Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers

  • Joon Soo ParkEmail author
  • Estie Kruger
  • Wendy Nicholls
  • Mohamed Estai
  • John Winters
  • Marc Tennant
Original Article



To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners.

Materials and methods

As part of a quality assurance program, intra-oral photographs were obtained from 77 patients (2–18 years) as part of a CDE before undertaking dental treatment under general anaesthesia. A DSLR camera was utilised to acquire images which were subsequently uploaded to a cloud-based server. The baseline for each participant was established during the CDE, utilising both visual and radiographic examination, which was then compared to the assessment made by a mid-level dental practitioners (MLDP). The evaluation was based on utilising an odontogram where the teeth were charted either as decayed or filled.


Specificity (95%) was higher than sensitivity (61.5%) when comparing the photographic assessment with the benchmark CDE assessment. The inter-rater reliability between the two methods of assessment was substantial, with a kappa score of 0.62. The photographic assessment method underestimated the decayed and filled teeth, as observed by the caries experience (dft/DFT scores) (CDE = 7.01 vs. photographic assessment = 5.22). There were lower levels of diagnostic detection in the posterior teeth as compared to the anterior teeth assessments.


Although the CDE is still considered to be the gold-standard, this study found that the photographic caries assessment by MLDP produced an acceptable diagnostic level of detection particularly for the anterior teeth.

Clinical relevance

The photographic method could offer a potential cost-saving and user-friendly screening.


Caries Radiography Photograph Dental screening Paediatric oral health 



We want to thank the staff at the Dental Department, Princess Margaret Hospital, Australia, for their kind assistance. Furthermore, we would like to acknowledge Dr. Matthew Payne for his assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This quality activity-based study was approved by the Princess Margaret Hospital for Children (Clinical Governance Number - 14107).

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Paediatric Oral Health Research Group, UWA Dental SchoolThe University of Western AustraliaCrawleyAustralia
  2. 2.International Research Collaborative - Oral Health and EquityThe University of Western AustraliaCrawleyAustralia
  3. 3.Dental DepartmentPrincess Margaret Hospital for ChildrenSubiacoAustralia

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