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University of Copenhagen
05/29/2012
Whohasbeeninvolvedsince2002?
TheICDASCoreGroupcomprises: UniversityofDundee (NigelPitts+team) TempleUniversity(wasMichigan) (AmidIsmail+team) IndianaUniversity (DomZero+team) UniversityofCopenhagen (KimEkstrand) (ElmarReich>MartinTyas>MichelGlick) FDI[whenabletocontribute] NIH/NIDCR:(wasRobSelwitz>) (AlKingman)
InternationalCariesDetectionand AssessmentSystem(ICDAS)
ProfessorNigelPitts
DentalHealthServicesResearchUnit &CentreforClinicalInnovations
ProfessorKimEkstrand
CariologyandEndodontics SchoolofDentistry
UniversityofDundee
UniversityofCopenhagen
www.icdas.org
AllworkingwithGailDouglasandthewiderICDASCoordinatingCommittee, withwideinvolvementfrommanyCountries,foroveradecade
www.icdas.org
OnbehalfoftheICDASFoundation
University of Copenhagen
University of Copenhagen
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
Outline
InternationalCariesDetectionandAssessmentSystem(ICDAS)
Outline
InternationalCariesDetectionandAssessmentSystem(ICDAS)
To lead to:
Better quality information to inform decisions about appropriate diagnosis, prognosis and clinical management at both the individual and public health levels
For more on Pitts N B, Community Dental Health 2004 21:193-198 ICDAS see:- http://www.icdas.org
05/29/2012
Stagingthecariesprocess comparetooncologydecisionmaking
+ clinically detectable D3
lesions in dentine
D3
2
D3 + enamel= D1
www.icdas.org
www.icdas.org
InternationalConsensusWorkshoponCariesClinicalTrials AgreeingWheretheEvidenceLeads ICWCCTSystematicReviewofprevious CARIESCLASSIFICATIONSYTEMS IsmailAI.Visualandvisuotactiledetectionof dentalcaries.JDentRes2004;83:C5666. Thisreviewcompileddetailsofthe(many)previously publishedsystemsforclassifyingcaries,inwhichthe variablediagnosticcriteriainmanycaseslacked constructvalidityandalsomadecomparisonof evidencefromdifferentstudiesimpossible
www.icdas.org
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Terminology:
ICW-CCT Consensus Statements
The consensus was to separate out three key terms:
TheEvidenceBaseinCaries DetectionandAssessment
Reliable inclusion of clinical visual enamel & dentine caries detection is not new
lesion detection (which implies an objective method of determining whether or not disease is present) lesion assessment (which aims to characterise or monitor a lesion, once it has been detected) caries diagnosis (which should imply a human professional summation of all available data)
ICDAS
Pitts N B and Stamm J. ICW-CCT Statements. J Dent Research 2004 83C: 125-128.
www.icdas.org
The ICDAS Committee recognised the urgent need for valid comparability and a histological basis, both for Systematic Reviews and getting evidence into practice
ICDAS Wardrobe
Epidemiology / Public Health Clinical Practice
ICDAS
ICDAS
CVA
Clinical Practice
Education ICDAS
Clinical Research
ICDAS
ICDAS Wardrobe
ICDAS
Lesion Detection Tool
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http://www.icdas.org
ICDAS in the literature e-learning programme
Two following documents [Microsoft Word] may be downloaded. The Rationale and Evidence for the International Caries Detection and Assessment System (ICDAS II) Criteria Manual for the International Caries Detection and Assessment System (ICDAS II)
For further information please contact: Prof. Gail Douglas - ICDAS Co-ordinator g.v.a.douglas@leeds.ac.uk
We need a validated method to STAGE the disease process to plan, deliver and monitor appropriate care
At the present time we have no substitutes which are the equal of original tooth tissues!
