Diagnostic Efficacy in Dental Caries Assessment: Insights from a CAST-WHO Comparative Study in Dibrugarh, Assam

Diagnostic Efficacy in Dental Caries Assessment: Insights from a CAST-WHO Comparative Study in Dibrugarh, Assam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Efficacy in Dental Caries Assessment: Insights from a CAST-WHO Comparative Study in Dibrugarh, Assam Maruf Hussain Barbhuiya, Indrani Barman, Alpana Talukdar, Rishba Singh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5652170/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To examine the comparability of the CAST index with the established WHO criteria across diverse populations and age groups. Methods and Material: In the Dibrugarh district of Assam, India, 728 schoolchildren between the ages of 5, 12 and 15 participated in a cross-sectional survey. Examiners received calibration and training in order to apply the CAST index. The CAST index was used for the first examinations, and after a set amount of time, the WHO 2013 criteria were used for the second examination. For every exam, the amount of time required was noted. The Wilcoxon signed-rank test evaluated the mean investigation time for the CAST index & WHO standards, while the Mc Nemar test compared caries experiences. Results The caries experience of children aged 5, 12 and 15 using the CAST index (52%, 48%, 54.6%) and the WHO criteria (42.3%, 40.0%, 26.7%), statistically significant differences were found (p < 0.05). In comparison to the WHO standards (60.56 ± 16.48 seconds and 59.27 ± 8.22 seconds) for primary and permanent dentition, the average examination duration for the CAST index (94.12 ± 23.68 seconds and 107.13 ± 8.39 seconds) was longer (p < 0.05). Conclusions Despite the CAST index requiring an extended investigation time, it provided more precise information, aiding researchers in treatment development that encompasses prevention of early lesions, restoration & rehabilitation. Clinical Relevance: The CAST index facilitates early diagnosis and targeted treatment planning, enabling preventive interventions for early lesions and appropriate restorative care, thus improving oral health outcomes in children. CAST index WHO criteria dental caries children Dibrugarh Figures Figure 1 Figure 2 Introduction Caries, a dynamic disease, evolves across enamel and dentine, amenable to control through various measures such as dietary restrictions, fluoride applications, and timely restorations. It remains a prevalent chronic disease, significantly impacting global oral health. Over time, various indices have been developed to assess caries experience in field studies, each attempting to capture the multifaceted nature of this condition. With acknowledged limitations, the widely used Decayed, Missing, and Filled Teeth (DMFT) index has been a cornerstone in assessing the status of caries in individuals and groups, as recommended by the World Health Organization. [ 1 ] Criticism of the DMFT index has centered around its failure to discern between enamel & dentine carious lesions, hampering targeted treatment planning. [ 2 ] Additionally, its equal weighting of missing, untreated decay, and restored teeth often masks variations in individuals' dental health status. [ 3 ] While efforts to address these shortcomings led to the development of alternative indices like ICDAS, PUFA, and FS-T, none have fully supplanted the DMFT index due to their own set of limitations. [ 4 ] Recognizing the dynamic nature of dental caries and the need for early identification of non-cavitated lesions, the Caries Assessment Spectrum and Treatment (CAST) index emerged in 2011. [ 5 ] This hierarchical instrument presents a comprehensive spectrum of carious conditions, encompassing lesions from enamel to dentine, and progression to pulp involvement and tissue- related complications, offering a more nuanced evaluation than its predecessors. [ 6 ] Extensive validation studies have demonstrated its heightened sensitivity, specificity, and reliability in epidemiological surveys. [ 7 – 9 ] Despite the advancements, the comparability of CAST with WHO criteria across diverse populations and age groups remains underexplored. [ 10 ] Limited studies have contrasted these indices based on mean dmf/DMF scores and caries prevalence, warranting deeper investigation, particularly in WHO-recommended age groups of 5, 12 and 15 years. [ 1 ] This study aims to fill the gap by comprehensively comparing the CAST index with