Factors Affecting the Detection and Treatment of Occlusal Caries Using the International Caries Detection and Assessment System

Objective: To assess the variability in diagnosis and treatment of occlusal caries among dental practitioners in Kuwait using the International Caries Detection and Assessment System (ICDAS) criteria. Methods: A representative random sample of 156 dentists were interviewed. After completing a survey that included information about their gender, age, years in practice, place of practice, place of dental education, and specialty, practitioners examined four separately mounted molars (I-IV) for probable occlusal caries according to the ICDAS-II visual criteria. They were then asked to answer a set of questions related to their diagnosis and treatment of each tooth. The teeth were then histologically sectioned, and two independent investigators evaluated the depth of the caries according to Hintze and Wenzel's histologic criteria. Results: According to the histologic examination, tooth I and III had caries into enamel, while tooth II and IV had caries into dentin. About 50% of the participants diagnosed teeth with enamel caries as sound. About 60% of the participants correctly diagnosed teeth with caries extending into dentin. A restorative treatment modality was recommended for enamel caries by approximately 50% of the participants and for dentin caries by more than 80% of the participants. Dentists with a specialty in restorative dentistry had a tendency to underdiagnose enamel caries, while general practitioners and other specialists tended to overtreat enamel caries. Conclusions: There was an evident variability in the diagnosis and treatment choices of occlusal caries among dentists working in Kuwait. Among the factors studied, the specialty of the participants was the only factor that had an effect on the participants' diagnosis and treatment of occlusal caries.