04/08/2016

ICDAS II Description

The Caries Management System 1 After drying for 5 seconds, an opacity or discolouration
(white or brown) appears within a pit/fissure or on another
surface that is not consistent with the normal appearance
of sound enamel

Key Learning Area 5 2 When wet, an opacity (as for Code 1) is wider than the

The status of each lesion pit/fissure system or > 2mm diameter on another surface
and remains visible after air-drying for 5 seconds

3 As for Code 2 but after drying for 5 seconds discloses

enamel breakdown, confirmed when the ball end of the
CPI probe slides along the pit/fissure or surface and
Prepared by drops into an enamel cavity.
Wendell Evans
Associate Professor, Faculty of Dentistry 4 When wet or dry , a blue, grey, or brown shadow of
discolored dentin is visible through an apparently intact
enamel surface or marginal ridge which may or may not
show signs of enamel breakdown
The University of Sydney Source: International
Caries Detection and
Assessment System

5&6 Cavity into dentine - 1mm & > 2mm Coordinating

Committee
September 2005.
http://www.icdas.org

ICDAS II Criteria for Primary Caries Detection

Smooth surfaces - Pits and fissures - CARS1 - Root caries
Caries Management System - Step 3 Note: Teeth should be cleaned prior to coding

When wet, surfaces may have …

1. Clinical examination of the dentition Normal White or brown A shadow Cavitation3 Extensive4

using ICDAS II criteria for dental caries appearance spot lesions from dentine with exposed cavitation
plus/minus dentine
enamel loss2
Code 0 or 1 ?? Code 2 or 3 ?? Code 4 Code 5 Code 6

2. Bitewing radiographic survey but drying for 5 seconds reveals …

Nothing else Nothing else

Code 0 Code 2
White or Enamel loss2
Brown spots
Code 1 Code 3

1 Caries Associated with Restorations and Sealants

2 Confirmed if, on sliding the ball end of the WHO probe
across the suspected lesion, it drops into a hard-based enamel cavity. Source: International
Caries Detection and
3 For the smallest cavity coded 5, the ball end of the WHO would Assessment System
drop out of sight into a soft-based dentine cavity. Coordinating
4 No need for probe confirmation. Committee
September 2005.
Note: For root caries, codes 2, 3, and 4 do not apply. http://www.icdas.org

A summary of the ICDAS II coding system is shown 1 After drying for 5 seconds, an opacity or discolouration
in the next slide. (white or brown) appears within a pit/fissure or on another
surface that is not consistent with the normal appearance
The codes apply to: of sound enamel
☻ smooth surface caries
☻ pit and fissure caries
☻ caries associated with restorations and sealants -
CARS
☻ root caries

The following slides show details and some

examples.

© RW Evans
 04/08/2016

This opacity here is

not caries related

If this opacity was located within

the fissure, it would be scored 2.

© RW Evans

Why ?
Because it not associated with © RW Evans
a thick plaque cover.

This white patch is

This opacity here is located on a caries (the thick plaque
ridge. Since it does not extend into has been brushed off)
the fissure, it cannot be caries Code 2
related.

© RW Evans
© RW Evans

2 When wet, an opacity (as for Code 1) is wider than the

3 As for Code 2 but after drying for 5 seconds discloses
pit/fissure system or > 2mm diameter on another surface enamel breakdown, confirmed when the ball end of the
and remains visible after air-drying for 5 seconds
CPI probe slides along the pit/fissure or surface and
drops into an enamel cavity.

© RW Evans

© RW Evans
 04/08/2016

This brown spot is either

code 2 or 3. Enamel
breakdown (EBD) will
need to be confirmed
using the WHO probe
4 When wet or dry , a blue, grey, or brown shadow of
discolored dentin is visible through an apparently intact
enamel surface or marginal ridge which may or may not
show signs of enamel breakdown

© RW Evans

© RW Evans

When using the ball-ended WHO probe to 5&6 Cavity into dentine - 1mm & > 2mm
confirm the presence of enamel breakdown
(EBD):
© RW Evans © RW Evans
☻ use only the slightest pressure
☻ unless, when sliding the probe across the
site of the suspected lesion, it drops into
an enamel cavity (that is, greater than the
ball diameter of 0.5mm), EBD is not
confirmed and the lesion is coded 2
A suspected dentine
cavity here is confirmed
in the adjacent slide -
Code 5.

