Introduction to ICDAS

Question 1

Lesion detection

Answer 1

(which implies an objective method of determining whether or not disease is present).

Question 2

Lesion assessment

Answer 2

(which aims to characterise or monitor a lesion, once it has been detected).

Question 3

Caries diagnosis

Answer 3

(which should imply a human professional summation of all available data).

Question 4

Restoration code 0-8

Answer 4

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

Question 5

Caries Codes 0-6

Answer 5

0 Sound tooth surface
1 First visual change in enamel
2 Distinct visual change in enamel
3 Enamel breakdown, no dentine visible
4 Dentinal shadow
5 Distinct cavity with visible dentine
6 extensive distinct cavity with visible dentine

Question 6

Missing Teeth

Answer 6

97 extracted due to caries
98 Missing for other reason
99 Unerupted
P= Implant

Question 7

1st D: Determine the patient’s caries risk

Answer 7

Understanding their personal level of risk of disease is a key determinant of a patient’s motivation to engage with healthcare and modify their own behaviour to enhance their oral health. Patients who perceive that they are susceptible to disease are more likely to take action to ameliorate the impact of that susceptibility.

Question 8

2nd D: Detect and Assess – caries staging and activity assessment

Answer 8

Assessment is the foundation of all care planning. Practitioner and patient work together to create a shared understanding of the patients’ current health status and their priorities. Conceiving of caries severity as a series of stages helps to identify the importance of both patient and practitioner behaviour in modifying the disease process.

Question 9

3rd D: Decide – personalised care plan at the patient and the tooth levels

Answer 9

A core component of Patient Centred Care is the discussion of a shared
personalised plan of care. The DECIDE stage focuses on identifying that plan and making it explicit. The co-creation of a care plan with the patient enhances the patients’ understanding and commitment to
the plan.
The aim of this step is to synthesise all of the information gathered about the patient’s caries risk (1st D) and any caries lesions (severity and activity) (2nd D) to develop an informed, risk-based, tooth preserving care plan.

Question 10

4th D: Do – appropriate tooth-preserving and patient-level prevention and control

Answer 10

Having finalised a mutually agreed care plan in the DECIDE phase, the DO phase involves both the planning and implementation of that care plan. Planning is good for both the practitioners and patients - making an explicit plan has repeatedly been shown to ensure adherence to
healthcare recommendations. The DO stage is not only about professional treatment but working with the patient to ensure that they have a clear plan of action to support their own oral health.

Question 11

This 4th D consists of two elements:

Answer 11

• Managing patient’s caries risk, tailored at the individual level with actions to improve the risk status where possible.
Managing individual caries lesions according to their severity and activity. Caries care options may differ between the primary and permanent dentition.

Question 12

The 4 D’s

Answer 12

1st D: Determine the patient’s caries risk
2nd D: Detect and Assess – caries staging and activity assessment
3rd D: Decide – personalised care plan at the patient and the tooth levels
4th D: Do – appropriate tooth-preserving and patient-level prevention and control