CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx

CONTENTS
• Introduction
• Definition
• Objectives of an Index
• Ideal requisites of an Index
• Historical background of caries indices
• Indices used for assessing dental caries
• Recent developments on caries indices
• Conclusion
• References
2

• Dental diseases are the most prevalent and the most neglected of all the
chronic diseases affecting mankind.
• The backlog of unmet treatment need is greater than the amount of
available treatment time.
• Indeed, the dental profession, for all the progress it has made in techniques
and instrumentation, is yet unable to provide treatment enough to pace with
the newly occurring needs for care.
INTRODUCTION
3

• An Index can be defined as a numerical value describing the relative
status of a population on a graduated scale with definite upper and lower
limits, which is designed to permit and facilitate comparison with other
populations classified by the same criteria and methods.
- Russell A. L
• Epidemiologic Indices are attempts to quantitate clinical conditions on a
graduated scale, thereby facilitating comparison among populations
examined by the same criterion and methods.
- Irving Glickman
DEFINITION
4

1. To increase understanding of the disease process.
2. To discover populations at high and low risk.
3. To define specific problem under investigation.
OBJECTIVES OF AN INDEX
5

IDEAL REQUISITES OF AN INDEX
Clarity
Simplicity
Objectivity
Validity Reliability
Quantifiability Sensitivity Acceptability
6

1. Clarity: The examiner should be able to remember the rules of the
index clearly in his mind
2. Simplicity: Index should be simple and easy to apply so that there
is no undue time lost during field examinations
3. Objectivity: Index should be objective and unambiguous, with
mutually exclusive criteria
4. Validity: Index must measure what it is intended to measure
7

5. Reliability: Index should measure consistently at different
times and at variety of conditions
6. Quantifiability: Index should be amenable to statistical analysis
7. Sensitivity: Index should be able to detect reasonably small
shifts, in either direction in group condition
8. Acceptability: The use of index should not be painful or
demeaning to the subject
8

Uses of the Index
• For Individual patients
• In research
• In Community
9

CLASSIFICATION OF INDICES
1) Direction in which the scores can fluctuate
REVERSIBLE IRREVERSIBLE
Measures the conditions whose
scores will not decrease on
subsequent examinations
Eg: DMFT Index
Measures conditions that can
increase or decrease on subsequent
examinations
Eg: Loe and Silness Gingival
Index
10

2) The extent to which areas of oral cavity are measured
Full Mouth Index Simplified Index
Measures only a representative
sample of the dental apparatus.
Eg: Greene & Vermillion’s Oral
Hygiene Index-Simplified (OHI-S)
Measures the patients entire
periodontium or dentition.
Eg: Russell’s Periodontal Index
11

3) The entity they measure
Disease Index Treatment Index
‘D’ portion of the DMFT
Symptom Index
‘F’ portion of the DMFT
Indices measuring gingival/
sulcular bleeding
12

4) The special categories
Simple Index Cumulative Index
Measures all the evidence of a
condition, past and present.
Eg: DMFT Index for dental caries
Measures the presence or absence
of a condition.
Eg: Silness and Loe Plaque Index
13

Statistical measurement of Dental Caries serves 3 broad purposes:
• For epidemiological investigation on characteristics of dental caries in
population groups
• For Public Health Programme planning and evaluation
• For testing prevention and control procedures
14

HISTORICAL BACKGROUND OF CARIES
INDICES
Bodecker CF and Bodecker HWC
• Developed a Caries Index in 1931
• It was found to be sensitive but too complex for use in epidemiological
surveys.
• It was modified later by including count of decayed surfaces, and an extra
count was allotted for those surfaces that could experience multiple carious
attacks.
15

Trendley H Dean
• Recorded carious teeth visible in the mouth in a systematic manner.
Mellanby M, 1934
• Described the carious lesions depending upon the degree of
severity of caries into slight caries, moderate caries, and advanced
caries.
16

INDICES FOR ASSESSING DENTAL CARIES
1. Decayed, Missing, Filled Teeth (DMFT) Index
2. Decayed, Missing, Filled Surfaces (DMFS) Index
3. Modified DMFT Index
4. Caries indices for primary dentition:
a. def index
b. dmf index
c. df index
d. Simplified index for dental caries experience
e. Dental Caries Severity Index for primary tooth (CSI)
17

5. Root caries index
6. Caries Severity Index
7. Dental Caries Severity Classification Scale (D1-D3)
8. Czechoslovakian caries Index
9. Stone’s Index
10. Caries susceptibility Index
11. D-M-F- surface percentage Index
12. Restorative Index
18

13. Moller’s Index
14. WHO Index for caries
15. Functional measure index
16. T- Health index (Tissue Health Index)
17. Dental health index
19

Recent Developments on Caries Indices
1. Nyvad’s criteria
2. Significant Caries (SiC) Index
3. Specific Caries Index
4. ICDAS II
5. PUFA
6. Caries assessment spectrum and treatment (CAST) index
7. FDI World Dental Federation Caries Matrix
20

Different criteria for diagnosing pit and fissure caries:
1. Anglo-Saxon system (Liberal)
2. European system (Conservative)
21

DMFT INDEX (DECAYED-MISSING-FILLED TEETH
INDEX)
• Henry T. Klein, Carrole E. Palmer and Kuntson J.W. in 1938
• To determine the prevalence of coronal caries
Advantages
• Simple
• Rapid
• Versatile
• Universally accepted and applicable measurement – widely used for
several decades
22

• It is used to determine total dental caries experience past and
previous.
• DMFT - Irreversible index
Procedure
• Permanent teeth
• Composed of 3 components
Decayed Missed Filled
23

• Instruments used
• All 28 permanent teeth are examined
• The teeth not included are
3rd Molars
Teeth removed for
reasons other than
dental caries
Unerupted teeth
Teeth restored for
reasons other than
dental caries
Congenitally
missing &
Supernumerary
teeth
Primary tooth
retained with
permanent successor
erupted
24

The criteria for identification of dental caries:
 The lesion is clinically visible and obvious.
 The explorer tip can penetrate deep into soft yielding material.
 There is discoloration or loss of translucency typical of undermined or
demineralized enamel.
 The explorer tip in a pit or fissure catches or resists removal after moderate
to firm pressure on insertion and when there is softness at the base of the
area
25

Principles and rules in recording DMFT:
 No tooth must be counted more than once.
 Decayed, Missing, Filled teeth should be recorded separately.
 When counting the number of decayed teeth, also include those teeth which
have restorations with recurrent decay.
 Care must be taken to list as missing only those teeth, which have been lost
due to decay. Also included should be those teeth which are so badly decayed
that they are indicated for extraction.
26

 The following should not be counted as missing :
a) Unerupted teeth
b) Missing teeth due to accident
c) Congenitally missing teeth
d) Teeth that have been extracted for orthodontic reasons.
• A tooth may have several restorations but it is counted as one tooth.
• Deciduous teeth are not included in DMF count.
27

