundred eighty-eight surfaces were examined. There was total agreement of the 3 examiners on 69.8% (n=201) of areas where no calculus remained and 4.6% (n=4) where calculus remained. There were 30.2% (n=87) surfaces that were marked by 1, 2, or 3 for having “clickable” calculus. Two examiners agreed on 33.3% (n=29) surfaces with remaining calculus, while 62.2% (n=54) surfaces were marked by only one examiner. In conclusion, there seems to be more agreement on areas with no detectable deposits. Total agreement was less likely on surfaces that were evaluated as having calculus remaining. More research needs to be done to determine accurate calibration methods for clinical dental hygiene faculty. The findings presented here suggest that subgingival calculus detection may be more subjective than dental hygiene educators realize and calibration is essential.