The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptxDrLasya
INDEX definition:
An Index can be defined as a numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other populations classified by the same criteria and methods.
- Russell A. L
Ideal requisites of an index:
Clarity, simplicity, objectivity
Validity
Reliability
Quantifiability
Sensitivity
Acceptability
CLASSIFICATION OF INDICES
1) Direction in which the scores can fluctuate
a) Reversible – Measures conditions that can increase/ decrease on subsequent examinations
Eg: Loe and Silness Gingival Index
b) Irreversible – Measures conditions whose scores will not decrease on subsequent examinations
Eg: DMFT Index
2) The extent to which areas of oral cavity are measured
a) Full Mouth Index - Measures the patients’ entire periodontium or dentition.
Eg: Russell’s Periodontal Index
b) Simplified Index - Measures only a representative sample of the dental apparatus.
Eg: Greene & Vermillion’s Oral Hygiene Index-Simplified (OHI-S)
3) The entity they measure
a) Disease Index - ‘D’ portion of the DMFT
b) Symptom Index – Indices measuring gingival/ sulcular bleeding
c) Treatment Index - ‘F’ portion of the DMFT
4) The special categories
a) Simple Index - Measures the presence or absence of a condition.
Eg: Silness and Loe Plaque Index
b) Cumulative Index - Measures all the evidence of a condition, past and present.
Eg: DMFT Index for dental caries
INDICES FOR ASSESSING DENTAL CARIES
1. Decayed, Missing, Filled Teeth (DMFT) Index
2. Decayed, Missing, Filled Surfaces (DMFS) Index
3. Modified DMFT Index
4. Caries indices for primary dentition:
a. def index
b. dmf index
c. df index
d. Simplified index for dental caries experience
e. Dental Caries Severity Index for primary tooth (CSI)
5. Root caries index
6. Caries Severity Index
7. Dental Caries Severity Classification Scale (D1-D3)
8. Czechoslovakian caries Index
9. Stone’s Index
10. Caries susceptibility Index
11. D-M-F- surface percentage Index
12. Restorative Index
13. Moller’s Index
14. WHO Index for caries
15. Functional measure index
16. T- Health index (Tissue Health Index)
17. Dental health index
Recent Developments on Caries Indices:
1. Nyvad’s criteria
2. Significant Caries (SiC) Index
3. Specific Caries Index
4. ICDAS II
5. PUFA
6. Caries assessment spectrum and treatment (CAST) index
7. FDI World Dental Federation Caries Matrix
Different criteria for diagnosing pit and fissure caries:
1. Anglo-Saxon system (Liberal)
2. European system (Conservative)
SIGNIFICANT CARIES INDEX (SiC Index):
• Introduced in 2000 by Bratthall D, to identify group of individuals with the highest caries scores among population
Procedure:
Individuals are scored according to their DMFT values.
SiC Index is the mean DMFT of one third of the population with the highest caries scores is selected
The index is used as a complement to the mean DMFT
dental indices and indices of dental caries assessment
decayed missing filled index, root caries index, caries severity classification scale, uses and properties of an ideal index
Orthodontic indices /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Running head Patient Safety and Risk Management in Dental Pra.docxtodd581
Running head: Patient Safety and Risk Management in Dental Practice: Are There Enough
Guidelines? An Evaluative Study on The Existing System in a Dental College of Riyadh 1
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh
Introduction
While it is essential to the practice of healthcare professionals to concern about patient
safety, it is relatively current that it has been transformed into a specific body of knowledge and
therefore patient safety may be considered as a relatively ‘innovative’ discipline. Its core ideas
are to prevent the occurrence of avoidable adverse events (errors, complications and accidents)
accompanying the practice of healthcare and to reduce the impact of unavoidable adverse events.
This is a simple definition for the multifaceted, complexed nature and many key elements in the
practice of patient safety. There are economic, financial, social, cultural and organizational
matters of a patient safety environment that makes it unpractical to simply define it as the
practicing safe health care or protecting patients from harm by health care professionals. It is
essential for all health care professionals and health care organizations to become more
acquainted with the overall framework of patient safety, to dynamically contribute in hard work
to apply patient safety procedures in everyday practice and to create a culture of patient safety
culture (Yamalik & Perea Pérez, 2012).