 A tooth is considered to be erupted when the occlusal surface or incisal edge is
totally exposed or can be exposed by gently reflecting the overlying gingival
tissue with the mouth mirror or explorer.
 A tooth is considered to be present even though the crown has been destroyed
and only the roots are left.
28

17 16 15 14 13 12 11 21 22 23 24 25 26 27
47 46 45 44 43 42 41 31 32 33 34 35 36 37
DT = MT = FT = DMFT =
Recording format for DMFT index
29

Calculation of the Index:
• The maximum possible DMFT score is 32 ( if third molars are included )
• DMFT score is 28 ( if third molars are excluded)
Group Average Total DMF
Total number of the subjects examined
Treatment Index (M+F/DMF) X 100
Care Index (F/DMF) X 100
Restorative Index (F/D+F) X 100
30

Limitations of DMFT Index:
1) DMFT values are not related to the number of teeth at risk.
2) This can be invalid in older adults because teeth can become lost for
reasons other than caries.
3) This can be misleading in children whose teeth have been lost due to the
orthodontic reasons.
4) This can overestimate caries experience in teeth in which "preventive
fillings" have been placed.
5) It is of little use in studies of root caries
6) It equates a disease state with a healthy state by assigning the same score
for a decayed tooth as well as for a filled healthy tooth.
31

• DMF data are of little use for estimating treatment needs.
• Many restorations are now carried out with tooth-coloured filling
materials and are therefore hard for epidemiologists to detect.
• The F (filled component) is influenced by the decision of practitioners
to fill the tooth.
• Reaches saturation level at particular point of time when all the teeth
are involved and prevents further registration of caries attack even
when caries activity is continuing.
32

• Even under extreme condition, the scores are same.
• Rate of caries progression cannot be assessed in terms of how fast
caries is progressing.
• They do not account for sealed teeth since sealants and other cosmetic
restorations did not exist in the 1930s when this method was devised.
• Early caries is notoriously difficult to diagnose and this aspect will
account for most of variability in the components of the index.
• No facility for multi-coding that is if a tooth has different clinical
conditions presenting on different surfaces, there is no facility to record
all the conditions.
33

• World Health Organization (WHO) - Described a shorthand method &
recommends the use of "half-mouth" DMF in its basic survey techniques.
• Half the upper arch only is scored. then the contra lateral lower half arch
and the results doubled.
• Objective - To obtain assessments of caries prevalence in a population
which has not been previously surveyed.
• It is Quicker and easier than full-mouth DMF Index
34

WHO modification of DMFT Index (1987)
1. All third molars are included.
2. Temporary restorations are considered as decayed
3. Only, carious cavities are considered as ‘D', the initial lesions (Chalky
spots. stained fissures, etc) are not considered as ‘D'. Caries is recorded
when there is an unmistakable cavity, undermined enamel or a softened
wall or floor.
4. Only teeth missing due to caries are included in its M-component.
35

WHO modification of DMFT Index (1997)
• The instruments used to record dental caries are a mouth mirror and
WHO/ CPI probe.
• For individuals 30 years and older, the M component should comprise
teeth missing due to caries or for any other reasons.
• But for subjects under 30 years of age, the M component should only
include teeth missing due to caries
36

DMFS Index
• Henry T. Klein, Carrolle E. Palmer and Knutson J.W. in 1938
• Assess the prevalence of coronal caries
Advantages
• More sensitive
• Usually the index of choice in a clinical trial of caries-preventive agent.
• Used to determine total dental caries experience past and present by
recording tooth surface involved instead of teeth.
37

Procedure
• Permanent teeth
• 3 components
• DMFS is a more detailed index than the DMFT
• By summing the total number of decayed, missing and filled
permanent tooth surfaces.
Instruments used
38

1. For Posterior teeth:
• Five surfaces examined and recorded: facial, lingual Mesial, distal and occlusal
2. For Anterior teeth:
• Four surfaces examined and recorded: facial, Lingual, mesial and distal.
DS = MS = FS = DMFS score =
39

Calculation of DMFS Index
1. Individual DMFS Index DMFS score = DS+MS+FS
2. Total surface count for a DMFS Index
(If 28 teeth are examined)
• 16 posterior teeth (16 X 5 = 80)
• 12 Anterior teeth (12 X 4 = 48)
• Total = 128 surfaces
3. Total surface count for a DMFS Index
(If 32 teeth are examined)
• If third molars are included (4 X 5) =
20 surfaces
• Total = 128 + 20 = 148 surfaces
40

Disadvantages
• The most important disadvantage is the score which has been allocated to
extracted teeth. Extraction results in loss of 4 or 5 surfaces, while fewer
surfaces might have been affected by caries.
• Whether it is correct to use the index literally or to make compromises
depends on the prevalence and severity of caries and on the availability of
dental health services in a given population. If there was low caries
prevalence, only occlusal surface of molars will be affected. If access to
dental health services is limited, decay in the occlusal surface may
progress to deep cavities.
41

• Takes three times longer than DMFT index.
• DMFS scores have added little extra information for cross sectional
studies. It should prove useful in forthcoming longitudinal investigation.
• May require radiographs to be fully accurate.
42

MODIFIED DMFT INDEX
• To overcome the shortcomings of DMFT Index, a modification of the
DMFT index was put forth by Joseph Z. Anaise in 1984.
• This index is simple and provides an estimate of dental needs which
can be interpreted in terms of treatment needs and of past dental
experience.
• This involves division of the D component in to four separate
categories
• The remaining 2 categories of the DMFT index i.e. M and F are
recorded as usual according to the WHO criteria.
43

Category Criteria
Unfilled teeth that are carious
Restored teeth that are either secondarily carious
around the margins of the restoration or primarily on a
tooth surface other than the restored one.
Carious teeth either filled or unfilled that in the
examiners opinion are indicated for extraction
Carious teeth either filled or unfilled that in the
examiners opinion are indicated for pulp treatment or
RCT
C
CF
IX
IRC
The ‘D' component is divided into 4 separate categories :
44

Advantages
1. The index remains simple and yet provides description of previous
dental experience.
2. It further shows the extent of dental services needed by the population,
which can be interpreted in terms of treatment hours and costs.
3. In addition to these four categories, the remaining two categories of
DMFT index (F- filled teeth with no decay and M- Missing teeth) are
recorded as usual according to the WHO criteria.
45

4. The DMFT score is then, the summation of all six categories and the
calculation of the individual components as well as sum remains
essentially the same as the original DMFT index
Calculation:
46
Percentage of unmet needs (C/DMF) X 100
Percentage of need supplied (F/DMF) X 100
(F+CF/ DMF) X 100
Tooth fatality ratio (M/DMF) X 100
(M+IX/DMF) X 100

