ICDAS-II Criteria Research Articles

Does the type of impacted third molar induce the formation of caries on the distal surface of the second molar? A different outcome and interpretation

Introduction: Investigators have different ideas about whether or not the third molars should be extracted as a preventive measure. The aim of this study is to evaluate the relationship of impacted third molar with the frequency of caries on the distal surface of the second molar.
 Material and Methods: In this prospectively designed study, oral examination and panoramic radiographic images of 438 patients were performed. All of the second and third molars on the mandible are classificated by the eruption levels and angulation degrees. The presence of caries on the distal surface of the second molars was determined with the help of ICDAS-II criteria. Pearson Chi-Square and McNemar test was used to compare categorical variables and both segments.
 Results: The participants in the study ranged in age from 18 to 62, with a mean age of 28.33± 9.2 years. While a total of 1752 teeth were examined and both segments were evaluated for angulation type and level of eruption. The most frequent angulation type was vertical, and the most frequent eruption level was A. Mesioangulation was the most common type of angulation associated with caries in adjacent teeth.There was a statistically significant variation in the prevalence of caries between the two segments (p

The Effect of MI Varnish™ on Caries Increment and Dietary Habits among 6- and 12-Year-Old Children in Riga, Latvia: A 3-Year Randomized Controlled Trial.

Aims: This randomized controlled trial investigated the effect of MI Varnish™ (5% NaF/CPP-ACP) on caries increment in 6- and 12-year-old children in Riga, Latvia within 36 months. Methods: Forty-eight 6-year-old children (Group 1) and forty-seven 12-year-old children (Group 3) received quarterly varnish application, while forty-eight 6-year-old children (Group 2) and thirty-seven 12-year-old children (Group 4) did not have varnish applied. All children/parents received the same preventive advice. All children were visually examined using ICDAS-II criteria. Questionnaires on dietary habits were completed by the children/parents at baseline and after 36 months. DMFS and dfs were calculated from ICDAS data. The statistical analysis was performed (α = 0.05) using a Chi-squared test, paired t-test (Welch test) and the Pearson correlation coefficient. The trial registration number is ISRCTN10584414. Results: In Group 1 versus Group 2, the DMFS(SD) (Baseline/36 months) values were 5.02(5.85)/13.21(6.67) (p < 0.001) versus 2.65(4.54)/10.81(6.14) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 36.75(12.96)/24.04(12.9) (p < 0.001) versus 33.67(12.74)/23.88(11.91) (p < 0.001), respectively. In Group 3 versus Group 4, the DMFS(SD) (Baseline/36 months) values were 48.62(23.18)/70.96(23.28) (p < 0.001) versus 34.73(17.99)/54.95(16.09) (p < 0.001), respectively; the dfs(SD) (Baseline/36 months) values were 1.7(4.4)/0 (p < 0.05) versus 2(6.39)/0 (p = 0.06), respectively. The prevalence of caries (dfs + DMFS) decreased by 4.52 (p < 0.001) and 1.63 (p < 0.001) in Groups 1 and 2, respectively, but increased by 20.64 (p < 0.001) and 18.22 (p < 0.001) in Groups 3 and 4, respectively. An analysis of the questionnaires indicated the habitual, frequent consumption of a sugary diet by all the children. A significant correlation (r = 0.321; p < 0.05) was observed between caries increment and the frequency of daily intake of sugary snacks, soft drinks and tea with sugar at baseline only in Group 1. Conclusions: A quarterly application of MI varnish (CPP-ACP/fluoride) reduced caries increment in 6- and 12-year-old children in Riga, Latvia.

The prevalence of enamel and dentine caries lesions and their determinant factors among children living in fluoridated and non-fluoridated areas.