There is a constant concern and interest in dentistry for matters related to patients and
practicing safe and quality care in the everyday dental practice. Yet, like other health
professions, more attention is given to patient related matters and safety-related matters
(Yamalik & Dijk, 2013).
Furthermore, there is an emerging professional consideration of risk management, patient
safety and handling errors. Rather than hiding them, errors are now understood as learning
material and by that, the number of publications on dental errors are increasing. As an example,
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 2
prescribing errors in dental practice is a potential ground for development in the medication
management process and patient safety (Yamalik & Dijk, 2013).
An empirical data on the attitudes of dental professionals and dental auxiliaries about the
reporting of medical errors was collected in Riyadh, Saudi Arabia by Al-Nomay et al., (2017),
most respondents (94.4% of them) expressed that medical errors should be reported. Yet, insights
of the norm, personal preferences and existing practices regarding which type of error should be
reported were inconsistent. Only 17.9% of respondents perceived that reporting errors that results
in.
Running head Patient Safety and Risk Management in Dental Pra.docxglendar3
Running head: Patient Safety and Risk Management in Dental Practice: Are There Enough
Guidelines? An Evaluative Study on The Existing System in a Dental College of Riyadh 1
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh
Introduction
While it is essential to the practice of healthcare professionals to concern about patient
safety, it is relatively current that it has been transformed into a specific body of knowledge and
therefore patient safety may be considered as a relatively ‘innovative’ discipline. Its core ideas
are to prevent the occurrence of avoidable adverse events (errors, complications and accidents)
accompanying the practice of healthcare and to reduce the impact of unavoidable adverse events.
This is a simple definition for the multifaceted, complexed nature and many key elements in the
practice of patient safety. There are economic, financial, social, cultural and organizational
matters of a patient safety environment that makes it unpractical to simply define it as the
practicing safe health care or protecting patients from harm by health care professionals. It is
essential for all health care professionals and health care organizations to become more
acquainted with the overall framework of patient safety, to dynamically contribute in hard work
to apply patient safety procedures in everyday practice and to create a culture of patient safety
culture (Yamalik & Perea Pérez, 2012).
There is a constant concern and interest in dentistry for matters related to patients and
practicing safe and quality care in the everyday dental practice. Yet, like other health
professions, more attention is given to patient related matters and safety-related matters
(Yamalik & Dijk, 2013).
Furthermore, there is an emerging professional consideration of risk management, patient
safety and handling errors. Rather than hiding them, errors are now understood as learning
material and by that, the number of publications on dental errors are increasing. As an example,
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 2
prescribing errors in dental practice is a potential ground for development in the medication
management process and patient safety (Yamalik & Dijk, 2013).
An empirical data on the attitudes of dental professionals and dental auxiliaries about the
reporting of medical errors was collected in Riyadh, Saudi Arabia by Al-Nomay et al., (2017),
most respondents (94.4% of them) expressed that medical errors should be reported. Yet, insights
of the norm, personal preferences and existing practices regarding which type of error should be
reported were inconsistent. Only 17.9% of respondents perceived that reporting errors that results
in.
Oral cancer is the most significant and growing concern worldwide. It ranks as 3rd in India and 8th
largest prevalent form of cancer in world. Oral cancer is often diagnosed, only after reached to an untreatable
stage. Early detection and prevention are the major objectives to control the oral cancer. Histopathology
analysis of biopsied lesion followed by visual examination is the current clinical procedure. This procedure is
invasive and requires a waiting period for the diagnostic results. Thus, there is a need to develop a non-invasive
screening device for oral cancer detection. Optical imaging has emerged as effective tool for detecting
malignant changes associated with oral cancer and also effective in assisting with the detection of oral mucosal
abnormalities. Hence, this paper focuses on development of non-invasive, real-time diagnostic tool based on
optical imaging technique in which involves - fluorescence emission and diffuse reflectance imaging modalities
for screening of oral cancer.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Outlines of the presentation
Introduction
Measuring Dental Caries
Review of caries assessment systems developed over the
last decade.
