Validity of caries data in the Swedish Quality Register (SKaPa) in a cohort of 19-year-olds in Region Värmland, Sweden
DOI:
https://doi.org/10.2340/aos.v85.46895Keywords:
Dental caries, registries, validation study, adolescentAbstract
Objective: The Swedish Quality Register for Caries and Periodontal Disease (SKaPa) is a national registry providing oral health data for children and adolescents. Since no validation has been performed on adolescents with permanent dentitions, the aim of this study was to evaluate SKaPa data for dental caries in 19-year-olds.
Material and Methods: This diagnostic accuracy study included a random sample of 19-year-olds (N = 250) examined in 2014 in the Public Dental Service, Region Värmland. Clinical records served as the reference standard and SKaPa variables as the index test. Number of decayed and filled teeth (DFT), number of decayed, missing, and filled teeth (DMFT), missing teeth due to caries (MTC), missing teeth due to any reason (MTA), number of decayed teeth (DT), and number of filled teeth (FT) were evaluated. Agreement was evaluated using exact agreement, Cohen’s kappa, and intraclass correlation coefficients.
Results: Data showed high agreement for DFT, DMFT, MTA, DT, and FT (kappa between 0.82 and 0.90; ICC 0.93–0.96). SKaPa underestimated caries by 6–7%. Among 155 participants with DFT/DMFT ≥1, only three had MTC, limiting evaluation.
Conclusions: SKaPa caries data demonstrate high accuracy. However, as MTC could not be evaluated, DMFT should be used with caution in research at this point. Researchers should instead use DFT but be observant of the risk of an underdiagnosis of dental caries in SKaPa for 19-year-olds.
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von Bultzingslowen I, Ostholm H, Gahnberg L, Ericson D, Wennstrom JL, Paulander J. Swedish quality registry for caries and periodontal diseases – a framework for quality development in dentistry. Int Dent J. 2019;69(5):361–8. DOI: https://doi.org/10.1111/idj.12481
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450. DOI: https://doi.org/10.1186/1471-2458-11-450
Sorensen HT, Sabroe S, Olsen J. A framework for evaluation of secondary data sources for epidemiological research. Int J Epidemiol. 1996;25(2):435–42. DOI: https://doi.org/10.1093/ije/25.2.435
Prang KH, Karanatsios B, Verbunt E, Wong HL, Yeung J, Kelaher M, et al. Clinical registries data quality attributes to support registry-based randomised controlled trials: a scoping review. Contemp Clin Trials. 2022;119:106843. DOI: https://doi.org/10.1016/j.cct.2022.106843
Rosén M. National health data registers: a Nordic heritage to public health. Scand J Public Health. 2002;30(2):81–5. DOI: https://doi.org/10.1177/14034948020300020101
Ljung R, Lundgren F, Appelquist M, Cederlund A. The Swedish dental health register – validation study of remaining and intact teeth. BMC Oral Health. 2019;19(1):116. DOI: https://doi.org/10.1186/s12903-019-0804-7
Mensah T, Tranaeus S, Cederlund A, Naimi-Akbar A, Klingberg G. Swedish quality registry for caries and periodontal diseases (SKaPa): validation of data on dental caries in 6- and 12-year-old children. BMC Oral Health. 2021;21(1):373. DOI: https://doi.org/10.1186/s12903-021-01705-x
Kirkinen T, Naimi-Akbar A, Cederlund A, Tranaeus S, Carlson C, Klingberg G. Accuracy of the Swedish quality registry for caries and periodontal diseases (SKaPa) – evaluation in 6- and 12-year-olds in the region of Varmland, Sweden. Acta Odontol Scand. 2023;81(8):615–21. DOI: https://doi.org/10.1080/00016357.2023.2235422
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Br Med J. 2015;351:h5527. DOI: https://doi.org/10.1136/bmj.h5527
Socialstyrelsen. Karies hos barn och ungdomar. Epidemiologiska uppgifter för år 2014. (in Swedish). [National Board of Health and Welfare. Caries in children and adolescents. Epidemiological data for year 2014] [Internet]. [cited 2026 Aug 28]. Available from: www.socialstyrelsen.se/contentassets/62bb78e73423436ca7cc0217bef1c6da/2015-11-36.pdf
Region Värmland. Flyktingmottagandet i Värmland. En ögonblicksbild från hösten 2015 [Internet]. 2017 [cited 2026 Aug 28]. Available from: https://www.regionvarmland.se/download/18.6b8233917a75a7b42c20c32/1626698679405/Rapport%2020%3A%20Flyktingmottagandet%20i%20V%C3%A4rmland%20-%20En%20%C3%B6gonblicksbild%20fr%C3%A5n%20h%C3%B6sten%202015.pdf
Socialstyrelsen. Hälso- och sjukvård och tandvård till asylsökande och nyanlända [Healthcare and dental care for asylum seekers and newly arrived migrants]. Slutrapport oktober 2016 (in Swedish). [National Board of Health and Welfare; 2016] [Internet]. [cited 2026 Aug 28]. Available from: https://www.socialstyrelsen.se/contentassets/2fc3409761124ba78aa846cdd9c5e736/2016-10-13.pdf
Socialstyrelsen. Karies bland barn och ungdomar – 2024. Art. nr: 2025-6-9683 (in Swedish). [National Board of Health and Welfare. Caries in children and adolescents]. 2024. [cited 2026 Aug 28]. Available from: http://www.socialstyrelsen.se/contentassets/62bb78e73423436ca7cc0217bef1c6da/2015-11-36.pdf
Everhov AH, Frisell T, Osooli M, Brooke HL, Carlsen HK, Modig K, et al. Diagnostic accuracy in the Swedish national patient register: a review including diagnoses in the outpatient register. Eur J Epidemiol. 2025;40(3):359–69. DOI: https://doi.org/10.1007/s10654-025-01221-0
Persson P, Bladh M, Teleka S, Milosavljevic A, Gustafsson N, Jaghagen EL, et al. Using dental register information and questionnaire data to assess periodontitis in large cohort studies. J Clin Periodontol. 2025;52(11):1529–39. DOI: https://doi.org/10.1111/jcpe.70015
Kirkinen T, Naimi-Akbar A, Cederlund A, et al. The Swedish out-of-home care children cohort (SweOHC) – evaluation of dental health and dental care. BMC Oral Health. 2025;25:1320. DOI: https://doi.org/10.1186/s12903-025-06389-1
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