To determine the prevalence and severity of dental caries (at dentine and enamel levels of diagnosis) amongst Malaysian children and to investigate determinant factors associated with caries detection at these different thresholds. This study involved life-long residents aged 12 years-old in fluoridated and non-fluoridated areas in Malaysia (n=595). The survey was carried out in 16 public schools by a calibrated examiner, using ICDAS-II criteria. A questionnaire on socio-demographic and oral hygiene practices was self-administered by parents/guardians. Data were analysed using Mann-Whitney U tests and logistic regression. The overall response rate was 74.4%. Caries prevalence at the dentine level or at the dentine and enamel level was significantly (p⟨0.001) higher among children in the non-fluoridated area (D₁₋₆MFT⟩0 = 82.4%, D₄₋₆MFT⟩0 = 53.5%) than in the fluoridated area (D₁₋₆MFT⟩0 = 68.7%, D₄₋₆MFT⟩0 = 25.5%). Considering only the decayed component of the index, no significant differences were observed between the two areas when the detection threshold was set at enamel caries (D₁₋₃) (p=0.506). However, when the detection criteria were elevated to the level of caries into dentine (D₄₋₆) there were clear differences between the fluoridated and non-fluoridated areas (p=0.006). Exposure to fluoridated water proved a significant predictor for lower caries prevalence in the statistical model. Children whose father and mother had a low monthly income had a significantly higher dentine caries prevalence. Results confirmed existing evidence of the benefit of water fluoridation in caries prevention. Detection criteria set at caries into dentine shows clear differences between fluoridated and non-fluoridated areas. Exposure to fluoridated water and socio-economic status were associated with caries prevalence.

Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images

Objective: Current diagnostic tools for non-cavitated occlusal caries are not very reliable. For this reason, newer systems need to be developed. The aim of this study was to compare the performance of visual inspection (ICDAS-II), laser fluorescence (DIAGNOdent pen), and the near-infrared transillumination technique (DIAGNOcam) in the detection of non-cavitated occlusal caries lesions under clinical and laboratory conditions in 90 third molar teeth planned for extraction. Materials and Methods:Ninety third molar teeth were firstly examined in clinical conditions, scored according to ICDAS-II criteria, and examined with DIAGNOdent pen and DIAGNOcam devices. After finishing the clinical examination, the teeth were re-evaluated shortly after the extractions with the same methods. Then, the teeth were sectioned for histological validation according to Downer’s criteria. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curves were calculated based on the histological results. Results: For the D₀–D_1–4 threshold, the area under the ROC curve values ranged between 0.754 and 0.881 for all systems. Sensitivity values ranged between 80.5 and 96.1%, and specificity values ranged between 61.5 and 84.6% for the three caries detection methods. DIAGNOcam had the best correlation value (0.616) according to histological observations and demonstrated a sensitivity rate of 96.1%, a specificity rate of 61.5%, and an accuracy rate of 91.1%. Conclusions: DIAGNOcam was found to be the most effective method for the diagnosis of occlusal caries without cavitation in permanent molar teeth.

Differences in Caries Status and Risk Factors among Privileged and Unprivileged Children in Colombia.

ObjectiveThe objective of this study was to compare the ICDAS-II caries status and caries-related factors among children from rural and urban schools in Pasto, Colombia.Materials and MethodsThe study included 120 children (4 - 6 year- old children) from rural (privileged) and urban (unprivileged) schools. Caries was evaluated using the ICDAS-II criteria. A survey about the factors related to the presence of caries was applied. Chi-square and Fisher’s tests were used to assess the differences in each study variable between the two groups. A Mann–Whitney U test was used to compare the number of teeth, per ICDAS-II category, between the groups. Negative binomial regression was used to estimate the percentage change in the mean number of teeth, per ICDAS-II category, among the rural and urban students.ResultsSignificant differences were found between the rural and urban students for the ICDAS-II 0 and 3-6 categories (p<0.001). The mean number of teeth with moderate-to-severe caries status increased 233% in children from the rural school compared to those attending the urban school (p=0.0). Toothbrushing frequency (p=0.006), cariogenic diet, time elapsed from last dental visit, socioeconomic status, and type of health regime (p<0.001) were among the significant factors related to the rural and urban schools.ConclusionsThis was the first study to compare ICDAS-II caries status between rural and urban students in Colombia. A worse caries status was found in rural students. This study identified the socioeconomic and clinical factors to guide specific interventions for rural children by modifying the available oral health promotion and disease prevention programs.

Dental Caries in Children and Adolescents During and After Antineoplastic Chemotherapy.

To assess caries incidence, intensity, and treatment in children and adolescents under/after antineoplastic treatment. Patients with permanent and mixed dentition were divided into three groups of 60 patients each (5-18 years): CH - under chemotherapy; PCH - after chemotherapy; CG - generally healthy subjects. Caries incidence, intensity (DMFT/dmft, DMFS/dmfs), and mean numbers of teeth/surfaces with white spot lesions-WSL (D1+2/d1+2) were assessed following the ICDAS-II criteria. Mann-Whitney U test, significance at p≤0.05). Caries incidence was significantly higher in PCH and CH (88.33% and 90%) than in CG (66.66%). Caries intensity was higher in both mixed and permanent dentition in patients under and after chemotherapy. The DMFS/DMFT correlation was the highest in PCH. Treatment indexes for primary and permanent teeth treatment were significantly lower in PCH and CH than CG. Antineoplastic chemotherapy is associated with caries development and its high incidence during/after treatment. As dental hygiene was poor in patients under and after antineoplastic treatment, dental checkups need to be more frequent and thorough.

