Caries detection and diagnosis methods: a narrative review




Dental caries; Diagnostic; ICDAS.


Dental caries is one of the most prevalent chronic diseases in people worldwide, individuals are susceptible to this disease at all stages of life. To review in the literature what tools are available for the diagnosis and detection of caries and its lesions. Data collection was performed at PubMed, between January 2019 and June 2020, with the keywords: “dental caries” AND “diagnostic” AND “ICDAS”, without language restriction or country of publication. Several detection methods were found, such as: ICDAS (International Caries Detection and Assessment System), Caries Assessment Spectrum and Treatment - CAST), DIAGNOdent® - LF; DIAGNOdent pen, CarieScan PRO (CP), VistaCam, DMF (Decayed – Missing – Filled - DMF) and others. The use of ICDAS in treatment recommendations for caries lesions varied between examiners. The use of an explorer in the evaluation of caries lesions has increased the validity and reliability of the decision on superficial cavitation. Decision-making about treatment can be influenced by the caries lesion detection and classification system. The research pointed out that there are variations between the studies and the use of the ICDAS system for caries. Conclusion: The ideal caries detection system should allow early diagnosis of caries at an early stage and improve decision-making in relation to an appropriate treatment plan.


Abogazalah, N., Eckert, G. J., & Ando, M. (2019). In vitro visual and visible light transillumination methods for detection of natural non-cavitated approximal caries. Clinical oral investigations, 23(3), 1287–1294.

Amaral, R.C., Fonseca, E. P., Lepri, C. P., Assis, L. C., Rocha, C. M., Tennant, M.. (2019). Cárie dentária em adolescentes do Estado de São Paulo, Brasil: uma análise espacial. Adolescencia e Saude, 6(4), 25-35

Berdouses, E. D., Koutsouri, G. D., Tripoliti, E. E., Matsopoulos, G. K., Oulis, C. J., & Fotiadis, D. I. (2015). A computer-aided automated methodology for the detection and classification of occlusal caries from photographic color images. Computers in biology and medicine, 62, 119–135.

Berdouses, E. D., Oulis, C. J., Michalaki, M., Tripoliti, E. E., & Fotiadis, D. I. (2019). Histological validation of the automated caries detection system (ACDS) in classifying occlusal caries with the ICDAS II system in vitro. European archives of paediatric dentistry: official journal of the European Academy of Paediatric Dentistry, 20(3), 249–255.

Cankar, K., Vidmar, J., Nemeth, L., & Serša, I. (2020). T2 Mapping as a Tool for Assessment of Dental Pulp Response to Caries Progression: An in vivo MRI Study. Caries research, 54(1), 24–35.

Campus, G., Cocco, F., Ottolenghi, L., & Cagetti, M. G. (2019). 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, 16(21), 4120.

Chen R. (2019). The International Caries Detection and Assessment System Is a Visual Diagnostic System That Is Highly Reproducible and Accurate for Coronal Carious Lesions Detection but Only Moderately Reproducible and Accurate for Assessing Lesion Progression. The journal of evidence-based dental practice, 19(1), 91–94.

Dąbrowski, P., Grzelak, J., Kulus, M., & Staniowski, T. (2019). Diagnodent and VistaCam may be unsuitable for the evaluation of dental caries in archeological teeth. American journal of physical anthropology, 168(4), 797–808.

Diniz, M. B., Eckert, G. J., González-Cabezas, C., Cordeiro, R., & Ferreira-Zandona, A. G. (2016). Caries Detection around Restorations Using ICDAS and Optical Devices. Journal of esthetic and restorative dentistry: official publication of the American Academy of Esthetic Dentistry .[et al.], 28(2), 110–121.

Diniz, M. B., Campos, P. H., Wilde, S., Cordeiro, R., & Zandona, A. (2019). Performance of light-emitting diode device in detecting occlusal caries in the primary molars. Lasers in medical science, 34(6), 1235–1241.

Dündar, A., Çiftçi, M. E., İşman, Ö., & Aktan, A. M. (2020). In vivo performance of near-infrared light transillumination for dentine proximal caries detection in permanent teeth. The Saudi dental journal, 32(4), 187–193.

