3 = Localized enamel breakdown due to caries with no visible dentin ICDAS II ( International Caries Detection & Assessment System) scores. Enamel Caries. ICDAS is a simple, logical, evidence-based system for detection and classification of caries in dental education, clinical practice, dental research, and dental. International Caries Classification and Management System (ICCMS)TM International Caries Detection and Assessment System (ICDAS)TM Codes.
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Dental caries is a complex multifactorial disease of the calcified tissues of the teeth, caused by interaction of various factors including the host, agent, substrate and time as demonstrated by the Keyes circle. Detecting carious lesion at the earliest possible stage of its development is definitely helpful in appropriate treatment planning for the same. The lack of consistency among the contemporary criteria systems for detecting carious lesions limits the comparability of outcomes measured in epidemiological and clinical studies.
Therefore, the ICDAS criteria was developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. It is a clinical scoring system for use in dental education, clinical practice, research, and epidemiology, and provides a framework to support and enable personalized total caries management for improved long-term health outcomes. The understanding of the caries process has continued to advance with the vast majority of evidence supporting caries as a dynamic process, which is affected by numerous modifiers tending to push the mineral equilibrium in one direction or another, i.
But the impending need of an evidence-based system which would permit standardized caries detection and diagnosis in differing environments and situations led to the development of International caries detection and assessment system ICDAS.
Hence, the ICDAS was developed to bring forward the current understanding of the process of initiation and progression of dental caries to the field of epidemiological and clinical research.
The ICDAS I and II criteria incorporate concepts from the research conducted by Ekstrand et al116 and other caries detection systems described in the systematic review conducted by Ismail et al The international caries detection and assessment system ICDAS was developed to provide clinicians, epidemiologists and researchers with an evidence-based system, which would permit standardized caries detection and diagnosis in different environments and situations.
The surface characteristics of a tooth structure determine the ICDAS measurements of potential histological depth of the carious lesions. Drying of the tooth surface is the key for detecting noncavitated lesions because water usually clogs the pores in the carious teeth and the similar refractive index of tooth and water obscures the detection of early white spot lesions.
A ball-ended explorer is used to remove any remaining plaque and debris, and to check for surface contour, minor cavitation or sealants. The teeth should be cleaned with a toothbrush or a prophylaxis cup before the clinical examination. The use czries a sharp explorer is not necessary because no additional accuracy is provided and it may damage the enamel surface covering the early carious lesions. The ICDAS detection codes for coronal caries range from 0 to 6 depending on the severity of the lesion.
There are minor variations between the visual signs associated with each code depending on a number of factors, including the surface characteristics pits and fissures versus free smooth surfaceswhether there are adjacent teeth present mesial and distal surfaces and whether or not the caries is associated with a restoration or sealant.
Therefore, a detailed description of each of the codes is given under the following headings to assist in the training of examiners in the use of ICDAS: Pits and fissures; smooth surface mesial or distal ; free smooth surfaces and caries associated with restorations and sealants CARS.
There should be no evidence of caries either no or questionable change in enamel ixdas after prolonged air drying suggested drying time 5 icdaw. Surfaces with developmental defects, such as enamel hypoplasias, fluorosis, tooth ccaries attrition, abrasion and erosionand extrinsic or intrinsic stains will be recorded as sound.
The examiner should also score as sound a surface with multiple stained fissures if such a condition is seen in other pits and fissures, a condition which is consistent with noncarious habits e. When seen wet lcdas is no evidence of any change in color attributable to carious activity, but after prolonged air drying, a carious opacity or discoloration white or brown lesion is visible that is not consistent with the clinical appearance of sound enamel or when there is a change of color due to caries which is not consistent with the clinical appearance of sound enamel and is limited to the confines of the pit and fissure area whether seen wet or dry.
The appearance of these carious areas is not consistent with that of stained pits and fissures as defined in code 0. The tooth must be viewed wet. As a shadow of discolored dentin visible through an apparently intact enamel surface which may or may not show signs of localized breakdown lcdas of continuity of the surface that is not showing the dentin.
