ICDAS Scores Research Articles

Clinical effectiveness of resin-modified glass ionomer-based fluoride varnish for preventing occlusal caries lesions in partially erupted permanent molars: A randomised active-controlled trial.

Deep pits and fissures in partially erupted permanent molars are vulnerable to dental caries. To assess the clinical effectiveness of resin-modified glass ionomer-based fluoride varnish (RMGI-F varnish: Clinpro XT™ varnish) in preventing occlusal caries lesions in partially erupted permanent first molars. In this randomised active-controlled superiority trial with a single-blind parallel design, 74 children with 182 partially erupted first permanent molars were allocated into two groups: Group 1: RMGI-F varnish; and Group 2: GI sealant (active control), with an application of 0.1% sodium fluoride varnish for all other teeth. The primary outcome was ICDAS score ≥1 at 12months of follow-up. Data were analysed using adjusted Chi-square test and GEE regression for binary outcomes. Group 1 (15.7%) and Group 2 (13.8%) did not differ significantly in ICDAS ≥1 scores at 12months of follow-up (adjusted χ2 =0.373, p=.541). There was no significant difference in retention between Group 1 (48.3%) and Group 2 (20.7%) at 12months of follow-up (adjusted χ2 =0.1, p=.752). Mean application time per tooth (16±5.9 vs 20.2±5.4min) was significantly different (t=5.26, p=.014). RMGI-F varnish was not superior to GI sealant in preventing occlusal caries lesions in partially erupted molars.

Dental drive through model of care to reduce caries incidence

Aim or purposeAn increase in number of people seeking emergency care due to inability to access dental services for general care was seen during COVID-19. This drive through model was developed to screen, educate and prioritise, based on individual risks, patients who were otherwise unable to get dental care due to COVID-19 restrictions.MethodsOn World Oral Health Day, 2021 dental examinations were conducted for patients while they drove through an existing COVID-19 screening clinic. The ICDAS-II index (International Caries Detection and Assessment System), score two to six, was used for caries assessment and management. Patients were categorised into three groups based on number of decayed teeth (less than three, three to six or more than six). The management criteria was based on the ICDAS score of teeth under each of the three categories.ResultsA total of 247 patients were screened and educated on the day. 102 patients with ICDAS score two to four were given education and preventative treatment appointment. While 118 patients with ICDAS score five or six were identified to be at risk of dental emergency in the near future and were booked in for emergency or general treatment. Another 27 patient were given clinical priority based on their periodontal or denture related needs. Patient survey revealed a high satisfaction rate of 92%.ConclusionsThis public health initiative was a great success in providing dental care to the patients during these unprecedented times who would not have had any care otherwise due to COVID-19 restrictions.

The efficacy of dental sealant used with bonding agent on occlusal caries (ICDAS 2-4): A 24-month randomized clinical trial.

Bonding before sealant application enhances retention on saliva-contaminated sound teeth; however, there are few studies of bonding's efficacy on sealant retention on occlusal caries. To evaluate a bonding agent's efficacy on sealant retention on occlusal caries and caries transition. One hundred twenty pairs of first permanent molars with occlusal caries (ICDAS 2-4) from 98 children aged 7.3-9.9years were included. One molar was randomly selected to use bonding (Adper™ Single Bond 2, 3M ESPE) applied before sealant application (Helioseal® clear, Ivoclar Vivadent). Bonding was not used on the contralateral tooth. Retention was determined using Simonsen's criteria; caries transition was evaluated using ICDAS scores, DIAGNOdent values, and bitewings at baseline, 6, 12, and 24months. Data were analyzed with McNemar's and Fisher's exact tests. Bonding agent use significantly increased sealant retention rates (P<.001). Bonded (B) sealants had a higher retention rate (83.3%) than non-bonded (NB) sealants (53.7%). The difference in the caries-transition rate was not significant between the groups (P>.05). Three teeth (1.4%; NB:B=2:1) were restored due to radiographic dentin-caries progression. Using a bonding agent before applying sealant on permanent molar occlusal caries (ICDAS 2-4) significantly enhanced sealant retention. Caries progression was rarely detected at the 24-month follow-up.

