The American Dental Association Caries Classification System for Clinical Practice
Abstract
Background The caries lesion, the most commonly observed sign of dental caries disease, is the cumulative result of an imbalance in the dynamic demineralization and remineralization process that causes a net mineral loss over time. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions. Methods In 2008, the American Dental Association (ADA) convened a group of experts to develop an easy-to-implement caries classification system. The ADA Council on Scientific Affairs subsequently compiled information from these discussions to create the ADA Caries Classification System (CCS) presented in this article. Conclusions The ADA CCS offers clinicians the capability to capture the spectrum of caries disease presentations ranging from clinically unaffected (sound) tooth structure to noncavitated initial lesions to extensively cavitated advanced lesions. The ADA CCS supports a broad range of clinical management options necessary to treat both noncavitated and cavitated caries lesions. Practical implications The ADA CCS is available for implementation in clinical practice to evaluate its usability, reliability, and validity. Feedback from clinical practitioners and researchers will allow system improvement. Use of the ADA CCS will offer standardized data that can be used to improve the scientific rationale for the treatment of all stages of caries disease.
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Artificial intelligence-driven algorithms can analyze clinical, dietary, and behavioral data to provide prompt, evidence-based recommendations for personalized preventive care.
“Artificial intelligence-driven algorithms can analyze clinical, dietary, and behavioral data, providing prompt, evidence-based recommendations for personalized preventive care [17].”
From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [17]
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Benavides, E., Krecioch, J., Allareddy, T., Buchanan, A., Keels, M., Mascarenhas, A. K., Duong, M.-L., O'Brien, K. K., Ziegler, K. M., Lipman, R., et al. (2026) · The Journal of the American Dental Association (1939) · doi:10.1016/j.adaj.2025.10.013 · Cited by 8 · see citing works
Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium
Divaris, K., Haworth, S., Shaffer, J., Anttonen, V., Beck, J., Furuichi, Y., Holtfreter, B., Jönsson, D., Kocher, T., Levy, S., et al. (2022) · Journal of dentistry research · doi:10.1177/00220345221109775 · Cited by 8 · see citing works
“The ascertainment of caries experience is harmonized at the moderate caries lesion threshold (International Caries Detection and Assessment System, ICDAS ≥ 3 or D 2 ; Young et al. 2015), which is characterized by visible enable break-down or signs of dentin demineralization.”
Kaisarly, D., Elgezawi, M., Haridy, R., Elembaby, A., Aldegheishem, A., Alsheikh, R., & Almulhim, K. S. (2021) · Operative dentistry · doi:10.2341/19-290-c · Cited by 8
Gudsoorkar, P., Nolan, R., Kafle, S., & Dubey, A. (2024) · Frontiers in Oral Health · doi:10.3389/froh.2024.1435555 · Cited by 7 · see citing works
Cao, J., Fang, Y., Liao, Y., Wang, Y., Yang, R., Zhang, Y., Zhang, Q., & Zou, J. (2023) · E -journal of dentistry · doi:10.1016/j.jdent.2023.104658 · Cited by 7
The problem of primary infection in endo-periodontal lesions: a systematic review
Moiseev, D., Kopetsky, I., Nikolskaya, I., Ilyukhin, G. S., Gazarov, S. Y., Madatyan, G. K., Sevastyanova, V. V., & Kurbatina, A. B. (2023) · Endodontics Today · doi:10.36377/1683-2981-2023-21-2-115-123 · Cited by 7
Muñoz-Sandoval, C., Gambetta-Tessini, K., Botelho, J. N., & Giacaman, R. (2022) · Caries Research · doi:10.1159/000525193 · Cited by 7
“Two examiners were trained by an expert radiologist, with more than 20 years of experience as specialist in the area, who calibrated the examiners for lesion detection, using the classification coding system of the American Dental Association [Young et al., 2015].”