International Caries Detection and Assessment System
(ICDAS)
Insights into the ICDAS
Future of ICDAS
Conclusions and Recommendations
04/09/16 2
Slides numbers: 70
Estimated time: 40 minutes
3. Introduction
An increasing concern more than a decade ago about
the quality and comparability of caries data assessed
using the traditional measurement of caries.
Further, it has been shown that the diagnosis of caries
at the cavitation level results in a significant
underestimation of the actual caries experience in
populations.
Pitts et al., 1988; Manji et al., 1989; Ismail et al 1992; Pitts, 1993
;Machiulskiene et al., 1998; Nyvad et al., 1999; Pitts et al., 2004
04/09/16 3
4. Introduction
The International Caries Detection and Assessment System
(ICDAS) has was developed based on a systematic review of the
available clinical caries detection and assessment systems, to
provide an international system for caries detection that would
allow for comparison of data collected in different locations at
different points in time, and to bring forward the current
understanding of the process of initiation and progression of
dental caries to the fields of epidemiological and clinical
research.
Nyvad et al., 1999; Ekstrand et al., 1995; 1998; Pitts 2004 ; Ismail 2007
04/09/16 4
5. What is Dental Caries?
A localized post eruptive pathological process
of external origin involving softening of the
hard tooth tissue and proceeding to the
formation of cavity.
04/09/16 5
7. What is Measuring Dental Caries?
Measurement is a process of assigning values to
characteristics according to a set of rules. This is facilitated
through indices.
“A numerical value describing the relative status of a
population on a graduated scale with definite upper and
lower limits, which is designed to permit and facilitate
comparison with other populations classified by same
criteria and methods.”
Russell A. L.
04/09/16 7
8. Why Measuring Dental Caries?
1. For epidemiological investigation in
population groups
2. For public health programme planning and
evaluation
3. For testing prevention and control
procedures.
04/09/16 8
9. Prevalence of Dental caries is measured in terms of:
Percentage of persons affected
Number of teeth attacked
Number of tooth surface involved
Number of discrete cavities
Size and degree of severity of carious lesion
04/09/16 9
10. Ideal Requisites of an Index
1. CLARITY: The examiner should be able to remember the
rules of the index clearly in his mind.
2. SIMPLICITY: The index should be simple and easy to
apply so that there is no undue time lost during field
examinations.
3. OBJECTIVITY: The criteria for the index should be
objective and unambiguous, with mutually exclusive
criteria.
4. VALIDITY: The index must measure what it is intended to
measure.
04/09/16 10
11. Ideal Requisites of an Index
5. RELIABILITY: The index should measure consistently
at different times and at variety of conditions.
6. QUANTIFIABILITY: The index should be amenable to
statistical analysis.
7. SENSITIVITY: The index should be able to detect
reasonably small shifts, in either direction in group
condition.
8. ACCEPTABILITY: The use of index should not be
painful or demeaning to the subject.
04/09/16 11
12. Review of caries assessment
systems developed over the last decade
04/09/16 12
13. Black’s Classification System
Developed by G.V. Black in the
early 1900s. Dental caries assessed
based on the tooth type and the
cavity location or tooth surfaces
involved.
04/09/16 13
14. Black’s Classification System
Strength
Simple and practical with long
history of use in general dental
practice.
Shortcoming
Does not record noncavitated
lesions leading to
underestimation of caries
experience.
04/09/16 14
15. The Decayed, Missing, Filled (DMF) index
Developed by Klein, Palmer and Knutson in 1938.
World health organization has adopted this index in its oral
health assessment form for conducting national oral health
surveys.
It has been used for more than 70 years as the key measure
of caries experience in dental epidemiology.
Larmas 2010
04/09/16 15
16. The Decayed, Missing, Filled (DMF) index
When its applied only to tooth surfaces it is called the
DMFS index, and scores per individual range from 0 to 128
or 148, depending on whether the third molars are
included in the scoring.
Cappelli and Mobley 2007
When written in lowercase letters, (dmft) is a variation
that is applied to expresses the number of affected teeth
in the primary dentition, with scores ranging from 0 to 20
for children.
