For the WHO caries assessment system, the examiner recorded a surface as decayed only if it presented with detectably softened floor, undermined enamel or a softened wall. According to this criterion, all the stages that precede cavitation as well as other conditions similar to the early stages of a carious lesion were considered sound.
For the ICDAS system, the D stands for detection of dental caries by (i) stage of the carious process; (ii) topography (pit and fissure or smooth surfaces); (iii) anatomy (crown vs roots); and (iv) restoration or sealant status. The A in the ICDAS stands for assessment of the carious process by the stage (non-cavitated or cavitated) and activity (active or arrested). This study does not include an assessment of the lesion activity or root caries.
WHO criteria for a carious lesion
|Sound tooth||A crown is recorded as sound if it shows no evidence of treated or untreated dental caries. The stages of caries that precede cavitation as well as other conditions similar to the early stages of caries are considered sound because they cannot be reliably diagnosed.|
|Decayed crown||Caries is recorded as present when a lesion in the pit and fissure or on a smooth tooth surface has an unmistakable cavity, undermined enamel, or a detectably softened floor or wall. Where any doubt exists, caries should not be recorded as present|
ICDAS II criteria for caries detection on the pit and fissures
|0||There should be no evidence of caries after prolonged air drying (5 seconds). Surfaces with developmental defects (enamel hypoplasia, fluorosis, attrition, abrasion and erosion) and intrinsic and extrinsic stains will be considered as sound.|
|1 – First visual change in enamel||When seen wet, there is no evidence of any change in color attributable to the 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.|
|2 – Distinct visual change in enamel||The tooth must be viewed wet. When wet there is a (a) carious opacity (white spot lesion) and⁄or (b) brown carious discoloration which is wider than the natural fissure⁄fossa that is not consistent with the clinical appearance of sound enamel.|
|3 – Localised enamel breakdown due to caries with no visible dentin or underlying shadow||The tooth viewed wet may have a clear carious opacity (white spot lesion) and/or brown carious discoloration which is wider than the natural fissure ⁄fossa that is not consistent with the clinical appearance of sound enamel.
Once dried for approximately 5 seconds there is carious loss of tooth structure at the entrance to, or within, the pit or fissure ⁄fossa. If in doubt, or to confirm the visual assessment, the CPI probe was used gently across a tooth surface to confirm the presence of a cavity apparently confined to the enamel.
|4 – Underlying dark shadow from dentin with or without localied enamel breakdown||This lesion appears as a shadow of discolored dentin visible through an apparently intact enamel surface which may or may not show signs of localized breakdown (loss of continuity of the surface that is not showing the dentin).|
|5 – Distinct cavity with visible dentin||Cavitation in opaque or discoloured enamel exposing the dentin beneath.|
|6 – Extensive distinct cavity with visible dentin||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.|
- Uribe SE, Innes N, Maldupa I. The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria. Int J Paediatr Dent. 2021 Nov;31(6):817-830. [Medline]
- Campus G, Cocco F, Ottolenghi L, Cagetti MG. Comparison of ICDAS, CAST, Nyvad’s Criteria, and WHO-DMFT for Caries Detection in a Sample of Italian Schoolchildren. Int J Environ Res Public Health. 2019 Oct 25;16(21):4120. [Medline]
Created Jan 19, 2022