WHO criteria among 5, 12 and 15-year-old school children. By examining caries experiences and assessment times, this research seeks to shed light on the efficacy of CAST in capturing the diverse spectrum of carious conditions, thereby informing more precise interventions and policy decisions for improved oral health outcomes. Materials and Methods A cross-sectional study was led in Dibrugarh district, Assam, India, to compare dental caries experiences in school children aged 5, 12 and 15 years using the CAST index & WHO criteria. Ethics Review Board of Regional Dental College, Guwahati granted ethical clearance. The study followed STROBE guidelines and received permission from school authorities. Prevalence data from published literature guided the sample size determination. Sampling and Schools Selection: According to the published data, the prevalence of dental caries in 5-year-old, 12-year-old and 15-year-old children in Dibrugarh district was reported to be 65.3%. As a result, it was determined that the minimal sample size for children aged five & twelve; n = 242 and fifteen; n = 244; i.e.728. Information on government and private schools in Dibrugarh district was obtained from the Department of Secondary Education, Government of Assam website. [ 11 ] A total of 130 Government/ Provincialized schools were shortlisted with 5 or 15-year-old children out of 143 total schools, excluding those with less than 35 such students. Using a lottery method, ten schools were selected for the study. Exclusion criteria 1. Fewer than 35 students in a class of selected age group. 2. Children who are going through orthodontic treatment and those in the mixed dentition phase were not included. Examiner Training and Calibration The principal investigator who is Assistant professor in the Department of Public Health Dentistry trained the 2 examiners, covering theoretical aspects of the CAST index & WHO criteria 2013 along with a hands-on session which involved examining extracted teeth & scoring them. Participant scores were compared, and in instances of disparity, examiners & the principal investigator engaged in discussions until a consensus was reached. Calibration exercises on twenty subjects, mirroring the study's age groups, assessed inter & intra- examiner agreement using Kappa statistics. [ 5 ] Both examiners achieved substantial to almost perfect agreement for both indices. Dental Examination Two skilled & calibrated examiners conducted the examinations in well-illuminated classrooms. Examinations were performed under natural light, occasionally aided by torchlight after obtaining informed consent from parents. There were two stages of the investigation. The CAST index mentioned in Table 1 [ 6 ] was used initially, with tooth surfaces not air-dried as per recommendations. [ 4 ] Another examination using WHO criteria was investigated 2–7 days later. Cotton rolls and CPI probes aided plaque removal, and excess saliva was managed with cotton rolls or gauzes as air drying was not recommended. [ 4 , 6 ] Trained assistants recorded proforma and indices. The period of each inspection was monitored, and fatigue was managed by restricting examinations to 25 children each day, with re-examinations after every seventh child. Statistical Analysis: The data analysis software utilized was SPSS version 20. For non-normally distributed data, descriptive statistics (mean, standard deviation, percentages) were used. Frequency and percentage distributions were shown for the CAST index codes and WHO scores at the tooth and surface levels. The codes utilized to calculate the caries experience using the WHO criteria and the CAST index are shown in Table 2 . The Wilcoxon signed-rank test evaluated the mean investigation time for the CAST index & WHO standards, while the Mc Nemar test compared caries experiences. A significant threshold of p < 0.05 was established. Results Table 1 Description of CAST codes. Characteristics Code Description Sound 0 No visible evidence of a distinct carious lesion is present Sealant 1 Pits and /or Fissures are at least partially covered with a sealant material Restoration 2 A cavity is restored with an (in)direct restorative material Enamel 3 Distinct visual change in enamel only. A clear caries related discoloration is visible, with or without localized enamel breakdown. Dentine 4 Internal caries related discoloration in dentine. The discolored dentine is visible through enamel, which may or may not exhibit a visible localized breakdown of enamel. 