Marginal defects of restorations and CARS Code 6

☻ a non-CARS defect of less than 0.5mm (the

WHO probe will not drop into this defect) is
considered to be sound and the surface
should be coded F, that is, filled and sound.
☻ defects along restoration margins of greater
than 0.5mm pose a serious caries risk and
should be assigned Code 3
☻ if a marginal defect of greater than 0.5mm
© RW Evans
has, in addition, evidence of CARS, assign
Code R, that is, filled with recurrent decay
 04/08/2016

Recording the codes Electronic data entry

The ICDAS II codes corresponding to each tooth The next slide shows the panel for electronic data entry
surface are entered on a form (see next slide) which of the ICDAS II diagnostic codes. Each tooth surface
also provides for the treatment plan codes. is to be assigned a code. On a blank form, each
surface is set to the default code, 0 (= sound) where
The boxes are left blank in relation to sound surfaces.
the 0 codes are replaced codeCode
The tooth numbers identifying primary and permanent
The boxes beside each tooth identify the dentition
teeth should either be circled or crossed to indicate where Code 0 = permanent tooth and Code 1 =
which dentition the tooth belongs to. primary tooth. The boxes beside the molars have no
function at this stage.

Further instructions relating to missing and filled teeth

are shown on the electronic data entry form.

ICDAS II DIAGNOSIS Date

55 54 53 52 51 61 62 63 64 65
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27
28

Electronic data entry

18 0 17 0 16 0 15 0 14 0 13 0 12 0 11 0 21 0 22 0 23 0 24 0 25 0 26 0 27 0 28 0
ID 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ddmmyy DOB
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ddmmyy DOE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SEX
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 RISK
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 EXAM
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
85 84 83 82 81 71 72 73 Patient74
Risk Low
75 Risk At Risk At Risk-High 48 0 47 0 46 0 45 0 44 0 43 0 42 0 41 0 31 0 32 0 33 0 34 0 35 0 36 0 37 0 38 0

ORAL CARE PLAN - To be developed on the basis risk status and inputs from the ICDAS and Bitewing data Date
55 54 53 52 51 61 62 63 64 65 Enter ICDAS II codes on occlusal, buccal, and lingual surfaces.
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27
28
Enter bitewing codes on mesial and distal surfaces.
Enter DOB (date of birth) and DOE (date of examination) as ddmmyy.
Other surface codes: F = filled, R = filled with recurrent caries, S = sealed
Other tooth codes to be entered in the occlusal cell only: M = missing, C = crown,
48 47 46 45 44 43 42 41
38
31 32 33 34 35 36 37 D = denture, P = implant, X = excluded.
85 84 83 82 81 71 72 73 74 75
ICDAS II ORAL CARE CODE ICDAS II ORAL CARE CODE
Special codes: If ICDAS Code 4 applies to an occlusal pit or the mesial or distal
Primary 1-2 Fluoride varnish or GIC F or G Permanent 1-2 Fluoride varnish or GIC F or G
teeth ● Restore only if associated bitewing radiolucency extends deeper than C3 R teeth 3-4 ● Restore with UCSR* only if associated radiolucency extends deeper than C4 U marginal ridges in association with a radiolucency, enter as follows: ICDAS 4 + C2 = 42,
4-6
● Otherwise, seal or protect with GIC and review in 6 months (bitewings)
Restore
S or G
R 5-6
● Otherwise, seal or protect with GIC and review in 6 months (bitewings)
Restore
S or G
R
ICDAS 4 + C3 = 43, etc
Other treatment codes Crown C, Pulpotomy P, Endodontics E, Extraction X *Ultra-conservative sealed restoration
Other diagnostic codes Filled or crowned surface F, Sealed S, Missing (extracted or unerupted tooth) M
Source: Evans RW , Dennison PJ.
Australian Dental Journal, in press.

Bitewing radiographic survey

Electronic data entry
The next slide shows the panel for electronic data entry Criteria for Bitewing Radiolucency Scores
of the ICDAS II diagnostic codes. Each tooth surface C0 No radiolucency evident (not recorded)
is to be assigned a code. On a blank form, each
C1 Radiolucency is evident within the outer half of enamel
surface is set to the default code, 0 (= sound). The 0
C2 Radiolucency extends to the inner half of enamel and
codes are replaced as appropriate with more may reach the DEJ
relevant codes. C3 Radiolucency extends just beyond the DEJ

The boxes beside each tooth identify the dentition C4 Radiolucency is evident within the outer third of dentine
where Code 0 = permanent tooth and Code 1 = C5 Radiolucency extends to the inner two thirds of dentine
primary tooth. The boxes beside the molars have no and may reach the pulp

function at this stage.