Success of resin infiltration treatment on interproximal tooth surfaces in young adults-A practice-based follow-up study.

ObjectivesArresting active initial caries lesions is part of the modern caries controlling system. Resin infiltration (RI) system has been found a promising method in arresting interproximal initial lesions. The aim was to investigate whether RI arrests progression of active caries lesions.Materials and methodsParticipants (n = 20) of the retrospective study were patients in the Dental Teaching Unit, City of Oulu, Finland, mean age 26 years (SD5.2). Indication for RI was radiographically diagnosed progressing (ICDAS 1–3) interproximal lesions (n = 54). RI treatments were performed in 2015–2017. Controls were initial lesions in the same bitewing radiographs without RI or other treatment (n = 24). For analyzes teeth were categorized as lower and upper premolars and molars. The change in lesions during the follow‐up period was recorded surface wise as follows: deterioration / improvement from ICDAS score 3/improvement from ICDAS score 2/improvement per se/at follow‐up, lesion was less diffuse/no change. The changes in each tooth surface were analyzed between RI intervention and control teeth by using Chi‐square test. Proportions of successful and failed surfaces were given.ResultsThe mean length of follow‐up period was 17.4 m (SD7.2). Arresting of caries lesions (ICDAS scores 2 and 3) was distinctly better in RI group (63.0%) compared with the controls (29.1%). The situation progressed among 29.2% of the controls whereas the respective proportion among the intervention group was 14.8%. Progression of lesions was more distinct in all tooth groups in the control group. Outcome was successful despite the lesion depth.ConclusionsResin infiltration seems effective in arresting progression of initial caries lesions with monitoring period of 1.5 years.

Evaluation of Carious Primary Teeth that Causes Swelling In Children Visiting a Private Dental Institute - An Observational Study

The worldwide incidence of ECC was found to be 1.76 billion. If left untreated, these carious lesions have high possibility to progress into oro-facial swellings. The purpose of this study was to evaluate the carious teeth in primary dentition, which causes oro-facial swelling. This observational study is carried out by observing the oro-facial infection in children and describing the associated carious teeth using GV Black's classification, ICDAS Criteria for carious teeth and also categorizing the caries index of the patient using dmft index. A total of 189 case sheets were reviewed, and cross-verification was done by photographs. Among the 189 case sheets, a total of 70 cases were selected after proper review. Out of 70 patients, 51 patients had Class 1 carious lesion, and 19 had Class 2 carious lesion all the teeth were categorized under ICDAS score 5 and 6, the mean dmft score was 8.64. Class 1 carious lesions with visible dentin were most commonly associated with Oro-facial Swelling in children. The carious teeth, which were ICDAS-6, were treated by extraction and which were ICDAS-5, were rendered pulp therapy.

In vivo correlation of near-infrared transillumination and visual inspection with bitewing radiography for the detection of interproximal caries in permanent and primary teeth.

To evaluate near-infrared light transillumination (NILT) for interproximal caries detection in children by comparing the correlation between both NILT and visual inspection (ICDAS) with bitewing (BW) radiography and by investigating possible differences in caries detection with NILT between primary and permanent teeth. From 35 patients, 121 and 63 interproximal surfaces in, respectively, primary and permanent teeth were included. NILT images were obtained using DIAGNOcam™ (KaVo) and scored by two calibrated raters. A consensus diagnosis was reached for BW radiography; whereas, the ICDAS scores were obtained by one calibrated rater. Weighted Kappa (wκ) was used to evaluate inter- and intra-rater reliability of NILT and to evaluate the correlation between NILT, ICDAS and BW radiography. The correlation between NILT and BW radiography was moderate to substantial for primary teeth [Rater 1: wκ = 0.61 (95% CI = 0.49-0.75), Rater 2: wκ = 0.55 (95% CI = 0.41-0.69)] and fair for permanent teeth [Rater 1: wκ = 0.34 (95% CI = 0.15-0.53), Rater 2: wκ = 0.33 (95% CI = 0.08-0.58)]. The correlation between ICDAS and BW radiography was moderate for primary teeth [wκ = 0.49 (95% CI = 0.35-0.63)] and substantial for permanent teeth [wκ = 0.62 (95% CI = 0.32-0.92)]. No significant differences were found between primary and permanent teeth. NILT cannot be recommended as a single diagnostic tool for interproximal caries detection in primary teeth. The number of false negatives for dentine caries, especially in first primary molars, was too high. For the use in permanent teeth, NILT could be more accurate than BW radiography.