The shadow appearance is often seen more easily when the tooth is wet. The darkened area is an intrinsic shadow which may appear as grey, blue or brown in color.
The shadow must clearly represent caries that started on the tooth surface being evaluated.
International Caries Detection and Assessment System (ICDAS): A New Concept
Code 3 and 4, histologically may vary in depth with one being deeper than the other and vice versa. This will depend on the population and properties of the enamel.
For example more translucent and thinner enamel in primary teeth may allow the undermining discoloration of the dentin to be seen before localized breakdown of enamel. However, in most cases code 4 is likely to be deeper into dentin than code 3.
Cavitation in opaque or discolored enamel are exposing the dentin beneath. The tooth viewed wet may have darkening of the dentin visible through the enamel. There is visual evidence of demineralization at the entrance to or within the pit or fissure and in the examiner judgment dentin is exposed. This is achieved by sliding the ball end along the suspect pit or fissure and a dentin cavity is detected if the ball enters the opening of the cavity and in the opinion of the examiner the base is in dentin in pits or fissures the thickness of the enamel is between 0.
The deep pulpal dentin should not be probed. Obvious loss of tooth structure, the cavity is both deep and wide and dentin is clearly visible on the walls and at the base. An extensive cavity involves at least half of a tooth surface or possibly reaching the pulp.
This requires visual inspection from the occlusal, buccal and lingual directions. There should be no evidence of caries either no or questionable change in enamel translucency after prolonged air drying. Surfaces with developmental defects, such as enamel hypoplasias; fluorosis; tooth wear attrition, abrasion and erosion and extrinsic or intrinsic stains will be recorded as sound.
When seen wet there is no evidence of any change in color attributable to carious activity, but after prolonged air drying a carious opacity white or brown lesion is visible that is not consistent with the clinical appearance of sound enamel.
International Caries Detection and Assessment System (ICDAS): A New Concept
This will be seen from the buccal or lingual surface. There is a carious opacity or discoloration that is not consistent with the clinical appearance of sound enamel. This lesion may be seen directly when viewed from the buccal or lingual direction. In addition, when viewed from the occlu-sal direction, this opacity icads discoloration may be seen as a shadow confined to enamel, seen through the marginal ridge.
Once dried for approximately 5 seconds, there is distinct loss of idcas integrity, viewed from the buccal or lingual direction. If in doubt, or to confirm the visual assessment, the CPI probe can be used gently across the surface to confirm the loss of surface integrity.
This lesion appears as a shadow of discolored dentin visible through an apparently intact marginal ridge, buccal or cariew walls of enamel. This appearance is often seen more easily when the tooth is wet. This is achieved by sliding the ball end along the surface and a dentin cavity is iccas if the ball enters the opening of the cavity, and in the opinion of the examiner the base is in dentin.
Obvious loss of tooth structure, the extensive cavity may be deep or wide and dentin is clearly visible on both the walls and at the base. The marginal ridge may or may not be present.
A simple decision tree is provided for applying the 7-code for classifying coronal tooth surfaces following the ICDAS criteria Flow Chart 1.
Since outer carious lesions adjacent to restorations are thought to be analogous with primary caries, the broad principles applied to the criteria for primary caries are also applied to CARS where relevant. However, it should be noted that the scientific basis for doing so has not been established and the literature in the area of secondary carjes is far more limited than that for primary coronal caries.
Surfaces with marginal defects less than icdass. Stained margins consistent with noncarious and which do not exhibit signs consistent with demineralization should be scored as sound. When seen wet there is no evidence of any change in color attributable to carious activity, but after prolonged air drying an opacity or discoloration consistent with demineralization is visible that is not consistent with the clinical appearance of sound enamel.
