Caries Lesions Progression over 48-months Using ICDAS and Activity Assessment

Objective: Compare dental caries progression in children enrolled on a 4 year longitudinal study in rural schools in the Commonwealth of Puerto Rico by tooth surface over a 48 month period using the International Caries Detection and Assessment System (ICDAS) and an activity assessment. Methods: 331 children provided informed consent and were examined with ICDAS at baseline (BL) and 4 month intervals for 48 months. Lesions were assessed as active/inactive using subjective criteria based on surface characteristics and plaque stagnation status. Enrolled children (49% female, 51% male) ranged from 5-13 yrs old (mean 9.27) and were mostly Hispanic (90%). Results: Focusing on permanent tooth surfaces without fillings at BL and scored ICDAS 0-3, progression of lesions varied according to severity scores and activity assessment. Progression was defined as worsening ICDAS score (ICDAS 0-3 to ICDAS 4- 6) and/or placement of a filling. Only 3% of surfaces scored as sound at BL progressed to cavitation, while 25% of the lesions scored as ICDAS 1 progressed to cavitation but they were just as likely to progress if they were considered active (22%) or not (27%), while almost 40% of lesions scored as ICDAS 2 to cavitation and they were twice as likely to progress if they were considered active (41% versus 21%). Over 80% of lesions scored ICDAS score 3 progressed to cavitation, and if considered active the likelihood of progression was even stronger (84% PPV versus 25% PPV). Conclusions: Characterization of lesion severity with ICDAS can be a strong predictor of lesion progression to cavitation.

Supported by NIH/NIDCR RO1DE017890-05