InternationalCaries Detection

and Assessment System II

DR KRANTHI RAJA
MAHSA UNIVERSITY
2ND SEPTEMBER 2015
Learning outcomes
Understand ICDAS II system
Comprehend the scoring criteria of ICDAS II
Apply ICDAS II for Diagnosis and Treatment plan of a carious lesion in
clinical scenario
WHAT ?
A simple, logical, evidence-based system for detection and classification
of caries in dental education, clinical practice, dental research, and
dental public health
WHY?
Evolved over the last decade keeping in view of limitations of other
systems
employs an evidence-based and preventive approach,
is a detection and assessment system classifying stages of the caries
process
dental education, clinical practice, research and public health,
common caries language
Patient centric
WHO ?
The ICDAS coordinating committee is comprised of an
international group of experts with a keen interest in the
broad field of dental caries detection, classification, and
management
WHERE ?
Revised version of ICDAS I 2002
Baltimore, Maryland, March 12th-14th 2005
Where it can be used :
Education
Clinic
Research
Public health
HOW ?
Cleaning of teeth
The coding criteria have to be understood
Classifying (score) the visual appearance
of a lesion (detection) and implicit
assessing its severity, (depth).
caries is scored after cleaning
of the teeth

Otherwise caries will be

underscored

Carvalho et al., 1989

 Probes?
perio-probes Explorers are not recommended as they
may produce traumatic defects.

Ekstrand et al., 1987

Ball-ended
Always
In doubt score low
The classification system operates
with 7 scores
Score 0=sound
Scores 1-2 involve different stages of white or brown spot
lesions
Score 3= Lesions with microcavities
Score 4= Shadowed lesions
Scores 5-6 involve cavitated (into the dentine) lesions
 1W
Detection system: Each of the
7 scores are illustrated with an
2W example

1B 2B
1W

SOUND OPACITY OPACITY SURFACE UNDERLYING DISTINCT EXTENSIVE

with air- without air- INTEGRITY GREY CAVITY CAVITY
drying: drying: LOSS SHADOW
WHITE, WHITE,
BROWN BROWN

Score Scores Scores Score Score Score Score

0 1 2 3 4 5 6

Sound
Ekstrand et al., (1997) modified by ICDAS (Ann Arbor), 2002 and again in 2004 (Baltimore)
During Charting
Code 1 and 2 as Code A
The detection system
The scores were devised related to the fact that each
scoring represents a severity stage (depth).
Members of the ICDAS group demonstrated a close
relationship between the scores and histological depth
The histological classification system used are based on the
criteria on the next slide
The histological
classification system
(Ekstrand et al., 1997)
0= no enamel demineralisation or a narrow surface zone of
opacity (edge phenomenon)
1= enamel demineralisation limited to the outer 50% of the
enamel layer
2=Demineralisation involving between 50% of the enamel
and 1/3 of the dentine
3= Demineralisation involving the middle 1/3 of the dentine
4=Demineralisation involving the inner 1/3 of the dentine
5 Demineralization involving the inner 1/3 of dentine± into the pulp,
clinically cavitated but the cavitation < ½ the surface
6   Demineralization involving the inner 1/3 of dentine± into the pulp,
clinically cavitated but the cavitation > ½ the surface
Based on location
1. Pit and fissure
2. Proximal smooth surfaces
3. Free smooth surfaces
4. The principles remain same
 Method for examining relationship
between visual appearence (ICDAS)
and histological changes (Step 1-3)
1. step 2. step 3. step
Visual appearance Sectioning
ICDAS score 3= microcavity Histological evaluation
0
*
1
2
3
4
0= no demineralization
1= demineralization limited to outer ½ enamel
2= demineralization in inner ½ enamel to outer 1/3 dentine
3= demineralization middle 1/3 of the dentine
4= demineralization inner 1/3 of the dentine
ICDAS score 5

Histological score 4
ICDAS score 3

Histological score 3
ICDAS score 2

Histological score 2
ICDAS score 1

Histological score 1
ICDAS score 0

Histological score 0
Score 0: Sound
Magnification 1X

Magnification 5X
Score 0:Brown discoloration
confined to fissure and generalized
Score 1: White opacity or brown
discoloration confined to fissure
and in isolation

1W 1B
Score 2: White opacity beyond
fissure
(no loss of surface integrity)
Score 2: Brown discoloration
beyond fissure (no loss of surface
integrity)
Score 3: Microcavities in white
spots and in brown spots

In doubt of shadow (score 4),

then score 3,
Score 4: Under lying shadow of
dentine no loss of surface integrity
Score 5: Distinct cavitation
exposing dentine
Score 6: Extensive cavity- dentine
clearly visible
ICDAS II scoring system
Clinical examples
Clinical examples on
score 1
Score 1 (W)

Score 1 (B)

Score 1 (W)
Clinical examples of
score 2
White spots
Clinical examples of
score 2
Brown spots
 Clinical example of
score 3
In doubt of score 4;
therefore
score 3
Clinical examples of
score 4
Clinicall example of score 5:
Distinct cavity exposing the dentine
Clinical example of
score 6
 Any carious discoloration
Could be code 0 or 1 seen when wet?
Could be codes 1-6

No
Code = 0 NO YES
Any carious lesions when dried? Is there cavitation?

Yes
Code = 1
Could be codes 1, 2, 4 Could be codes 3.5.6

NO YES
Is there shadowing? Is dentin exposed?
Could be codes 1 or 2

YES
NO Yes No More than ½ total surface involved?
Extends beyond pit/fissure? Code = 4 Code = 3

No Yes No Yes
Code = 1 Code = 2 Code = 5 Code = 6
Test: Please score 14 buccal and mesial; 13 buccal and
13 mesial; 24 mesial, buccal and distal
Test: Please score 14 buccal and mesial; 13 buccal and
13 mesial; 24 mesial, buccal and distal

Score 5
Score 6
Test: Please Score 37 occlusal; 36 occlusal and 35 occlusal
Test: Please Score 37 occlusal; 36
occlusal and 35 occlusal

Score 4
Score 3
Test: Please score at the occlusal
surfaces on 17
Score 1 (W)
Test: Please score on the occlusal
surface on 14
Test:

Score 1 (B)
Test: Please score on the
occlusal surface on 46
Score 4
Test: Please score on the mesial surfaces
om 12 and 22.
Test:

Score 2 (W)
Test: Please score on the distal surface on 17
Test:

Score 6
Test: Please score on
the occlusal surface on
16
Test:

Score 0