The ICDAS codes can be used in isolation to record caries severity or they can be supplemented by additional information from the examination such as activity coding of lesions as well as findings from other caries detection aids such as bitewing radiographs. You may also wish to consider recording patients’ caries risk status. The table illustrates the interrelationship between ICDAS caries severity codes and the other characteristics an epidemiological study may include.


ICCMS Wardrobe

In order to use the ICDAS criteria in epidemiological surveys the following conditions are essential to enable examiners to assess each of the caries codes accurately: overhead operating light; cleaned teeth and compressed air.  The ICDAS codes can be used to examine cleaned teeth in other conditions but the data recorded this way is unlikely to be comparable with other ICDAS examinations.  Variation from the ideal conditions detailed above will compromise the sensitivity of the examination, e.g. without compressed air many code 1 lesions cannot be detected and should be omitted from the code list.  It is suggested that if compressed air is unavailable the following codes should be used: [insert new ICDAS epi codes which use letters rather than numbers to highlight that the codes are not comparable with full ICDAS].


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

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