The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries

TLDR

The current lack of consistency among caries criteria limits comparability of epidemiologic and clinical outcomes, prompting the development of ICDAS as an integrated, internationally‑endorsed system. This study reports early findings from the Detroit Center for Research on Oral Health Disparities evaluating the ICDAS platform. Examining each tooth surface, trained examiners first classified its status (sound, sealed, restored, crowned, or missing) and then assigned a seven‑point ICDAS score indicating carious severity. Results indicate that higher ICDAS codes correspond to greater dentin demineralization, the system discriminates caries risk factors, and interexaminer reliability ranges from good to excellent, demonstrating practical content and correlational validity while highlighting the need for further refinement of activity assessment and treatment classification.

Abstract

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.