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Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 21-24

Assessment of dental caries experience of an adult population using caries assessment spectrum and treatment index

Department of Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

Date of Web Publication30-Mar-2017

Correspondence Address:
Abhishek Mehta
Department of Public Health Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi - 110 025
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_65_16

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Background: Dental caries is a pandemic disease affecting whole of the mankind. Methods of recording caries in a population are plenty, but researchers are still searching for an ideal caries recording system. Caries assessment spectrum and treatment (CAST) index is one such attempt where investigators' records spectrum of caries effects in an individual based on different codes and criteria. Materials and Methods: A cross-sectional survey was conducted on 224 adults of different socioeconomic (SE) background and their caries experience was recorded using CAST index. Kuppuswamy's scale was used to record SE status of individuals. SPSS version 17 was used for data analysis. Results: Of the 224 adults, 34.8% were suffering from chronic pulpitis and 10% had at least one tooth with periapical abscess/fistula in their mouth. Overall prevalence of caries was 45.9% and caries experience (decayed, missing, filled [DMF]) was 2.09 in the study population. Majority of subjects belonged to middle SE class. Conclusion: From the results of the present study, it is clear that CAST index is a simple, useful, and much more comprehensive tool in recording caries experience in a population than conventional DMF index.

Keywords: Caries assessment spectrum and treatment index, dental caries, Kuppuswamy's socioeconomic scale

How to cite this article:
Mehta A. Assessment of dental caries experience of an adult population using caries assessment spectrum and treatment index. SRM J Res Dent Sci 2017;8:21-4

How to cite this URL:
Mehta A. Assessment of dental caries experience of an adult population using caries assessment spectrum and treatment index. SRM J Res Dent Sci [serial online] 2017 [cited 2023 May 28];8:21-4. Available from:

  Introduction Top

Dental caries is a complex disease affecting the teeth, which is mainly caused by imbalance between demineralization and remineralization process around the tooth surface. It is a major cause of tooth loss and pain worldwide. Caries incidence is witnessing a decline in developed countries due to proper availability of fluoride products, better oral health services, and awareness regarding etiology of caries. At the same time, incidence of caries is increasing in developing countries.[1] Research over the years has shown that caries is a preventable and controllable disease. To apply measures which can prevent or control caries, a reliable picture of it in a population is prerequisite; this can only be obtained if we have a reliable caries assessment system (index).

In the low- and middle-income countries such as India, where people have little access to oral health care, there is a need of diagnostic index that addresses the advanced stages of untreated caries lesions so that caries data collected should have impact on health decision-makers, which is not possible with decayed, missing, filled (DMF) index. There have been various attempts to modify or replace DMF index for caries assessment.[2],[3]

The Caries Assessment Spectrum and Treatment (CAST) index [4],[5] is one such attempt which is developed to increase the sensitivity of DMF index and to record consequences of a carious lesion. This index was developed because of the need to find a reliable, pragmatic cohesive, and easy to read reporting system which is based on the strengths of pulp-ulceration-fistula-abscess [6] and International Caries Detection and Assessment System-II [7] indices and provides a link to the widely used DMF index (M and F component). It covers the total dental caries spectrum from no carious lesion through caries protection (sealant) and caries cure (restoration) to carious lesions in enamel and dentine, and the advanced stages of caries lesion progression in pulpal and tooth surrounding tissue. It comprises assessing stages of primary and so-called secondary carious lesion progression in enamel, dentine, and the pulp as well as lost and restored teeth resulting from dental caries. Furthermore, CAST has been developed such that the severity of the consequences of the dental caries process increases with increase in codes. Different to common caries indices, a restored tooth is considered a sound, well-functioning tooth, and is therefore positioned at the beginning of the list of codes.[5]

The CAST index has undergone face, content, and construct validation tests and results are positive.[8],[9] Clinical reproducibility was evaluated in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2–6-year-old, 6–9-year-old children, and 19–30-year-old adults. Four trained and calibrated examiners performed the examinations. The reproducibility of the CAST instrument for use in the primary dentition of 2–6-year olds and of 6–9-year olds was “substantial” to “almost perfect.” The reproducibility for its use in the permanent dentition of 19–30-year olds was “almost perfect.”[10]

Most of the studies which were done using CAST index were conducted on children [11],[12],[13] except one [10] in that study also adults of age group of 19–30 years were included and it was mainly done to check clinical reproducibility of the index. Therefore, the current study was conducted with the aim to assess the dental caries experience of adults in the age group of 35–44 years in an urban Indian population using CAST index.

