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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“Studies have demonstrated the correlation between the ICDAS II scores for caries classification and histologic, microscopic, radiologic, and fluorescence alterations (2, 3).”
WHITE SPOT LESIONS: DIAGNOSIS AND TREATMENT METHODS
Haberal, M. (2024) · Kırıkkale Üniversitesi Tıp Fakültesi Dergisi · doi:10.24938/kutfd.1409260 · Cited by 1
Effect of Two Different Invasive Tooth Surface Preparation Techniques on Penetration, Marginal Adaptation, and Retention of Pit and Fissure Sealant (An In Vitro Study)
Elbaz, A. A. S., Barakat, I., Rahim, R. A. A., & Badreldin, H. (2023) · Al-Azhar Journal of Dental Science · doi:10.21608/ajdsm.2022.151234.1350 · Cited by 1
“The preventive properties of PFS can only be guaranteed if the restoration is retained in its entirety (5) .”
Background
Assessment of the Object Detection Ability of Interproximal Caries on Primary Teeth in Periapical Radiographs Using Deep Learning Algorithms
Jeon, H., Kim, S., & Choi, N. (2023) · THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY · doi:10.5933/jkapd.2023.50.3.263 · Cited by 3
Effect of Light-Curable Resin-Modified Glass Ionomer Varnish on Non-Cavitated Proximal Caries Lesions in Primary Molars: A Randomized Controlled Trial
Khan, J. A., Alamoudi, N., El-Ashiry, E. A., Felemban, O., & Bagher, S. (2023) · Children · doi:10.3390/children10071164 · Cited by 1
“The following radiographic grading system was utilized [15]: (0) No radiolucency; (E1) radiolucency within enamel outer half; (E2) radiolucency in enamel inner half; (D1) radiolucency in dentin outer third; (D2) radiolucency in dentin middle third; (D3) radiolucency in dentin inner third.”
Method
The effect of Turkish dental practitioners’ perceptions and experience of ICDAS II on caries treatment decisions
Bahadır, H. S., & Çelik, Ç. (2022) · Journal of Oral Health and Oral Epidemiology · doi:10.34172/johoe.2022.10 · Cited by 1
980 nm diode laser irritation on Streptococcus mutans growth inhibition: in vitro study
Gabaran, Z. M., Taram, S., Karimi, J., & Khashabi, E. (2022) · Lasers in Dental Science · doi:10.1007/s41547-021-00140-z · Cited by 1
Pengaruh Efektivitas Antibakteri Ekstrak Daun Kumis Kucing Terhadap Bakteri Streptococcus Mutans
Mulyanti, R., Putra, M. R., Tanjung, D. S., & Salsabila, S. (2021) · doi:10.35816/jiskh.v10i1.578 · Cited by 1
“Di Amerika Serikat, lebih dari 90% orang dewasa pernah mengalami karies gigi sebelum usia 30 tahun (Young et al., 2015).”
Background
Performance of methods for detecting occlusal caries lesions: ICDAS X radiological image
Simões, T. C., Marques, L. C., de Sá, A. T. G., Maciel, S. M., Poleti, M. L., Prado, F. S., González, A. H. M., Rubira‐Bullen, I. R. F., Bussadori, S. K., & Moura, S. K. (2020) · Research Society and Development · doi:10.33448/rsd-v9i10.8490 · Cited by 3
“The radiographic measure is an estimate of the continual mineral loss and does not detect certain stages of the lesion or it’s activity, except in situations in which it’s possible to compare sequential radiographic images of the same caries lesion for a period of time (Young et al., 2015).”