CARIES INDICES FOR PRIMARY DENTITION
def INDEX
• Described by Gruebbel A.O. in 1944
• The caries indices used for primary dentition are the ‘deft’ index and
the ‘defs’ index equivalent to the DMFT and DMFS indices used for
permanent dentition.
47

• 3 components
• The basic principles and rules for def index are the same as
that for DMF index
d = decayed
deciduous tooth
e = extracted
deciduous tooth
f = filled
deciduous tooth
48

Calculation of def index
• Maximum ‘deft’ score = 20
• Maximum ‘defs’ score = 88
Disadvantages
• Difficult to determine whether the primary tooth has been extracted
or shed naturally.
49

Modifications of ‘def’ index
‘dmf’ index
• Used in children before ages of tooth exfoliation.
• Jackson (1950) recommended that ‘dmf’ index can be used for a full
mouth dentition from 3 to 5 years inclusive and for primary molars
from 3 to 8 years inclusive.
50
Ref: Haugejordan O. Dental caries indices for primary teeth: the need to comply
with international recommendations. Community dentistry and oral
epidemiology. 1978 Jun;6(3):126-8

‘df’ index
• Another method of getting around the exfoliation problem is the 'df'
index in which the missing teeth are ignored
• The 'df' index can be applied to the whole tooth as the decayed-filled-
tooth ('dft' index)
or
• to the individual surfaces as the decayed, filled- surfaces ('dfs' index).
51

Mixed dentition
• In case of mixed dentitions, the caries indices for the permanent
teeth and deciduous teeth have to be done separately. A DMFT or
DMFS and a deft and defs are never added together.
• Each child is given a separate index primary teeth and a separate
index for permanent teeth.
• The index for the permanent teeth is usually determined first, and the
index for primary teeth separately.
52

SIMPLIFIED INDEX OF DENTAL CARIES
EXPERIENCE
• Alfredo Reis Viegas in 1969 presented a simplified index of dental
caries experience
• Developed 3 methods to estimate the prevalence of dental caries-
experience in children aged 7-12 years.
53

• Method I (RLM Index)
– used in areas of low prevalence
- examination of only right lower molars (RLM)
• Method II (RLM – 2UCIS Index)
– used in areas of moderate to high prevalence
- examination of only right lower molars (RLM) and upper two
central incisors
54

• Method III
- Method I for 7 year old children
- Method II for 11 year old children
- Then scores for 8, 9, 10, 12 year old children are determined
without examining them.
55
Ref: 1) McClendon BG, Abrams AM, Horowitz HS. Test of a method for estimating
prevalence of DMFT. Journal of public health dentistry. 1972 Sep;32(3):165-8.
2) Viegas AR. Simplified indices for estimating the prevalence of dental caries-
experience in children seven to twelve years of age. Journal of public health
dentistry. 1969 Jun;29(2):76-91.

DENTAL CARIES SEVERITY INDEX FOR
PRIMARY TEETH
• Aubrey Chosack in 1985
• Teeth free of caries are not included
Instruments used
• Mouth mirrors
• Sharp sickle-shaped explorers
56
Ref: Chosack A. A dental caries severity index for primary teeth. Community dentistry
and oral epidemiology. 1986 Apr;14(2):86-9

Method
• Caries seen on the buccal, lingual and palatal surfaces in all teeth
continuous with occlusal or proximal caries is only scored for
these surfaces when normal pits or fissures of these surfaces are
affected or included, or when the caries extends along at least half
the gingival third of these surfaces
57

1 Early pit and fissure caries where the explorer ‘catches’ or resists
removal with moderate to firm pressure or softness at the base or
opacity adjacent to pit or fissure
2 Cavitation of at least 1mm on the tooth surface.
3 Cavitation with breakdown or undermining of at least half a cusp
Scoring Criteria
A) Occlusal surfaces and pit and fissure caries on buccal or
palatal surfaces of molars
58

B) Buccal, lingual and palatal smooth caries
1 A white lesion not extending to the embrasure areas found to be soft
and sticky by penetration with the explorer
2 Cavitation of at least 1mm but less than 2mm
3 Cavitation of at least 2mm
59

C) Proximal surfaces of molars
1 A discontinuity of the enamel in which an explorer will catch and
there is softness
2 Cavitation with early breakdown of the marginal ridge or obvious
discoloration
3 Breakdown of the marginal ridge with cavitation extending to the
mesial or distal extensions of the occlusal surfaces.
60

D) Proximal surfaces on incisors and canines
1 A discontinuity of the enamel in which an explorer will ‘catch’ if
there is softness.
2 Cavitation with breakdown or obvious discoloration
3 Cavitation with breakdown of the incisal edge or undermining of
the edge
61

• Score 1 = Filled surface
• Score 2 = Secondary caries at the margin of a restoration
• Score 5 = for full crown restoration
• Score 6 = tooth extracted due to caries
• Score for each tooth = Total score of all surfaces
62

• Although a theoretical score of 15 is possible for molars and 12 for
canines and incisors, part of the tooth material loss may have occurred
because of fracture of unsupported surface, rather than caries of that
surface.
• Thus a maximum of 12 is scored for molars and a maximum of 9 for
canines and incisors
• If caries has resulted in complete breakdown of the crown, leaving
only roots, the maximum score is recorded for this tooth.
• CSI for the population is the mean scores for the caries teeth
63

ROOT CARIES INDEX (RCI)
• Ralph V Katz in 1979
• This was to make the simple prevalence measures for root caries
more specific by including the concept of teeth at risk for root caries.
• This index is specifically designed for analytical epidemiological
studies in which risk factors and causes of diseases are being studied.
• This index can be computed for an individual, for a particular tooth
types, or for a population at large.
64
Ref: Katz RV. Assessing root caries in populations: the evolution of the root
caries index. Journal of public health dentistry. 1980 Jan 1;40(1):7-16.

