The influence of audit on the diagnosis of occlusal caries

Audit is widely used to improve the quality of care in both medicine and dentistry but has not always been subject to systematic evaluation. The aim of this study was to assess the effect of an audit exercise on the diagnosis of occlusal caries. Using combined visual and radiographic methods, 11 dentists assessed 60 extracted molars for occlusal caries on two occasions. An audit exercise, in the form of a meeting, was carried out in the intervening period. Inter- and intra-examiner reproducibility were estimated for each of the two examinations. Validation was through a gold standard set up by sectioning the teeth. Wide diagnostic disparity was seen at both examinations, all inter- and intra-examiner kappa values were below 0.73. Intra-examiner kappa values increased significantly on the second occasion. Mean sensitivity and specificity were 0.65 and 0.74, respectively, at the first examination and 0.65 and 0.72 at the second. No changes were seen that could be attributed directly to the audit exercise but practising the diagnostic test appeared to be beneficial to intra-examiner reproducibility of diagnosis.