June 2016

Examiner reliability in fluorosis scoring: a comparison of photographic and clinical methods N.A. Mohd Nor, I.G. Chestnutt and B.L. Chadwick Objective: To assess examiner reliability when scoring dental fluorosis in Malaysian children using clinical (Dean’s Index) and photographic methods. Method: The upper central incisors of 111 children were examined both clinically and photographically for fluorosis status using Dean’s index. Twenty children were re-examined after a two-week interval for intra-examiner reliability by a single examiner. In addition, two independent examiners and the clinical examiner scored 111 photographic images of the same children in a standardized manner. Fluorosis scores were compared individually between examiners for both clinical and photographic scoring. Examiner reliability was assessed using both simple and weighted kappa statistics at tooth level. Sensitivity, specificity, positive-negative predictive values and a Receiver Operating Characteristic (ROC) curve were also calculated to determine the accuracy of the test. Key words: Dean’s index, dental fluorosis, Malaysia, reliability, photographic, clinical