The Caries Assessment Spectrum and Treatment (CAST) Instrument

Abstract

The Caries Assessment Spectrum and Treatment (CAST) instrument is a visual/tactile caries detection tool initially developed for global use in epidemiological surveys. As of now, the WHO criterion for caries detection is the most widespread, but it assesses only dentin cavities and restored and missing teeth. In many societies, the prevalence and severity of cavitated dentin carious lesions have decreased during the last four to five decades, emphasizing the need to develop a detection instrument that covers the total spectrum of dental caries. The CAST instrument includes the total spectrum of dental caries, from a sound tooth/surface through all stages of carious lesion development to abscessed/fistulated teeth, in addition to dental treatments (sealants and restorations). The CAST instrument has been validated, and high levels of intra- and inter-examiner agreement are reported in the literature. It provides more detailed information about the caries status of a population without increasing the examination time in comparison with the WHO criterion. Moreover, the organization of CAST codes in hierarchical order facilitates the categorization of the disease according to severity levels and provides a link to treatment needs. However, more research is still needed with respect to the applicability of CAST in different age groups and cultures.