In dental education ICDAS can be used a common language between patients, students, clinicians and educators to help facilitate discussions on caries detection and management. It helps to focus on the full range of treatments including caries prevention by emphasising the ability to detect and consequently manage early caries lesions with prevention.


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In order to use the ICDAS criteria 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.

Those teaching ICDAS should at least be familiar with the ICDAS e-learning material which is available for free use from here ICDAS.org website

 

Explanation to the table

 

Column 1: Relationship between scores 0-6 in the table and histological depth

Scores  Histological depth 

0  No enamel demineralization or a narrow surface zone of opacity (edge phenomenon) 

1  Enamel demineralization limited to the outer 50% of the enamel layer

2  Demineralization involving between 50% of the enamel and 1/3 of the dentine

3  Demineralization involving the middle 1/3 of the dentine, clinically microcavitated

4 (3)  Demineralization involving the middle 1/3 of the dentine, clinically shadowed

5 (4)  Demineralization involving the inner 1/3 of dentine± into the pulp, clinically cavitated but the cavitation < ½ the surface

6 (4)  Demineralization involving the inner 1/3 of dentine± into the pulp, clinically cavitated but the cavitation > ½ the surface

 

See table at the end of this page      Modified from Ekstrand et al., 1997

  

Column 2: Terms of increasing severity stages of caries for lay persons

Column 3: Terms for the visual apperance for increasing severity stages of caries for professionals

Column 4 Related scores to coulmn 3

Column 5: Activity assessment posibilities for the scores in column 4 and thus also columns 3 and 2. +=active lesion;- =arrested lesion

Column 6: 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 7: 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 8: Risk assessment:h=high, m=medium, l=low

Column 9: PTO = Preventive treatment option; OTO = Operative treatment option

Column 10: p = progressing; a = arrested; r = regressing


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