04/09/16 16
17. The Decayed, Missing, Filled (DMF) index
The dmfs index expresses the number of affected surfaces in
primary dentition with a score range of 0 to 88 surfaces.
Strength;
Simple to use; accepted at global level;
long track record of use supported by literature;
allows for meaningful comparison of caries situation in various
populations;
recognized by majority of countries and ministries of health
04/09/16 17
18. Shortcomings of DMF Index
1. Researchers have noted a significant amount of inter-
observer bias and variability.
A practitioner has to judge whether a minor lesion will
develop into a major lesion over time, and whether a lesion
in primary tooth can safely remain untreated for the life of
the tooth.
LeSaffre et al., 2004
2. Inability of D component of DMF score to provide any
indication as to the number of teeth at risk or data that is
useful in estimating treatment needs.
04/09/16 18
19. Shortcomings of DMF Index
3. It assesses only cavitated lesion extended into dentin and
cannot be use to assess root caries.
4. The indices do not account for teeth lost for reasons
other than decay (such as periodontal disease) and do not
account for sealed teeth since sealants and other.
5. DMF index gives equal weight to missing, untreated
decayed and well restored teeth.
Broadbent JM, Thomson 2005; Burt 1997
04/09/16 19
20. Shortcomings of DMF Index
6. Underestimation of the prevalence and severity of
caries, because it does not register the initial
manifestation of caries like the white spot lesion.
Gonzales 1999
8. Cannot assess caries progression rate.
9. DMF index is invalid in elderly population, as teeth can
be lost for reasons other than caries.
Broadbent JM, Thomson 2005; Burt 1997
04/09/16 20
21. Nyvad Caries Diagnostic Criteria
Proposed by Nyvad in 1999.
includes the initial manifestation of caries in the pre-
cavitated stages.
This system differentiates between active and inactive caries
lesions at both the cavitated and non cavitated levels.
Nyvad et al., 1999
04/09/16 21
23. Nyvad Caries Diagnostic Criteria
Strength
1. Can identify incipient caries lesion, hence can be used for
planning prevention programmes.
2. Underestimation of prevalence and severity of caries with
def index can be omitted as it measures only cavitation
state.
3. Reduce the need of treatment on a long term basis because
diagnosis of initial lesions can stop the progression of
lesion.
04/09/16 23
24. Nyvad Caries
Diagnostic Criteria
The prevalence values
with Nyvad´s caries
diagnostic criteria were
97%, were higher than
those obtained with the
def index being 73%.
04/09/16 24
25. Shortcomings of Nyvad Caries
Diagnostic Criteria
1. It is more difficult to make an exact diagnosis of a
precavitated active lesion such as a white spot lesion over the
occlusal surface than over the facial surface, because of the
physiologic wear of the occlusal surface during mastication,
these lesions can disappear.
These lesions can be underdiagnosed, progressing to frank
cavitation.
04/09/16 25
26. Significant caries Index (SiC)
In 1981, WHO declared that “the global goal for oral health by
the year 2000 should be that the DMFT for the 12-year-olds
should not exceed 3”.
Over a period of 20ys, nearly 70% of the countries in the world
have achieved this goal, or being at borderline value.
A detailed analysis of the caries situation in many countries
showed a skewed distribution of caries prevalence and that a
proportion of 12-year-olds still has high or even very high
DMFT values even though a proportion is totally caries free.
04/09/16 26
27. Significant caries Index (SiC)
Thus DMFT value does not accurately reflect this skewed
distribution leading to incorrect conclusion that the caries
situation for the whole population is controlled, while in
reality, several individuals still have caries.
Bratthall in 2000 proposed SiC indix in order to bring
attention to the individuals with the highest caries values in
each population under investigation.
Bratthall 2000
04/09/16 27
28. Significant caries Index (SiC)
While mean scores provide a good measure of population
disease levels, it is important to also look at those who might
be carrying a significant burden of the dental disease
experience in the population.
SiC indix is used together with DMF to highlight oral health
inequalities more accurately among different population
groups within the community in order to identify the need
for special preventive oral health interventions.
