Visual Detection Criteria Using the International Caries Detection and Assessment System (ICDAS)

  • Kim R. Ekstrand
  • Mariana M. M. B. BragaEmail author


The International Caries Detection and Assessment System (ICDAS) was devised as a visual detection system with histological validation. ICDAS comprises of 7 codes and can be used on primary caries and caries around restorations, on coronal and root surfaces. The system can be used on coronal and root caries as well as caries around restorations and sealants. There is a detection part of the scoring system that categorize lesions according to severity and an assessment aspect that categorize lesions according to activity. Specific guidelines are suggested to be used during clinical examination.


Caries detection Visual assessment Caries activity 


  1. 1.
    Bader JD, Shugars DA, Bonito AJ. A systematic review of selected caries prevention and management methods. Community Dent Oral Epidemiol. 2001;29:399–411.CrossRefGoogle Scholar
  2. 2.
    Pitts NB, Stamm JW. International consensus workshop on caries clinical trials (ICW-CCT)—final consensus statements: agreeing where the evidence leads. J Dent Res. 2004;83 Spec No C:C125–8.CrossRefGoogle Scholar
  3. 3.
    Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res. 1997;31(3):224–31.CrossRefGoogle Scholar
  4. 4.
    Ekstrand KR, Ricketts DNJ, Kidd EAM, Qvist V, Schou S. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res. 1998;32:247–54.CrossRefGoogle Scholar
  5. 5.
    Côrtes DF, Ekstrand KR, Elias-Boneta AR, Ellwood RP. An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth. Caries Res. 2000;34:443–7.CrossRefGoogle Scholar
  6. 6.
    Ricketts DN, Ekstrand KR, Kidd EA, Larsen T. Relating visual and radiographic ranked scoring systems for occlusal caries detection to histological and microbiological evidence. Oper Dent. 2002;27:231–7.PubMedGoogle Scholar
  7. 7.
    Pitts N. “ICDAS”—an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health. 2004;21:193–8.PubMedGoogle Scholar
  8. 8.
    Ismail AI, Sohn W, Tellez M, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170–8.CrossRefGoogle Scholar
  9. 9.
    Pitts N. Monographs in oral science—detection, assessment, diagnosis and monitoring of caries. Basel: Karger; 2009.CrossRefGoogle Scholar
  10. 10.
    Facetti M, Elizabeth C. Association between visual characterization of root caries and histological severity in vitro. MS (Master of Science) thesis. University of Iowa; 2010.
  11. 11.
    ICDAS Foundation. International Caries Assessment and Detection System (ICDAS).
  12. 12.
    Ekstrand KR, Martignon S, Ricketts DJ, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent. 2007;32:225–35.CrossRefGoogle Scholar
  13. 13.
    Ekstrand KR, Zero DT, Martignon S, Pitts NB. Lesion activity assessment. Monogr Oral Sci. 2009;21:63–90.CrossRefGoogle Scholar
  14. 14.
    Braga MM, Mendes FM, Martignon S, Ricketts DN, Ekstrand KR. In vitro comparison of Nyvad’s system and ICDAS-II with lesion activity assessment for evaluation of severity and activity of occlusal caries lesions in primary teeth. Caries Res. 2009;43:405–12.CrossRefGoogle Scholar
  15. 15.
    Ismail AI, Pitts NB, Tellez M, Authors of International Caries Classification and Management System (ICCMS), Banerjee A, Deery C, Douglas G, Eggertsson H, Ekstrand K, Ellwood R, Gomez J, Jablonski-Momeni A, Kolker J, Longbottom C, Manton D, Martignon S, McGrady M, Rechmann P, Ricketts D, Sohn W, Thompson V, Twetman S, Weyant R, Wolff M, Zandona A. The International Caries Classification and Management System (ICCMS™) an example of a caries management pathway. BMC Oral Health. 2015;15(Suppl 1):S9. Epub 2015 Sep 15.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Braga MM, Ekstrand KR, Martignon S, Imparato JC, Ricketts DN, Mendes FM. Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth. Caries Res. 2010;44:300–8.CrossRefGoogle Scholar
  17. 17.
    Guedes RS, Piovesan C, Ardenghi TM, Emmanuelli B, Braga MM, Ekstrand KR, Mendes FM. Validation of visual caries activity assessment: a 2-yr cohort study. J Dent Res. 2014;93(Suppl):101S–7S.CrossRefGoogle Scholar
  18. 18.
    Ferreira Zandoná A, Santiago E, Eckert GJ, Katz BP, Pereira de Oliveira S, Capin OR, Mau M, Zero DT. The natural history of dental caries lesions: a 4-year observational study. J Dent Res. 2012;91:841–6.CrossRefGoogle Scholar
  19. 19.
    Ekstrand KR, Bruun G, Bruun M. Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res. 1998;32:41–5.CrossRefGoogle Scholar
  20. 20.
    Ekstrand KR, Qvist V, Thylstrup A. Light microscope study on the effect of probing in occlusal surfaces. Caries Res. 1987;21:368–74.CrossRefGoogle Scholar
  21. 21.
    Mattos-Silveira J, Oliveira MM, Matos R, Moura-Netto C, Mendes FM, Braga MM. Do the ball-ended probe cause less damage than sharp explorers?—an ultrastructural analysis. BMC Oral Health. 2016;16:39.CrossRefGoogle Scholar
  22. 22.
    Gimenez T, Bittar DG, Piovesan C, Guglielmi CAB, Fujimoto KY, Matos R, Novaes TF, Braga MM, Mendes FM. Influence of examiner experience on clinical performance of visual inspection in detecting and assessing the activity status of caries lesions. Oper Dent. 2013;38:583–90.CrossRefGoogle Scholar
  23. 23.
    Ekstrand KR, Gimenez T, Ferreira FR, Mendes F, Braga MM. Aims, advantages and limitations of the International Caries Detection and Assessment System—ICDAS. Caries Res. 2018;52(5):406–19. Epub 2018 Mar 8.
  24. 24.
    Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;13(3):319–40.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OdontologyUniversity of CopenhagenCopenhagenDenmark
  2. 2.Pediatric DentistryUniversity of São PauloSão PauloBrazil

Personalised recommendations