Risk Factors for Early Childhood Caries in Toddlers: An Institution-based Study.

BackgroundTooth decay experience among toddlers and preschoolers is of epidemic proportions worldwide and dental caries still remains an important childhood disease affecting a considerable part of this population. Though the prevalence of Early Childhood Caries (ECC) is associated with several risk factors such as feeding and oral hygiene practices, Streptococcus mutans levels, socioeconomic status (SES), etc., it is suggested that these factors should be studied adequately to aid in the early prevention and management of ECC.ObjectiveThe objectives of the study were to: a) evaluate the distribution of ECC, b) study the role of SES in the occurrence of ECC, c) record the variations in feeding and dietary practices along with oral hygiene practices and d) Correlate the sweet score with ECC.Materials and MethodsThis cross-sectional observational study was conducted over a period of 6 months among 100 toddlers (12-36 months) attending the Pediatric outpatient department of a single medical institution in Chennai, India. The study consisted of an intra-oral examination followed by a face to face interview of the mothers of the children using a validated structured oral health questionnaire.ResultsSES and ECC were negatively correlated with statistically significant association. Majority of the subjects did not follow any oral hygiene practices before teeth erupted; few subjects used tooth brush and tooth paste after teeth erupted and followed oral hygiene practices once a day. Statistically significant positive correlation with ICDAS scores was noted in relation to the sweet score and the frequency of intake of sweet foods, candy, etc. Cavitated lesions were more common than non-cavitated lesions and majority of the posterior teeth had ICDAS score 4.ConclusionHealthcare providers for children must be well informed on the etiology and risk factors of ECC and guide children for their first dental visit within one year of age.

Assessment of Near-Infrared (780nm) Light Transillumination Accuracy for Detection of Incipient Caries Lesions

The aim of study was to evaluate the accuracy of the near-infrared light transillumination technique used in the detection of the proximal incipient dental caries. The study was performed on 12 medium caries risk subjects (mean age of 26.5). A total number of 312 proximal dental surfaces from the posterior dental group were included in the study. All the proximal surfaces, which had not been restored, or unaffected by cavitated dental caries, were assessed by a near-infrared transillumination camera system using light with a 780nm wavelength (DIAGNOcam, KaVO). Bitewing radiographies were performed for all patients included in study. Visual and tactile examination after tooth separation was performed as gold standard to detect the incipient proximal dental caries (ICDAS scores 02 and 03). Statistical analysis using Chi-square test was performed to compare the diagnostic performance of near-infrared light transillumination and the bitewing radiography. Near-infrared light transillumination showed higher sensitivity (81.80%) when compared to bitewing radiography (65.90%) to detect the non-cavitated proximal enamel caries (ICDAS score 02). Near-infrared light transillumination method showed higher sensitivity (100%) when compared to bitewing radiography (81.50%) to detect the incipient cavitated proximal enamel caries (ICDAS score 03). Specificity values for proximal incipient dental caries (ICDAS codes 02 and 03) were 95.03% for near-infrared light transillumination and 99.18% for bitewing radiography. DIAGNOcam (KaVO) is a reliable tool with high diagnostic accuracy of the incipient dental caries localized on proximal surfaces of the posterior dental group.

Prevalence and Severity of Molar-Incisor Hypomineralization, Maternal Education, and Dental Caries: A Cross-Sectional Study of Mexican Schoolchildren with Low Socioeconomic Status.