• RCI is based on the requirement that gingival recession must occur
before root surface lesions begin.
• Therefore, only, teeth with gingival recession are examined
Procedure :
• To obtain the RCI, each of the four surfaces, the mesial, distal, buccal
(labial) and lingual of a root are examined for a single tooth. (both
arches)
• For teeth with multiple roots and extreme recession – the most severely
affected root surface be recorded for that tooth.
65

• The root surfaces are characterized and recorded as
• If calculus is present in the absence of any other findings on a recessed
root surface, a judgment of sound (R-N) is made on the assumption that
decay is not found underneath the band of calculus.
R-N Recession present, surface normal or sound
R-D Recession present, decayed root surface
R-F Recession present, filled root surface
NoR No association with gingival recession
M Root surfaces characterized as missing
66

• RCI is obtained by adding the number of root lesions and restorations and
dividing that number by number of root surfaces with gingival recession in
decayed, filled, and sound teeth.
• The root caries index is calculated for an individual using the formula
67

• Diagnostic convention proposed for RCI
Convention no. 1 If the diagnosis of caries or filled is uncertain, score the surface as sound.
Convention no. 2 All caries detected on root surface near CEJ shall be scored as decayed, regardless of
the adjacent enamel condition.
Convention no. 3 For any coronal filling which extends to the root surface, the filling material must
extend more than 3 mm, beyond the CEJ in order to score that root surface as filled
(except crowns)
Convention no. 4 In order to score a filling as involving multiple surfaces, the filling must extend across
at least 1/3rd of each additional surface.
Convention no. 5a Recurrent decay associated with root filling should be recorded as an independent
disease category called “Recurrent Root Decay”
Convention no. 5b Recurrent decay associated with coronal filling or crown should be recorded as an
independent disease category called root decay contiguous with coronal filling.
Convention no. 6 For any root surface that is decayed, the events of an additional but separate root lesion
is recorded as an independent disease category called additional root caries lesion.
Convention no. 7 Any root surface that appears sound but has more than 20% of its area inaccessible to
clinical examination due to calculus, or heavy plaque deposits will be regarded as
unreadable
68

Disadvantages
• Time consuming
• Includes only caries status of root structure
69

CARIES SEVERITY INDEX
• Gertrude Tank and Clara A. Storvick , 1960.
• Developed to study the depth and extent of the caries surfaces and the
extent of pulpal involvements based on clinical and radiographic
examinations.
• It expresses the severity of the caries attack on affected teeth.
70
Ref: Tank G, Storvick CA. Caries experience of children one to six years old in two Oregon
communities (Corvallis and Albany). The Journal of American Dental Assocition. 1964 Dec
1;69(6):749-57.

Score Criteria
1 Superficial (caries in enamel)
2 Moderate (caries in enamel and superficial dentine)
3 Moderately severe (enamel undermined)
4 Severe (approaching pulp, enamel collapsed)
5 Pulpitis (caused either by deep-seated caries or by
trauma without caries)
6 Death of pulp (caused either by deep-seated caries or by
trauma without caries).
7 Peri-apical infection (caused either by deep-seated
caries or by trauma without caries).
71

DENTAL CARIES SEVERITY
CLASSIFICATION SCALE (D1-D3)
• First published by World Health Organization (WHO) in 1979
• Referred as D1-D3 scale
• It permits identification of lesion initiation, progression.
• Teeth to be dried prior to the examination
72

0 Sound
D1 Initial caries
No clinical detectable loss of substance
For pits & fissures, there may be significant staining, discoloration
or rough spots in the enamel that do not catch the explorer, but loss
of substance cannot be positively diagnosed.
For smooth surfaces, these may be white, opaque areas with loss of
luster
CODE STAGE CRITERIA
No evidence of treated or untreated clinical caries
D2 Enamel caries Demonstrable loss of tooth substance in pits & fissures , or on
smooth surfaces, but no softened floor or wall or undermined
enamel. The texture of the material within the cavity may be chalky
or crumbly, but there is no evidence that cavitation has penetrated
the dentin.
D3 Caries of dentin Detectably softened floor, undermined enamel or a softened wall, or
the tooth has a temporary filling. On proximal surfaces, the explorer
point must enter a lesion with certainty
D4 Pulpal
involvement
Deep cavity with pulpal involvement. Pulp should not be probed.
(usually included with D3 in data analysis
73

Limitations
• Requires meticulous examiner training
• Very lengthy & detailed examination
74

CZECHOSLOVAKIAN CARIES INDEX
• J. Novak, V. Poncova, and V. Matena in 1956.
• Mainly used to compare caries experience in one group with that of the
other groups with a similar population density but living in different
environments.
75

• The following formula serves as the basis for this caries index (in adults):
1- C - FC - 4/5 E - 2/3 AT
Base
• C - Caries
• FC – Fillings and Crowns
• E – Extractions
• AT - Anchorage teeth
76

• In individual examination, the "Base" is given by the amount of
teeth in adult dentition (32).
• In collective studies, the "Base" is the number of persons examined
multiplied by 32.
• Average index value - 0 to 1.
• The index value of 1 - higher caries frequency.
77

CARIES SUSCEPTIBILITY INDEX
• Richardson A. in 1961
• 2 factors involved in measuring caries susceptibility using the dynamic survey,
namely
a) Amount of tooth surface at risk.
b) Amount of caries developing during the period of observation.
• ‘b’ divided by ‘a’ will give a measure of susceptibility
78

Method
• Each tooth is divided into various surfaces, to use one caries tooth surface
as the unit of measurement.
• Susceptible surfaces are scored as follows:
 Incisors – Mesial, Distal, Lingual, Labial = 4
 Canine - Mesial, Distal, Lingual, Labial = 4
 Premolar - Mesial, Distal, Lingual, Buccal Occlusal = 5
 Molar - Mesial, Distal, Lingual, Buccal, Occlusal = 5
79

• Full permanent dentition thus would have 148 susceptible surfaces and
full deciduous dentition would have 88 susceptible surfaces.
• Each individual is examined initially and scoring for susceptible tooth is
noted and reexamined after 6/12 months caries level is noted.
• Susceptibility Ratio (SR) = Number of caries surfaces developed during
period of observation
• Susceptibility Index = Susceptibility Ratio X 100 (i.e., S.I = S.R X 100)
80

STONE’S INDEX
• Stone H.H, Lawton F. E, Bransby E. R. and Hartley H.O. 1949.
Score Criteria
1 One or more cavities in the same tooth detectable by sharp
probe where the lesion has not penetrated through the enamel
to involve the dentine.
2 One or more cavities in the same tooth where the dentine is
involved, where a total of less than a quarter of the crown is
estimated to have been destroyed.
3 One or more cavities in the same tooth resulting in a total
destruction of more than a quarter of the crown.
81

D-M-F SURFACE PERCENTAGE INDEX
• Jager CL in 1963
Method
• All the teeth are given surface values (SV) –
 The incisors and canines are given ‘four’ values.
 The premolars and molars are given ‘five’ values.
82

1. Deciduous and permanent teeth are treated alike and a mixed dentition
does not upset this index.
2. Caries teeth are allotted ‘ONE’ carious surface value (CSV) for every
surface attacked by caries.
3. Missing teeth are allotted equivalent to their total surface values
(missing teeth lost other than caries are not included).
83

In the suggested DMFS percentage index:
• The age of the subject is considered, since different number of surfaces
are present at different ages
• The simplified age factors for different age groups are as follows:
84
AGE AGE FACTOR
6 to 7 1/2 months 6
7 to 9 months 3
12 to 14 months 2
16 to 18 months 1.5
20 months to 5 years 1
6 to 11 years 0.9
12 to 16 years 0.8
17 years 0.7

Calculation:
• To determine the DMFS percentage caries index of an individual, total the
carious surface values and multiply by the age factor for the particular
individuals age group.
DMFS percentage caries index = Total of caries surface value X Age factors
Individual age groups
85

RESTORATIVE INDEX
• D. Jackson in 1973
• This index reflects the restorative care of those who have suffered the disease.
• RI=F/F+D
• Does not depend on DMF index & hence can be used at all ages
• RI is not a weighted index, it is a simple proportion with a definite meaning.
86

e) It is the objective of the unmet restorative treatment needs (UNT) used
by Glick et al in 1972, which is [D/F+D]%
f) The restorative index as a community index: The RI can be used to
measure the level of restorative care in any community and for any
subsection of a community at any age.
87
Ref: Jaber MA. Dental caries experience, oral health status and treatment
needs of dental patients with autism. Journal of Applied Oral Science.
2011;19:212-7.

