International Caries Detection &
Assessment System
Some ICDAS questions which have been emailed via the ICDAS website:
How are you approaching
these situations: in secondary caries
1. Lost of restoration with exposed dentin: if carious, do you score
as 5 or 6? Let's say a small area carious
2. Enamel broke but there is a restoration intact – no signs of
caries.
There is an ICDAS
restoration status code (first digit of the double digit code) for a
lost restoration which is code 7, so a lost restoration with caries
affecting less than half the tooth surface would be a code 75. It
wouldn't matter how large the non-carious exposure of dentine was in
this regard it would still be coded 7 and the caries code then follows
the primary caries principles.
When the enamel is broken but there are no signs of caries next to a
restoration it should be the appropriate restoration code - 4 for
amalgam, 3 for tooth coloured plus a caries code of 0, so 40 or 30.
Even if the broken part of tooth exposed dentine, in the absence of
caries it would still be a 40 or 30.
How do you code a tooth
like this root cap for over-denture without cavitation.
The Second code is 0, but how about the first digit.
Well, I still think the
issue is whether a tooth surface is fully covered or not (regardless of
caries risk issue). That’s what the code 6 was designated for.
In terms of interpretation of data, an important issue that should be
determined (by examiner) is whether any restoration is related to
caries. Denture abutment may not related to caries, then code 6 may
results in overestimation, or vice versa.
I am still not convinced why a simple one surface metal or gold inlay
(which is not popular in the US, but very popular in Korea) should be
coded differently from a one surface-amalgam filling. What about one
surface ceramic inlay? Is it 3 or 6?
Maybe it is a good time to re-visit the restoration code altogether as
you suggested, Gail.
How about simplified restoration codes: a. partial surface, b. full
surface, c. broken or missing, d. temporary? Maybe a and b can be
further differentiated to tooth colored or not, if necessary.
Let me know how do you
code a tooth restored with metal Inlay not gold which
also has an extensive cavity with visible dentin?
The Second code is 6, but how about the first digit
Customisation possible per study depending on what information you need to derive from the information collected.
I wonder if you could
answer the question from Youichi below regarding how to code an
intracoronal restoration as he describes - inlays aren't mentioned in
our list - should we consider them the same as an amalgam restoration
(code 4) or are they more like a crown or veneer (code 6)? I've been
going through the pro's and cons for placing inlays in either code
grouping. I have two ways of thinking about why we differentiate
between a code 4 (and 3) and a code 6 - either in terms of the
complexity of the restoration which might be related to the time taken
and cost of such a restoration or we differentiate because the reasons
for placing crows and veneers can include aesthetics while amalgams will
nearly always be placed to replace tooth tissue lost because of caries
and therefore. It all comes down to compatibility with previous systems
and how we interpret the findings. My instinct is to place the inlays
with the crowns and veneers because these are all indirect restorations.
Anyway, I would very much appreciate your thoughts on how an inlay
should be coded and whether it should be added to the second digit
coding list to make this explicit, I have cut and pasted the second
digit codes right from the ICDAS criteria document below for ease of
reference.
0 = Sound: i.e. surface not restored or sealed (use with the codes for
primary caries)
1 = Sealant, partial
2 = Sealant, full
3 = Tooth colored restoration
4 = Amalgam restoration
5 = Stainless steel crown
6 = Porcelain or gold or PFM crown or veneer
7 = Lost or broken restoration
8 = Temporary restoration
9 = Used for the following conditions
96 = Tooth surface cannot be examined: surface excluded
97 = Tooth missing because of caries (tooth surfaces will be coded 97)
98 = Tooth missing for reasons other than caries (all tooth surfaces
will be coded 98)
99 = Unerupted (tooth surfaces coded 99)
My primary interest is in exploring the feasibility for conducting a pilot of ICDAS in the U.S. I wonder what type of instrumentation that you might use, such as a WHO ball ended perio probe or FOTI or CARIES Scan. Also, any cost data that you might share per patient examined for a larger study.
Add in information about the typical time taken for an ICDAS examination to allow calculations of costs to be made
For Gerry, we have used
the ICDAS root caries examination criteria on a rather young adult
population in the US. The prevalence was very low and we haven’t
carefully analyzed the data.
Anyhow, here are my answers to your questions:
-
On this sheet it does have a space entitled “root”. Is the ICDAS applicable to root surfaces? Yes. There are specific criteria and codes for root caries in the ICDAS. However, there are rooms to improve, and the coding system has not been well validated as the coding system of “coronal” caries.
