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The International Caries Detection and Assessment System (ICDAS)

By Maria Perno Goldie, RDH, MS



The International Caries Detection and Assessment System (ICDAS) is a clinical scoring system for use in dental education, clinical practice, research, and epidemiology.

The ICDAS is designed to: lead to better quality information to inform decisions about appropriate diagnosis, prognosis, and clinical management at both the individual and public health levels. It provides a framework to support and facilitate personalized management of the caries process and dental decay for improved long term health outcomes.

The ICDAS fosters a new model for the measurement of dental caries, developed and based on a systematic review of the literature on clinical caries detection systems.(1) A review found that there were inconsistencies in how the caries process is measured, a difference between European and American systems for caries detection, as well as inconsistencies among the research criteria for measuring dental caries.

It was found that, in the USA, dental caries has been synonymous with presence of cavitation, or decay. In Europe, in the research community, the understanding of dental caries appeared to be more advanced than in America. The standards for measuring caries include clinical stages of the disease process which precede cavitation, not simply the decay in the tooth. This is beginning to change, but at the time of the review, this information was accurate.

Here is an overview of the development of the International Caries Detection and Assessment System (ICDAS):

Core ICDAS Criteria 2004
• For use on coronal and root surfaces, as well as caries adjacent to restorations and sealants
• These unifying, predominantly visual, criteria code a ange of the characteristics of clean, dry teeth in a consistent way that promotes the valid comparison of results between studies, settings & locations
•ICDAS criteria record both enamel and dentine caries and explore the measurement of caries activity in all of the domains below

The ICDAS Detection Codes are in use now and are recommended
The ICDAS Assessment codes are part of a developing research agenda
The ICDAS System provides an evidence based framework to validate and explore the impact of existing and new-technology aids to caries "diagnosis"

 

The ICDAS group met in 2009 and developed Coronal Primary Caries Detection Criteria.(2) The ICDAS detection codes for coronal caries range from 0 to 6 depending on the severity of the lesion.

Description of Codes(2)
0 Sound
1 First Visual Change in Enamel (seen only after prolonged air drying or restricted to within the confines of a pit or fissure)
2 Distinct Visual Change in Enamel
3 Localized Enamel Breakdown (without clinical visual signs of dentinal involvement)
4 Underlying Dark Shadow from Dentin
5 Distinct Cavity with Visible Dentin
6 Extensive Distinct Cavity with Visible Dentin

In addition to the codes, they have a form for Differential Diagnosis between Milder Forms of Dental Fluorosis (Questionable, Very Mild, And Mild) and Nonfluoride Opacities of Enamel.(2) Caries Associated with Restorations and Sealants Codes are outlined and presented. The report discusses use of the codes in research settings and outlines codes for the detection and classification of carious lesions on the root surfaces.

The group has a working definition for lesions: an Active Lesion is considered to have a greater likelihood of transition (progress, arrest or regress) than an inactive lesion; an Inactive (arrested) Lesion is considered to have a lesser likelihood of transition than an active lesion.(2)

Core ICDAS Criteria 2010 are: for use on coronal and root surfaces, as well as caries adjacent to restorations and sealants; these unifying, predominantly clinical, criteria code a range of the characteristics of clean, dry teeth in a consistent way that promotes the valid comparison of results between studies, settings, and locations; and ICDAS criterion record both enamel and dentine caries and explore the measurement of caries activity in all of the domains below.(3)

The ICDAS Detection Codes are in use currently and are recommended, and are part of a developing research agenda. They provide an evidence-based framework to validate and explore the impact of existing and new technology aids to caries diagnosis.

In the diagnosis of the caries process and tooth decay, the objective is to decide correctly if the observed condition is a caries lesion and not something else (e.g. dental fluorosis), then assess its severity and the activity status of the lesion. If the caries lesion is assessed to be in a state of progression, an active caries lesion, and the relevant disease-promoting factors are anticipated to stay the same, some form of non-operative or operative treatment is needed. However, if the lesion is judged to be not progressing, an arrested lesion, and the relevant disease-promoting factors stay the same, no treatment is needed.(4)

The ICDAS e-learning program, developed by the ICDAS Foundation (distribution from Smile-On Limited), is a novel tool available by download via the Internet to explain the ICDAS method and to provide an introduction of the criteria to new users.(5) The training has a ninety-minute course divided into an introduction, the ICDAS examination protocol, the ICDAS caries codes, how to apply the coding system, a decision tree to help with the codes, special considerations, and how to collect data for the recording codes. It also incorporates interactive quizzes, which helps with retention of knowledge.

The influence of ICDAS training in a group of dental students for occlusal car¬ies detection in permanent teeth was evaluated.(6) The ICDAS e-learning program improved the performance of the diagnostic skills of the students in the study for the detection of occlusal caries lesions.

As the ICDAS, a visual criteria system, was developed to help the examiners detect the initial changes in dental surfaces due to decay development, it seems to show some success. This study showed that the ICDAS e-learning program improved the reproducibility and validity in terms of specificity of the diagnostic skills of the students for the detection of occlusal decay in permanent teeth.(6)

The authors suggested that the ICDAS e-learning program can be a helpful tool for providing feedback to students on caries detection protocol. The dental students displayed a positive reaction to the ICDAS training-learning program, and were receptive to the new visual criterion, as they felt improvement in their diagnostic skills.

For more information, visit www.icdas.org/.

References
1. Ismail AI. Visual and Visuo-tactile Detection of Dental Caries. J Dent Res 2004a;83(Spec Iss C):C56-C66.
2. International Caries Detection and Assessment System Coordinating Committee. International Caries Detection and Assessment System (ICDAS II): Criteria Manual. Revised in December and July 2009 Bogota, Colombia and Budapest, Hungary.  www.icdas.org/assets/downloads/Appendix.pdf
3. www.icdas.org/index.html
4. Zandoná AF Zero DT. Diagnostic tools for early caries detection. J Am Dent Assoc, Vol 137, No 12, 1675-1684. 2006.
5. icdas.smile-on.com/
6. Diniz, MB, Lima LM, Santos-Pinto L, Eckert GJ, Ferreira Zandoná AG, and de Cassia Loiola Cordeiro R. Influence of the ICDAS E-Learning Program for Occlusal Caries Detection on Dental Students. J Dent Educ. 2010 74: 862-868.

Maria Perno Goldie, RDH, MS

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