MOLLER’S INDEX
• Moller IJ and Poulsen S 1966
• This index system is used for diagnosing, recording and analyzing dental
caries data.
Equipment's used:
• Unscratched, plane mouth mirrors
• Standardized dental probes ("Holst" probe)
 Pre-cleaning of teeth, isolation with cotton rolls and saliva ejector, and
drying with compressed air is highly recommended.
88

Recording procedure
• All teeth in the dentition (excluding the third molars) are examined.
• A tooth is recorded as erupted when any part of it projects through the
gingiva.
• For each permanent molar and premolar - 5 surfaces are examined.
• For each canine and incisor - 4 surfaces are examined.
• Examination of the teeth is performed in routine order - from maxillary
right to maxillary left and from mandibular right to mandibular left.
89

 The tooth surfaces are indicated as follows:
‘O' = Occlusal; 'M' = Mesial, ‘V‘ = Vestibular; 'D' = Distal,
‘L’ = Lingual.
• The diagnostic criteria are specified for
* pit and fissure surfaces
* smooth surfaces
* radiographic evaluation of proximal surfaces
90

• Untreated carious lesions are divided into 4 types.
• Type 1,2,3,4 which makes it possible to exclude certain types of carious
lesions in either diagnosis or during the analysis.
91
Score Criteria
0 Sound tooth
1 Type 1 caries
2 Type 2 caries
3 Type 3 caries
4 Type 4 caries
5 Filled tooth
6 Missing tooth due to caries
7 Tooth or tooth surface not erupted
8 Tooth missing for reasons other than caries
9 Congenitally missing
- Not recordable

Advantages
1. The basis for the development of this system was to make available a
system which could be used in many different situations .
2. It is flexible in meeting the various needs of different types of clinical
studies on dental caries.
Disadvantages
1. It involves use of radiographs.
92
Möller IJ, Poulsen S. A standardized system for diagnosing, recording and
analyzing dental caries data. European Journal of Oral Sciences. 1973
Feb;81(1):1-1.

WHO INDEX FOR DENTAL CARIES
93
• Given by WHO in 1997.
Dentition status and Treatment need:
• The examination for dental caries should be conducted with a plane
mouth mirror.
• Use of radiographs and fibre-optics are not recommended.
• A tooth should be considered present in the mouth when any part of it is
visible.

 If a permanent and primary tooth occupy the same tooth space, the status
of the permanent tooth only should be recorded
 Permanent dentition status (crown and roots) is recorded using numbered
scores and the primary dentition status is recorded using letter scores in
the same boxes.
• Boxes 66-97 – for upper teeth
114-145 – for lower teeth
• In the case of surveys of children, where the root status is not assessed, a
code “9” (not recorded) should be entered in the box pertaining to root
status.
94

96
0 Sound
1 Caries • A tooth or root with a definite cavity, undermined enamel or
detectably softened or leathery area of enamel or cementum
• Tooth with temporary filling
• Teeth that are sealed but decayed (tooth with fissure sealant but
decayed)
• In cases where the crown of a tooth is entirely decayed, leaving
only the root (Root stumps)
• In cases, where both the crown and root are involved with decay,
whichever site is judged the site of origin.
• Score 1 is not assigned to any tooth in which caries is only
suspected.
CODE STAGE CRITERIA
• No evidence of treated or untreated clinical caries
2 Filled, with
caries
• Tooth with one or more permanent restorations and one or more
areas that are decayed.
• When no distinction is made between primary and secondary
caries regardless of whether the carious lesions are in contact with
the restoration.

97
6 Fissure sealant Teeth with fissure sealant, composite restorations
5 Permanent tooth
missing due to
any other reason
• Teeth extracted for orthodontic purposes, periodontal disease, teeth
that are congenitally missing, teeth missing because of trauma.
• Score 5 – for crown; score 7 or 9 – for root
• Missing teeth replaced by fixed partial denture pontics are coded 4
or 5 – for crown; score 9 – for root
4 Missing due to
caries
• Permanent or primary teeth that have been extracted due to caries
• Only crowns are given score 4; Roots have been scored 7 or 9.
• When primary teeth are missing, the score should be used only if
the tooth is missing prematurely.
• Primary teeth missing because of normal exfoliation needs no
recording.
3 Filled, with no
caries
• If a tooth has been crowned because of previous decay or for
another reasons such as aesthetics or for use as a bridge abutment.

98
8 Unerupted
crown/
Unexposed root
7 Fixed dental
prosthesis
abutment, special
crown or veneer
• When tooth has been crowned for a reason other than decay
• When tooth is part of a fixed bridge abutment
• Teeth with veneers or laminates on facial surface
• Used for a space with an unerupted permanent tooth, where no
primary tooth is present.
• Code 8 teeth are excluded from calculations of caries.
• When root surface is not exposed; there is no gingival recession
beyond the CEJ.
9 Not recorded • Erupted permanent teeth that cannot be examined because of
orthodontic bands, severe hypoplasia
• When applied to a root, score 9 indicates the tooth has been
extracted.
T Trauma
(fracture)
• A crown is scored as fractured when some of its surface is missing
as a result of trauma and there is no evidence of caries

100
Dentition status of
Children, 2013

101
Dentition status of
Adults, 2013

Advantages
• Ease in mastering the criterion and its use in practice, the high levels of
agreement among examiners and the possibility for comparing results
collected from many populations worldwide over long periods.
Disadvantages
• Absence of codes for recording caries lesions in enamel.
• The difficulty for differentiating caries lesions in dentine that can be
treated restoratively from those that require more complicated treatment.
102

• Sheiham A, Maizels J, and Maizels A in 1987
• Developed as modification of DMFT
• First composite index to measure dental health rather than
disease.
Definition - The aggregate of healthy restored (i.e. filled) teeth
and sound teeth with no decay.
FUNCTIONAL MEASURE INDEX
103

