From 'ICDAS' to 'CariesCare International': the 20-year journey building international consensus to take caries evidence into clinical practice

Abstract

This paper charts the 20-year collaborative journey made by international teams of dental researchers, educators and practitioners. Following the initial development of the International Caries Detection and Assessment System (ICDAS) in 2002, the International Caries Classification and Management System (ICCMS) was collaboratively developed between 2010-2017 with several dental research and practice organisations, and influenced by best evidence judged via SIGN methodology, the UNEP Minamata Treaty (and linked phasing down of dental amalgam), three Dental Policy Labs and an international movement in operative dentistry to move towards minimally invasive dentistry. The FDI World Dental Federation publicised and advocated the ICCMS in 2019, when the 'CariesCare International' Consensus Guide and 4D caries management system was published to aid the delivery of ICCMS into practice. This system, which is designed to help practitioners deliver optimal caries care for patients, is now being adapted internationally for post-pandemic use in the 'Caries OUT' study. It is also being used as a vehicle for implementing the updated Delivering better oral health guidance on caries, as part of the minimum intervention oral healthcare delivery framework in the UK.

Enhanced Clinical Decision-Making and Delivery of Minimally Invasive Care Using the ICCMS4D Integrated with Hands-Free Fluorescence-Based Loupes and a Chemomechanical Caries Removal Agent

“…Traditional methods for caries identification showed low accuracy and reproducibility. 6 To improve its shortcomings, an enhanced visual system was developed: the ICDAS. The ICDAS has been shown to be accurate and reproducible.…”

“…Ultraviolet (UV) exposure, especially in unaged composites, results in intense blue fluorescence, facilitating their discovery (►Fig. 6). The use of fluorescence identification of restorative materials is well documented in splint removal, orthodontic brackets debonding, and dental forensics.…”

“…In the last decades, a better understanding of the pathophysiologic process of caries progression, along with the developments of ion-releasing materials (IRB), has led to contemporary methods for their management. 1 2 3 4 5 6 7…”

“…In the last decades, a better understanding of the pathophysiologic process of caries progression, along with the developments of ion-releasing materials (IRB), has led to contemporary methods for their management. [1][2][3][4][5][6][7] In 2005, an "International Caries Detection and Assessment System" (ICDAS) was developed to standardize the variations in which caries lesions were detected, assessed, and classified among the dental disciplines. 5 Active lesions were described as yellowish/light brown, and soft/leathery, while arrested lesions were defined as darkly stained and hard textured.…”

“…To put the ICCMS into practice, a concise version (ICCMS 4D) was published in 2019, integrating risk-based minimally invasive and preventive caries management. 6 Current recommendations on deep caries management support the removal of caries tissue up to sound tissue at its periphery to allow for a quality adhesive seal. 1,2 Centrally, removal up to firm/leathery affected dentine is preferred, since the affected dentin is low in bacterial load and capable of re-mineralizing with a variety of IRB (e.g., calcium silicate based, high-viscosity glass ionomer cements [GICs], and silver diamine fluoride).…”