Ei, T. Z., Shimada, Y., Abdou, A., Sadr, A., Yoshiyama, M., Sumi, Y., & Tagami, J. (2019). Three-dimensional assessment of proximal contact enamel using optical coherence tomography. Dental materials: official publication of the Academy of Dental Materials, 35(4), e74–e82.

ElSalhy, M., Ali, U., Lai, H., Flores-Mir, C., & Amin, M. (2019). Caries reporting in studies that used the International Caries Detection and Assessment System: A scoping review. Community dentistry and oral epidemiology, 47(1), 92–102.

El-Housseiny, A. A., & Jamjoum, H. (2001). Evaluation of visual, explorer, and a laser device for detection of early occlusal caries. The Journal of clinical pediatric dentistry, 26(1), 41–48.

Faustino-Silva, D. D., & Figueiredo, M. C. (2019). Atraumatic restorative treatment-ART in early childhood caries in babies: 4 years of randomized clinical trial. Clinical oral investigations, 23(10), 3721–3729.

Freitas, L. A., Guaré, R. O., Diniz, M. B. (2016). Caries risk assessment by CAMBRA in children attending a basic health unit. Pesquisa Brasileira em Odontopediatria e Clínica Integrada, 16(1),195-205.

Ginnis, J., Ferreira Zandoná, A. G., Slade, G. D., Cantrell, J., Antonio, M. E., Pahel, B. T., Meyer, B. D., Shrestha, P., Simancas-Pallares, M. A., Joshi, A. R., & Divaris, K. (2019). Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition. Methods in molecular biology (Clifton, N.J.), 1922, 511–523.

Gliosca, L. A., Stoppani, N., Lamas, N. S., Balsamo, C., Salgado, P. A., Argentieri, Á. B., D'Eramo, L., Squassi, A. F., & Molgatini, S. L. (2019). Validation of an adherence assay to detect group mutans streptococci in saliva samples. Validación del Test de adherencia para el recuento de estreptococcos del grupo mutans en muestras de saliva. Acta odontologica latinoamericana: AOL, 32(2), 97–102.

Goodarzi, F., Mahvi, A. H., Hosseini, M., Nodehi, R. N., Kharazifard, M. J., & Parvizishad, M. (2017). Prevalence of dental caries and fluoride concentration of drinking water: A systematic review. Dental research journal, 14(3), 163–168.

Guaré, R. O., Perez, M. M., Novaes, T. F., Ciamponi, A. L., Gorjão, R., & Diniz, M. B. (2019). Overweight/obese children are associated with lower caries experience than normal-weight children/adolescents. International journal of paediatric dentistry, 29(6), 756–764.

Guerra, F., Mazur, M., Rinaldo, F., Corridore, D., Salvi, D., Pasqualotto, D., Nardi, G.M., Ottolenghi, L. (2015). New diagnostic technology and hidden pits and fissures caries. Senses and Sciences, 2(1), 20-23.

Jablonski-Momeni, A., Rüter, M., Röttker, J., & Korbmacher-Steiner, H. (2019). Use of a laser fluorescence device for the in vitro activity assessment of incipient caries lesions. Einsatz eines Laserfluoreszenzverfahrens zur Erfassung der Aktivität von initialen kariösen Läsionen in vitro. Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie: Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie, 80(6), 327–335.

Khattak, M. I., Csikar, J., Vinall, K., & Douglas, G. (2019). The views and experiences of general dental practitioners (GDP's) in West Yorkshire who used the International Caries Detection and Assessment System (ICDAS) in research. PloS one, 14(10), e0223376.

Kitasako, Y., Sadr, A., Shimada, Y., Ikeda, M., Sumi, Y., & Tagami, J. (2019). Remineralization capacity of carious and non-carious white spot lesions: clinical evaluation using ICDAS and SS-OCT. Clinical oral investigations, 23(2), 863–872.

Leite, F. R. M., Rodrigues, J. A., Groisman, S. (2010). Principais índices clínico-visuais para classificação de lesões de cárie e doença periodontal. Perionews, 623-632, 2010.