• Filled and sound teeth are weighed equally
• Decayed and the missing teeth are given zero weights
• FMI = Filled + Sound
28
• Score range: 0 - 1
104

Advantages
• More reliable indicator of dental health status than conventional DMFT
• More efficient at revealing the antecedent and behavioral factors that
are associated with dental health status.
Limitations
• Very little research can be found utilizing this index.
• It is a sound approach in measuring dental health and function rather
than the disease that probably deserves more attention.
105

• Sheiham A, Maizels J and Maizels A in 1987
• Second alternative composite indicators of dental health
• T-Health indicator was defined as a weighted average of sound teeth, filled
teeth and teeth with some decay.
• Measures the amount of healthy dental tissue
T- HEALTH INDEX
(TISSUE HEALTH INDEX)
106

Principle
The weights represents the relative amount of sound tissue surrounding
these three categories of teeth that means-
• Sound teeth contains- more sound tissue
• Filled tooth contains – more sound tissue compared to decayed tooth.
• Missing tooth – contains no healthy dental tissue
Use
To assess dental health rather disease
107

• In THI selective weights are given to the 3 components as follows
1 – Sound
0.5 - Filled
0.25 – Decayed
0 - Missing
Formula to calculate
THI = (0.25 DT) + (0 MT) + (0.5 FT) + (1 ST)
28
• Score ranges from 0 – 1
108
(High score to sound teeth indicates that this index influence primary prevention)

Advantages
1. More reliable indicator of dental health than the conventional DMFT.
2. Measures the dental health status, as influenced by past and present
disease experience, and its treatment.
3. Unlike the DMFT index, this index measure the changes in the quality of
teeth that have been diseased. (When a decayed tooth is filled, T-Health
score changes, whereas no change in DMFT score.)
4. Easy to calculate and does not require the collection of additional data in
epidemiological surveys.
109
Ref: Bernabé E, Suominen‐Taipale AL, Vehkalahti MM, Nordblad A, Sheiham A.
The T‐health index: A composite indicator of dental health. European
journal of oral sciences. 2009 Aug;117(4):385-9.

• Carpay JJ , Nieman FHM, Konig KJ, Felling AJ and Lammers JGM in
1988.
• This index uses selected teeth for developing the index.
• Any number of teeth may be examined and the denominator is adjusted
accordingly.
• This index was developed to minimize the difference between sound and
affected (or extracted) teeth.
DENTAL HEALTH INDEX
110

Formula - DHI = (Sound teeth) - (decayed + filled + missing teeth)
Sound + decayed + filled+ missing teeth
• DHI – is the ratio of sound teeth minus unsound teeth divided by the
total number of teeth examined.
Score
 Sound teeth given score of +1
 Affected (extracted teeth) - 1
111

• Given by Bente Nyvad in 1999
• The Nyvad caries diagnostic criteria was the first classification system
to define clear criteria for the activity assessment of both non-cavitated
and cavitated lesions.
112
NYVAD’S CARIES DIAGNOSTIC CRITERIA

Advantages
• Differentiates between active and inactive caries lesions at both
the cavitated and non-cavitated levels.
• Good reproducibility and validity to detect carious lesions and
estimate their severities.
• It also measures the activity of the carious lesion favoring the
cost-benefit relationship when treatment plans are made.
115

Disadvantages
• Difficult to make an exact diagnosis of pre-cavitated active lesions
on the occlusal surface than facial surface.
• Physiological wear of the occlusal surface due to mastication can
lead to the disappearance of the lesion.
116
Ref: Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries
diagnostic system differentiating between active and inactive caries
lesions. Caries research. 1999;33(4):252-60.

SIGNIFICANT CARIES INDEX (SiC Index)
• Introduced in 2000 by Bratthall D, to identify group of individuals with
the highest caries scores among population.
Procedure
• Individuals are scored according to their DMFT values.
• SiC Index is the mean DMFT of one third of the population with the
highest caries scores is selected
• The index is used as a complement to the mean DMFT value.
117

Calculation
• Sort the individuals according to their DMFT
• Select the one third of the population with the highest caries value
• Calculate the mean DMFT for this subgroup
Step 1
• Total number of individuals = 11
• Sum of the DMFT values:
0+0+2+1+0+5+0+14+2+0+3 = 27
• Mean DMFT: 27/11 = 2.5
118

Step 2
One third of the population: 11/3 = 3.66
Select 4 individuals with highest DMFT values
4
119

Merits Demerits
1. Solves the problem related to skewed
caries distribution
2. More specific targeted preventive
actions can be implemented
1. If only SiC is used, it leads to lack of
relevant information – high caries prevalence
countries
2. This index is just an extension of DMF index
as it follows same criteria for assessing
dental caries and will have same limitations
in assessing caries in a population as DMF
index.
120

SPECIFIC CARIES INDEX
• Shashidhar Acharya, 2006
• Used in conjunction with the DMFS index to provide qualitative and
quantitative information about caries prevalence, location, type of caries
lesion as well as untreated dental caries in an individual based on
clinical examination.
Strengths
• Good reliability and validity
121

Criteria
Score
0 No carious lesion detected
1 Carious lesion occurring on the occlusal, buccal pits & fissures of
molars & premolars & the lingual pits of the anterior teeth
2 Proximal caries affecting the molars & premolars
3 Carious lesion situated on the proximal surface of the anteriors & not
involving the incisal angles
4 Carious lesion situated on the proximal surface of the anteriors &
involving the incisal angles
5 Carious lesion situated on the cervical region of the tooth
6A Grossly decayed tooth/root stumps indicated for extraction
6 Carious lesion situated on the occlusal cusp tips of molars and on the
incisal edges of the incisors
122

Short-comings
• It gives the same criteria caries detection as that of DMF or DMFS.
• In cases of large lesions, which cover more than one surface, only an
assumption can be made regarding the originating lesion.
• Number of proximal lesions be underestimated in absence of
bitewing radiograph.
123

• Inability of this index, if used alone, to capture information useful for treatment
planning.
• Lack of provision for assessing root caries
124
Ref: Acharya S. specific caries index: A new system for describing untreated
dental caries experience in developing countries. Journal of public health
dentistry. 2006 Sep;66(4):285-7.

