Accuracy of Visible Plaque Identification by Pediatric Clinicians During Well-Child Care

Objectives. Assess pediatric providers’ ability to identify visible plaque on children’s teeth. Methods. Pediatric providers (residents, nurse practitioners, and attendings) conducting well-child care on 15-month to 5-year-olds in an academic practice examined children’s maxillary incisors for visible plaque (recorded yes/no). A dental hygienist then examined the children and recorded the degree of visible plaque present. Results. The children’s mean age was 34 months (±15 months), and 50% had visible plaque. Providers (n = 28) identified visible plaque on 39% of children (n = 118), with 55% sensitivity and 80% specificity, and agreement with hygienist measured as a κ score was 0.34. Subgroup analyses (based on provider training level, exam experience, child age, and plaque scores) did not appreciably improve sensitivity, specificity, positive predictive value, negative predictive value, or κ scores. Conclusions. Visible plaque exams performed during well-child care may not be accurate. To comply with caries-risk assessment guidelines, providers require further education in oral exams.