International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries.
01 Feb 2013-Community Dentistry and Oral Epidemiology (Community Dent Oral Epidemiol)-Vol. 41, Iss: 1
TL;DR: The evolution of these systems over the past decade are explained and how they are being used for staging of the caries process are outlined in order to enable dentists to manage caries appropriately.
Abstract: Objectives
The aim of this article is to provide an overview of the International Caries Detection and Assessment System (ICDAS) and its associated International Caries Classification and Management System (ICCMS™), explain the evolution of these systems over the past decade and outline how they are being used for staging of the caries process in order to enable dentists to manage caries appropriately.
Methods
the article outlines and references the key steps in development of these systems.
Results
ICDAS employs an evidence-based and preventively oriented approach, is a detection and assessment system classifying stages of the caries process on the basis of histological extent and activity, is designed for use in the four domains of clinical practice, education, research and public health and provides all stakeholders with a common language for staging caries. Over a decade ICDAS has evolved to comprise a number of approved, compatible ‘formats’, supports decision making at both individual and public health levels and has generated the ICCMS™ to enable improved long-term caries outcomes. A range of further developments are in train, to assist with information capture and making clinical systems simpler and more practice friendly.
Conclusion
ICDAS provides flexible and increasingly internationally adopted methods for classifying stages of the caries process and the activity status of lesions which can be incorporated into the ICCMS™. The ICCMS™ provides options to enable dentists to integrate and synthesize tooth and patient information, including caries risk status, in order to plan, manage and review caries in clinical and public health practice.
Citations
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TL;DR: This study presents the global burden of major oral diseases with an exegetical commentary on their current profiles, the critical issues in oral healthcare and future perspectives, and it is of great importance to integrate oral health into global health agenda via the common risk factor approach.
Abstract: Objectives
This study presents the global burden of major oral diseases with an exegetical commentary on their current profiles, the critical issues in oral healthcare and future perspectives.
Methods
A narrative overview of current literature was undertaken to synthesise the contexts with critical elaboration and commentary.
Results
Oral disease is one of the most common public health issues worldwide with significant socio-economic impacts, and yet it is frequently neglected in public health policy. The oral data extracted from the Global Burden of Disease Study in 2010 (Murray et al, 2012) show that caries, periodontal disease, edentulism, oral cancer and cleft lip/palate collectively accounted for 18 814 000 disability-adjusted life-years; and the global burden of periodontal disease, oral cancer and caries increased markedly by an average of 45.6% from 1990 to 2010 in parallel with the major non-communicable diseases like diabetes by 69.0%. Oral diseases and non-communicable diseases are closely interlinked through sharing common risk factors (e.g. excess sugar consumption and tobacco use) and underlying infection/inflammatory pathways.
Conclusions
Oral disease remains a major public health burden worldwide. It is of great importance to integrate oral health into global health agenda via the common risk factor approach. The long-term sustainable strategy for global oral health should focus on health promotion and disease prevention through effective multidisciplinary teamwork.
424 citations
Cites background from "International Caries Detection and ..."
...…of caries, a ‘new’ classification (Figure 2a with examples shown in Figure 2b,c) and management matrix system was proposed to facilitate effective prevention of initial lesion and management of sepsis and pain that result from the end-stage lesion (Fisher and Glick, 2012; Pitts and Ekstrand, 2013)....
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...What is being proposed now is a more integrated preventive approach using management pathways to preserve dental tissues and promote oral health, using a wider team within and beyond dentistry (Ismail et al, 2013; Pitts and Ekstrand, 2013)....
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Lithuanian University of Health Sciences1, University of Bern2, University of Sassari3, Catholic University of Leuven4, Aarhus University5, University of Copenhagen6, University of Marburg7, Universidade Federal do Rio Grande do Sul8, University of Melbourne9, King's College London10, El Bosque University11, Indiana University – Purdue University Indianapolis12, Witten/Herdecke University13, University of Greifswald14, University of Michigan15, Tufts University16
TL;DR: A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology, selecting terms related to definition, diagnosis, risk assessment, and monitoring of dental caries.
Abstract: A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.
187 citations
TL;DR: This chapter will describe the scientific, and clinical management protocols that have been developed over the last several years by over 70 cariologists, epidemiologists and clinicians that address all diagnostic, preventive and restorative decisions necessary to preserve tooth structure.
