Cited by 237Dental Health and Care UtilizationOral microbiology and periodontitis researchDental materials and restorations

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The American Dental Association Caries Classification System for Clinical Practice

Young, Douglas A., Nový, Brian B., Zeller, Gregory G., Hale, Robert, Hart, Thomas C., Truelove, Edmond L., Ekstrand, Kim R., Featherstone, John D.B., Fontana, Margherita, Ismail, Amid, Kuehne, John, Longbottom, Chris, Pitts, Nigel, Sarrett, David C., Wright, Tim, Mark, Anita M., Beltran-Aguilar, Eugenio·2015·The Journal of the American Dental Association

DOI 10.1016/j.adaj.2014.11.018

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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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Mohapatra, S., Prabakar, J., Indiran, M., Kumar, R. P., & Sakthi, D. (2021) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-1859 · Cited by 14
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Altner, S., Ebel, M., Ritschl, V., Stamm, T., Hirsch, C., & Bekes, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052983 · Cited by 13
Secondary Sjögren syndrome
Young, D. A., Frostad-Thomas, A., Gold, J., & Wong, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.03.021 · Cited by 15
Self-citation
Evidence-based approaches and considerations for nonrestorative treatments within modern caries management
Fontana, M., González‐Cabezas, C., & Tenuta, L. M. A. (2024) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2024.09.007 · Cited by 20
Self-citation
Dental caries and risk of newly-onset systemic lupus erythematosus: a nationwide population-based cohort study
Perng, W., Sheng‐Kai, K., Hung, H.-Y., Tsai, Y.-C., Huang, J., Liao, P., Hung, Y., & Wei, J. C. (2022) · Current Medical Research and Opinion · doi:10.1080/03007995.2022.2159146 · Cited by 14
Analysis of Quality, Usefulness, Reliability, Visibility, and Popularity of Videos about Dental Caries on YouTube
Rachmawati, Y. L., Putri, D. W., Hariyani, N., Bahar, A., & Maharani, D. A. (2022) · Journal of International Society of Preventive and Community Dentistry · doi:10.4103/jispcd.jispcd_246_21 · Cited by 20
Children’s dental treatment requirements of first permanent molars with poor prognosis
Gürcan, A., & Bayram, M. (2021) · Clinical Oral Investigations · doi:10.1007/s00784-021-04059-4 · Cited by 12
Comparison of Fissure Sealant Chair Time and Patients’ Preference Using Three Different Isolation Techniques
Mattar, R. E., Sulimany, A. M., Binsaleh, S. S., & Al-Majed, I. (2021) · Children · doi:10.3390/children8060444 · Cited by 12
“Dental caries represent one of the most common chronic and multifactorial diseases affecting the human population [1].”
Background
Dental Hygienist-Led Chronic Disease Management System to Control Early Childhood Caries.
Ng, M., & Fida, Z. (2016) · Journal of Evidence-Based Dental Practice · doi:10.1016/j.jebdp.2016.01.015 · Cited by 12
Preventive management of carious lesions: from non-invasive to micro-invasive operative interventions
Tassery, H., Miletić, I., Turkun, L. S., Sauro, S., Gurgan, S., Banerjee, A., Basso, M., Khelafia, S., Terrer, E., Pilliol, V., et al. (2024) · British Dental Journal · doi:10.1038/s41415-024-7292-0 · Cited by 11
Evaluation of the quality of YouTube™ videos about pit and fissure sealant applications.
Erturk-Avunduk, A. T., & Delikan, E. (2022) · International Journal of Dental Hygiene · doi:10.1111/idh.12646 · Cited by 11
Stakeholder Assessment of Evidence-Based Guideline Dissemination and Implementation in a Dental Group Practice
Gruß, I., Pihlstrom, D. J., Kaplan, C. D., Yosuf, N., Fellows, J. L., Guerrero, E. G., & Polk, D. E. (2020) · JDR Clinical & Translational Research · doi:10.1177/2380084420903999 · Cited by 11
“Noncavitated lesions are characterized by a change in color, glossiness or surface structure as a result of demineralization before there is macroscopic breakdown in surface tooth structure” (Young et al. 2015).”
Background
CaViT: Early Stage Dental Caries Detection from Smartphone-image Using Vision Transformer
Hossain, M. S., Rahman, M. M., Syeed, M. M. M., Hannan, U. H., Uddin, M. F., & Mumu, S. B. (2023) · International Conference on Artificial Intelligence, Robotics and Control (AIRC) · doi:10.1109/airc57904.2023.10303012 · Cited by 14
“American Dental Association (ADA) classy cares as sound, initial, moderate or advanced [12].”
Background
Association of Vital Pulp Therapy Outcomes with Tooth Type, Arch Location, Treatment Type, and Number of Surfaces Destroyed in Deciduous Teeth: A Retrospective Study
Maqbool, M., Noorani, T., Samsudin, N., Nawi, M. A. A., Rossi-Fedele, G., Karobari, M., Messina, P., & Scardina, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18157970 · Cited by 10
“Furthermore, the depth of caries was analyzed radiographically to choose between an IPT or FSP, following the American Dental Association Caries Classification System [15], as illustrated in Figure 2.”
Method
Clinical validation of a novel bioluminescence imaging technology for aiding the assessment of carious lesion activity status
Pitts, N. B., Shanks, N., Longbottom, C., Willins, M., & Vernon, B. (2021) · Clinical and Experimental Dental Research · doi:10.1002/cre2.400 · Cited by 14
Self-citation
Knowledge, Attitudes, Behaviors of Women Related to Pregnancy, and Early Childhood Caries Prevention: A Cross-Sectional Pilot Study
Shimpi, N. A., Glurich, I., Maybury, C., Wang, M. Q., Hashimoto, K., Acharya, A., & Horowitz, A. M. (2021) · Journal of Primary Care & Community Health · doi:10.1177/21501327211013302 · Cited by 9
Apoptosis Activation in Human Carious Dentin. An Immunohistochemical Study
Loreto, C., Musumeci, G., Leonardi, R., Psaila, A., & Castorina, S. (2015) · European Journal of Histochemistry · doi:10.4081/ejh.2015.2513 · Cited by 10
