Assessment of Oral Health-Related Photographs by Dentists and Professional Non-Dental Caregivers - A Quantitative Comparative Study

Background Photographs might aid professional non-dental caregivers to detect problems when inspecting the mouth of care-dependent older individuals. This study evaluated whether the assessment of oral health-related conditions presented on photographs systematically differed between dentists and professional non-dental caregivers. Methods Photographs were taken from long-term care facility residents and from patients at the Department of Dentistry of a University Hospital. The following oral health aspects were depicted: denture hygiene, oral hygiene, teeth, gums, tongue and palate/lips/cheeks. Collection continued until a pool of 20-35 photographs was available for each oral health aspect, including a variety of conditions from perfect health and hygiene to severe problems. The total pool consisted of 179 photographs. A segmented Visual Analogue Scale was applied to assess the conditions presented on the photographs. The benchmark was established by three dentists with academic-clinical expertise in gerodontology, special needs dentistry and periodontology. For each photograph they provided a collective score after reaching consensus. Photographs were assessed individually by 32 general dentists and by 164 professional non-dental caregivers. Linear mixed effects models and generalized linear mixed effects models were fitted and mean squared errors were computed to quantify differences between both groups related to the benchmark. Results For the different oral health aspects, absolute distances from the benchmark scores were 1.13 (95%CI:1.03-1.23) to 1.51 (95%CI:1.39-1.65) times higher for the caregivers than for the dentists. The odds to overestimate the condition were higher for the caregivers than the dentists for oral hygiene (OR=0.72, 95%CI=0.62-0.84) and teeth (OR=0.74; 95%CI=0.61-0.88). The odds to underestimate the condition were higher for the caregivers than the dentists for gums (OR=1.39; 95%CI:1.22-1.59) and palate/lips/cheeks (OR=1.22; 95%CI=1.07-1.40). Over all assessments, the variance in caregiver scores was 1.9 (95%CI:1.62-2.23) times higher than that for the dentists. Conclusion Small but significant systematic differences were found between dentists and non-dental caregivers regarding the assessment of oral health-related conditions presented on clinical photographs. When photographs are used to aid non-dental caregivers with the oral health assessment, these visualizations should be complemented with comments to facilitate accurate interpretation.