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Assessment of early childhood caries using ICDAS and Snyder caries activity test among preschool children: a cross-sectional study

  • Se-Yeon Kim1
  • Han-Na Kim2,*,

1Department of Dental Hygiene, Jinju Health College, 52655 Jinju, Republic of Korea

2Department of Dental Hygiene, College of Medical and Health Sciences, Cheongju University, 28503 Cheongju, Republic of Korea

DOI: 10.22514/jocpd.2023.091 Vol.47,Issue 6,November 2023 pp.163-170

Submitted: 14 April 2023 Accepted: 06 June 2023

Published: 03 November 2023

*Corresponding Author(s): Han-Na Kim E-mail:


The aim of the present study was to elucidate the correlation between the International Caries Detection and Assessment System (ICDAS) and the Snyder caries activity test (SCAT) for the assessment of early dental caries in preschool children. Dental health status of 153 children aged 3–5 years was evaluated by oral examination. The ICDAS stage (enamel opacity stage to cavitated dentine caries stage (stages 1–6)) was assigned based on the evaluation of each tooth surface by a trained dentist based on the number of decayed (d) and filled teeth (ft). In this study, scores of d3–6t (t, teeth), d3–6s (s, tooth surface), d3–6ft and d3–6fs were the cut-off points for enamel caries, set to ICDAS code 3 (d3). SCAT score was assigned based on the acid production level of lactic acid bacteria in plaque (scores: 1–4). Linear correlation analysis was used to determine the correlation between ICDAS and SCAT scores. The proportion of children for each of the dental caries status were as follows: d0, 46.4%; d1–2, 28.1%; d3–4, 9.8%; d5–6, 15.7%. Regarding SCAT scores, 30%, 30.1%, 26.8% and 12.4% children had no, mild, moderate and severe caries activity, respectively. The d3–6t, d3–6s, d3–6ft and d3–6fs indices increased with age and were 0.56, 0.82, 2.03 and 5.05, respectively. Children with a higher SCAT score had higher ICDAS scores (p < 0.05). Our findings suggest that a combination of ICDAS and SCAT scores is beneficial for diagnosing caries progression and highly active caries. Early childhood caries should be managed early to prevent the enamel opacity stage to progress to cavitation.


Dental caries; ICDAS; Snyder caries activity test; Child; Oral health; Prevention

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Se-Yeon Kim,Han-Na Kim. Assessment of early childhood caries using ICDAS and Snyder caries activity test among preschool children: a cross-sectional study. Journal of Clinical Pediatric Dentistry. 2023. 47(6);163-170.


[1] Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. British Dental Journal. 2021; 231: 749–753.

[2] Wen PYF, Chen MX, Zhong YJ, Dong QQ, Wong HM. Global burden and inequality of dental caries, 1990 to 2019. Journal of Dental Research. 2022; 101: 392–399.

[3] Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. Does early childhood caries increase caries development among school children and adolescents? A systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2022; 19: 13459.

[4] Qin X, Zi H, Zeng X. Changes in the global burden of untreated dental caries from 1990 to 2019: a systematic analysis for the global burden of disease study. Heliyon. 2022; 8: e10714.

[5] Hughes SL, Parkes RC, Drage N, Collard M. Early tooth loss in children: a warning sign of childhood hypophosphatasia. Dental Update. 2017; 44: 317–321.

[6] Zaror C, Matamala-Santander A, Ferrer M, Rivera-Mendoza F, Espinoza-Espinoza G, Martínez-Zapata MJ. Impact of early childhood caries on oral health-related quality of life: a systematic review and meta-analysis. International Journal of Dental Hygiene. 2022; 20: 120–135.

[7] Rustam R, Jurabek TD, Qobilovna BZ. The role of hygienic education in the system primary prevention of dental diseases. Eurasian Research Bulletin. 2023; 17: 45–49.

[8] Gurunathan D, Jayachandar D, Jeevanandan G. Prevalence of early loss of primary molars among children aged 5–10 years in Chennai: a cross-sectional study. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2019; 37: 115–119.

[9] Korea Ministry of Health and Welfare. National oral health survey in 2006. 2007. Available at: (Accessed: 01 March 2022).

[10] Korea Ministry of Health and Welfare. National oral health survey in 2010. 2010. Available at: (Accessed: 01 March 2022).