INTERNATIONAL CARIES DETECTION
AND ASSESSMENT SYSTEM (ICDAS) – I & II
• Developed in the year 2001 by the effort of large group of
researchers, epidemiologists and restorative dentists.
• ICDAS is a clinical scoring system that is used to detect and assess
dental caries.
125

• The ‘D’ in ICDAS stands for detection of dental caries by
i) Stage of the carious process
ii) Topography (pit and fissure or smooth surfaces)
iii) Anatomy (crown versus roots)
iv) Restoration or sealant status
• The ‘A’ in ICDAS stands for assessment of caries process by stage (non-
cavitated or cavitated) and activity (active or arrested)
126

• The current version of ICDAS does not yet include an assessment
of lesion activity.
• ICDAS coordinating committee came up with ICDAS-II in the year
2009 which describes both coronal caries and caries associated with
restorations and sealants (CARS).
• Its codes for coronal caries ranges from 0 to 6, indicating the
severity of the carious lesions involving pulp are not being scored.
127

Code 0 Sound tooth surface
Code 1 First visual change
in enamel
Code 2 Distinct visual
change in enamel
Code 3 Localized enamel
breakdown due to
caries with no
visible dentine or
underlying shadow
No evidence of caries after prolonged air drying
Opacity or discoloration (white or brown) is visible
at the entrance to the pit or fissure after prolonged air
drying, which is not or hardly seen on a wet surface
Opacity or discoloration distinctly visible at the
entrance to the pit and fissure when wet, lesion must
still be visible when dry
Opacity or discoloration wider than the natural
fissure/fossa when wet and after prolonged air drying
128

Code 4 Underlying dark shadow from dentine +/- localized enamel breakdown
Code 5 Distinct cavity with visible dentine
Code 6 Extensive distinct cavity with visible dentine and more than half of the
surface involved
129

130
Codes for the Detection and Classification of Carious Lesions
on the Root Surfaces
• One score will be assigned per root surface. The facial, mesial, distal
and lingual root surfaces of each tooth should be classified as follows:

• ICDAS II system have two digit coding for detection criteria of primary
coronal caries.
• The first one is related to the restoration of teeth and has a coding that ranges
from 0 to 9.
• The second digit is used for coding the caries and coding ranges from 0 to 6.
131

Caries associated with Restoration and Sealants (CARS)
0 Sound tooth surface with restoration and sealant
1 First visual change in enamel
2 Distinct visual change in enamel/dentin adjacent to
restoration/sealant margin
3 Carious defect of ˂ 0.5mm, with signs of code-2
4 Marginal caries in enamel/ dentin/ cementum adjacent to
restoration/sealant, with underlying dark shadow from dentin
5 Distinct cavity adjacent to restoration/ sealant
6 Extensive distinct cavity with visible dentin
132

Advantages
• The ability to evaluate non-cavitated lesions
• Good reproducibility and validity to detect carious lesions and estimate
their severities.
Disadvantages
• Long application time when compared to WHO criteria
• Overestimate the caries activity assessment of cavitated lesions when
compared to Nyvad’s caries diagnostic criteria.
• The root caries assessment criteria have not been tested in any studies.
133

• Results are difficult to compare against widely used DMF indices
• Need to use compressed air in assessing caries codes 1 and 2, which
makes the system unsuitable for use in places where a portable
compressor is not available or cannot be used;
• The absence of information on how to report the 2-digit ICDAS II in a
meaningful way.
134
Ref: 1) The International Caries Detection and Assessment System (ICDAS): An
integrated system for measuring dental caries. Community Dent Oral Epidemiol
2007; 35: 170–178.
2) Dikmen B. ICDAS II criteria (international caries detection and assessment
system). Journal of Istanbul University Fcaulty of Dentistry. 2015;49(3):63

PUFA (PULP-ULCER-FISTULA-ABSCESS)
INDEX
• Monse B, Heinrich-Weltzien R et al in 2010
• Used to assess the presence of oral conditions resulting from untreated
dental caries
• The index is recorded separately from the DMFT⁄ dmft and scores the
presence of either a
P – Visible pulp
U – Ulceration of the mucosa due to root fragments
F – A fistula
A – An abscess
135

• Lesions in the surrounding tissues that are not related to a tooth with
visible pulpal involvement as a result of caries are not recorded.
• The assessment is made visually without the use of an instrument.
• Only one score is assigned per tooth.
• In case of doubt concerning the extent of odontogenic infection, the
basic score (P ⁄ p for pulp involvement) is given.
136

 If the primary tooth and its permanent successor tooth are present and
both present stages of odontogenic infection, both teeth will be scored.
 Uppercase letters are used for the permanent dentition and lowercase
letters used for the primary dentition.
137

• Codes and Criteria for PUFA index are as follows:
138

 The PUFA⁄ pufa score per person is calculated in the same cumulative
way as for the DMFT⁄ dmft and represents the number of teeth that meet
the PUFA⁄ pufa diagnostic criteria.
 The PUFA for permanent teeth and pufa for primary teeth are reported
separately. For an individual person, score ranges from
 0 – 20 pufa – for Primary dentition
 0 – 32 PUFA – for Permanent dentition
140

• The prevalence of PUFA/ pufa is calculated as percentage of the
population with a PUFA/ pufa score of one or more.
• The ‘Untreated caries, PUFA Ratio’ is calculated as
PUFA + pufa
D+d
141
X 100

Uses of PUFA index :
• PUFA index will provide health planners with relevant information,
which is complementary to the DMFT.
• PUFA index records the presence of severely decayed teeth with visible
pulp involvement (P/p), ulceration caused by dislocated tooth fragments
(U/u), fistula (F/f) and abscess (A/a). PUFA index is helpful to set
priorities in oral health planning. A reduction in PUFA must be the
priority goal in any National Oral Health Plan.
142

 During the last decade, international caries epidemiology has focused
on the development of more sensitive diagnostic criteria to allow for
assessment of the initial stages of caries.
• This is considered important in the light of the decline of cavitated
caries lesions in high-income countries where non operative and
preventive interventions require an index that distinguishes between
the different stages of initial caries lesions.
143

 PUFA data may be used for planning, monitoring and evaluating access
to emergency treatment and exposure to ﬂuoride as components of the
Basic Package of Oral Care (BPOC) and national oral health plans and
may have a higher potential than the DMFT to get oral health onto
political agendas.
144

Merits
• Simple to record
• Can be used for primary and permanent teeth along with DMF index
• Easy and safe to use, even for non dentists.
• Takes little time to perform and does not require any additional
equipment.
• The index proved to be appropriate in quantifying the consequences
of severity of tooth decay it is universally applicable in all settings,
even under simple ﬁeld conditions.
145

Limitations
• Stages of caries lesion progression in enamel are not being assessed
• The definition of code ‘u’ is not directly related to the caries process.
Few studies had suggested the need to modify the index by eliminating
“u” and combining f and a components.
• The reliability of this index needs further research and discussions.
146
Ref: 1. PUFA – An index of clinical consequences of untreated dental caries. Community
Dent Oral Epidemiol 2010; 38: 77–82.
2. Figueiredo MJ, De Amorim RG, Leal SC, Mulder J, Frencken JE. Prevalence and
severity of clinical consequences of untreated dentine carious lesions in children from
a deprived area of Brazil. Caries research. 2011;45(5):435-42.

