Using ICDAS in the dental practice setting necessitates consideration of not only the ICDAS caries severity codes but may also include additional diagnostic information from radiographs or other lesion detection aids.  Knowledge of the activity of lesions and patient risk factors is also necessary in order to consider appropriate treatment planning. ICDAS is a tool which can help focus upon prevention and can be used to help facilitate discussion with patients about the condition of their teeth and what they can do to prevent and arrest lesions.


ICCMS Wardrobe

In order to use the ICDAS criteria in clinical practice the following conditions are essential to enable examiners to assess each of the caries codes accurately: overhead operating light; cleaned teeth and compressed air.  Since caries forms in areas of plaque stagnation it is essential that the teeth are cleaned with at least a toothbrush and floss before conducting an examination using the ICDAS criteria.


Explanation to the table


Column 1: Terms of increasing severity stages of caries for lay persons

Column 2: Terms for the visual apperance for increasing severity stages of caries for professionals

Column 3 Related scores to coulmn 2

Column 4: Activity assessment posibilities for the scores in column 3 and thus also columns 2 and 1

Column 5: Scores for radiographical classification of lesion severity:


  0=no radiolucency 

  1= radiolucency in outer ½ of the enamel

  2= radiolucency in inner ½ of the enamel± EDJ 

  3= radiolucency limited to the outer 1/3 of dentine

  4= radiolucency reaching the middle 1/3 of dentine

  5= radiolucency reaching the inner 1/3 of dentine, clinically cavitated

  6= radiolucency into the pulp, clinically cavitated


Column 6: Scores for Fibre-optic translumination (FOTI); classification of lesion severity: Proximal and occlusal


  0= no shadow or stained area

  1= Lesion stays the same width when transilluminated/Thin grey shadow into enamel when transilluminated

  2= Wide grey shadow into enamel when transilluminated 

  3= Wide grey shadow into enamel with no evidence of dentine shadow

  4= Orange/brown or bluish/black shadow < 2mm in width

  5= Shadow as described above and/or transillumination light is blocked > 2mm in width

  6= Large area of frank cavitation with likely pulpal involvement


Column 7: Risk assessment:h=high, m=medium, l=low

Column 8: PTO = Preventive treatment option; OTO = Operative treatment option

Column 9: p = progressing; a = arrested; r = regressing

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