These are illustrated on the next slide.
Source: Evans RW ,
Pakdaman A, Dennison PJ,
Howe ELC. Australian Dental
Journal 53: 83-92, 2008
 04/08/2016

Source: Evans RW ,
Pakdaman A, Dennison PJ,
Howe ELC. Australian Dental
Journal 53: 83-92, 2008

D O M
C1 Outer 1/2 of Enamel

C1 Outer 1/2 enamel

C2 Inner 1/2 of Enamel
C2 Inner 1/2 enamel
C3 Just into Dentine
C3 Just into dentine

C4 Outer 1/3 of Dentine C4 Outer 1/3 dentine

C5 Inner 2/3’s of Dentine C5 Inner 2/3 dentine

For each tooth, there is provision
to record lesions on non-restored
Source: Evans RW ,
Pakdaman A, Dennison PJ,
Example: tooth 16 D (distal), O (occlusal) and M
Howe ELC. Australian Dental
Journal 53: 83-92, 2008 (mesial) surfaces.

WSDR - 007

Source: Evans RW ,
Pakdaman A, Dennison PJ,
Bite-Wing Patient label here
Radiographic Bitewing findings on non- Howe ELC. Australian Dental
Journal 53: 83-92, 2008
Assessment restored surfaces are
Key to Rating Caries 18 17 16 15 14 13 23 24 25 26 27 28 D O M
Outer 1/2 of Enamel 1
DOM D OM DO M
55
DOM
54
DO M
53
DO M
63
MOD
64
M OD
65
MOD MOD MOD MOD
recorded on this chart.
1
Inner 1/2 of Enamel 2 2
3
4

Just into Dentine 3

5
There are three panels.
Outer 1/3 of Dentine 4
1
2
3
4
C1 Outer 1/2 enamel
Inner 2/3’s of Dentine 5
5
DOM DOM DO M DOM

85
DOM

84
DO M

83
MOD

73
M OD

74
MOD

75
MOD MOD MOD
This enables the tracking of
Date of radiograph: / /
48 47 46 45 44 43 33 34 35 36 37 38
lesions over time.
BITE-WING RADIOGRAPHIC ASSESSMENT

Read by: (Print name)..........................................................

Other findings:-
Date of reading: / /
Signature:..........................................................................
e.g. bone loss,
unerupted teeth,
resorption, cysts, etc. C2 Inner 1/2 enamel
Key to Rating Caries 18 17 16 15 14 13 23 24 25 26 27 28
Binding Margin - No W riting

Outer 1/2 of Enamel 1 55 54 53 63 64 65

DOM D OM DO M DOM DO M DO M MOD M OD MOD MOD MOD MOD
1
Inner 1/2 of Enamel 2 2

Just into dentine

3

Just into Dentine 3

4
5 C3
1
Outer 1/3 of Dentine 4 32
4
5
Inner 2/3’s of Dentine 5 DOM DOM DOM DOM DOM DOM M OD M OD M OD M OD MOD MOD

85 84 83 73 74 75
Date of radiograph: / /
48
Read by: (Print name)..........................................................
47 46

Other findings:-
45 44 43 33 34 35 36 37 38
C4 Outer 1/3 dentine
Date of reading: / / e.g. bone loss,
unerupted teeth,
Signature:......................................................................... resorption, cysts, etc.

Key to Rating Caries 18 17 16 15 14 13 23 24 25 26 27 28

Outer 1/2 of Enamel

Inner 1/2 of Enamel

1

2
1
2
3
DOM D OM DO M
55
DOM
54
DO M
53
DO M
63
MOD
64
M OD
65
MOD MOD MOD MOD C5 Inner 2/3 dentine
4
5
Just into Dentine 3
1
Outer 1/3 of Dentine 4 32

Inner 2/3’s of Dentine 5

4
5

DOM DOM DOM DOM DOM DOM M OD M OD M OD M OD MOD MOD

This entry indicates that tooth
Date of radiograph: / /
48
Read by: (Print name)..........................................................
47 46

Other findings:-
45
85 84
44
83
43
73
33
74
34
75
35 36 37 38 Source: Evans RW ,
Pakdaman A, Dennison PJ,
Example: tooth 16 16 has lesions on the Distal
Date of reading: / /
Signature:.........................................................................
e.g. bone loss,
unerupted teeth,
resorption, cysts, etc.
Howe ELC. Australian Dental and Mesial surfaces.
Journal 53: 83-92, 2008
5/03

