Variation among examiners in early detection of palatally displaced maxillary canines, using visual inspection and palpation. A pilot study

Abstract

Objective: The aim was to study inter-examiner variation in detection of palatally displaced maxillary canines by using the palpation method, and to examine how different dental health care personnel evaluate the need for X-ray when ectopic eruption of maxillary canines is suspected. Materials and Methods: The subjects comprised 52 ten-year-olds (104 canines). Four investigators (2 dental students, dental hygienist and orthodontist) examined each patient by visually inspecting and palpating the developing maxillary canines into 4 categories according to the position of the non-erupted canine. The need for control radiograph to confirm the diagnosis was also included in the examination. The results were registered in a scheme. The statistical analysis was performed using kappa-analysis for interrater agreement. Sensitivity and specificity were calculated using the orthodontist as a gold standard. Results: When evaluating canines as palpable or not palpable the interrater agreement coefficient (κfree) was 0.78, indicating substantial agreement. Pair-wise interrater-agreement on palpation of the maxillary canines was low, -0.04-0,25, indicating poor to fair agreement. The agreement on need for further radiographic examination when ectopic eruption was suspected was (κfree) 0.49, which indicated moderate agreement. Sensitivity was clearly lower than the specificity. Conclusions: The results suggest that palpation method among the examiners of this study seemed more reliable in diagnosing normally erupting canines, while detection of palatally displaced canines may not be reliable enough. Experience may affect the prescription of radiographs in favor of fewer radiographs with the more experienced examiners.