Enhancing dental sealant performance: Effects of mesoporous bioactive glass and 10-MDP on adhesion and remineralization.
Yun, N., Kim, H.-J., Kwon, J., Kim, S.-Y., & Kim, D.-S. (2025) · E -journal of dentistry · doi:10.1016/j.jdent.2025.105869 · Cited by 9
Knowledge and attitude of dentists toward minimally invasive caries management in Almadinah Almunawwarah province, KSA
Algarni, A. A., Alwusaydi, R. M., Alenezi, R. S., Alharbi, N. A., & Alqadi, S. (2023) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2023.08.005 · Cited by 9
Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey
Elkady, D. M., & Khater, A. G. A. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03333-z · Cited by 11
Can composite packaging and selective enamel etching affect the clinical behavior of bulk-fill composite resin in posterior restorations? 24-month results of a randomized clinical trial
Barceleiro, M. D. O., Tardem, C., Albuquerque, E. G., Lopes, L. D. S., Marins, S., Poubel, L. A., Barcelos, R., Ñaupari-Villasante, R., Loguércio, A., & Calazans, F. (2023) · Journal of Applied Oral Science · doi:10.1590/1678-7757-2022-0323 · Cited by 9
Effect of Different Cavity Disinfectants on Adhesion to Dentin of Permanent Teeth
Coelho, A., Vilhena, L., Antunes, M., Amaro, I., Paula, A., Marto, C., Saraiva, J., Ferreira, M., Carrilho, E., & Ramalho, A. (2022) · Journal of Functional Biomaterials · doi:10.3390/jfb13040209 · Cited by 9
Visualization of Initial Bacterial Colonization on Dentin Using Fluorescence Activating headlight for Fluorescence Enhanced Theragnosis.
Steier, L., Sidhu, P., Qasim, S., Mahdi, S., & Daood, U. (2022) · Photodiagnosis and Photodynamic Therapy · doi:10.1016/j.pdpdt.2022.102732 · Cited by 9
Caries Risk Documentation And Prevention: eMeasures For Dental Electronic Health Records
Bangar, S., Neumann, A. C., White, J. M., Yansane, A., Johnson, T. R., Olson, G., Kumar, S. V., Kookal, K. K., Kim, A., Obadan-Udoh, E. M., et al. (2022) · Applied Clinical Informatics · doi:10.1055/s-0041-1740920 · Cited by 12
Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches
Imes, E. P., Ginnis, J., Shrestha, P., Simancas‐Pallares, M., & Divaris, K. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.751733 · Cited by 9
Temperature Dependence of Specific Heat of Human Enamel and Dentin: An Experimental Study
Soori, A., Kowsary, F., & Kasraei, S. (2021) · International Journal of Thermophysics · doi:10.1007/s10765-021-02885-y · Cited by 9
American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography
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
Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium
Divaris, K., Haworth, S. J., Shaffer, J. R., Anttonen, V., Beck, J. D., Furuichi, Y., Holtfreter, B., Jönsson, D., Kocher, T., Levy, S. M., et al. (2022) · Journal of Dental Research · doi:10.1177/00220345221109775 · Cited by 11
“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.”
Reliability of Class II Bulk-fill Composite Restorations With and Without Veneering: A Two-year Randomized Clinical Control Study.
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
Exploration of oral hygiene practices, oral health status, and related quality of life of individuals residing in the Rorya district of Tanzania, east Africa
Gudsoorkar, P., Nolan, R., Kafle, S., & Dubey, A. (2024) · Frontiers in Oral Health · doi:10.3389/froh.2024.1435555 · Cited by 7
Clinical Validation of Near-infrared Imaging for Early Detection of Proximal Caries in Primary Molars.
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
Detection of Cavitated Proximal Carious Lesions in Permanent Teeth: A Visual and Radiographic Assessment
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].”
BackgroundMethod
Moisture 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
Comparison of Survival Rates of Stainless-Steel Crowns Placed with and without Pulpotomy: A Two-Year Retrospective Study
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
Novel bioactive caries-detecting dye solution: Cytotoxicity, antimicrobial activity, scanning electron microscope, and stereomicroscopic analysis in diagnosis of dental caries
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/”
Method
Laser 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
Caries reporting in studies that used the International Caries Detection and Assessment System: A scoping review
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
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
Decoding longitudinal microbiome trajectories: an interpretable machine learning approach for biomarker discovery and prediction
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 12
“…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
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
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
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

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: Nový, Brian B.
Zeller, Gregory G.
Hale, Robert
Hart, Thomas C.
Ekstrand, Kim R.
Featherstone, John D.B.
Fontana, Margherita
Ismail, Amid
Pitts, Nigel
Wright, Tim
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)
DOI: 10.1016/j.adaj.2014.11.018
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Journal of the American Dental Association (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Dentistry › General Dentistry › Dental Health and Care Utilization
Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Health Sciences › Dentistry › General Dentistry › 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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The American Dental Association Caries Classification System for Clinical Practice

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