Bratthall 2000
04/09/16 28
29. Significant caries Index (SiC)
SiC is calculated by sorting individuals according to their
DMFT values, than one third of the population with the
highest caries scores is selected and the mean DMFT for this
subgroup is calculated.
Strength:
It can bring authorities attention to the need of preventive
measures required for prevention/control of caries in these
subgroups.
Bratthall 2000
04/09/16 29
30. Shortcomings of Significant caries Index
(SiC)
1. It is just an extension of DMF index as it follows same
criteria for assessing dental caries and thus the same
limitations in assessing caries in a population as DMF
index.
2. Is more of significance in population where caries
prevalence is low and has a skewed distribution.
04/09/16 30
31. Specific Caries Index
Proposed by Acharya in 2006 to be used in conjunction with
the DMFS index to provide qualitative and quantitative
information about caries prevalence, location, type of caries
lesion as well as untreated dental caries in an individual based
on clinical examination.
Strength;
The index has shown good reliability and validity in the study
conducted by original author but further search on various
databases did not reveal any other study using this index.
04/09/16 31
32. Specific Caries Index
The SCI score for an
individual is
calculated by adding
the individual tooth
scores, scores for an
individual can range
from 0 to 192 (for 32
teeth).
04/09/16 32
33. Shortcomings of Specific Caries Index
1. It employs same caries detection criteria as DMF or DMFS;
2. Inability of this index, if used alone, to capture
information useful for treatment planning.
3. In cases of large lesions, which cover more than one
surface, only an assumption can be made regarding the
originating lesion.
4. Number of proximal lesions be underestimated in absence
of bitewing radiograph.
5. Lack of provision for assessing root caries.
04/09/16 33
34. PUFA (pulp-ulcer-fistula-abscess) index
Developed by Monse et al in 2010 to overcome DMF index
failure to provide information on the clinical consequences of
untreated dental caries, such as pulpal abscess, which may be
more serious than the carious lesions themselves.
Monse et al 2010
04/09/16 34
36. PUFA (pulp-ulcer-fistula-abscess) index
Strength;
1.Simple to record.
2.Can be used for primary and permanent teeth alongside with DMF
index.
3.Can provide useful information for researches and authorities in
many developing countries, where access to oral health services is
limited and teeth are often left untreated or are extracted because
of pain or discomfort.
04/09/16 36
37. Shortcomings of PUFA
(pulp-ulcer-fistula-abscess) index
1. Stages of carious lesion progression in enamel are not
being assessed.
2. Few subjects with score “u” (ulcer).
3. Assessment of abscess and fistula can be combined into
one code.
4. Reliability and validity of this index requires further
discussion and research.
04/09/16 37
38. Caries Assessment Spectrum and Treatment
(CAST) Index
Developed by Frencken et al 2011, because of the need to find
a reliable, pragmatic cohesive and easy to read reporting
system.
Combines elements of the ICDAS II and PUFA indices, and the
M- and F-components of the DMF index.
Strength;
It covers the total dental caries spectrum – from no carious
lesion, through caries protection (sealant) and caries cure
(restoration) to carious lesions in enamel and dentine, and
the advanced stages of caries lesion progression in pulpal and
tooth surrounding tissue.
Frencken et al 2011
04/09/16 38
40. Shortcomings CAST Index
1. It does not record active and inactive carious lesions.
2. The CAST index has not been validated, nor has its
reliability been tested.
3. It is also not suggested for use in clinical trials.
4. It does not provide data on treatment or preventive
measures required for each code.
04/09/16 40
41. The Problem Of Diagnosis ?
Sensitivity Vs Specificity
Sensitivity: It is defined by the probability of the test
giving a positive finding when disease is present.
Specificity: It is the probability of a negative finding
when disease is absent.
The indications that are currently used of dental caries
diagnosis gives sensitivities of 60% and a specificity of 85%.
Leading to a profound effects on possible negligence of
early pathological demineralization.
Lussi 1991; Pitts 1995
04/09/16 41
42. The Problem Of Diagnosis ?
Sensitivity Vs Specificity
04/09/16 42
43. Need for an Integrated System
Unfortunately, in carious lesion detection, the scale of
measurement differs with clinicians, researchers,
techniques, and gadgets because a baseline or a gold
standard is absent.