Objectives:The aims of this study were to identify the prevalence of molar–incisor hypomineralization (MIH) in a group of low-income schoolchildren and to evaluate the role of maternal education on MIH and dental caries in these children.Materials and Methods:This cross-sectional study enrolled 686 schoolchildren. To evaluate dental caries, the International Caries Dental Assessment System II (ICDAS) criteria were utilized. MIH was assessed by using the European Academy of Paediatric Dentistry criteria. Mixed-effects models were applied for the data analysis.Results:The prevalence of MIH was 35.4% (244). Most children exhibited moderate MIH (163, 67.1%), followed by mild MIH (45, 18.5%) and severe MIH (35, 14.4%). Caries presence in the first permanent molars, evaluated using ICDAS score, indicated that the mean number of noncavitated and cavitated lesions (ICDAS ≥2) was 0.90 (±0.30); the mean number of lesions with ICDAS ≥3 was 0.36 (±0.48). Odds ratio (OR) analysis of MIH severity revealed that the children of mothers with low education were more likely to exhibit MIH (OR 2.13; 95% confidence interval [CI]: 1.25–3.85). Modeling of dental caries (ICDAS ≥3) revealed that low maternal education (OR 2.27; 95% CI: 1.25–4.16) and the presence of MIH (OR 4.37; 95% CI: 3.05–6.25) were associated with dental caries.Conclusions:There were associations between low maternal education and both MIH and dental caries. The presence of both initial and cavitated caries lesions was associated with MIH. Dentists should offer adequate advice to mothers with children with MIH, based on their educational background.

Calibration of dentists for Caries Management by Risk Assessment Research in a Practice Based Research Network - CAMBRA PBRN

BackgroundTo prove that Caries Management by Risk Assessment (CAMBRA) can be successfully implemented in dental practices outside of the university setting, dentists in the San Francisco Bay Area (CA) were approached to participate in a Practice Based Research Network (PBRN) study. The overall goal of the CAMBRA-PBRN study was to recruit 30 dentists to perform a two-year study involving approximately 900 patients. Goal of the calibration study was to standardize and calibrate dentists potentially participating in the CAMBRA-PBRN study.MethodsTo minimize inter-examiner variability in data collection, including classification of carious lesions and recording of existing restorations, participating dentists were trained and calibrated in accurate DMFS (decayed, missing, filled surfaces) charting. Dentists were also trained and calibrated to diagnose and differentiate between sound surfaces and non-cavitated caries lesions (International Caries Detection and Assessment - ICDAS scores 1 and 2) for posterior occlusal surfaces.Thirty dentists were calibrated to a single gold standard examiner (BJ) during 6 calibration sessions, between 2011 and 2014. Kappa statistics were used to determine inter-examiner reliability on 13 or more patients, aged 12–63 (average age 38 ± 15 years), per examiner during each session, resulting in 94 patient encounters over the course of all 6 sessions. To participate in the main study, examiners needed to achieve a minimum required kappa of 0.75. During the calibration process, examiners scored between 1036 and 2220 tooth surfaces.ResultsThe kappa values (unweighted kappa) of the participating dentists compared to the gold standard examiner ranged from 0.75 to 0.90, with an average kappa of 0.84 ± 0.03. 90% of the examiners achieved overall kappa values above 0.8. However, separate reliability for assessment of non-cavitated lesions, as in other studies, was lower (0.55 ± 0.15). Multiple subcategories were evaluated. All dentists reached sufficient reliability values to proceed into the study; nevertheless, one dentist discontinued with the study due to scheduling conflicts.ConclusionsThe high inter-examiner reliability results have shown that dentists who work in primarily non-research based practices can be effectively standardized and calibrated in data collection, based on specific guidelines created to anticipate potential research study scenarios.

