Application of ICDAS II for Caries Detection in Community-Based Settings

The International Caries Detection and Assessment System (ICDAS II) is now recognized as the international gold standard diagnostic criteria for the assessment of caries experience in children and adults. Objective: To develop a protocol for using the ICDAS II within community-based studies where compressed air for drying the tooth surface is not available. Methods: To overcome the significant barrier of no compressed air for drying the tooth surface, the ICDAS II protocol was modified where the use of caries code 1 (requiring the tooth to be air dried for 5 seconds) was removed leaving only codes 0, 2, 3, 4, 5 and 6. Therefore the modified score of zero (0) ‘sound tooth surface' also included code 1 ‘first visual changes in enamel' which requires the tooth to be dried for 5 seconds. This modified protocol was reviewed and tested by a team of six oral health practitioners after training with the ICDAS II e-learning program and two experienced clinical researchers who also provided the ‘gold standard' assessment for the calibration of the OHPs for use with the modified codes. The dental examination included using an artificial light source (head lamp), a plane front mouth mirror, and a periodontal probe with a ball ended tip. Results: The results of the pilot testing using the modified ICDAS II index in a home setting and the calibration of OHPs have shown that this modified version of ICDAS II is acceptable. Conclusion: The reported modified ICDAS II protocol described above is likely to make a significant contribution to community oral health research by enabling the collection of high quality clinical data outside of a clinical setting without compromising the possibility of comparison with other studies using ICDAS II.