Thus future of research, practice, and education in
cariology requires the development of an integrated
definition of dental caries and uniform measuring system
designed in such a way to produce reliable/reproducible
results.
04/09/16 43
44. International Caries Detection
and Assessment System
(ICDAS) – I and II
Developed in the year 2001 by the effort of large group
of researchers, epidemiologists and restorative dentists to
find a common caries assessment system based on of
insights gained from a systematic review of the literature
on clinical caries detection systems.
Ismail 2004
04/09/16 44
45. International Caries Detection
and Assessment System
(ICDAS) – I and II
To lead to better quality information to inform decisions
about the appropriate diagnosis, prognosis and clinical
management of dental caries at both the individual and
public health levels.
Pitts, 2004
04/09/16 45
46. International Caries Detection and Assessment
System (ICDAS) – I and II
The ‘D’ in ICDAS stands for detection of dental caries by
i. stage of the carious process;
ii. topography (pit-and-fissure or smooth surfaces);
iii. anatomy (crowns versus roots);
iv. restoration or sealant status
The ‘A’ in ICDAS stands for assessment of the caries process
by stage (non-cavitated or cavitated) and activity (active or
arrested)
04/09/16 46
47. International Caries Detection and
Assessment System
ICDAS I (2001) ICDAS II (2009)
Include (D) component for
caries detection and (A)
component for assessment of
caries process (whether
cavitated or non-cavitated
and active or arrested
caries). Root caries were not
included due to lack of
consensus and need for
further discussions.
Modified by ICDAS
coordinating committee in
2009 which describes both
coronal caries and caries
associated with
restorations and sealants
(CARS) and root caries.
04/09/16 47
48. International Caries Detection
and Assessment System
(ICDAS) – I and II
There is insufficient” evidence on the validity of clinical
diagnostic systems for root caries based on the National
Institutes of Health (NIH) Consensus Development
Conference on dental caries diagnosis and management.
Bader et al 2001
Root caries are frequently observed near the cemento-enamel
junction (CEJ), although lesions can appear anywhere on the
root surface.
04/09/16 48
49. International Caries Detection and Assessment
System (ICDAS) – I and II
The color of the root lesions has been used as an indication of
lesion activity.
Active lesions have been described as being;
Yellowish or light brown in color,
Darkly stained for arrested lesions.
However, color subsequently has been shown not to be a reliable
indicator of caries activity.
Hellyer et al, 1999; Lynch and Beighton 1994
04/09/16 49
50. ICDAS/ A. Pits and fissures
B- Smooth surface (mesial and distal)
04/09/16 50
51. CARIES ADJACENT TO RESTORATIONS AND
SEALANTS (CARS) New in ICDAS II
04/09/16 51
53. International Caries Detection and Assessment
System (ICDAS) – I and II
ICDAS has a 2-digit coding system (X-Y).
I.The first decision (code X; lesion detection) is to classify each tooth
surface on whether it is sound, sealed, restored, crowned, or
missing.
II.The second decision (attributed to code Y; lesion assessment) that
should be made for each tooth surface is the classification of the
carious status on an ordinal scale.
The ICDAS systems advocate the removal of plaque prior to the
initial examination in order to accurately detect the lesion.
04/09/16 53
56. ICDAS two-digit coding method
Example
A tooth restored with amalgam, which also exhibits an extensive
distinct cavity with visible dentin will be coded 4 (for an amalgam
restoration) and 6 (for a distinct cavity).
04/09/16 56
57. Wardrobe approach of ICDAS
To facilitate the use of ICDAS in different settings there is a range
of validated tools to select from, much as you would select the
appropriate clothes from your wardrobe depending on what you
were doing that day.
04/09/16 57
58. Wardrobe approach of ICDAS
This ‘wardrobe’ of validated tools allows users to select the best
criteria and conventions for each specific application of the
system.
Example; in a national study that aims to compare dental caries
prevalence over time, the number and configuration of tooth
surfaces may be selected to match previous surveys. Also, the
stage of caries detection may be adjusted to match previous
studies conducted in a country.