Bite-wing
Bite-Wing Patient label here
Radiographic Lesions that:
Caries Report
Assessment
Key to Rati ng Caries 18 17 16 15 14 13 23 24 25 26 27 28 ● progress
1 55 54 53 63 64 65
Out er 1/2 of E na mel

Inn er 1/2 of E na mel

2
1
2
DO M DO M DO M DO M DO M DO M MO D MOD M OD MOD M OD M OD ● remain static, or
3

Key to Rating Caries 18 17 16 15 14 13 23 24 25 26 27 28 Just i nto De ntin e

3
4
5
● regress
55 54 53 63 64 65 Out er 1/3 of Den tin e
4 1
2
3

Outer 1/2 of Enamel 1 D O M D O M D O M D O M D O M D O M M O D M O D M O D M O D M O D M O D Inn er 2/3’s of De ntin e

5
4
5
DO M DOM DOM DOM DOM DO M MO D M OD M OD M OD M OD M OD
1
2 Date of rad io g raph : / / 85 84 83 73 74 75 and the occurrence of new
Inner 1/2 of Enamel 2 3 48 47 46 45 44 43 33 34 35 36 37 38
4
5
Read b y: (Print name)... .... .... .... .... .... .... .... .... .... .... .... .... .... ...
Co mments:- lesions
BITE-W ING CARIES REPORT

Date of read in g: / /
Just into Dentine 3 Sign atu re:....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... ...
Binding Margin - No Writing

1 Key to Rati ng Caries 18 17 16 15 14 13 23 24 25 26 27 28 tell us something about

Outer 1/3 of Dentine 4 2
Out er 1/2 of E na mel 1 55 54 53 63 64 65
3
4
Inn er 1/2 of E na mel 2
1
2
3
DO M DO M DO M DO M DO M DO M MO D MOD M OD MOD M OD M OD
caries activity and the risk
5
Inner 2/3 of Dentine
4

5 D O M D O M D O M D O M D O M D O M M O D M O D M O D M O D M O D M O D Just i nto De ntin e 3 5

status of patients.
85 84 83 73 74 75 Out er 1/3 of Den tin e 4
1
2
3

Date of radiograph: / / 48 47 46 45 44 43 33 34 35 36 37 38
4

Inn er 2/3’s of De ntin e 5

5
DO M DO M DO M DO M DO M DO M MO D MOD MOD M OD MO D M OD
Lesion behaviour is readily
Read by: (Print name) ………………….………….. Other findings: Date of rad io g raph : / / 85 84 83 73 74 75

Date of reading: / / Eg: Bone loss Read b y: (Print name)... .... .... .... .... .... .... .... .... .... .... .... .... .... ...
48 47 46
Co mments:-
45 44 43 33 34 35 36 37 38
tracked over time on this
Unerupted teeth Date of read in g: / /
Resorbtion, Cysts, etc Sign atu re:....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .. chart.
Signature: …………………………………………...
Key to Rati ng Caries 18 17 16 15 14 13 23 24 25 26 27 28

Out er 1/2 of E na mel 1 55 54 53 63 64 65

This is one panel. There is provision for charting the findings on posterior Inn er 1/2 of E na mel 2
1
2
3
DO M DO M DO M DO M DO M DO M MO D MOD M OD MOD M OD M OD

teeth included on the right and left bitewings. Just i nto De ntin e 3 5

Out er 1/3 of Den tin e

4 1
2
3
4

Inn er 2/3’s of De ntin e

5 5

DO M DOM DOM DOM DOM DO M MO D M OD M OD M OD M OD M OD

Source: Evans RW , Date of rad io g raph : / / 85 84 83 73 74 75 Source: Evans RW ,

Pakdaman A, Dennison PJ, 48 47 46 45 44 43 33 34 35 36 37 38 Pakdaman A, Dennison PJ,
Read b y: (Print name)... .... .... .... .... .... .... .... .... .... .... .... .... .... ...
Howe ELC. Australian Dental Co mments:- Howe ELC. Australian Dental
Journal 53: 83-92, 2008 Date of read in g: / / Journal 53: 83-92, 2008
Sign atu re:....... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... ..
 04/08/2016

The data recorded on the Bitewing Radiographic On first encounter with a patient,
Assessment Form is for caries monitoring purposes.
caries risk is determined solely on the basis of the
In addition, however, there needs to be a record of other presenting clinical situation
findings, such as sound restorations, or recurrent caries
which are diagnosed radiographically, or other and not from an analysis of a history of exposure to a list
information that has treatment planning implications. of epidemiologic explanatory variables.