Abstract: The International Caries Classification and Management System (ICCMS™) is a comprehensive set of clinical protocols that address all diagnostic, preventive and restorative decisions necessary “to preserve tooth structure and restore only when indicated,” which is the mission adopted at the Temple University Caries Management Pathways workshop, in 2012 [1]. The foundation for ICCMS™ is based on extensive critical analyses, research, and clinical feedback on the best approaches to move away from the mechanical or restorative care that has been followed around the world, towards a system where prevention is emphasized, initial caries lesions are prevented from progressing (controlled), and moderate or extensive caries lesions are restored with the goal of preserving, as much as possible, natural tooth structure [2]. This chapter will describe the scientific, and clinical management protocols that have been developed over the last several years by over 70 cariologists, epidemiologists, and clinicians.
While ICCMS™ is recommended as the most comprehensive pathway for caries management to achieve the desired aforementioned mission, it is important to emphasize that ICCMS™ is not the only system available today that promotes staging of the caries process and risk assessment and management [1]. The ICCMS™, in contrast to other systems, has well-developed and documented protocols for the implementation of a new model of caries management. It is based on the well-established and widely used International Caries Detection and Assessment System (ICDAS™).
161 citations
Cites background from "International Caries Detection and ..."
...The foundation for ICCMSTM is based on extensive critical analyses, research, and clinical feedback on the best approaches to move away from the mechanical or restorative care that has been followed around the world, towards a system where prevention is emphasized, initial caries lesions are prevented from progressing (controlled), and moderate or extensive caries lesions are restored with the goal of preserving, as much as possible, natural tooth structure [2]....
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Temple University1, King's College London2, University of Copenhagen3, Willamette University4, University of Sheffield5, University of the Pacific (United States)6, University of California, San Francisco7, University of Sydney8, American Dental Association9, Indiana University10, El Bosque University11, University of Michigan12
TL;DR: A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided, and a new 'Caries Management Cycle' is presented.
Abstract: In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided.
139 citations
Cites methods from "International Caries Detection and ..."
...The ICDAS – ICCMS considers that a patient’s caries risk assessment is the basic component in the decision-making process for adequate prevention of dental caries and for setting and resetting individual recall intervals....
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...The four key elements of the ICCMS (22, 24) are: Initial Patient Assessments (collecting personal and risk-based information through histories and systematic data collection); Lesion Detection, Activity, and Appropriate Risk Assessment [detection and staging of lesions, assessment of caries activity, and caries risk assessment using appropriate methods – such as Cariogram (with or without microbiological tests) or CAMBRA]; Synthesis and Decision-Making (integrating the patient level and lesion level information); and Clinical Treatments (Nonsurgical & Surgical) with prevention (ensuring that the treatment planning options available are prevention-orientated and include nonsurgical options whenever appropriate)....
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...The ICCMS development team is also examining the potential of using new and more user-friendly computer-assisted methods of risk assessment....
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...However, the ICDAS-ICCMS (International Caries Classification and Management System) focuses on clinical caries management and does assess the risk status of patients....
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TL;DR: This CariesCare practice guide is derived from the International Caries Classification and Management System and provides a structured update for dentists to help them deliver optimal caries care and outcomes for their patients.
Abstract: This CariesCare practice guide is derived from the International Caries Classification and Management System (ICCMS) and provides a structured update for dentists to help them deliver optimal caries care and outcomes for their patients. This '4D cycle' is a practice-building format, which both prevents and controls caries and can engage patients as long-term health partners with their practice. CariesCare International (CCI™) promotes a patient-centred, risk-based approach to caries management designed for dental practice. This comprises a health outcomes-focused system that aims to maintain oral health and preserve tooth structure in the long-term. It guides the dental team through a four-step process (4D system), leading to personalised interventions: 1st D: Determine Caries Risk; 2nd D: Detect lesions, stage their severity and assess their activity status; 3rd D: Decide on the most appropriate care plan for the specific patient at that time; and then, finally, 4th D: Do the preventive and tooth-preserving care which is needed (including risk-appropriate preventive care; control of initial non-cavitated lesions; and conservative restorative treatment of deep dentinal and cavitated caries lesions). CariesCare International has designed this practice-friendly consensus guide to summarise best practice as informed by the best available evidence. Following the guide should also increase patient satisfaction, involvement, wellbeing and value, by being less invasive and more health-focused. For the dentist it should also provide benefits at the professional and practice levels including improved medico-legal protection.
