Salud Dental Para Todos


International Caries Detection and Assessment System (ICDAS II)

D.D.S.Marcelo Alberto Iruretagoyena

Caries code in smooth surface (mesial and distal)

Sound tooth surface: Code 0

There should be no evidence of caries (either no or questionable change in enamel translucency after prolonged air drying (suggested drying time 5 seconds)). Surfaces with developmental defects such as enamel hypoplasias; fluorosis; tooth wear (attrition, abrasion and erosion), and extrinsic or intrinsic stains will be recorded as sound.

First visual change in enamel: Code 1

When seen wet there is no evidence of any change in color attributable to carious activity, but after prolonged air drying a carious opacity (white or brown lesion) is visible that is not consistent with the clinical appearance of sound enamel. This will be seen from the buccal or lingual surface.

Distinct visual change in enamel when viewed wet: Code 2

There is a carious opacity or discoloration (white or brown lesion) that is not consistent with the clinical appearance of sound enamel (Note: the lesion is still visible when dry). This lesion may be seen directly when viewed from the buccal or lingual direction. In addition, when viewed from the occlusal direction, this opacity or discoloration may be seen as a shadow confined to enamel, seen through the marginal ridge.


Initial breakdown in enamel due to caries with no visible dentin: Code 3

Once dried for approximately 5 seconds there is distinct loss of enamel integrity, viewed from the buccal or lingual direction.

If in doubt, or to confirm the visual assessment, the CPI probe can be used gently across the surface to confirm the loss of surface integrity.



Underlying dark shadow from dentin with or without localized enamel breakdown: Code 4

This lesion appears as a shadow of discolored dentin visible through an apparently intact marginal ridge, buccal or lingual walls of enamel. This appearance is often seen more easily when the tooth is wet. The darkened area is an intrinsic shadow which may appear as grey, blue or brown in color.


Distinct cavity with visible dentin: Code 5.

Cavitation in opaque or discolored enamel (white or brown) with exposed dentin in the examiner’s judgment.

If in doubt, or to confirm the visual assessment, the CPI probe can be used to confirm the presence of a cavity apparently in dentin. This is achieved by sliding the ball end along the surface and a dentin cavity is detected if the ball enters the opening of the cavity and in the opinion of the examiner the base is in dentin.


Extensive distinct cavity with visible dentin: Code 6

Obvious loss of tooth structure, the extensive cavity may be deep or wide and dentin is clearly visible on both the walls and at the base. The marginal ridge may or may not be present. An extensive cavity involves at least half of a tooth surface or possibly reaching the pulp.


Salud Dental Para Todos

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E-mail: D.D.S. Marcelo Alberto Iruretagoyena

Wilde.  Provincia de Buenos Aires. Argentina

Revised: September 2018