-
And if so should the entire root surface be considered as a separate entity i.e “root” only generates one 2 digit score. This is true. Root caries is supposed to be coded as one surface. Coding for root caries per se requires one digit (please refer to attached ICDAS document; Gail may have more updated one), but for some special cases (e.g., missing tooth surfaces = 98) there are spaces for two digits in the coding sheet.
-
Does some sort of cumulative mechanism exist to give a patient an overall score? There are numerous ways to summarize caries status of an individual. ICDAS provide you a decision tool for detection of a lesion there for status of a tooth surface. Results of each tooh surface based on ICDAS criteria can be summarized as DMFS score. DMFS produces a ratio (DMFS can be used to generate ratios or rates, but by itself it is just a “count”), is there something similar for ICDAS? How do we compare patients or even the same patient over time? This is what we are currently working on, and it is not simple due to examiner error/inconsistence + natural changes (progress and regress of a lesion) among others. A good guide would be Beck et al’s paper on analytic approaches to longitudinal caries data; and Kingman’s caries progress and DMFS – all in CDOE 1997.
After studying carefully the ICDAS system, we have found out that it is not possible to record, separately, white spot lesions from dark ones. This is important for us, once we intend to follow up the sample for 6 years. Are you working on this topic? Is there any way that we can be assisted in how to do it?
Do you think it would be appropriate to use the package to calibrate
oral health practitioners for assessing white spot lesions and dmft for
young children - aged from 6 months to 2 years?
From what you have said it seems like the package would be useful for
this. Are there any publications I can read on validation of the package
etc?
My name is Chris Rahiotis. I am Lecturer in Oral Biology and Cariology at University of Athens, Greece. I am interested in e-learning programm on ICDAS system. We are interested to introduce this method in our educational modules.
I would like to ask you to give us more detailed information and how we could get this information package. I have one more question, how can anybody certificate to ICDAS system?
> 1) in field research
or in clinics , use the same instrument ?
> Only air brow 5min. ?
> in clinics some japanese fellow want to use floss and XP for aid.
> Answer: the same instrument is used in all field settings and the air
is blown for approximately 5 seconds, the elearning programme will give
you information about when this is appropriate as it is not necessary
for every tooth and every surface
>
> 2)if one teeth surface we found many white lesion , we record the
%of area or only code ?
> Answer: how you might record this depends on the type of study that
you are doing, but it would be common to record only the worst lesion.
However, in the clinic if this was a patient whose oral health you were
monitoring then you might wish to record all of the white spot lesions.
Many researchers score smooth surfaces separately from pits or fissures
on the same surface eg on the palatal surface of an upper first
permanent molar.
>
> 3)most famouse or important literature do you think about Kapper
between examiner using ICDAS2
> Answer: we are continuing to look at how inter examiner agreement
should be measured, kappa is the most frequently used measure reported
in the literature but it is recognised to have shortcomings if used
alone to determine agreement.
>
> 4)Do Examiner need long time for check one person ?
> How long average ?
> IF one teeth brow 5min.all surface ,it will need long time.
> Air brow 5 min. IF it can be zone brow, will do wihtin considerable
time.
> Answer: In a recent study of 100 patients conducted by a family
dentist here in Scotland, the average time taken to examine a patient
was less than 5 minutes, from start to finish of the examination, using
air drying where necessary.
I'm very thaks for
friedly and precise answer.
Yesterday I recived another res. from DR, Woosung in michigan univ.
I met him last year in tokyo , he invited from japanese socity for
dental health
http://www.kokuhoken.or.jp/jsdh/index.htm
He teach me one thing.
All plaque remove then start record the ICDAS.
We ca't understand this simple act without his advice.
Because all literatue did not wrote details of ICDAS recording way.
I hope the e-learnig proglam. and want Know format for field research
and clinic recording .
Well anyway I thank your suport and advice. I try with my collegue
making the guide photo album for introduce ICDAS code. We want use this
album for ICDAS developement in Japane. When completion this album, I
will open it in PICASA system (by google) Please, advice it .
Well,
one comment I had about the assessment procedure and the form. As
in FDI index system the surfaces are numbered as: 1=occlucal, 2=mesial,
3=buccal etc. In your form the recommended sequence of assessments was
mesial, occlusal, distal etc., although the numbers were not used for
surfaces.
Another question about the forms. Do you have a computer software, which
could be used in clinical exams? I wonder, if BASCD surveys already used
this kind of data entry method? It would be extremely convenient to
enter the clinical findings straight to the data by a computer. Those
paper forms would not be necessary, neither the separate data entry. In
the follow up studies the new findings could then just be entered on the
screen view of the dentition with the previous findings. The logical
checking could be conducted in this way, when the subject is still in
the chair.