http://www.icdas.org
ARegisteredCharity
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www.icdas.org
www.icdas.org
www.icdas.org
www.icdas.org
ICDAS and the International Caries Classification and Management System ICCMS
ICDAS & ICCMS Research Population and Clinical Research on caries and caries management
ICDAS & ICCMS Public Health Population focussed Health Promotion, Prevention and Needs Assessment
www.icdas.org
05/29/2012
FDIWorldDental Federation
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
Outline
InternationalCariesDetectionandAssessmentSystem(ICDAS)
IntroductionandHistoricalDevelopment Evidencetosupportvalidityofstagingandadoptiontodate
Histologicalvalidation ICDASintheliterature Stagingdiseaselinkingtoplanningandmonitoringtreatment
a)Soundb)Visibleafterairdryingc)visiblewithoutairdrying a)Soundb)Visibleafterairdryingc)visiblewithoutairdrying
d)Visiblewithoutairdryinge)Microcavitationorshadowedf)dentinecavitation d)visiblewithoutairdryinge)Microcavitationorshadowedf)dentinecavitation
1.1
Fig.1
Fig.2 Lesionopenforassessment(extracted)
Fig.3
ICDASintheliterature
Worldwideadoption (asofMay2012) Country ofstudyorfirstauthor
Australia Baileyetal.(2009)JournalofDentalResearch Brazil Arruda etal.(2012)CommunityDentistryandOralEpidemiology Bragaetal.(2010)CommunityDentistryandOralEpidemiology Bragaetal.(2010)JournalofBiomedicalOptics Bragaetal.(2010)DentalClinicsofNorthAmerica Bragaetal.(2010)CariesResearch Bragaetal.(2009)CariesResearch Bragaetal.(2009)CariesResearch Bragaetal.(2009)OralSurg OralMedOralPathol OralRadiol Endod. Cadavid etal.(2010) BrazilianOralResearch deAmorim etal.(2011)ClinicalOralInvestigation Diniz etal.(2012) JournaloftheAmericanDentalAssociation[Brazil] Diniz etal.(2011) OperativeDentistry Diniz etal.(2010) JournalofDentalEducation Diniz etal.(2009) CommunityDentistryandOralEpidemiology
Peer Reviewed Papers using ICDAS 2012 2011 2010 2009 2008 2007 2006 2004 12 23 19 12 10 6 5 1
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Colombia DazCrdenasandGonzlezMartnez(2010)RevistadeSaludPblica Martignonetal.(2010)CommunityDentalHealth Denmark Bakhshandeh etal.(2011)CariesResearch Ekstrandetal.(2010) CariesResearch Ekstrandetal.(2011) CariesResearch Ekstrandetal.(2007) OperativeDentistry France Aidara etal.(2011)InternationalDentalJournal Josephetal.(2011)EuropeanArchivesofPaediatricDentistry Germany Bergeretal.(2009)ClinicalOralInvestigation JablonskeMomeni (2012)LasersinMedicalScience JablonskiMomeni etal.(2011)CariesResearch JablonskiMomeni etal.(2010)LasersinMedicalResearch JablonskiMomeni etal.(2009)JournalofDentistry JablonskiMomeni etal.(2009)InternationalJournalofDentistry JablonskiMomeni etal.(2008)CariesResearch Khnisch etal.(2008)CommunityDentistryandOralEpidemiology Parisetal.(2011)EuropeanJournalofOralScience Greece Michalaki etal.(2010) EuropeanArchivesofPaediatricDentistry Mitropoulis etal.(2012)CariesResearch Mitropoulis etal.(2010)JournalofDentistry Parapanisiou etal.(2009)EuropeanArchivesofPaediatricDentistry
Romania a Societ ii de Medici i Naturaliti din Maxim DC, Dnila I, Dasclu CG, Balcos C. (2010) Revista medico-chirurgical Iai Sweden Baeshen etal.(2011)AmericanJournalofOrthodonticsandDentofacial Orthopedics Switzerland Neuhausetal.(2010)ClinicalOralInvestigation Rodriques etal.(2008) CariesResearch UK Banerjee etal.(2011)JournalofDentistry Bonneretal.(2011)PrimaryDentalCare Ormondetal.(2010) PrimaryDentalCare Nazir etal.(2011)JournalofOrthodontics Pretty,I.A.(2006)JournalofDentistry
