The International Caries

Classification and
Management System is a
health outcomes focused
system that aims to
DETECT
maintain health and
preserve tooth structure.
& Assess
It uses a simple form of
the ICDAS Caries
Classification model to Caries Staging & Activity
stage caries severity and
assess lesion activity in (CLASSIFICATION &
order to derive an INTRA-ORAL RISK)
appropriate,
personalised,
preventively based, risk-
adjusted, tooth
preserving Management
Plan.
DETERMINE DECIDE
Patient-level Caries Risk
ICCMS™4D Personalised Care Plan:
Caries Management Patient & Tooth Levels

(DECISION MAKING)
(HISTORY)

Risk-based
Recall
interval
DO
Appropriate Tooth
& Patient
Preserving Caries
Prevention & Control
Interventions
(MANAGEMENT)
 ICCMS™ Caries Categories
1 DETERMINE Patient Level Caries Risk 2.1 DETECT & ASSESS Sound Initial Active Initial Inactive
First/distinct
Caries Staging & visual changes in
enamel (ICDAS
Patient-level Risk Factors Activity Status 1& 2)

The International Caries

‒ Head and Neck Radiation
No evidence
Moderate Active Moderate Inactive Enamel
Classification and
‒ Dry mouth
of visible
breakdown/
‒ Inadequate OH practices underlying
Management System is a
health outcomes focused
system that aims to
‒
‒
Deficient exposure to topical Fluoride-
High frequency/amount of sugar
DETECT caries after
5-second
air-drying
dentine shadow
(ICDAS 1 & 2)
consumed
maintain health and
preserve tooth structure. ‒ Symptomatic-driven attendance
& Assess (ICDAS 0) Extensive Active Extensive Inactive
Distinct cavity with
It uses a simple form of ‒
‒
Socioeconomic Status/Access barriers
Mothers high DMF (caries experience)
Note: Where available
combine with radiographs.
11 visible dentine
the ICDAS Caries (ICDAS 5 & 6)
Classification model to Risk factors in red will always classify an
Caries Staging & Activity
stage caries severity and individual as high caries risk.
assess lesion activity in (CLASSIFICATION & 2.2 ASSESS Intra-Oral Risk Factors
order to derive an INTRA-ORAL RISK) Intra-Oral Risk Factors
appropriate,
personalised, ‒ Hypo-salivation/Dry mouth
preventively based, risk- ‒ PUFA- Dental Sepsis
Risk factors
adjusted, tooth ‒ Caries experience in red will
preserving Management ‒ Thick plaque always
classify an
Plan.
DETERMINE DECIDE ‒ > biofilm retention individual

Patient-level Caries Risk

ICCMS™4D Personalised Care Plan:
‒ Exposed root surfaces as high
caries risk.

DO Appropriate Caries Management Patient & Tooth Levels

DECIDE on a
4 3
Prevention & (DECISION MAKING) Personalised
(HISTORY)
Preservation Interventions Care Plan
Management at the patient level
Homecare Clinical Interventions/Approaches
2-day toothbrushing
[≥1,000 ppm F-]
Motivational engagement: improve oral
hygiene & reduce free sugars
Risk-based
Recall
interval
DO Tooth & surface level Patient level
ICCMS™ Likelihood for progression
Improve oral-health Professional cleaning ICCMS™ Caries Diagnosis
Appropriate Tooth of existing or new caries lesions
behaviour Sealing
F- mouthrinse 2-4/year-F- varnish/gel/ solution & Patient ICCMS™ Sound Low Likelihood
Modifying hyposalivation Preserving Caries ICCMSTM Initial Active/Inactive Moderate Likelihood
Interval recalls: 1-3 m in high-, 3-6 m in Prevention & Control
moderate-, 6-12 m in low likelihood ICCMSTM Moderate Active/Inactive High Likelihood
Interventions
ICCMSTM Extensive Active/Inactive
(MANAGEMENT)
Management of individual lesions
Non-Operative Care- Control Tooth-Preserving Operative Care
Management of individual Management at the patient
Fluoride varnish, gel, toothpaste (+ Tooth-preservative restorations
Oral Hygiene) Step-wise excavation / Pulp Preserving restorations active lesions level
Sealing (resin-based, GI, infiltrants) Sealing / Hall Technique / ART
Mechanical biofilm removal