Completion of the following form will put all bitewing Such an analysis enables the prediction of the caries
information that is relevant for treatment planning (at experience of the population,
Step 5) in one convenient place.
but not of a single individual member.

At a recall visit, caries risk is determined on the basis of

Bitewing scores caries activity since the baseline examination.
55 54 53 63 64 65 Code Condition
18 17 16 15 14 13 23 24 25 26 27 28 X Extracted/unerupted
Distal Mesial 9 Not in field of view The caries risk assessment criteria for:
Occlusal Occlusal 8 Overlap
Mesial Distal 7 Unreadable ● too dark
1. Children - primary dentition only
0 C0 ● blurred
2. Children and adolescents - mixed and permanent
Bitewing ID Bitewing ID 1 C1 ● artifact
dentitions
85 84 83 73 74 75 2 C2 ● other 3. Adults
48 47 46 45 44 43 33 34 35 36 37 38 3 C3

Distal Mesial 4 C4 are set out in the following tables.

Occlusal Occlusal 5 C5
Mesial Distal

Other codes: Crown C, Filled & sound F, Filled & recurrent decay R, Filled/crowned & over/under-hang H

Caries Management System - Step 4

Criteria for Caries Risk - Primary Dentition

Diagnosis and Caries Risk Assessment Caries risk

category
New patient Recall patient

Low ● dmfs = 0 ● < 1 new lesion per year*

● ICDAS II score = 0 ● and no progression of existing lesions
● no radiolucencies
● no sites with Plaque Index = 3

At risk ● dmfs > 0 ● 1 new lesion per year*

● demineralised enamel - ICDAS II score =1
or greater
● C1 or greater radiolucencies
● any site with Plaque Index = 3 in cases
where dmfs = 0
● and/or progression of existing lesions
● any site with Plaque Index = 3 in cases
where dmfs = 0

At risk - High ● Not assigned to new patient ● > 1 new lesion per year*

* ... on approximal surfaces as diagnosed by bitewing scores C1 or greater

or on other surfaces diagnosed as ICDAS score 1 or greater.

Source: Evans RW , Dennison PJ.

Australian Dental Journal, in press.
 04/08/2016

Criteria for Caries Risk - Mixed and/or Permanent Dentition

Children and Adolescents aged 6 to 17 years
Bitewing scores
Caries risk New patient Recall patient 55 54 53 63 64 65 Code Condition
category 18 17 16 15 14 13 23 24 25 26 27 28 X Extracted/unerupted

Low ● dmfs + DMFS = 0 ● < 1 new lesion per year* Distal Mesial 9 Not in field of view
● ICDAS II score = 0 ● and no progression of existing lesions Occlusal Occlusal 8 Overlap
● no radiolucencies
● no sites with Plaque Index = 3 Mesial Distal 7 Unreadable ● too dark
● no hypomineralised or hypoplastic 6s or 7s 0 C0 ● blurred
Bitewing ID Bitewing ID 1 C1 ● artifact
At risk ● dmfs > 0 ● 1 new lesion per year*
● demineralised enamel - ICDAS II score > 0 ● and/or progression of existing lesions 85 84 83 73 74 75 2 C2 ● other
or greater 48 47 46 45 44 43 33 34 35 36 37 38 3 C3
● C1 or greater radiolucencies Distal Mesial 4 C4
● any site with Plaque Index = 3 in cases ● any site with Plaque Index = 3 in cases
where dmfs + DMFS = 0 where dmfs + DMFS = 0 Occlusal Occlusal 5 C5
● dmfs + DMFT = 0 but 6s or 7s are ● dmfs + DMFT = 0 but 6s or 7s are Mesial Distal
hypomineralised or hypoplastic hypomineralised or hypoplastic
Other codes: Crown C, Filled & sound F, Filled & recurrent decay R, Filled/crowned & over/under-hang H
At risk - High ● not assigned to new patient ● > 1 new lesion per year*

* ... on approximal surfaces as diagnosed by bitewing scores C1 or greater

or on other surfaces diagnosed as ICDAS score 1 or greater.
Source: Evans RW , Dennison PJ.
Australian Dental Journal, in press.