USA Burtetal.(2006)CariesResearch Graye etal.(2012)JournalofClinicalDentistry FerreiraZandon etal.(2010)CariesResearch FerreiraZandon andZero(2006)JournalofAmericanDentalAss. Finlaysonetal.(2007)CommunityDentistryandOralEpidemiology Ismailetal.(2011)CommunityDentistryandOralEpidemiology Ismailetal.(2008)CommunityDentistryandOralEpidemiology Ismailetal.(2008)Pediatric Dentistry Ismailetal.(2007)CommunityDentistryandOralEpidemiology Kolker etal.(2007)Pediatric Dentistry Limetal.(2008)JournaloftheAmericanDentalAssociation Nriagu etal.(2006) InternationalJournalofHygieneandEnvironmentalHealth Nelsonetal.(2011)CommunityDentalHealth Rechmann etal.(2012) JournalofBiomedicalOptics Reisine etal.(2008) CommunityDentistryandOralEpidemiology Sohn etal.(2008)JournaloftheAmericanDentalAssociation Sohn etal.(2007)JournaloftheAmericanDentalAssociation StahlandFerreiraZandon (2007) GeneralDentistry Tellezetal.(2012)CommunityDentalHealth Tellezetal.(2006)JournalofPublicHealthDentistry Zandona etal.(2009) OperativeDentistry
www.icdas.org
ICDAScodesstagethecontinuumofcaries
www.icdas.org www.icdas.org
05/29/2012
ICCMS ICCMS ICDAS ICDAS and and thethe International International Caries Caries Classification Classification and and Management Management System System
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
for Clinicians
ICCMS Practice Prevention-focussed Clinical Care for individual patients
Outline
InternationalCariesDetectionandAssessmentSystem(ICDAS)
ICDAS & ICCMS Public Health Population focussed Health Promotion, Prevention and Needs Assessment
NextstepsinuseofICDASforCliniciansandEducators Summary
ICCMS Education Standardized and EBD Cariology Education
www.icdas.org
Patient
Patient: Caries Risk Assessment Patient: Dentition / Lesion History Patient: Behavioural Assessment
integrated, personalised
Treatment Planning
BLC
Background Level Care
PTO
Preventive Treatment Options:
OTO
Operative Treatment Options
RRM
Recall, Reassessment & Monitoring
The product platform is based on the application of a technique called ac impedance spectroscopy (ACIST). The measurement relies on the application of small electrical signals through the tooth while monitoring the response to the sensor. Analysis of the impedance response relates to the physical structure of the tooth and any subsurface loss of mineral within it
www.Cariescan.com
05/29/2012
Goal: to improve oral health through the implementation of a new paradigm for managing dental caries and its consequences, one that is based on our current knowledge of the disease process and its prevention, so as to deliver optimal oral and thus general health and well being to all peoples
(FDI Global Caries Initiative)
Clinical Treatments Detection, Activity and Enhanced Risk Assessment Synthesis and Decision Making
(Non-surgical & Surgical) with prevention
A holistic view of the The International Caries Classification and Management System
Health
ICDAS stages
Disease
1
Initial
Health
0
Wellness
Disease
1
Initial
Dental Caries: The ICDAS* Caries Continuum (using ICDAS stages and assessment with PUFA)
0
Wellness
2
Caries
3
Moderate
4
Caries
5
Extensive
6
Caries
PUFA
Pain / Sepsis
2
Caries
3
Moderate
4
Caries
5
Extensive
6
Caries
PUFA
Pain / Sepsis
www.icdas.org
www.icdas.org
ICDASbased personalised care in Japan The ICDAS Framework develops into the ICCMS
dmft DMFT
2 1 0 2 5
CariesRisk
0 10
0 1 2 3 0 2 4 6 3 3
50 100 100 6
1,000 10 1
4 1 3
Common Information
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ICDAS & ICCMS Research Population and Clinical Research on caries and caries management
ICDAS & ICCMS Public Health Population focussed Health Promotion, Prevention and Needs Assessment
for Educators
ICCMS Education Standardized and EBD Cariology Education
www.icdas.org
Domain IV
Caries Management Decision Making & Surgical Therapy
Monitoring&Review
Domain V Evidence-based Cariology in Clinical & Public Health Practice
Schulte A G, Pitts N B, Huysmans M C D N J M, Splieth C, Buchalla W. European Core Curriculum in Cariology for undergraduate dental students. European Journal of Dental Education 2011, 15, Supplement 1
ICCMS ICCMS ICDAS ICDAS and and thethe International International Caries Caries Classification Classification and and Management Management System System
for Researchers