Pitts, 2004
04/09/16 58
59. Performance of ICDAS
Peer review papers
Search methods for identification of studies
Google, Google Scholar, the Cochrane Library MEDLINE and EMBASE electronic databases were searched.
04/09/16 59
61. Performance of ICDAS
Evidence Based Results
Author& Location Objectives Findings
Ekstrand et al., 2007
Dundee, Scotland
and Copenhagen,
To test the
reproducibility and
accuracy of the ICDAS I
and ICDAS II caries
detection systems for
coronal primary caries
in vitro.
Both the ICDAS caries
detection systems I and II are
valid and reliable for
detecting caries and
predicting the depth of the
lesion at any coronal surface.
04/09/16 61
63. Performance of ICDAS
Evidence Based Results
Author& Location Objectives Findings
Ismail et al., 2008
US
Assessed the prevalence,
severity of dental caries,
using the International
Caries Detection and
Assessment System
(ICDAS).
The use of ICDAS
provided useful
information on caries
distribution including
both cavitated (ICDAS 3-
6) as well as the non
cavitated carious lesion
(ICDAS 1-2).
04/09/16 63
65. Performance of ICDAS
Evidence Based Results
Author&
Location
Objectives MMethodology Findings
Shoaib et al.,
2009
Malaysia
To assess the
validity and
reproducibility
of the ICDAS II
criteria in
primary teeth.
Three trained examiners
independently examined
112 extracted primary
molars (52 first primary
molars and 60 second
primary molars), ranging
from clinically sound to
cavitated using ICDAS II
system.
The ICDAS II
criteria are
appropriate for use
in the
primary dentition
both for
approximal and
occlusal surfaces.
04/09/16 65
66. The ICDAS has been shown to be reproducible and accurate
(Jablonski-Momeni et al., 2008) and to allow the detection
and assessment of early lesions and longitudinal follow-up
(Burt et al., 2006; Ekstrand et al., 2007; Finlayson et al.,
2007; Ismail et al., 2007, 2008; Sohn et al., 2007; Cook et al.,
2008; Jablonski-Momeni et al., 2008; Varma et al., 2008).
Summary of evidences
04/09/16 66
67. Strength of ICDAS
1. Clinically reliable in permanent teeth and acceptable in
primary teeth.
2. Designed to detect 6 stages of caries severity, varying from
initial changes visible in enamel to frank cavitation in
dentine.
3. Very suitable for use in clinical trials assessing the efficacy
and/or effectiveness of caries control agents.
04/09/16 67
68. Shortcomings of ICDAS
1. Root caries assessment criteria has not been tested in any
epidemiological or clinical studies.
2. Data obtained are unpragmatic, non-cohesive and difficult to
read.
3. May lead to overestimation of seriousness of dental caries.
4. Results are difficult to compare against the widely-used DMF
index.
5. In very young children, some claim it is not practical to dry
6. surfaces to assess for early enamel caries (others, however
have used it successfully for this age group).
04/09/16 68
69. ICDAS adaptation of
the WHO “Stepwise”
approach to the
Surveillance of Non-
Communicable
Diseases for use
with dental caries
and oral health
indicators.
FUTURE OF ICDAS
04/09/16 69
Pitts, 2009
70. WHO Stepwise approach to Surveillance (STEPS) is a simple,
standardized method for collecting, analysing and
disseminating data in WHO member countries.
By using the same standardized questions and protocols, all
countries can use STEPS information not only for
monitoring within-country trends, but also for making
comparisons across countries. The approach encourages
the collection of small amounts of useful information on a
regular and continuing basis.
FUTURE OF ICDAS
04/09/16 70
71. This philosophy is entirely consistent with the
wardrobe approach of ICDAS and its use would result
in improved comparability of data collected nationally
and internationally and thereby facilitates systematic
reviews in the area. This foundation allows researchers
and clinicians to choose the stage of disease and
characteristics for assessment.
FUTURE OF ICDAS
04/09/16 71
72. The future of ICDAS depends on acceptance of the
concepts of integration and utility within a caries
detection and assessment system and to the fields of
epidemiological and clinical research by the
cariology community.