Criteria for Caries Risk Status - Adults

Caries Risk New patient Recall patient

1 No clinical signs of caries 1 < 1 new lesion per year

Low 2 May have bitewing radiolucencies 2 or no progression of
not greater than C3 existing lesions

1 No frank cavitation
Medium 2 May have sticky pits or fissures 1 1 new lesion per year
3 And/or bitewing radiolucencies 2 and or progression of
not greater than C4 existing lesions

1 Untreated frank cavities

High 2 And/or extensive white spot lesions > 1 new lesion per year
3 And/or C5 bitewing radiolucencies

Source: Evans RW ,
Pakdaman A, Dennison PJ,
Howe ELC. Australian Dental
Journal 53: 83-92, 2008
 04/08/2016

ores
w5 in5g4 63 64 65 Code Condition
sc
5 53ores
14 1 553 54 53 23 24 6325 64 2665 27 28 XCodEextraC
cto
endd
/uintieorn
upte Ethics
17 16 15 14 13 23 24 25 26 27 28 d X Extracted/unerupted
Mesial 9 Not in field of view You will be working together in groups of 3.
Mesial 9 Not in field of view
Occlusal 8 Overlap The examination of each others bitewings does not usually
Occlusal 8 Overlap raise sensitive questions about confidentiality.
Distal 7 Unreadable ● too dark
Distal 7 Unreadable ● too dark
0
We must respect the feelings of others.
C0 ● blurred
0 C0 ● blurred
tewing ID Bitewing ID 1 C11 C1 ● ar●tifarctitfac
If you wish to discuss a situation confidentially with a staff
Bitewing ID Bitewing ID member, this may be arranged.
5 84 73 74 7375 74 75 2 C22 ●t
85 84 83 C33 C2 The diagnostic information you become aware of is not to be
457 4446 45 44 43 33 34 3335 34 3635 3736 3837 38 3 C3 ot●
heorther
C44 disclosed to members of other groups without the express
Mesial Mesial 4 C4
permission of the “patient”.
C55
Occlusal Occlusal 5 C5
It is possible that an interesting diagnosis may be discovered
Distal Distal and that a staff member might feel that the image should be
CFriollwen&C,soFuinlledd F&,soFuinlldedF&, rFeiclleudrre&nrtedcuercreanyt dRe,caFy seen by other students. In this case, it can be arranged to do
so in such a manner that confidentiality is maintained.
d ilRle,d/cFrilolewdn/cerdow&neodve&r/ouvnedr/eurn-hdearn-hganHg H

ores
w5 in5g4 63 64 65 Code Condition
sc
5 53ores
14 1 553 54 53 23 24 6325 64 2665 27 28 XCodEextraC
cto
endd
/uintieorn
upte
17 16 15 14 13 23 24 25 26 27 28 d X Extracted/unerupted
9 Not in field of view
REMEMBER
Mesial
Mesial 9 Not in field of view
Occlusal 8 Overlap
Occlusal 8 Overlap Bitewing images reveal radiolucencies, not cavities.
Distal 7 Unreadable ● too dark
Distal 7 Unreadable ● too dark
Whether of not a radiolucency corresponds with a clinical
0 C0 ● blurred
0 C0 ● blurred cavity is confirmed separately - either by (1) direct clinical
tewing ID 1 C11 C1 ● ar●tifarctitfac inspection or (2) on the balance of probabilities as
Bitewing ID Bitewing ID wing ID
Bite 2 C22 ●t determined against the best epidemiological evidence
5 84 83
85 84 83 73 74 7375 74 75 C33 C2 available.
83 C3 ot●
heorther
5
47 44
46 43
45 44 43 33 34 3335 34 3635 3736 3837 C44
3 4 C4
C55
Mesial Occlusal
Occlusal Mesial 5 C5

Distal Distal

CFriollwen&C,soFuinlledd F&,soFuinlldedF&, rFeiclleudrre&nrtedcuercreanyt dRe,caFy

d ilRle,d/cFrilolewdn/cerdow&neodve&r/ouvnedr/eurn-hdearn-hganHg H

Evaluation of bitewing images

☻ Not all bitewing images are perfect.
☻ What defines satisfactory ?
☻ What criteria would indicate the need for a
retake ?
☻ Quality - over or under exposed ?
☻ Is it of diagnostic quality ?
☻ Are teeth over-lapped ?
☻ If so, does the over-lap, or other problems
compromise diagnostic reliability ? Meaning are
you sure that if you would assign the same
diagnosis if you were to read the film on another
occasion ? If not, a retake is required.