Background
Comparative study on stress analysis in human molar tooth between metallic and nonmetallic dental filling material
Soliheen, M. A. M., Kadir, A., Kurniawan, D., & Nor, F. M. (2019) · IOP Conference Series: Materials Science and Engineering · doi:10.1088/1757-899x/694/1/012047 · Cited by 1
Amalgam and Composite Use among Dental Students in Saudi Arabia
Al-Safadi, R., Al-Safadi, R., Al-Lowaim, N., Al-Alwi, F., Al-Yahya, D., Al-Shallaa, B., Al-Ghanim, G., Al-Ismail, D., & Al-Haddad, F. (2019) · INTERNATIONAL JOURNAL OF EMERGING TRENDS IN SCIENCE AND TECHNOLOGY · doi:10.18535/ijetst/v6i09.01 · Cited by 1
Alternative Caries Management Approaches in Children
(2018) · Journal of Oral Biology · doi:10.13188/2377-987x.1000043 · Cited by 1
“A non-cavitated caries lesion develops as an initial lesion as a change in surface gloss, color or structure via enamel demineralization before macroscopic breakdown and cavitation in the tooth surface [42].”
Background
Caries Arresting Approaches for Aging and Medically Complex Patients
Gillette, J. (2018) · Journal - California Dental Association · doi:10.1080/19424396.2018.12221989 · Cited by 1
Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis
de Almeida, H. C. R., Oliveira, G. H. P., Calado, R. V., Heimer, M. V., Romão, D. A., Pugliesi, D. M. C., & dos Santos, V. E. (2023) · Pesquisa Brasileira em Odontopediatria e Clínica Integrada · doi:10.1590/pboci.2023.062 · Cited by 2
“Caries have a complex etiology of a multifactorial nature and dependent biofilm – sucrose [5], considered a chronic-cumulative disease shaped by social and behavioral factors [6,7].”
Background
The Visual Presentation of Dental Caries
Cortés, A., Martignon, S., & Douglas, G. V. A. (2019) · Springer eBooks · doi:10.1007/978-3-030-16967-1_3 · Cited by 1
Multicentre Evaluation of AI-Assisted Caries Detection on Panoramic Radiographs Among Early-Career Dentists
Wu, Y.-J., Hou, X., Ding, P., Xu, Z.-N., Bai, H.-L., Liu, Y., Chen, L.-L., Xu, M., & Deng, X.-L. (2026) · International Dental Journal · doi:10.1016/j.identj.2026.109812
Diagnostic accuracy of deep learning for detection of incipient and advanced radiographic interproximal caries in mixed dentition periapical radiographs
Baraka, M., Elsayed, A., Issa, A., Elhaddad, M., & Torki, M. (2026) · Journal of Dentistry · doi:10.1016/j.jdent.2026.107071 · Cited by 1
CENet: A lightweight context-enhanced network for efficient and accurate medical image classification
Benabid, A., Cheng, K., Liu, Y.-F., & Elhassan, M. A. M. (2026) · Journal of King Saud University: Computer and Information Sciences · doi:10.1007/s44443-026-01027-4
“…of dental erosion (Imfeld 1996) and systematic assessments of oral health (Feliciano and Caldas 2006) to implant classiﬁcation frameworks (Al-Johany et al. 2017) and standardized systems for caries diagnosis (Young et al. 2015) have shown the importance of structured radiographic evaluation.”
Is there consensus for the treatment of initial to moderate caries lesions? - a Delphi first-round study
Tassery, H., Banerjee, A., Turkun, L. S., Miletić, I., Ceinos, R., Perić, T., Pilliol, V., Terrer, E., Tardivo, D., Sauro, S., et al. (2026) · BMC Oral Health · doi:10.1186/s12903-026-09441-w
Resin Infiltration in the Conservative Management of Incipient Dental Caries: An Evidence-Based Review
Santos, G., & Santos, M. J. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15166485
“Initial lesions are generally non-cavitated and may present as white or brown areas depending on mineral loss, surface characteristics, and extrinsic pigmentation [8,36].”
Clinical and radiographic outcomes of indirect pulp treatment and direct pulp capping using MTA in deeply carious primary second molars: a 12-month prospective study
Kaya, S., Satılmış, Ö. B., Cihan, A. I., & Öz, F. T. (2026) · BMC Oral Health · doi:10.1186/s12903-026-08821-6
“The study included systemically healthy children aged 7–9 years who were diagnosed with deep dentin caries in their primary second molars according to the International Caries Detection and Evaluation System (ICDAS codes 5 and 6) [13].”