FUTURE OF ICDAS
04/09/16 72
74. These recommendations have been formulated following
the ICDAS II workshop in Baltimore (USA) for improvement
in caries diagnosis using ICDAS;
1. Investigate different methods for effectively cleaning and
drying of teeth and their impact on the usability of ICDAS.
2. Develop and test new explorers to allow for the detections
of surface roughness or “tackiness” of root surfaces without
causing damage to the surface.
3. Define the appropriate time required to dry teeth to
identify the first visible signs of dental caries.
FUTURE OF ICDAS
04/09/16 74
75. Additionally, a need for the following supporting
resources was identified in the workshop:
1. A library of images to depict the different codes and
conditions related to ICDAS.
2. Statistical protocols for analysis of reliability data
as well as for analysis of the ICDAS system in clinical
and epidemiological studies.
3. Standardized protocols and online simulations to
train examiners to use ICDAS.
FUTURE OF ICDAS
04/09/16 75
76. References
World Health Organization. Oral health surveys– basic methods. 4. ed. Geneva:
World Health Organization; 1997.
Klein H, Palmer C. Studies on dental caries vs. familial resemblance in the caries
experience of siblings. Pub Hlth Rep. 1938;53:1353-64.
Larmas M. Has dental caries prevalence some connection with caries index
values in adults? Caries Res. 2010;44(1):81-4.
Cappelli DP, Mobley CC. Prevention in Clinical Oral Health Care. Philadelphia,
Pa: Mosby Elsevier; 2007.
LeSaffre E, Mwalili SM, Declerk D. Analysis of caries experience taking inter-
observer bias into account. J Dent Res. 2004;83(12):951-5.
Broadbent JM, Thomson WM. For debate: problems with the DMF index
pertinent to dental caries data analysis. Community Oral Dent Epidemiol.
2005;33(6):400-9.
Burt BA. How useful are cross-sectional data from surveys of dental caries?
Community Dent Oral Epidemiol. 1997 Feb;25(1):36-41.
04/09/16 76
77. References
Gonzales, María Clara y col.Caries Dental. Guías de Práctica Clínica Basada en la
Evidencia ISS-ACFO 1999.
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic
system differentiating between active and inactive caries lesions. Caries
Research. 1999;33:252-260
Bratthall D, Introducing the Significant Caries Index together with a proposal
for a new global oral health goal for 12-year-olds. Int Dent J 2000, 50: 378-384.
Mehta, Abhishek. "Comprehensive review of caries assessment systems
developed over the last decade." RSBO (Online) 9.3 (2012): 316-321.
Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein
Helderman W. PUFA– An index of clinical consequences of untreated dental
caries. Community Dent Oral Epidemiol. 2010;38:77-82.
Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H et al. The International
Caries Detection and Assessment System (ICDAS): an integrated system for
measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170-8.
04/09/16 77
78. References
Ismail AI. Visual and visuo-tactile detection of dental caries. J Dent Res.
2004;83:C56-66.
Bader JD, Shugars DA, Bonito AJ. Systematic review of selected dental caries
diagnostic and management methods. J Dent Educ. 2001;65:960–8. [PubMed]
Hellyer PH, Beighton D, Heath MR, Lynch EJ. Root caries in older people
attending a general practice in East Sussex. Br Dent J. 1990;169:201–6. [PubMed]
Lynch E, Beighton D. A comparison of primary root caries lesions classified
according to color. Caries Res. 1994;28:233–9.
Ahlawat.P Comprehensive Implementation of the International Caries
Detection and Assessment System (ICDAS) in a Dental School and University
Oral Health Centre: A Stepwise Framework Dent. J. 2014, 2, 41-51.
Pitts NB. Modern Concepts of Caries Measurement. J Dent Res 83(Spec Iss
C):C43-C47, 2004.
ICDAS Coordinating Committee. Rationale and Evidence for the International
Caries Detection and Assessment System (ICDAS II) in
http://www.icdas.org/uploads/Rationale%20and%20Evidence%20ICDAS%20II
%20September%2011-1.pdf
04/09/16 78