Lim, L. Z., Preisser, J., Benecha, H. K., & Zandona, A. F. (2020). Longitudinal assessment on the impact of caries status of nearby surfaces on caries progression on the mesial surface of first molars. International journal of paediatric dentistry, 30(6), 775–781.

Luczaj-Cepowicz, E., Marczuk-Kolada, G., Obidzinska, M., & Sidun, J. (2019). Diagnostic validity of the use of ICDAS II and DIAGNOdent pen verified by micro-computed tomography for the detection of occlusal caries lesions-an in vitro evaluation. Lasers in medical science, 34(8), 1655–1663.

Marczuk-Kolada, G., Luczaj-Cepowicz, E., Obidzinska, M., & Rozycki, J. (2020). Performance of ICDAS II and fluorescence methods on detection of occlusal caries-An ex vivo study. Photodiagnosis and photodynamic therapy, 29, 101609.

Marquezan, P. K., Alves, L. S., Dalla Nora, A., Maltz, M., & do Amaral Zenkner, J. E. (2019). Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth. Clinical oral investigations, 23(10), 3879–3883.

Mazur, M., Jedliński, M., Ndokaj, A., Corridore, D., Maruotti, A., Ottolenghi, L., & Guerra, F. (2020). Diagnostic Drama. Use of ICDAS II and Fluorescence-Based Intraoral Camera in Early Occlusal Caries Detection: A Clinical Study. International journal of environmental research and public health, 17(8), 2937.

Nor, N., Chadwick, B. L., Farnell, D., & Chestnutt, I. G. (2019). The prevalence of enamel and dentine caries lesions and their determinant factors among children living in fluoridated and non-fluoridated areas. Community dental health, 36(3), 229–236.

Nagireddy, V. R., Reddy, D., Kondamadugu, S., Puppala, N., Mareddy, A., & Chris, A. (2019). Nanosilver Fluoride-A Paradigm Shift for Arrest in Dental Caries in Primary Teeth of Schoolchildren: A Randomized Controlled Clinical Trial. International journal of clinical pediatric dentistry, 12(6), 484–490.

Nogueira, V. K. C. (2015). Critérios de codificação da lesão de cárie X Decisão de tratamento. Dissertação de Mestrado - Universidade Estadual Paulista, Araraquara. 58f.

Nyvad, B., & Baelum, V. (2018). Nyvad Criteria for Caries Lesion Activity and Severity Assessment: A Validated Approach for Clinical Management and Research. Caries research, 52(5), 397–405.

Olley, R. C., Wilson, R., Bartlett, D., & Moazzez, R. (2014). Validation of the Basic Erosive Wear Examination. Caries research, 48(1), 51–56.

Panayotov, I., Terrer, E., Salehi, H., Tassery, H., Yachouh, J., Cuisinier, F. J., & Levallois, B. (2013). In vitro investigation of fluorescence of carious dentin observed with a Soprolife® camera. Clinical oral investigations, 17(3), 757–763.

Paris, S., Schwendicke, F., Soviero, V., & Meyer-Lueckel, H. (2019). Accuracy of tactile assessment in order to detect proximal cavitation of caries lesions in vitro. Clinical oral investigations, 23(7), 2907–2912.

Pitts, N. B., Ekstrand, K. R., & ICDAS Foundation (2013). International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries. Community dentistry and oral epidemiology, 41(1), e41–e52.

Qudeimat, M. A., Altarakemah, Y., Alomari, Q., Alshawaf, N., & Honkala, E. (2019). The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study. BMC oral health, 19(1), 41.

Ramírez-De Los Santos, S., López-Pulido, E. I., Medrano-González, I., Becerra-Ruiz, J. S., Alonso-Sanchez, C. C., Vázquez-Jiménez, S. I., Guerrero-Velázquez, C., & Guzmán-Flores, J. M. (2020). Alteration of cytokines in saliva of children with caries and obesity. Odontology, 10.1007/s10266-020-00515-x. Advance online publication.

Selwitz, R. H., Ismail, A. I., & Pitts, N. B. (2007). Dental caries. Lancet (London, England), 369(9555), 51–59.