Biocompatibility of Pit and Fissure Sealants: Scoping Review of In Vitro and In Vivo Evidence
Badrov, M., Dzaja, K., Badrov, B., Glavina, A., & Tadin, A. (2026) · Dental journal · doi:10.3390/dj14070425
Micro-XRF-Based Enamel Mineral Analysis for Early Caries Detection
Sakunwong, P., Kanyunthong, N., Tansavetwong, S., & Yookwan, W. (2026) · International Joint Conference on Computer Science and Software Engineering · doi:10.1109/jcsse68839.2026.11597077
“Furthermore, the use of mineral-distribution overlay maps increases the interpretability of the diagnostic outcomes, providing clinicians with more informative and reliable evidence for decision-making in preventive dentistry [5]..”
Comparative Evaluation Of Retention And Microleakage In Acid-Etch And Self-Etch Pit And Fissure Sealants In Primary Teeth Post Radiotherapy: An In-Vitro Study
Thirah, D., Debnath, S., Alam, S. P., Singh, A., Kedoneikho, & Singh, P. (2026) · Genetics and Molecular Research · doi:10.4238/1s8ed159
“Non-cavitated carious lesions are the earliest stages of caries lesion development, causing discoloration of teeth, loss of lusture, and changes in surface structure, due to demineralization before macroscopic breakdown takes place 9 .”
Clinical performance of a flowable bulk-fill composite compared with highly viscous glass ionomer cement in class II restorations of primary molars: A 1-year randomized clinical trial.
Fahmy, M. F., El-Geleel, O. M. A., Anwar, M., & Khattab, N. M. (2026) · The Journal of the American Dental Association (1939) · doi:10.1016/j.adaj.2026.03.026
Clinical Evaluation of an Organoselenium-Enhanced Sealant and a Moisture-tolerant Sealant: A 16-month Study
Balasubramanian, N., Naik, S. S., Kodical, S. R., Sharma, R., Choudhury, S., & Mali, S. S. (2026) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-3533
The effect of using silver diamine fluoride at two different times on the microshear bond strength of adhesives to sound and caries-affected dentin
Sadeghpour, K., Maleki-Pour, M., & Shirani, F. (2026) · Dental Research Journal · doi:10.4103/drj.drj_321_23
“According to the International Caries Detection and Assessment System, half of the teeth were caries‑free, [13] and the other half had occlusal caries, which involved about two‑thirds of the dentin in periapical radiography.”
Spatial Mineral Distribution Analysis of Tooth Enamel Using Micro-XRF and Dental Imaging for Early Caries
Sakunwong, P., Kanyunthong, N., Tansavetwong, S., & Yookwan, W. (2026) · International Conference on Electrical Engineering/Electronics, Computer, Telecommunications and Information Technology · doi:10.1109/ecti-con68836.2026.11609040
“Furthermore, the use of mineral-distribution overlay maps increases the interpretability of the diagnostic outcomes, providing clinicians with more informative and reliable evidence for decision-making in preventive dentistry [5]..”
Two-Year Evaluation of a CAMBRA-Based Caries Prevention Program in Preschool Children: Risk Reduction and Clinical Outcomes
Sardellitti, L., Floris, F. L., Bonardi, M., Landi, G., Marzio, A. D., Caviglia, M., Ciacciarelli, C., Deidda, E., Filigheddu, E., & Milia, E. P. (2026) · Oral · doi:10.3390/oral6010019 · Cited by 1
“These categories guide the implementation of tailored preventive and therapeutic plans, which may include oral hygiene counselling, dietary advice, fluoride therapy, antimicrobial rinses (such as chlorhexidine), sealants, and individualized recall schedules [11,12].”
