What is the one digit ICDAS system?
- For detection of carious lesions
- Graded 0 to 6 depending on severity
What is the two digit ICDAS system?
- Digit 1: To record exisiting restorations/sealants
- Digit 2: For detection of carious lesion (as per one digit system)
- Often used in research for recording all clinical findings
What is the ICDAS examination protocol? (7 steps)
- Ask pt to remove any removable appliances
- Clean
- Place cotton wool in buccal vestibules
- Remove excess/frothy saliva
- Visual examination of the surface wet
- Dry surface for 5 seconds
- Visual inspection of the dry surface
What is the main clincial feature of an ICDAS 4 lesion?
- Shadowing
What codes would active non-cavitated lesions that can be arrested or remineralised be?
Codes 1 and 2 and some 3
What codes would cavitated lesions that need to be restored be?
Some 3s. 5 and 6.
What texture would white dental caries be?
Mushy soft texture with fast progression
What texture would yellow dental caries be?
Often texture of butter
What texture would light grey/brown caries be?
Firmer, often texture of soft wax
What texture would medium brown or grey caries be?
Firmer, often texture of hard wax
What texture would dark brown or black caries be?
Hard. Similar texture to sound tooth. Arrested.
ICDAS chart scores 0-6
0- Sound
1- Opacity with air drying; white, brown
2- Opacity without air drying; white, brown
3- Surface integrity loss
4- Underlying grey shadow
5- Distinct cavity
6- Extensive cavity
What is the radiographic system?
R1- Radiolucency in outer half of enamel
R2- Radiolucency in the inner half of the enamel +/- EDJ
R3- Radiolucency limited to the outer one third of dentin
R4- Radiolucency reaching the middle one third of dentin
R5- Radiolucency reaching the inner one third of dentin, clinically cavitated
R6- Radiolucency reaching into the pulp, clinically cavitated
What is RA, RB and RC
- RA = R1, R2 and R3
- RB = R4
- RC = R5 and R6
What does the ICCMS system take into account?
- Risk assessment
- Clinical evidence
- Radiographic evidence
- Use all above to help guide management
What are the 14 risk factors for ICCMS?
- Diet
- OH
- Primary or permanent teeth (primary enamel thinner, pulp bigger)
- Tooth eruption (newly erupted teeth, bi-lateral risk of caries)
- Caries compliance (Compliance, treated and untreated, family history)
- Medical history
- Fluoride history
- Attendance history
- SES/Health access barriers
- Dry mouth (Medications, Smoking)
- Alcohol and drug use
- Appliances, restoration overhangs, extractions
- Exposed root surfaces
- Developmental enamel defects
How to record ICDAS in practice?
- Under examination
- Risk factors assessed and recorded
- High, medium, low risk
- Under tx plan
- Record clinical observation
- Record radiographic observations