BackgroundMethodMoisture Tolerant Pit and Fissure Sealant: A Literature Review
Priscilla, S., Gs, P., Mohandoss, S., & Kavitha, M. (2022) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-2354 · Cited by 7
Almotawah, F. N., Pani, S. C., AlKharashi, T., Alkhalaf, S., Alkhathlan, M. R., AlSultan, F., & Almughirah, A. M. (2020) · International Journal of Dentistry · doi:10.1155/2020/8883189 · Cited by 6 · see citing works
Shashirekha, G., Jena, A., Mohanty, N., & Kamilla, S. (2020) · Journal of Conservative Dentistry · doi:10.4103/jcd.jcd_154_20 · Cited by 7
“according to the modified American Dental Association Caries Classification[9] as R0 (E0) – no radiolucent/”
MethodLaser Tooth Preparation for Pit and Fissure Sealing
Schwimmer, Y., Beyth, N., Ram, D., Mijiritsky, E., & Davidovich, E. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217813 · Cited by 7
ElSalhy, M., Ali, U., Lai, H., Flores‐Mir, C., & Amin, M. S. (2018) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12430 · Cited by 9 · see citing works
Dual convolutional neural network framework for segmenting dental caries in panoramic radiographs.
Lim, Y.-S., Chun, D., Kim, J., Lee, J.-Y., Ju, M., Park, J. H., & Jeon, H.-J. (2025) · The Journal of prosthetic dentistry (Print) · doi:10.1016/j.prosdent.2025.09.040 · Cited by 6 · see citing works
Dai, Y., Qian, Y., Qu, Y., Guan, W., Xie, J., Wang, D., Butler, C. A., Dashper, S. G., Carroll, I. M., Divaris, K., et al. (2025) · Briefings in Bioinformatics · doi:10.1093/bib/bbaf374 · Cited by 7 · see citing works
“…six time points, with a binary disease outcome indicating the presence of dental caries in early childhood (ECC, i.e. cavities in primary teeth) measured via a clinical examination at age 5 [8], defined as having an International Caries Detection and Assessment System (ICDAS) score 3 or above [36].”
AI-initiated second opinions: a framework for advanced caries treatment planning
Dascalu, T., Ramezanzade, S., Bakhshandeh, A., Bjørndal, L., & Ibragimov, B. (2024) · BMC Oral Health · doi:10.1186/s12903-024-04551-9 · Cited by 6 · see citing works
Risk Indicators for Noncavitated and Cavitated Carious Lesions in Preschool Children
Manchanda, S., Liu, P., Lee, G. H. M., Lo, E. C. M., & Yiu, C. K. Y. (2023) · International Dental Journal · doi:10.1016/j.identj.2023.03.010 · Cited by 4 · see citing works
Variants in taste genes on caries risk and caries activity status
Telatar, G. Y., Saydam, F., Güzel, A., & Telatar, B. C. (2020) · Medical Molecular Morphology · doi:10.1007/s00795-020-00263-5 · Cited by 6
Improvement of Pit-and-Fissure Sealant Bonding to Enamel with Subpressure Treatment
Zhang, C., Li, Y., Zhang, Z., Tian, Y., Ding, N., & Ma, Y. (2019) · BioMed Research International · doi:10.1155/2019/5070383 · Cited by 7 · see citing works
Evaluation of Ion Release from Four Dental Sealants
Chen, L., Zeng, S., Li, Y., & Du, M. (2018) · Current Medical Science · doi:10.1007/s11596-018-1910-5 · Cited by 4 · see citing works
- Authors
- Young, D. A., Nový, B. B., Zeller, G. G., Hale, R., Hart, T. C., Truelove, E. L., Ekstrand, K. R., Featherstone, J. D. B., Fontana, M., Ismail, A., Kuehne, J., Longbottom, C., Pitts, N., Sarrett, D. C., Wright, T., Mark, A. M., & Beltran-Aguilar, E.
- Affiliations
- University of the Pacific (US)
- Loma Linda University (US)
- University of Kentucky (US)
- United States Army (US)
- University of Illinois Chicago (US)
- University of Washington (US)
- Corresponding author
- Truelove, Edmond L.
- ORCID
- Venue
- The Journal of the American Dental Association
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 146
- Issue
- 2
- Pages
- 79-86
- ISSN
- 0002-8177 (ISSN-L)
- OpenAlex
- W2006219947
- Cited by
- 237
- References
- 0
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 27 · 2023: 32 · 2022: 31 · 2021: 28 · 2020: 23 · 2019: 13 · 2018: 12 · 2017: 8 · 2016: 8 · 2015: 3
- FWCI
- 13.97
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-06-01)
- Open access
- closed
- Locations
- The Journal of the American Dental Association (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
- Keywords
- dental caries, cavitated caries lesions, demineralization and remineralization, caries treatment, clinical standardization
- MeSH terms
- Dental Caries, Humans, Societies, Dental, Tooth
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