If the restoration margin is placed on enamel, the tooth must be viewed wet. When wet, there is an opacity consistent with demineralization or discoloration that is not consistent with the clinical appearance of sound enamel and If the restoration margin is placed on dentin, discoloration that is not consistent with the clinical appearance of sound dentin or cementum is code 2.
Cares tooth surface may have characteristics of code 2 and has a shadow of discolored dentin which is visible through an apparently intact enamel surface or with localized breakdown in enamel but no visible dentin.
Icdas II criteria (international caries detection and assessment system)
This appearance is often seen more easily when the tooth is wet and is a darkening and intrinsic shadow which may be grey, blue, orange or brown in color. According to the National Institutes of Health NIHconsensus development conference on dental caries diagnosis and management, it was concluded that there was insufficient evidence on the validity of clinical diagnostic systems for root caries. The color of the root lesions has caires used as an indication of lesion activity.
Active lesions have been described as being yellowish or light brown in color whereas arrested lesions appear darkly stained. However, color subsequently has been shown not to be a reliable indicator of caries activity. One score will be assigned per root surface.
The facial, mesial, distal and lingual root surfaces of each tooth should be classified as follows:.
If the root surface cannot be visualized directly as a result of gingival recession or by gentle air-drying, then it is excluded. Surfaces covered entirely by calculus can be excluded or the calculus can be removed prior to determining the surface. The root surface neither exhibits any unusual discoloration that distinguishes it from the surrounding or adjacent root areas nor does it exhibit a surface defect either at the CEJ or wholly on the root surface.
The root surface may have a natural anatomical contour or the root surface may exhibit a definite loss of surface continuity or an anatomical contour not consistent with the caries process. But such studies rely on recording of cavitated lesions only.
Studies have also shown good inter- and intraexaminer reproducibility and the accuracy of ICDAS II in detecting occlusal caries, especially in the outer half of the enamel. An in vitro study was done by Diniz MB et al 22using molars that were assessed twice by two examiners using carkes ICDAS II scoring and were validated histologically using Ekstrand and Lussi histological scores. The inter- and intraexaminer kappa values were 0. Another similar study was performed by Momeni AJ et al 23 to cariex intra- and interexaminer reproducibility of ICDAS II on occlusal caries diagnosis when different time intervals were allowed to elapse between examinations.
Weighted kappa values for intra- and interexaminer reproducibility were 0. The most advanced caries on the occlusal and approximal surfaces was recorded on extracted primary molars followed by their sectioning and histological validation using the Downer and Ekstrand-Ricketts-Kidd ERK scoring systems and it was concluded that validity and reproducibility of the ICDAS II criteria were acceptable when applied to primary molar teeth.
Surveys have been done to compare the ICDAS criteria cries the other conventional methods of detecting, scoring and diagnosing dental caries. The sensitivities for dentine caries detection were 0. International caries detection and assessment system allows us to record the severity and incidence of the caries in its continuum. It is certainly leading to a paradigm shift in the concept of recording both the cavitated and noncavitated lesions.
As a consequence of this changing trend to record the noncavitated lesions in the daily practice, ICDAS would certainly promote preventative therapies worldwide that encourage the remineralization of noncavitated cidas resulting in inactive lesions and the preservation of tooth structure, function and esthetics and a much decreased DMF all-over. National Center for Biotechnology InformationU. Int J Clin Pediatr Dent.
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Icdas II criteria (international caries detection and assessment system)
Received Feb 2; Accepted Icdsa This work is licensed under a Creative Commons Attribution 3. To view a copy of this license, visit http: This article has been cited by other articles in PMC. Abstract Dental caries is a complex multifactorial disease of the calcified tissues of the teeth, caused by interaction of various factors including the host, agent, substrate and time as demonstrated by the Keyes circle.
Discussion The international caries ccaries and assessment system ICDAS was developed to provide clinicians, epidemiologists and researchers with an evidence-based system, which would permit standardized caries detection and diagnosis in different environments and situations.
Open in a separate window. Figs 1A to G.