Efficacy of Sealing with Glass Ionomer Cement and Transversal Brushing Technique in Erupting First Molars: 18-Month Clinical Follow-Up

Objective: To verify the effectiveness of sealing with glass ionomer cement and transversal brushing in the prevention and treatment of initial caries lesions in erupting permanent molars of children aged 5-7 years. Material and Methods: Healthy teeth with ICDAS scores 1 or 2 were selected. One hundred and thirty-one children (79 teeth in the control group - 75 teeth in the test group) were randomly assigned into the two experimental groups: (1) transversal brushing technique for plaque control with conventional flat bristles and fluoridated dentifrice or (2) sealing the occlusal surfaces with glass ionomer cement (Vitro Molar ® ). Follow-up was performed for 18 months and the survival analysis was applied to test the occurrence of lesion progression. Results: The mean age of children was 5.4 years and it was verified that, by examining the initial tooth condition, the probability of progression was 66% lower when the tooth had initial caries lesions than when it was healthy; the probability of molar progression was about 74% lower in the test group compared to the control group. The mean time for lesion development in the test group (16.8 months; SD = 0.5) was greater than that in the control group (16.5 months; SD = 0.5; p=0.008). Conclusion: Sealing reduces the progression of caries disease in initial lesions when compared to the transversal brushing technique.

Correlation with Caries Lesion Depth of The Canary System, DIAGNOdent and ICDAS II.

Introduction:The aim of this study was to correlate lesion depth of natural caries, measured with Polarized Light Microscopy (PLM), to Canary Numbers (CN) derived from The Canary System™ (CS), numerical readings from DIAGNOdent (DD), and lesion scores from ICDAS II.Methods:A total of 20 examination sites on extracted human molars and premolars were selected. The selected examination sites consisted of healthy and enamel caries on smooth and occlusal surfaces of each tooth. Two blinded dentists ranked each examination site using ICDAS II and the consensus score for each examined site was recorded. The same examination sites were scanned with CS and DD, and the CN and DD readings were recorded. After all the measurements were completed, the readings of the three caries detection methods were validated with a histological method, Polarized Light Microscopy (PLM). PLM performed by blinded examiners was used as the ‘gold standard’ to confirm the presence or absence of a caries lesion within each examined site and to determine caries lesion depth.Results:Pearson’s coefficients of correlation with caries lesion depth of CNs, DD readings and ICDAS scores were 0.84, 0.21 and 0.77, respectively. Mean ± SD CN for sound sites (n=3), caries lesion depths <800 µm (n=11), and caries lesion depths >800 µm (n=6) were 11±1, 55±15, and 75±22, respectively. Mean ± SD DD readings for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 1±1, 7±11, and 8±9, respectively. Mean ± SD ICDAS II scores for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 0±0, 2±1, and 2±1, respectively. The intra-operator repeatability for the Canary System was .953 (0.913, 0.978).Conclusion:This study demonstrated that the CS exhibits much higher correlation with caries lesion depth compared to ICDAS II and DD. CS may provide the clinician with more information about the size and position of the lesion which might help in monitoring or treating the lesion.The present extracted tooth study found that The Canary System correlates with caries lesion depth more accurately that ICDAS II and DIAGNOdent.

Caries Experience of Black Stained Teeth Using ICDAS II

Background: Black Tooth Stain (BS) is one of the local extrinsic discolorations generally seen on cervical area of a tooth and associated with low caries experience. The aim was to analyse caries status of black stained teeth by International Caries Detection and Assessment System (ICDAS II). Methods: A total of 111 teeth with BS and 144 with non-BS teeth of 10 subjects were recorded. ICDAS Scores after visual (naked eye, mirror-sound and digital photography) and radiographic examinations. Group 1 ICDAS 0 scores has indicated ‘non-carious’; group 2 ICDAS 1-2 as reversible lesion (White spot lesion) and group 3 ICDAS 3,4,5,6 were saved as ‘cavitated carious’ teeth. All teeth which have restorations, crowns and such appliances were excluded from the data. Results: The proportion of the teeth without caries is significantly higher among the teeth with black-stain (BS) than the teeth without BS. (62.2% and 36.1% respectively; X2=18.231, p<0.001). More detailed analysis showed that statistically significant difference exists between all of the three groups (p<0.001). Additionally, six of total 10 patients were reported as suffering from Fe+ deficiency with different degrees. Conclusion: Black stained teeth showed less caries scores compared to non-BS. While it was a tooth-specific and local formation, ICDAS II enabled exact and tooth-specific definition.