The weighted DMFT (W-DMFT) model: A conceptual framework for severity-adjusted caries assessment in epidemiology

To critically examine the structural limitations of the classical Decayed-Missing-Filled Teeth (DMFT) index and to propose a biologically structured, severity-adjusted conceptual framework through the Weighted DMFT (W-DMFT) model. This study presents a conceptual-analytic framework without quantitative field data. The methodological constraints of the DMFT index were examined across four domains: biological progression, functional impact, radiographic detectability, and restorative assessment. Based on the enamel-dentin-pulp hierarchy, a structured weighting system (0-3) was developed to reflect increasing biological invasion and functional consequences.The W-DMFT score is expressed as a severity-adjusted mean value per tooth. The classical DMFT index applies uniform scoring that does not differentiate lesion depth or functional severity. In contrast, the W-DMFT model introduces hierarchical weighting to capture biological progression, incorporates radiographically detectable dentinal involvement, and numerically represents functional impairment. The model provides a theoretically enhanced framework for severity-sensitive caries assessment. The W-DMFT model offers a structured conceptual extension of the classical DMFT by integrating lesion depth and functional considerations into epidemiological scoring. While biologically grounded, empirical validation studies are required to assess reliability, reproducibility, and population-level performance.