CARIES ASSESSMENT SPECTRUM AND
TREATMENT INDEX(CAST INDEX)
• Developed by Jo E. Frencken et al in 2011
• Combines elements of the ICDAS II and PUFA indices, and the
M- and F-components of the DMF index.
• It covers the total dental caries spectrum, from no carious lesion,
through caries protection (sealant) and caries cure (restoration) to
carious lesions in enamel and dentine, and the advanced stages of
carious lesion progression in pulpal and tooth-surrounding tissue.
147

CHARACTERSTIC SCORE DESCRIPTION
Sound 0 No carious lesion detected
Sealed 1 Pits & fissures have been atleast partially
sealed with a sealant material
Restored 2 A cavity has been restored with a restorative
material currently without a dentine carious
lesion & no fistula/abscess present
Enamel 3 Distinct visual change in enamel. A clear
carious related discolouration (white or brown
in colour) is visible, including localized
enamel breakdown without clinical visual
signs of dentine involvement
148

Dentine 4 Internal caries-related discolouration in
dentine. The lesion appears as shadows of
discoloured dentine visible through enamel
which may or may not exhibit a visible
localized breakdown
5 Distinct cavitation into dentine. No pulpal
involvement is present.
Pulp 6 Involvement of pulp chamber. Distinct
cavitation reaching the pulp chamber or only
root fragments are present.
7 Abscess/Fistula. A pus containing swelling or a
pus releasing sinus tract related to a tooth
with pulp involement due to caries is present.
149

Lost 8 The tooth has been removed because of
dental caries
Other 9 Does not match with any of the other
categories
150

Advantages
• A DMF score can be easily calculated from the CAST index
• Used only for epidemiological surveys
• Visual/ tactile hierarchical one digit coding system
• Includes total spectrum of stages of caries lesion (demineralizing of
enamel to extensive caries involving the pulp)
• Built on the strengths of the ICDAS, DMF and PUFA indices
151

Limitations
• It does not record active and inactive carious lesions.
• This index has not been validated, nor has its reliability been
tested.
• It is not suggested for use in clinical trials.
• It does not provide data on treatment.
152

• The World Health Organization’s Global Oral Health Programme has
recognized the importance of promoting “a new paradigm among dental
practitioners, shifting from a restorative to preventive/health promotion
model.”
• Developed by FDI Science Committee in 2012
FDI World Dental Federation Caries Matrix

Objective: The intent of this matrix was not to establish a new caries
lesion classification system, but to integrate existing systems into a
framework that could be used by clinicians, researchers, educators,
public health workers and decision makers

Different criteria for diagnosing pit and fissure caries:
1. Anglo-Saxon system (Liberal)
2. European system (Conservative)
155

1. Anglo-Saxon system (liberal)
• By Horowitz H.S in 1972
• Pits and fissures on the occlusal, vestibular and lingual surfaces are
carious when the explorer “catches” after insertion with moderate to
firm pressure and when the catch is accompanied by one or more of the
following signs of decay
 Softness at the base of the area.
 Opacity adjacent to the area provides evidence of undermining or
demineralization.
 Softened enamel adjacent to the area that may be scraped away by
the explorer.
156

2. European System (Conservative)
• By Backer-Dirks O., Houwink B., Kwant G.W. in 1961
• Teeth are first dried and sharp new explorers are used
• Upper molars: Mesio-occlusal and disto-occlusal-palatine fissures
are assessed separately.
• Lower molars: Occlusal fissures and buccal pits are assessed
separately.
157

C I - Minute black line at the base of fissure
C II - In addition, a white zone along margins of fissure.
C III - Smallest perceptible break in the continuity of enamel.
C IV - Large cavity, more than 3mm wide
158
Ref: 1) Horowitz HS. Clinical trials of preventives for dental caries.
Journal of public health dentistry. 1972 Dec;32(4):229-33.
2) Backer Dirks O, Van Amerongen J, Winkler KC. A reproducible
method for caries evaluation. Journal of dental research. 1951
Jun;30(3):346-59.

CONCLUSION
• In practice no index or measure is wholly accurate and probably no
index used in oral epidemiology completely meets all of the conditions,
but the choice of an index in any given situation should be made on the
basis of how closely the index approximates them and by the
requirements of the study in which the index being used.
164

REFERENCES
1. Hiremath SS. Textbook of Public Health Dentistry. 3rd Edition. New Delhi:
Elsevier; 2016.
2. Peter S. Essentials of preventive and community dentistry. 6th edition Arya
publishers; 2017.
3. Dental Indices – Ready reckoner by Dr P Kalyan Chakravarthy, 2014.
4. Ramanarayanan V, Karuveettil V, Sanjeevan V, Antony BK, Varghese NJ,
Padamadan HJ, Janakiram C. Measuring dental diseases: A critical review of
indices in dental practice and research. Amrita Journal of Medicine. 2020 Oct
1;16(4):152.
165

5. Katz RV. Clinical signs of root caries: measurement issues from an
epidemiologic perspective. J Dent Res. 1990 May;69(5):1211-5.
6. Anu V, Priyadarshini MJ, Kannan PK. New caries assessment systems- a
review. J. Bio. Innov. 2018;(7):398-411.
7. Praveen BH, Prathibha B, Reddy PP, Monica M, Samba A, Rajesh R. Co
relation between PUFA index and oral health related quality of life of a rural
population in India: A Cross-sectional study. Journal of clinical and diagnostic
research: JCDR. 2015 Jan;9(1):ZC39.
8. Reliability of Cast Index for Dental Caries Detection. J Dow Uni Health Sci
2014; 8(1): 7-10
166

9. Campus G, Cocco F, Ottolenghi L, Cagetti MG. Comparison of ICDAS,
CAST, Nyvad’s criteria, and WHO-DMFT for caries detection in a sample
of Italian schoolchildren. International journal of environmental research
and public health. 2019 Jan;16(21):4120.
10. Reddy ER, Rani ST, Manjula M, Kumar LV, Mohan TA, Radhika E.
Assessment of caries status among schoolchildren according to decayed-
missing-filled teeth/decayed-extract-filled teeth index, International Caries
Detection and Assessment System, and Caries Assessment Spectrum and
Treatment criteria. Indian Journal of Dental Research. 2017 Sep
1;28(5):487.
167

11. Prabakar J, Arumugham IM, Sakthi DS, Kumar RP, Leelavathi L. Prevalence and
Comparison of Dental Caries experience among 5 to 12 year old school children
of Chandigarh using dft/DMFT and SiC Index: A Cross-sectional study. Journal
of family medicine and primary care. 2020 Feb;9(2):819.
12. Kumara-Raja B, Radha G. Prevalence of root caries among elders living in
residential homes of Bengaluru city, India. Journal of clinical and experimental
dentistry. 2016 Jul;8(3):e260.
13. Jaber MA. Dental caries experience, oral health status and treatment needs of
dental patients with autism. Journal of Applied Oral science. 2011;19:212-7.
168

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