Evaluation of cavitated and non-cavitated carious lesions using the WHO basic methods, ICDAS-II and laser fluorescence measurements.

This study was aimed to compare the diagnostic outcome of the WHO criteria, ICDAS-II criteria and laser fluorescence measurements in measuring the caries ratings of children. Cross-sectional study. The study involved 31 children between 3 and 14 years of age, attending the Department of Pedodontics at Maulana Azad College of Dental Sciences, New Delhi. The surface-related caries status was registered according to the WHO basic method criteria (1997). Additionally, the ICDAS-II visual criteria and the DIAGNOdent readings were documented. The data were analysed with ezANOVA and Excel 2000 (Microsoft Corporation, Redmond, WA, USA). The mean ICDAS-II values amounted to 8.76 ± 0.72. The mean values for DMFS/def were 7.67 ± 0.91, whereas for DIAGNOdent it amounted to 4.00 ± 0.62. In conclusion, this study showed the diagnostic potential of the ICDAS-II criteria in comparison to the traditional WHO criteria by means of the non-cavitated caries lesions additionally detected. The DIAGNOdent use in field studies that already apply detailed visual criteria seems to bring limited additional information.

Dental caries in Victorian nursing homes.

The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

Use of ICDAS-II Criteria in the Detection of Caries Lesion in Cleft Lip and Palate Patients

Objective: To use the International Caries Detection and Assessment System (ICDAS-II) to evaluate the scores of different stages of caries lesion development in cleft lip and palate children. Material and Methods: Fifty cleft lip and palate children aged6-10 years at mixed dentition were selected. Two examiners, one after the other, performed the visual examination of dental surfaces. Firstly, the teeth were cleaned with the aid of pumice and water paste. The examination was carried out under the dental chair reflector, after air drying for 5 seconds with air-water syringe, and with the aid of a WHO probe. The sites comprising the sample were classified according to criteria proposed by ICDAS-II. Results: Ten children met the inclusion criteria. Twenty-five anterior teeth at the cleft area and 93 posterior teeth were assessed, totalizing 590 surfaces classified by ICDAS-II. Four hundred and ninety-four surfaces were scored as sound (code 0-0) regarding the Caries Lesion Condition. Only one surface was scored as partial sealant (code 1), according to the Tooth Surface Condition, but classified as sound regarding the Caries Lesion Condition (code 1-0). No surface exhibited stainless steel; porcelain, gold or porcelain fused to metal crowner veneer; lost or broken restoration; and temporary restoration (codes 5, 6, 7, and 8, respectively). Conclusion: ICDAS-II shows good performance in analyzing caries lesions through more specific assessment and more accurate examination, enabling the detection of caries lesion development at several stages.

Diagnosing the severity of buccal caries lesions in orthodontic patients at de-bonding using digital photographs

Objective. The aims of this study were (1) to evaluate the severity of buccal caries lesions according to the International Caries Detection and Assessment System (ICDAS) criteria via scoring buccal caries lesions on digital photographs at the time of de-bonding and (2) to compare this method with clinical examination. Materials and methods. In total, 89 patients treated with upper and lower fixed appliances were clinically examined immediately after de-bonding by the first author and buccal caries were scored according to the ICDAS-II. Close-up digital photographs were taken of 245 teeth with different buccal caries lesion scores according to the ICDAS-II. Thirteen postgraduate orthodontics students independently scored the buccal caries lesions in the digital photographs using the modified clinical criteria (ICDAS-II). Intra- and inter-examiner reliabilities were evaluated by calculating the weighted kappa. To evaluate the validity of diagnosing the severity of buccal caries lesions using digital photographs compared to clinical examination, Spearman's correlation coefficient was calculated. Results. Intra-examiner reliability and the reliability between each examiner and the clinical examination showed moderate-to-excellent agreement, with kappa values of 0.52–0.83. Scoring buccal caries lesions via clinical examinations and scoring via photographs were well correlated according to the modified ICDAS-II criteria (Spearman's correlation coefficient, 0.76). Conclusions. Thus, scoring buccal caries lesions on digital photographs according to ICDAS-II criteria is a reliable and valid method for assessing the severity of buccal caries lesions.

