ICCMS CARIES PREVENTION AND
TREATMENT
§ The International Caries Classification and
Management System is a health outcomes focused
system that aims to maintain health and preserve
tooth structure.
§ It uses a simple form of the ICDAS Caries
Classification model to stage caries severity and
assess lesion activity in order to derive an
appropriate, personalised, preventively based,
riskadjusted, tooth preserving Management Plan.
DETERMINE
1 Determine Patient Level Caries Risk
Patient-level Risk Factors
Head and Neck Radiation
Dry mouth (conditions, medications/recreational
drugs/self report)
Inadequate OH practices
Deficient exposure to topical fluoride
High frequency/amount of sugar consumed
Symptomatic drive attendance
Socioeconomic status/Health access barriers
Mother’s High DMF (caries experience)
Risk factor in red will always classify an individual
at high caries risk.
DETECT & ASSESS
2.1 Caries Staging & Activity Status
Sound
§ ICDAS 0 - No evidence of visible dental caries after
5 seconds of air drying.
Initial Caries
§ ICDAS 1 - White spot lesion
§ ICDAS 2 - Brown discoloration.
For stains
§ Generally confined to all of the pits and fissures
For discoloration/developing carious lesion
§ Confined to specific location.
Moderate Caries - Pertaining to having a defect in the
enamel without dentin involvement.
§ ICDAS 3 - Enamel breakdown
§ ICDAS 4 – Underlying dentin shadow
Extensive - Distinct cavity with visible dentin
§ ICDAS 5 – less than half a distance of surface is
involved
§ ICDAS 6 – more than half of the surface is involved
2.2 Assess Intra-Oral Risk Factors
Intra-Oral Risk Factors
Hyposalivation/Dry mouth – no self-cleansing of saliva
PUFA – Dental sepsis (open cavity that leads to pulp
exposure)
P-ulpal Involvement
U-lceration
F-istula
 A-bscess Management of individual lesions
Non-Operative Care Tooth-Preserving Operative
Caries experience – number of teeth with carious lesion Control Care
Thick plaque Fluoride varnish, gel, Tooth-preservative
>biofilm retention toothpaste (+ Oral restorations
Exposed root surfaces Hygiene)
Risk factor in red will always classify an individual at Sealing (resin-based, GI, Step wide excavation/Pulp
high caries risk. infiltrants) Preserving restorations
Mechanical biofilm Sealing
removal
Sealing/ hall
DECIDE Techniques/ART
3 Decide on a Personalized Care Plan
TOOTH AND SURFACE LEVEL
ICCMS Caries Diagnosis
ICCMS Sound
ICCMS Initial Active/Inactive
ICCMS Moderate Active/Inactive
ICCMS Extensive Active/Inactive

Management of Individual Active Lesions

PATIENT LEVEL
ICCMS Likelihood for Progression of New or Existing
Caries Lesion
Low Likelihood
Moderate Likelihood
High Likelihood
Prevention (Primary Prevention)
§ No treatment given
Management at the patient level § Provide oral health education or preventive measures
to patients
DO Non-surgical (Secondary Prevention)
4 Do Appropriate Prevention and Preservation § No drilling
intervention § Clean the surfaces and remove debris or plaque
§ Induce mineralization, interceptive or arrest dental
Management at the patient level caries by topical fluoride application and sealants
Homecare Clinical Surgical (Tertiary Prevention)
Interventions/Approaches § Minimal Surgical Interventions – for moderate
2-day toothbrushing Motivational engagement: carious lesion treatment
(>1,000 ppm F) improve oral hygiene and o Preventive Resin Restoration (PRR)
reduce free sugars § Traditional Surgical – for extensive carious lesion
Improve oral health Professional cleaning treatment
behavior o Restorative treatment by removing the
Fluoride mouthrinse Sealing carious lesion and extend beyond the carious
2-4/year Fluoride lesion. After removal of carious lesion, do
varnish/gel/solution etching, bonding, and composites.
Modifying hyposalivation o Cavity preparation by G.V Black for
Interval recalls: amalgam restoration.
1-3 months in HIGH o Direct pulp capping – minimal pulp
3-6 months in MODERATE exposure by placing medicaments such as
6-12 months on LOW calcium hydroxide, glass ionomer cement
(GIC), and composite.
o Indirect pulp capping – no pulp exposure yet
to preserve vitality of the pulp. Place
medicaments in the form of calcium
hydroxide, glass ionomer cement (GIC), and
composite. If you are planning to use IRM
as a base instead of GIC, place Intermediate
Restorative Material.
Calcium Hydroxide – induce secondary dentin formation
Glass Ionomer Cement – it has a fluoride or antibacterial
property
Intermediate Restorative Material – Sedative effect

§ Endodontic Treatment – pulp involvement and

exposure
o Pulpotomy – if the infection is still within
the confines of coronal pulp. Our treatment
only is to remove coronal pulp and preserve
the radicular pulp. After removing the
coronal pulp, place formocresol for 5
minutes then clean the pulp chamber. Place
IRM and corresponding filling material an
amalgam and stainless steel crown.
o Pulpectomy – radicular pulp is already
infected, aka root canal therapy.
§ Extraction – if the tooth is no longer salvageable.
Last resort

Management Elements
1. Preventing New Caries
2. Non-operative Care of Lesion (control)
3. Tooth Preserving Operative Care Lesson