ICDAS & ICCMS Research Population and Clinical Research on caries and caries management ICDAS & ICCMS Public Health Population focussed Health Promotion, Prevention and Needs Assessment
Domain III
Caries Management Decision Making & Preventive Non-Surgical Therapy
Domain IV
Caries Management Decision Making & Surgical Therapy
0
Wellness
1
Initial
2
Caries
6
Caries
PUFA
Pain / Sepsis
MonitoringandReview
Domain V Evidence-based Cariology in Clinical & Public Health Practice
PittsN,MeloP,MartignonS,EkstrandK,IsmailA.Cariesriskassessment,diagnosisandsynthesisinthecontext ofaEuropean CoreCurriculuminCariology. European Journal ofDentalEducation2011,15,Supplement 1
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Research
ICCMS ICCMS ICDAS ICDAS and and thethe International International Caries Caries Classification Classification and and Management Management System System
VENEZUELA
COLOMBIA ECUADOR
PERU
BRASIL
CHILE
URUGUAY
ICDAS & ICCMS Public Health Population focussed Health Promotion, Prevention and Needs Assessment
ARGENTINA
www.icdas.org
ICDASCode:14
Seconddigit=Cariescode
Restoration and Sealant Codes 0 = Not sealed or restored 1 = Sealant, partial 2 = Sealant, full 3 = Tooth coloured restoration 4 = Amalgam restoration 5 = Stainless steel crown 6 = Porcelain, gold, PFM crown or veneer 7 = Lost or broken restoration 8 = Temporary restoration 8 = Temporary restoration
Caries Severity Codes 0 1 2 3 4 5 6 = = = = = = = Sound tooth surface First visual change in enamel Distinct visual change in enamel Enamel breakdown, no dentine visible Dentinal shadow (not cavitated into dentine) Distinct cavity with visible dentine Extensive distinct cavity with visible dentine
Percentage no detectable caries at 12 years was 48%, or 34%, or 22% or 15%! Percentage with no detectable caries at 15 yrs was 35%, or 20%, or 16% or 6%!
www.icdas.org
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University of Copenhagen
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
Outline
InternationalCariesDetectionandAssessmentSystem(ICDAS)
Summary
ICDASelearning training Programmedeveloped withSmileon.com, supported byEducational Grant fromColgate Palmolive
CASESTUDIES
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05/29/2012
Methodsforstagingofthecariesprocesstoenabledentiststomanage caries
Summary
InternationalCariesDetectionandAssessmentSystem(ICDAS)
www.icdas.org
IntroductionandHistoricalDevelopment
o Formorethanadecade anInternational Group,constitutesd asaCharitable Foundation, hasbeen synthesising bestevidencetostagethecariesprocessto obtainbetterqualityinformation toinformdecisionsaboutappropriate clinical management atboththeindividual andpublic health levels
Acknowledgements
Theworkandconceptsincludedinthispresentationhavebeen theresultofcollaborations withinDundee,withinthecore ICDASCommittee,withORCA,FDIandIADRcolleaguesandwith otheracademicandclinicalcolleaguesworldwide. Wewouldliketospecificallyacknowledge:thesignificant contributionsthatalltheseindividualshavemadebygenerously sharingtheirtime,effortandexpertise,aswellasthesupportof awiderangeoffundingagenciesaswellasanumberof internationaloralhealthcompanies Specificthanksto:Colgate,Smileonandothercompanieswho havesupportedthisworkthroughnostringseducationalgrants overtheyears:including J&J,CadburyandCariesScan.
Evidencetosupportvalidityofstagingandadoptiontodate
o Thereisnowawealthofpublished international evidencetosupport the validityandutilityofthismethodofstagingcariesandwidespread adoption continues using aflexiblechoiceofformatsfromtheICDASICCMSWardrobe
ICDASDomains
o Since2002,thishasbeen acrossfourdomains,for:Clinicians, Educators, ResearchersandthoseinPublicHealth
NextstepsinuseofICDASforCliniciansandEducators
o Arangeofdevelopmentsareintrain,manyofwhich shouldhelp clinicians and educators toplan, deliverandmonitorappropriate cariestreatment
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