The Performance of ICDAS-II Using Low-Powered Magnification with Light-Emitting Diode Headlight and Alternating Current Impedance Spectroscopy Device for Detection of Occlusal Caries on Primary Molars

Early detection of occlusal caries in children is challenging for the dentists, because of the morphology of pit and fissures. The aim of this study was to compare in vitro the diagnostic performance of low-powered magnification with light-emitting diode headlight (LPMLED) using ICDAS-II criteria and AC Impedance Spectroscopy (ACIS) device, on occlusal surfaces of primary molars. The occlusal surfaces of 18 extracted primary molars were examined blindly by two examiners. The teeth were sectioned and examined under light microscopy using Downer's histological criteria as gold standard. Good to excellent inter- and intraexaminer reproducibility, higher sensitivity, specificity, and AUC values were achieved by LPMLED at D1 threshold. Also the relationship between histology and LPMLED was statistically significant. In conclusion visual aids have the potential to improve the performance of early caries detection and clinical diagnostics in children. Despite its potential, ACIS device should be considered as an adjunct method in detecting caries on primary teeth.

Zahngesundheit bei 12-Jährigen unter Einbeziehung von Initialläsionen und Dentinkaries

The aim of this study was to assess caries prevalence among 12-year-olds, including initial lesions and dentine caries (ICDAS-II criteria, Codes 0-6). The study was conducted in 2 regions of Hesse with different group prevention programmes (in region 1 children receive regular school-based prophylaxis using fluoride varnish twice a year from 1(st)-6(th) grade, in region 2 there is no use of fluoride varnish in schools. The samples were selected by a random sampling procedure using a list of all public schools. Dental caries was recorded on surface base and the presence of sealants was recorded. Additionally, a school-based analysis was performed. Statistical analysis was performed using SPSS 17.0. To compare the mean caries scores of the subgroups, non-parametric tests were performed (α=0.05). 270 12-year-olds were examined in each region. Mean DF-S values were: Region 1: D1-6FS=1.61; D1+2FS=1.5; D3-6FS=0.84; D5+6FS=0.74. Region 2: D1-6FS=2.8; D1+2FS=2.3; D3-6FS=1.1; D5+6FS=0.72. In region 2 significantly more initial lesions were assessed (p=0.01, D1+2FS). The difference between the regions was not statistically significant at the level of dentine caries (p=0.531, D3-6FS and p=0.113, D5+6FS). In region 1 mean DFS values differ significantly between children with and without fissure sealants at all levels (p<0.05). The analysis for region 1 based on the type of school visited showed a significant difference of mean D1+2F-S and D1-6F-S values (p=0.01 and p=0.012, respectively). In total, the caries prevalence in both regions was low. Differences between mean DFS values were clearer when initial lesions were included. The results point out the impact of assessing initial lesions for evaluation of prevention programs.

Clinical Performance of Two Visual Scoring Systems in Detecting and Assessing Activity Status of Occlusal Caries in Primary Teeth

This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems – the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity assessment (ICDAS-LAA) – were compared using 763 primary molars of 139 children aged 3–12 years. The examinations were performed by 2 calibrated examiners. A subsample (n = 50) was collected after extraction and histology with 0.1% red methyl dye was performed to validate lesion depth and activity. The reproducibility of the indices was calculated (kappa test) and ROC analysis was performed to assess their validity and related parameters were compared using McNemar’s test. The association between the indices and with the histological examination was evaluated using Spearman’s correlation coefficient (r_s). Visual criteria showed excellent reproducibility both regarding severity (NY: 0.94; ICDAS-II: 0.91) and activity (NY: 0.90; LAA: 0.91). The NY and LAA showed good association in caries activity assessment (r_s = 0.88; 95% CI = 0.86–0.89; p < 0.001). Nevertheless, considering only cavitated lesions, this association was not significant (p > 0.05). Concerning the severity, both indices presented similar validity parameters. At D2 threshold, the sensitivity was higher for NY (NY = 0.87; ICDAS = 0.61, p < 0.05). Regarding activity status, NY showed higher specificities and accuracies. In conclusion, NY and ICDAS-II criteria are comparable and present good reproducibility and validity to detect caries lesions and estimate their severities, but the LAA seems to overestimate the caries activity assessment of cavitated lesions compared to NY.