  Materials and Methods Top

The present study was conducted on adults of 35–44 years range visiting outpatient department (OPD) of Government Dental Hospital in New Delhi, India. A convenience sample of 224 adults was selected for the study. Permission to carry out this study was obtained from the Ethical Committee of the Jamia Millia Islamia University. Calibration of investigator was carried out on twenty patients before commencing main survey. Kappa statistics obtained for intraexaminer reproducibility was 0.82, suggesting excellent intraexaminer reproducibility. Instruments used for survey were mouth mirror and community periodontal index probe.

Socioeconomic status

It was recorded using Kuppuswamy's socioeconomic (SE) scale. This scale is commonly used for assessing SE status of Indian population. It records SE status based on education, occupation, and per capita monthly income of the person. The population is divided into five social classes, namely, upper, upper middle, lower middle, upper lower, and lower class.[14]

Statistical analysis

The collected data were analyzed using SPSS version 17 (IBM software company, USA). Mean and standard deviations were calculated to express the mean def/DMF. CAST index values were presented as frequency tables. Comparison between two genders was done using Chi-square test, and level of significance was set at P< 0.05.

  Results Top

This cross-sectional study was done on 224 adults in the age group of 35–44 years; out of them, 100 were males and rest 124 were females. SE-wise majority of the patients were from middle class as seen in [Table 1]. Analyses of codes of CAST index were done as suggested by Frencken et al. in 2013.[5] The first level of analyses is to find out the presence of CAST codes in at least one tooth in a participant. Only 5% (11) adults had sound dentition, 24.5% had at least one restoration, presence of caries in enamel and/or dentine ranged from 27% to 43%. Pulpal involvement was observed in 34.8% and abscess/fistula was present in 10% of participants in at least one tooth. Thirty-nine percent had lost at least one tooth due to caries [Table 2].
Table 1: Distribution of participants according to socioeconomic class

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Table 2: Frequency distribution of caries assessment spectrum and treatment codes (at least one tooth affected)

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On the basis of epidemiological concept of health and disease, the developers of CAST index described findings as healthy dentition is denoted by codes 0, 1, and 2, this was observed in our study in 10% (21) individuals. Nonhealthy dentition can be divided into:

  1. A reversible premorbidity stage (code 3) - this stage was the most severe condition in 8% (18) of the children
  2. Dentition with morbidity (codes 4 and 5) - this stage was the most severe condition in 22% (17 and 32) of the children and with serious morbidity (codes 6 and 7), this stage was the most severe condition in at least 21.5% (36 and 12) of the children; and lastly
  3. Dentition with mortality (code 8) - this stage was the most severe condition in at least 39.3% (88) of the children [Graph 1].

Overall prevalence of caries was 45.9% and caries experience (DMF) was 2.09 in this population. There was no significant difference between different genders and SE status for different codes of CAST index (Chi-square, P > 0.05).

  Discussion Top

Search for an ideal caries index is still in pursuit by many researchers worldwide. DMF index is considered as reference index and is adopted and modified by the WHO for its oral health survey manuals. From the public health viewpoint, major disadvantage of using DMF index is that it records only cavitated lesions and ignore incipient carious lesions. These lesions can be reversed by application of various preventive measures such as fluorides if detected at earlier stages. Hence, an index should be able to record these lesions to apply primary preventive measures in a population.[15] One such attempt is CAST index,[4] the major advantage of this index is that it records wide spectrum of lesions develops due to caries ranging from sound tooth to extraction of tooth due to caries.

The current study is an attempt to record caries experience of adults (35–44 years) in an urban Indian population using this index system. All the studies done using CAST index were on children and none on adult population. Therefore, it was not possible to compare the results of this study.

