Assessing the usability and perception of the index for interceptive orthodontics referral among dental frontliners in Selangor and federal territories of Kuala Lumpur and Putrajaya

Malocclusion is a prevalent oral disorder in children, often manifesting early life development. Timely identification of these developing malocclusion and referral of these cases is crucial for initiating interceptive orthodontic treatment at the appropriate stage. However, dental frontliners face challenges in identifying and referring developing malocclusions timely during the late mixed dentition and early permanent dentition phases due to the lack of standardized guidelines. The Index for Interceptive Orthodontics Referral (IIOR) was recently developed and validated as a tool to guide the timely referral of developing malocclusion that may benefit from interceptive orthodontics. This research seeks to evaluate the reliability, reproducibility, usability and perception of the IIOR among dental frontliners in Selangor, Federal Territories of Kuala Lumpur, and Putrajaya, emphasizing its potential to enhance clinical decision- making and referral practices during dental screening. The objectives of this research were to validate the modified perception questionnaire of IIOR and calibrate the expert standard grading (ESG), to determine the reliability and reproducibility of the IIOR among the dental frontliners and compare the agreement to the expert standard grading. Additionally, to assess the usability and perception of the IIOR among dental frontliners. The validation of the Perception Questionnaire involved 6 experts and was determined using the Content Validity Index (CVI) which comprised of item-content validity index (I-CVI) and scale-level content validity index (S-CVI/Ave) for the content validity. The validation process also involved 12 assessors for Face Validity Index (FVI) which comprised of item face validity index (I-FVI) and scale-level face validity index (S- FVI/Ave). Grading calibration between 3 experts was carried out to determine the Expert Standard Grading by grading study models to be used in the pilot study and main research. A pilot study was conducted to assess the feasibility of the research involving 13 participants from the Faculty of Dentistry, UiTM. The methodology of the main research was for the participants to attend a pre-recorded video briefing on IIOR, then grade 30 study models using the IIOR based on its malocclusion severity and urgency for referral. After grading the study models, they answered a perception questionnaire on IIOR. Then, after 14 days, the participants did a retest to grade the study models. This main research involved 279 dental frontliners who had attempted the perception questionnaire on the IIOR, while 226 dental frontliners were involved in the retest of the grading. The results showed that the perception questionnaire was highly valid with S-CVI/Ave=0.96 and S-FVI/Ave=0.97. There was substantial agreement between the experts for the calibration of the 10 study models in the pilot study and excellent agreement in the main research with 30 study models. The reliability on grading the study models using IIOR was in moderate agreement (K=0.57) among the dental frontliners on the first grading and substantial agreement on the retest (K=0.62). There was substantial agreement between frontliners to the ESG (0.61-0.80) with n=150. The reproducibility showed high level of agreement with n=81 with substantial agreement and n=67 with almost perfect agreement. It revealed that the IIOR had high reliability and reproducibility among dental frontliners and when compared to the expert standard grading. The results from the perception questionnaire proved IIOR to be highly acceptable because it was easy to use, simple to understand, and fast to identify developing malocclusion to be referred for interceptive orthodontics treatment possibility during dental screening.