[11] Korea Ministry of Health and Welfare. National oral health survey in 2012. 2012. Available at: (Accessed: 01 March 2022).

[12] Korea Ministry of Health and Welfare. National oral health survey in 2015. 2015. Available at: (Accessed: 01 March 2022).

[13] Korean Statistical Information Service. The rate of primary dental caries among 5 years Korean child. 2018. Available at: (Accessed: 06 August 2022).

[14] Luczaj-Cepowicz E, Marczuk-Kolada G, Obidzinska M, Sidun J. Diagnostic validity of the use of ICDAS II and DIAGNOdent pen verified by micro-computed tomography for the detection of occlusal caries lesions—an in vitro evaluation. Lasers in Medical Science. 2019; 34: 1655–1663.

[15] Dhanavel C, Sai CK, Neelamurthy PS, Raja SV, Vigneshwari SK, Gokulapriyan K, et al. Evaluation of reliability and validity of occlusal caries detection by direct visual, indirect visual and fluorescence camera using ICDAS II (codes 0, 1, and 2): an in vivo study. International Journal of Clinical Pediatric Dentistry. 2023; 16: 74–78.

[16] Castelo Branco CMC, Cabral GMP, Castro AMGS, Ferreira ACFM, Bonacina CF, Lussi A, et al. Caries prevalence using ICDAS visual criteria and risk assessment in children and adolescents with cerebral palsy: a comparative study. Special Care in Dentistry. 2021; 41: 688–699.

[17] Achilleos E, Rahiotis C, Kavvadia K, Vougiouklakis G. In vivo validation of diagnodent and vista proof devices vs. ICDAS clinical criteria on incipient carious lesions in adults. Photodiagnosis and Photodynamic Therapy. 2021; 34: 102252.

[18] Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. The Lancet. 2019; 394: 249–260.

[19] Ribeiro AA, Paster BJ. Dental caries and their microbiomes in children: what do we do now? Journal of Oral Microbiology. 2023; 15: 2198433.

[20] Kim JY, Kim KR, Kim HN. The potential impact of salivary IL-1 on the diagnosis of periodontal disease: a pilot study. Healthcare. 2021; 9: 729.

[21] Buzalaf MAR, Ortiz ADC, Carvalho TS, Fideles SOM, Araújo TT, Moraes SM, et al. Saliva as a diagnostic tool for dental caries, periodontal disease and cancer: is there a need for more biomarkers? Expert Review of Molecular Diagnostics. 2020; 20: 543–555.

[22] Jamal Abbas M, Khairi Al-Hadithi H, Abdul-Kareem Mahmood M, Mueen Hussein H. Comparison of some salivary characteristics in Iraqi children with early childhood caries (ECC) and children without early childhood caries. Clinical, Cosmetic and Investigational Dentistry. 2020; 12: 541–550.

[23] Hauss Monteiro DD, Elias DC, Costa R, Carvalho M, Ferreira RC, Moreira AN, et al. Effect of salivary flow on bleached enamel roughness and mineral content: an in situ and in vitro study. Operative Dentistry. 2023; 48: 155–165.

[24] Alban A. An improved snyder test. Journal of Dental Research. 1970; 49: 641.

[25] Liu J, Hsu C, Chen L. Correlation between salivary mutans streptococci, lactobacilli and the severity of early childhood caries. Journal of Dental Sciences. 2019; 14: 389–394.

[26] Min H, Zhu S, Safi L, Alkourdi M, Nguyen BH, Upadhyay A, et al. Salivary diagnostics in pediatrics and the status of saliva-based biosensors. Biosensors. 2023; 13: 206.

[27] Kim S, Song Y, Kim S, Kim S, Na H, Lee S, et al. Identification of a biomarker panel for diagnosis of early childhood caries using salivary metabolic profile. Metabolites. 2023; 13: 356.

[28] Sánchez-Pérez L, Golubov J, Irigoyen-Camacho ME, Moctezuma PA, Acosta-Gio E. Clinical, salivary, and bacterial markers for caries risk assessment in schoolchildren: a 4-year follow-up. International Journal of Paediatric Dentistry. 2009; 19: 186–192.

