The Caries Assessment Spectrum and Treatment (CAST) index: rational and development

Abstract

Serious difficulties in reporting results were encountered when using ICDAS II and PUFA separately in an epidemiological survey in a child population in Brazil. That necessitated the development of a comprehensive but pragmatic caries assessment index. This publication describes the rationale, development and content of a novel caries assessment index. Strengths and weaknesses of ICDAS II, PUFA and other indices were analysed. The novel caries index developed for use in epidemiological surveys is termed 'Caries Assessment Spectrum and Treatment' (CAST). 'Spectrum' indicates what is considered the main strength of the new index - its usefulness in describing the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and caries cure (restoration) to lesions in enamel and dentine, and the advanced stages of carious lesion progression in pulpal and tooth-surrounding tissue. CAST combines elements of the ICDAS II and PUFA indices, and the M- and F-components of the DMF index. A DMF score can easily be calculated from the CAST score, thereby enabling retention of the use of existing DMF scores. The CAST index for use in epidemiological surveys is very promising. It should be validated and its reliability and usefulness be tested in different age groups in different countries and cultures.

Face and Content Validation of Caries Assessment Spectrum and Treatment Index among Few Subject Matter Experts in India

“…There were two similar studies conducted by Dr. Frencken which included 15 and 27 countries that included all codes and was done using On-line Rand modified e-Delphi consensus method [11,12,19] Furthermore, the recent article on CAST published in 2013 [19] stated various changes in the index. i.e., in cases where two codes are assigned consider the severity of the condition that comes first and code accordingly.…”

“…Frencken stated that "the quantity and the quality of information that can be gathered from a whole population through the adoption of this new index clarified the extent of dental caries and facilitated easy communication between the dental community and policy makers." [11] Thus having all these data accumulated in one index, the spectrum of dental caries status was justified, and various strategic treatment protocols to deal with it were developed.…”

“…These newly introduced indices included, the International Caries Detection and Assessment System (ICDAS-I, ICDAS-II) by [8,9] and the Pulpal involvement, Ulceration, Fistula and Abscess (PUFA) index published by Monse et al [10] The ICDAS indices does not record the pulpal involvement occurring as a consequence of severe dental caries whereas on the other hand PUFA did not record the enamel, dentinal or root caries lesions as it was concerned with only the extreme ends of the caries disease spectrum. [11] Authors of caries assessment spectrum and treatment (CAST) Index have tried to combine the advantages of three indices namely ICDAS II, PUFA and M-and F-components of DMF Index by WHO. It has been designed to record the caries in enamel, dentine, pulp, along with sealants and restorations and teeth lost due to caries.…”

“…[11,12] Before any index can be recommended for widespread use, it has to be validated in the country of use. CAST Index has not been validated in India.…”

Microscópio operatório no diagnóstico de cárie dentária em crianças com fissura labiopalatina

“…A aplicação do sistema ICDAS-II permitiu a comparação da prevalência de lesões de cárie e eficácia dos três métodos usados neste presente estudo. Alguns estudos têm relatado que o uso desse sistema não teria utilidade em pesquisas epidemiológicas e levaria a uma superestimação da prevalência de lesões de cárie, pelo ponto de corte entre saúde e doença ser a lesão inicial (escore 1) passível de remineralização (FRENCKEN et al, 2011;AMORIM et al, 2012;DOWNER, 2012;FRENCKEN et al, 2012). Tal fato não foi encontrado no presente estudo, onde a prevalência das lesões de cárie foi baixa, em torno de 8%.…”