An assessment of three contemporary dental caries epidemiological instruments: a critical review

Aim Dental caries epidemiological surveys produce information that may be used to assist health policy makers in the planning of preventive and curative strategies. The detection instruments used in these surveys should be able to identify the correct, true stage of the disease or medical condition. This makes it essential that valid instruments are used. This study aimed to critically review commonly used visual/tactile caries assessment instruments in epidemiological surveys with respect to their manageability, reproducibility and validity, and how results are reported.Method A Pubmed search identified the following international visual/tactile instruments for caries detection more than once between 2013 and 2018: World Health Organisation (WHO), International Caries Detection and Assessment System (ICDAS) and Caries Assessment Spectrum and Treatment (CAST).Results The review revealed that the WHO instrument can be considered a screening instrument, that the ICDAS instrument lacks sufficient validity and takes time to apply and that the CAST instrument is promising, but requires further field testing before it can be considered a fully proven caries-assessment instrument in epidemiology. It is recommended that calculating caries prevalence should be based on the presence of cavitated dentine carious lesions, that the prevalence of enamel carious lesions be reported separately and that the dmf/DMF index not be used in its current form.Conclusion Researchers/dentists should be knowledgeable of the limitations and advantages of common caries assessment instruments. Caries prevalence should not be based on the dmf/DMF index but on cavitated dentine carious lesions (d/D-component) as the M- and F-component do not refer to a disease stage.