Evaluation of Clinical Performance of Moisture-tolerant Sealant on Pit and Fissure Caries in Two Different Setting Conditions: A Randomized Controlled Trial
Dangi, S., Chhabra, K. G., S., N., Chaudhary, P., T, S., & Srivastava, H. (2026) · European Journal of Dentistry · doi:10.1055/s-0045-1814727
Restorative Treatments for Carious Lesions: An Executive Summary of the Clinical Practice Guideline
Fontana, M., & Weyant, R. (2025) · Journal - California Dental Association · doi:10.1080/19424396.2025.2588956
Self-citation
Crucial X-ray Examination in Dentistry: A Case of Hidden Carious Lesion in Tooth #20
Чорна, Л. (2025) · Cureus · doi:10.7759/cureus.96874
Assessment of posterior interproximal surfaces on bitewing and panoramic radiographs by dental interns and an artificial intelligence application
Köse, E., & Hoşgör, S. (2025) · Oral Radiology · doi:10.1007/s11282-025-00872-9 · Cited by 3
A CNN-Based Grading and Feedback System for Dental Cavity Preparation Using Top-View Images
Jayawardhane, P. L., Asanka, P., Mahanama, T. V., Rajapaksha, C., Fonseka, M., Wimalarathna, A., Rathnayake, R. M. S. C., Piyarathna, N. K. R., Rathnayake, R., & Jayawardena, C. (2025) · 2025 2nd International Conference on Innovations in Engineering, Science and Technology for Sustainable Development (ICEST) · doi:10.1109/icest65883.2025.11428734
“Dental education focuses primarily on teaching students to prepare cavities accurately because this technique influences restoration longevity along with patient treatment success [9].”
Application of Artificial Intelligence in Dental Caries Detection: Advances and Challenges
Montazerlotf, M., Hosseinishakib, M., Radfar, R., & Khayamzadeh, M. (2025) · journal of research in dental sciences · doi:10.61882/jrds.22.3.266
To Assess the Knowledge, Attribution, and Perception for Disinfection of Prosthesis Sent Back from the Lab among the Dental Practitioners in Lucknow: A Survey-based Study
Srivastava, S., Shekhar, A., Bhatia, L., Chaturvedi, A., Sikdar, C., & Saxena, S. (2025) · Dental Journal of Advance Studies · doi:10.5005/djas-11014-0077
Changes of proximal caries during orthodontic treatment using intraoral scans with near-infrared imaging.
Cho, B., Sreng, Y., Lee, J. H., Kim, K.-H., & Chung, C. (2025) · The Journal of the American Dental Association (1939) · doi:10.1016/j.adaj.2025.04.016
Safety and Feasibility of Dental Evaluation in Patients Undergoing Heart Valve Replacement Surgery: Retrospective Analysis
Sviličić, L., Topolnjak, K., Ivanišić, P., Mikić, I., Juras, D. V., Janković, B., Rajić, V., Vuletić, M., Granić, M., Gabrić, D., et al. (2025) · Oral · doi:10.3390/oral5020042
A Fuzzy System to Detect the Degree of Severity of Dental Caries
Sehgal, P., Bansal, R., & Singh, P. (2025) · Pattern Recognition and Image Analysis · doi:10.1134/s1054661824701463
The Correlation Between Odontogenic Infection and Total Spectrum of Dental Caries with Oral Health Related Quality of Life in Children with Intellectual Disabilities
Sabila, A., Riyanti, E., Indriyanti, R., Tjahajawati, S., Rikmasari, R., & Rakhmatia, Y. D. (2024) · Clinical Cosmetic and Investigational Dentistry · doi:10.2147/ccide.s486015
Oral health problems and treatment seeking behavior of children during COVID 19 pandemic as perceived by parents- A cross sectional study
Reshmi, J., & Ammal, P. B. (2024) · Journal of Orofacial & Health Sciences · doi:10.18231/j.johs.2024.013
Management of dental cavities and their treatment
Kadirova, Z. (2024) · Eurasian Journal of Medical and Natural Sciences · doi:10.70413/ejmns-v04-i06-s10412
Caries Lesions Treatment
Keeper, J. H. (2023) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2023.07.017

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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