Simões, T. C., Marques, L. C., Sá, A. T. G. de, Maciel, S. M. ., Poleti, M. L., Prado, F. S., González, A. H. M. ., Rubira-Bullen, I. R. F. ., Bussadori, S. K. ., & Moura, S. K. . (2020). Performance of methods for detecting occlusal caries lesions: ICDAS X radiological image. Research, Society and Development, 9(10), e1859108490.

Subka, S., Rodd, H., Nugent, Z., & Deery, C. (2019). In vivo validity of proximal caries detection in primary teeth, with histological validation. International journal of paediatric dentistry, 29(4), 429–438.

Sürme, K., Kara, N. B., & Yilmaz, Y. (2020). In Vitro Evaluation of Occlusal Caries Detection Methods in Primary and Permanent Teeth: A Comparison of CarieScan PRO, DIAGNOdent Pen, and DIAGNOcam Methods. Photobiomodulation, photomedicine, and laser surgery, 38(2), 105–111.

Tassoker, M., Ozcan, S., & Karabekiroglu, S. (2020). Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images. Medical principles and practice: international journal of the Kuwait University, Health Science Centre, 29(1), 25–31.

Taqi, M., Razak, I. A., & Ab-Murat, N. (2019). Comparing dental caries status using Modified International Caries Detection and Assessment System (ICDAS) and World Health Organization (WHO) indices among school children of Bhakkar, Pakistan. JPMA. The Journal of the Pakistan Medical Association, 69(7), 950–954.

Teo, T. K., Ashley, P. F., & Louca, C. (2014). An in vivo and in vitro investigation of the use of ICDAS, DIAGNOdent pen and CarieScan PRO for the detection and assessment of occlusal caries in primary molar teeth. Clinical oral investigations, 18(3), 737–744.

Tonkaboni, A., Saffarpour, A., Aghapourzangeneh, F., & Fard, M. (2019). Comparison of diagnostic effects of infrared imaging and bitewing radiography in proximal caries of permanent teeth. Lasers in medical science, 34(5), 873–879.

Tschammler, C., Simon, A., Brockmann, K., Röbl, M., & Wiegand, A. (2019). Erosive tooth wear and caries experience in children and adolescents with obesity. Journal of dentistry, 83, 77–86.

Ünal, M., Koçkanat, A., Güler, S., & Gültürk, E. (2019). Diagnostic Performance of Different Methods in Detecting Incipient Non-Cavitated Occlusal Caries Lesions in Permanent Teeth. The Journal of clinical pediatric dentistry, 43(3), 173–179.

van der Veen, M. H., & de Josselin de Jong, E. (2000). Application of quantitative light-induced fluorescence for assessing early caries lesions. Monographs in oral science, 17, 144–162.

Vasconcelos, N. P., Melo, P., Gavinha, S. (2004). Estudo dos factores etiológicos das cáries precoces da infância numa população de risco. Rev Port Estomatol Cir Maxilofac, 45(2), 69-77.

Vollú, A. L., Rodrigues, G. F., Rougemount Teixeira, R. V., Cruz, L. R., Dos Santos Massa, G., de Lima Moreira, J. P., Luiz, R. R., Barja-Fidalgo, F., & Fonseca-Gonçalves, A. (2019). Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial. Journal of dentistry, 88, 103165.

Yanikoglu, F., Avci, H., Celik, Z. C., & Tagtekin, D. (2020). Diagnostic Performance of ICDAS II, FluoreCam and Ultrasound for Flat Surface Caries with Different Depths. Ultrasound in medicine & biology, 46(7), 1755–1760.

Winter, J., Bartsch, B., Schütz, C., Jablonski-Momeni, A., & Pieper, K. (2019). Implementation and evaluation of an interdisciplinary preventive program to prevent early childhood caries. Clinical oral investigations, 23(1), 187–197.



How to Cite

Araújo, A. A., Braga, L. S., Dietrich, L., Caixeta, D. A. F., Santos-Filho, P. C. F., & Martins, V. da M. (2020). Caries detection and diagnosis methods: a narrative review. Research, Society and Development, 9(11), e36291110019.



Health Sciences