Treatment needs can also be derived from this index such as healthy dentition requires maintenance through twice-daily cleaning of teeth with a toothbrush and fluoride-containing toothpaste. In a premorbidity dentition situation, management relies on the same regime as for healthy dentition, and some teeth may require extra surface protection with a sealant and/or fluoride treatment. Dentition with morbidity requires intra-or extra-coronal restoration or an ultraconservative treatment. Dentition with serious morbidity requires extraction or pulpotomy and dentition with mortality may require a space maintainer. It goes without saying that children with diseased dentition need to maintain their teeth, using a toothbrush and fluoride-containing toothpaste. and that parents should consider their diet, i.e., codes 4–7.[5]

A major limitation of this study is that sample is not representative of adult population in the study area as it was obtained conveniently from OPD of a dental hospital. Therefore, further studies are required to check out reliability and validity of CAST index in adults on a larger and more representative sample.

  Conclusion Top

CAST index has been found useful in epidemiological surveys, especially in recording early carious lesion. Developers of CAST index should throw more light on treatment needs part of the index as well as how each code of this index can be utilized in controlling dental caries in a community. Furthermore, while recording the index, it was felt that the presence of root fragments should not be combined with involvement of pulp chamber only (code-6) as they are two separate conditions with different treatment protocol.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.  Back to cited text no. 1
Bratthall D. Introducing the Significant Caries Index together with a proposal for a new global oral health goal for 12-year-olds. Int Dent J 2000;50:378-84.  Back to cited text no. 2
Broadbent JM, Thomson WM. For debate: Problems with the DMF index pertinent to dental caries data analysis. Community Dent Oral Epidemiol 2005;33:400-9.  Back to cited text no. 3
Frencken JE, de Amorim RG, Faber J, Leal SC. The caries assessment spectrum and treatment (CAST) index: Rational and development. Int Dent J 2011;61:117-23.  Back to cited text no. 4
Frencken JE, de Souza AL, van der Sanden WJ, Bronkhorst EM, Leal SC. The caries assessment and treatment (CAST) instrument. Community Dent Oral Epidemiol 2013;41:e71-7.  Back to cited text no. 5
Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA – An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 2010;38:77-82.  Back to cited text no. 6
ICDAS Coordinating Committee (ICDAS CC). Rationale and Evidence for the International Caries Detection and Assessment System (ICDAS-II); 2005. Available from: [Last accessed on 2016 Aug 10].  Back to cited text no. 7
de Souza AL, van der Sanden WJ, Leal SC, Frencken JE. The caries assessment spectrum and treatment (CAST) index: Face and content validation. Int Dent J 2012;62:270-6.  Back to cited text no. 8
de Souza AL, Leal SC, Chaves SB, Bronkhorst EM, Frencken JE, Creugers NH. The caries assessment spectrum and treatment (CAST) instrument: Construct validation. Eur J Oral Sci 2014;122:149-53.  Back to cited text no. 9
de Souza AL, Bronkhorst EM, Creugers NH, Leal SC, Frencken JE. The caries assessment spectrum and treatment (CAST) instrument: Its reproducibility in clinical studies. Int Dent J 2014;64:187-94.  Back to cited text no. 10
Baginska J, Rodakowska E, Kierklo A. Status of occlusal surfaces of first permanent molars in 6-8-year-old children evaluated by the CAST and DMF indices. Eur J Paediatr Dent 2014;15:107-12.  Back to cited text no. 11
de Souza AL, Leal SC, Bronkhorst EM, Frencken JE. Assessing caries status according to the CAST instrument and WHO criterion in epidemiological studies. BMC Oral Health 2014;14:119.  Back to cited text no. 12
Baginska J, Rodakowska E, Wilczko M, Kierklo A. Caries assessment spectrum and treatment (CAST) index in the primary molars of 6- to 7-year-old polish children. Oral Health Prev Dent 2016;14:85-92.  Back to cited text no. 13
Kumar N, Gupta N, Kishore J. Kuppuswamy's socioeconomic scale: Updating income ranges for the year 2012. Indian J Public Health 2012;56:103-4.  Back to cited text no. 14
  [Full text]  
Mehta A. Comprehensive review of caries assessment systems developed over the last decade. RSBO South Braz Dent J 2012;9:316-21.  Back to cited text no. 15


  [Table 1], [Table 2]


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