ICDAS Criteria and Clinical Experience - A Study with Histological Validation

In an effort to achieve higher sensitivity and precise quantification to allow monitoring lesions at an early stage (pre-cavitation), a new visual criteria has been developed, ICDAS (International Caries Detection and Assessment System). OBJECTIVE: The aims of this study were to assess intra-examiner agreement using ICDAS severity and activity criteria, and to assess sensitivity, specificity, and agreement with histology, as well as agreement with activity scores. The null hypothesis was that experience would not affect any of the parameters examined. METHODS: Predoctoral dental students, graduate dental students and faculty from IUSD were invited to participate in the study. Thirty participants were selected. After a lecture and hands-on training session on the ICDAS criteria the participants examined sixty teeth, representing all scores of the criteria mounted on 10 models in phantom heads. For intra-examiner reliability calculations, all teeth (60) were examined a second time. All teeth were initially scored using the severity and activity component of the ICDAS criteria by two examiners expert in these criteria. This was used as the expert's severity and activity scores. The teeth were sectioned and analyzed under a stereomicroscope. Caries lesions were categorized according to Ekstrand et al. (1998) criteria. RESULTS: All groups achieved substantial to almost perfect intra-examiner agreement for severity scores (0.80-0.84 wtk) and substantial agreement for activity scores (0.62-0.65 K). Agreement with expert's severity scores ranged from 0.69-0.74 wtK; while agreement with expert's activity scores ranged from 0.45-0.56 K. Agreement with histology was in the moderate range (0.55-0.59 wtk). Specificity ranged from 82.9 to 87.1 and sensitivity ranged from 88.3 to 91.1. CONCLUSIONS: There were no significant differences between the groups for intra and inter-examiner agreement for ICDAS activity or severity as measured by kappa. These results suggest that previous experience does not play a role on learning ICDAS.