[29] Galvão-Moreira LV, de Andrade CM, de Oliveira JFF, Bomfim MRQ, Figueiredo PMS, Branco-de-Almeida LS. Sex differences in salivary parameters of caries susceptibility in healthy individuals. Oral Health & Preventive Dentistry. 2018; 16: 71–77.

[30] Arrow P, Piggott S, Jamieson L, Brennan D, Tonmukayakul U, Kularatna S, et al. Dental enamel defects and dental caries of primary teeth among Indigenous children in Western Australia. Australian Dental Journal. 2023; 68: 35–41.

[31] Taqi M, Razak IA, Ab-Murat N. Comparing dental caries status using modified international caries detection and assessment system (ICDAS) and world health organization (WHO) indices among school children of Bhakkar, Pakistan. JPMA. The Journal of the Pakistan Medical Association. 2019; 69: 950–954.

[32] Laajala A, Pesonen P, Anttonen V, Laitala M. Association of enamel caries lesions with oral hygiene and DMFT among adults. Caries Research. 2019; 53: 475–481.

[33] Tomer AK, Mangat P, Raina AA, Ayub FB, Bhatt M, Ramachandran M, et al. Diagnostic aids to detect caries—a review. International Journal of Applied Dental Sciences. 2019; 5: 16–20.

[34] Kunte SS, Chaudhary S, Singh A, Chaudhary M. Evaluation and co-relation of the Oratest, colorimetric Snyder’s test and salivary streptococcus mutans count in children of age group of 6–8 years. Journal of International Society of Preventive and Community Dentistry. 2013; 3: 59–66.

[35] Featherstone JD. Dental caries: a dynamic disease process. Australian Dental Journal. 2008; 53: 286–291.

[36] Qudeimat MA, Alyahya A, Karched M, Behbehani J, Salako NO. Dental plaque microbiota profiles of children with caries-free and caries-active dentition. Journal of Dentistry. 2021; 104: 103539.

[37] Qudeimat MA, Altarakemah Y, Alomari Q, Alshawaf N, Honkala E. The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study. BMC Oral Health. 2019; 19: 41.

[38] Korea Ministry of Health and Welfare. National oral health survey in 2018. 2019. Available at: (01 March 2023).

[39] Park K, Kim D, Lee D, Kim J, Yang Y, Kim J. Evaluation of caries status among adolescents in jeonju city with who basic methods, international caries detection and assessment system II (ICDAS-II). Journal of the Korean Academy of Pedtatric Dentistry. 2016; 43: 382–390.

[40] Ali YA, Chandranee NJ, Wadher BJ, Khan A, Khan ZH. Relationship between caries status, colony forming units (CFU) of streptococcus mutans and Snyder caries activity test. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 1998; 16: 56–60.

[41] Diamanti I, Berdouses ED, Kavvadia K, Arapostathis KN, Reppa C, Sifakaki M, et al. Caries prevalence and caries experience (ICDAS II criteria) of 5-, 12- and 15-year-old Greek children in relation to socio-demographic risk indicators. Trends at the national level in a period of a decade. European Archives of Paediatric Dentistry. 2021; 22: 619–631.

[42] Li K, Wang J, Du N, Sun Y, Sun Q, Yin W, et al. Salivary microbiome and metabolome analysis of severe early childhood caries. BMC Oral Health. 2023; 23: 30.

[43] Hwang SY, Ahn SH, Park JH, Kim HJ, Chul SS. Caries activity and salivary pH after intaking several kinds of beverages. International Journal of Clinical Preventive Dentistry. 2008; 4: 61–70.

[44] Agrawal A, Saxena S, Baviskar B, Govilkar E S, Mishra S D, Nepale M. Effects of carbonated beverage and fruit juice on salivary pH among children in orphanage of Bareilly city: an in vivo study. International Journal of Basic & Clinical Pharmacology. 2023; 12: 216–221.

[45] Brown CJ, Smith G, Shaw L, Parry J, Smith AJ. The erosive potential of flavoured sparkling water drinks. International Journal of Paediatric Dentistry. 2007; 17: 86–91.

[46] Inchingolo AM, Malcangi G, Ferrante L, Del Vecchio G, Viapiano F, Mancini A, et al. Damage from carbonated soft drinks on enamel: a systematic review. Nutrients. 2023; 15: 1785.

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