Diagnosing Developmental Defects of Enamel: Pilot Study of Online Training and Accuracy

Purpose: The purpose of this study was to assess dentists' ability to correctly identify and classify development defects of enamel (DDE). Methods: The modified DDE (MDDE) index was used to classify enamel defects into two types: (1) enamel hypoplasia-pitted, grooved, or missing enamel; or (2) enamel opacity-translucency of enamel not caused by dental caries or fluorosis (can be either demarcated or diffuse). A panel of six experts selected and scored 36 images using the MDDE, and the consensus score was used as the gold standard score in the evaluation of survey respondents. A short training table was developed to match training images to descriptors for the MDDE. A survey, including the training table, was then distributed electronically to 2,036 U.S. dentists and expanded function dental assistants from the Indian Health Service and 6,174 members of American Academy of Pediatric Dentistry. The percent of correct responses was evaluated for each image. Results: Survey respondents (348 total) showed great variability in correct responses for each image, ranging from 41 to 97 percent, for each category of the MDDE. Conclusions: Enhanced training and calibration on the ability of dental providers is needed to identify the different types of development defects of enamel.