Comparing self-reported and clinically diagnosed dental treatment needs in the Canadian population

Objective: To describe the validity and diagnostic accuracy of self-reported data compared with clinically assessed data for the ascertainment of dental treatment needs in the Canadian population. Methods: A secondary analysis of data from the Canadian Health Measures Survey (2007-2009) was undertaken. Dental treatment needs were classified into preventive, restorative, endodontic, periodontic, surgical, and orthodontic categories. Sensitivity, specificity, positive and negative predictive values, kappa statistics and likelihood ratios (LR) were calculated to compare self-reported and clinically determined needs. Survey weights were applied to generate findings nationally representative of the Canadian population. Results: Generally across most dental need categories, agreement between self-reported and clinically-determined dental need was found to be moderate to poor (kappa <0.6). Self-reported data was found to be highly specific (>90%) for most needs, but not very sensitive. Echoing these results, with low positive and high negative predictive values, self-reported information was found to be more precise in reassuring when most dental needs were not present, opposed to confirming needs that were required. High positive LRs (>10) were obtained for endodontic and orthodontic needs, indicating good diagnostic accuracy of positive self-report for these outcomes. Conclusion: Our findings suggest that in general, self-reports are poor estimates for normative dental treatment needs but do have some merit in confirming non-needs. Exceptionally, self-reports do have suitable diagnostic accuracy for predicting orthodontic and endodontic needs.