News

Professor Nigel B.Pitts
Director of the Dental Health Services & Research Unit and the Centre for Clinical Innovation, University of Dundee, UK

This presentation had provided an overview of recent International joint working and initiatives to promote the standardisation of evidence based approaches to caries terminology, caries classification and caries management. The recent work led by the ICDAS Foundation had been reviewed. This activity started with a clinical visual scoring system which has been developed from a systematic review of earlier systems and is intended for use in dental education, clinical practice, research and epidemiology. ICDAS is designed to lead to: better quality information to inform decisions about appropriate diagnosis, prognosis and clinical management at both the individual and public health levels. The ICDAS Foundation has also been working to provide a framework to support and enable personalised comprehensive clinical caries management for improved long-term outcomes and has developed, with partners, an open International Caries Classification and Management System, the ICCMStm. The ICCMStm has a number of modules of variable complexity suitable for different applications. The ICCMStm can be used to help deliver:

1. Epidemiological and Clinical Research
2. Prevention-focussed Clinical Caries Control for individual patients in dental practise
3. Population focussed Health Promotion & Prevention in Public Health
4. Standardized and Evidence Based Cariology Education

This framework provides an overall structure with which to view the important contributions to clinical caries management which can be made by risk assessment and the use of fluorides.

Key messages from the lecture

1. ICDAS (International Caries Detection & Assessment System) is a clinical visual scoring system developed from systematic reviews. It can be used for education, clinical practice, research and epidemiology.
2. The organizations currently involved in the international initiatives on caries terminology, classification and managements include ICDAS, IADR, ORCA, FDI, ADEE and ADEA.
3. The ORCA/ADEE European Core Curriculum in Cariology comprises 5 Domains:
   • Domain I: The Knowledge Base
   • Domain II: Risk assessment, Diagnosis & Synthesis
   • Domain III: Caries Management, Decision Making & Preventive Non-Surgical Therapy
   • Domain IV: Caries Management, Decision Making & Surgical Therapy
   • Domain V: Evidence-based Cariology in Clinical & Public Health Practice
4. The Detection & Assessment of Caries is based on the following three steps:
   • Detection of lesion extent
   • Assessing lesion activity
   • Monitoring of lesion behavior over time
5. In a National Survey of Icelandic children, the percentage of 12-year children with ?no detectable caries? can be recorded as 48%, or 34%, or 22% or 15% (depending on the diagnostic threshold employed and whether radiographic information is used)! The corresponding percentages of 15-year children with no detectable caries was 35%, or 20%, or 16% or 6%! These disparities reflect how accurate and reliable comparisons are impossible unless there is standardization of caries measurement.
6. Guiding Principles for Caries Treatment Interventions from ICCMStm:
   • Prevention* as a priority, surgical intervention only used as a last resort (*primary and secondary)
   • Where surgery is indicated, use minimal removal of tooth tissue
   • Cavity size and selection of choice of material are governed by preservation of tooth tissue destruction and healthy patient outcomes
7. A Holistic View of the International Caries Classification and Management System™
   • Wellness (0): how to stay healthy
   • Initial Caries (1-2): ?Non-cavitated? d1 lesions (can derive d1mft or d1mfs)
   • Moderate Caries (3-4) & Extensive Caries (5-6): (traditional ?cavitated? d3mft or d3mfs)
   • Pain/Sepsis (PUFA): Pain, Pulp & Sepsis
8. Key elements of the International Caries Classification and Management System™:
   • Initial Patient Caries Risk Assessment
   • Detection, Activity and Enhanced Risk Assessment
   • Synthesis and Decision-Making
   • Clinical Treatments (Non-surgical & Surgical) with prevention

There are now a wide range of increasingly coordinated international activities around caries prevention and control with an emphasis on children. The ICDAS International Caries Classification and Management Systemtm (ICCMStm) provides a flexible framework to explicitly link preventively ?orientated clinical practice with research evidence, education and public health.