87 citations
References
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TL;DR: This early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.
Abstract: This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.
1,093 citations
"International Caries Detection and ..." refers methods in this paper
...The systems that were merged to create the ICDAS (8, 9) included those by Pitts & Fyffe; Ismail and co-workers; British Association for the Study...
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TL;DR: The reproducibility and accuracy for the ECM is acceptable while radiographs miss early occlusal lesions, and the new visual system appears promising, but takes time to learn.
Abstract: This laboratory study of 100 occlusal surfaces investigated the reproducibility and accuracy of a visual ranked caries scoring system, an electronic caries scoring system (ECM) using a continuous conductance scale, and a radiographic ranked caries scoring system. Histological examination of the teeth served as a gold standard to validate the ability of each system to assess lesion depth and predict softened, demineralized dentine. After training, 3 examiners carried out each scoring system on two separate occasions. Kappa values for visual, ECM and radiographic ranked scoring systems showed good inter- and intra-examiner reproducibility levels and acceptable limits of agreement for ECM readings. When scoring systems were tabulated against histological scores there was a high correlation between the visual and ECM methods and lesion depth in both enamel and dentine, but radiographic examination could not detect enamel caries. When compared to the histological scoring, the Spearman correlation coefficients for the visual scoring ranged between 0.87 and 0.93, for the ECM between 0.80 and 0.85 and for the radiographic scoring system between 0.76 and 0.78. No tooth scored as visually sound had histological evidence of dentine caries. Soft dentine corresponded to demineralization involving the middle third of the dentine or more which was related to visual cavity formation or an ECM reading above 9 (score 3 or 4). The radiograph was an excellent predictor of soft dentine. In conclusion, the new visual system appears promising, but takes time to learn. The reproducibility and accuracy for the ECM is acceptable while radiographs miss early occlusal lesions.
412 citations
Journal Article•
402 citations
"International Caries Detection and ..." refers background or methods in this paper
...with visible dentine) were built following careful reviews of the literature (2), including earlier work...
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...ity information to inform decisions about appropriate diagnosis, prognosis and clinical management at both the individual and public health levels’ (2)....
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...ened to trying to communicate within a Tower of Babel) in this area as possible (2)....
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TL;DR: It is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from visual appearance, location of the lesion and tactile sensation during probing.
Abstract: Clinical Relevance The results from this study indicate that it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowle...
261 citations
TL;DR: A review of the content validity of a sample of caries detection criteria reported in the literature found substantial variability in disease processes measured, inclusion and exclusion criteria, and examination conditions.
Abstract: The objective of this review is to describe and discuss the content validity of a sample of caries detection criteria reported in the literature between January 1, 1966, and May 1, 2000. Using filters to locate randomized or controlled clinical trials on dental caries, fluorides, sealants, and "restorative" care, I identified a total of 171 documents from MEDLINE and the Cochrane Collaboration's Oral Health Group (CC-OHG) special register. These articles met the following inclusion criteria: (1) Data had been collected from samples of patients or populations; and (2) dental caries was assessed clinically, and criteria were either published or described in the paper. From the selected articles, evidence tables were prepared describing each caries detection criterion. Analysis of the content validity of the criteria systems was based on evaluation of the disease process, exclusion of non-caries lesions, subjectivity, use of explorers, and drying of teeth prior to examination. This review included 29 unique criteria systems. Of those, 13 originated from the UK, 3 from the USA, 4 from Denmark, and others from the World Health Organization (WHO), Sweden, Switzerland, Norway, Netherlands, and Canada. Thirteen of the criteria systems either measured active and inactive early and cavitated lesions or defined separate criteria for smooth and occlusal tooth surfaces. Nine systems measured early as well as cavitated stages of the caries process, and 7 measured cavitation only. Eleven of the criteria systems provided explicit descriptions of the disease process measured or information on how to exclude non-caries from caries lesions. The use of explorers and drying and cleaning of teeth varied widely among the criteria. The majority of the newly developed criteria systems originated from Europe. In conclusion, this review of the content validity of the 29 criteria systems found substantial variability in disease processes measured, inclusion and exclusion criteria, and examination conditions.
236 citations
"International Caries Detection and ..." refers background in this paper
...review of previous caries classification systems was planned and undertaken (4)....
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