5 Distinct cavitation into dentine. The pulp chamber is intact. Pulp 6 Involvement of the pulp chamber. Distinct cavitation reaching the pulp chamber or only root fragments are present. Abscess/ fistula 7 A pus containing swelling or a pus releasing sinus tract related to a tooth with pulpal involvement. Lost 8 The tooth has been removed because of dental caries. Other 9 Does not correspond to any of the other descriptions Table 2 Caries experience calculation according to CAST index and WHO criteria. CAST index WHO criteria Decayed Code 3–7 Code B, C or 1,2 Missing Code 8 Code E or 4 Filled Code 2 Code D or 3 Caries experience Code 2–8 Codes B-E/1–4 Table 3 Distribution of CAST code tooth-wise in primary and permanent dentition CAST codes Dentition Treatment option Primary Permanent 3 110 (1.51%) 148 (1.45%) Preventive care/ Pit and fissure sealant 4 58 (0.79%) 40 (0.39%) Restoration 5 424 (5.82%) 128 (1.25%) Restoration 6 154 (2.11%) 48 (0.47%) Endodontic treatment/ Pulpectomy/ Extraction 7 5 (0.06%) 2 (0.02%) Endodontic treatment/ Pulpectomy/ Extraction 8 1(0.01%) 3 (0.03%) Space maintainer / Prosthodontic treatment Table 4 Caries experience in two age groups according to CAST index and WHO criteria. Age Caries experience p value Cast index (code 2,3–8) WHO criteria 5-year-old (n = 242) 52% (190) 42.3% (154) 0.000# 12-year-old (n = 242) 48% (198) 40% (97) 0.000# 15-year-old (n = 244) 54.6% (198) 26.7% (97) 0.000# * CAST index compared with WHO criteria (McNemar test) #p < 0.05 The dispersion of CAST codes by tooth in the deciduous & permanent dentition, as well as the corresponding treatment choices, are shown in Table 3 . Regarding the dispersion of CAST codes by tooth, enamel lesions (CAST code 3) were found in 110 (1.51%) deciduous teeth and 138 (1.45%) permanent teeth; these teeth required sealants or preventive therapy. Furthermore, 2 (0.02%) permanent teeth and 5 (0.06%) primary teeth had CAST code 7, indicating pulpal involvement, necessitating extraction or endodontic therapy. Based on the CAST index and WHO standards, Table 4 compares the prevalence of caries in 3 age sets. Using the CAST index codes 2, 3–8, the caries experience was 52% for children aged 5, 48% for children aged 12 and 54.6% for those aged 15. When assessed with the WHO criteria, caries experience for all 3 age groups was 42.3%, 40% and 26.7%, respectively. The disparities in caries experience, as determined by the CAST & WHO criteria, were statistically significant in both age sets (p < 0.05). As illustrated in Fig. 1 , the caries experience proportions assessed by the CAST index and WHO criteria show notable differences across age groups. The variation in caries experience across the three age groups is depicted in Fig. 2 , highlighting the significant disparities between the indices. The average period required for applying the CAST index & WHO criteria during the assessment of deciduous dentition was found to be 94.12 ± 23.68 seconds and 60.56 ± 16.48 seconds, respectively. In the case of permanent dentition, the average investigation period for implementing the CAST index & WHO criteria was computed as 107.13 ± 8.39 seconds and 59.27 ± 8.22 seconds, respectively. A statistical analysis using the Wilcoxon signed rank test revealed that the application of the CAST index took a significantly lengthier period compared to the WHO criteria for both deciduous and permanent dentition (p < 0.05). Discussion Dental caries, now acknowledged as a wholly reversible and avoidable ailment affecting dental hard tissues, exhibits optimal manageability when identified at an initial non-cavitated stage. [ 12 ] While the DMFT index stands as the widely accepted caries assessment system, its drawback lies in the omission of preliminary carious lesions. Recognizing the imperative for a comprehensive caries assessment instrument encompassing all phases of the condition, the CAST instrument was developed. This study marks a noteworthy contribution by presenting a comparative analysis of the CAST index & WHO criteria 2013 in the context of 5, 12 and 15- year-old schoolchildren in Dibrugarh District, Assam, India, an area where limited studies on the practical application of the CAST index in field settings have been reported. The age groups of 5, 12 and 15 years, as suggested by the WHO for global caries monitoring, facilitate international comparisons and trend monitoring for both primary and permanent teeth. [ 1 ] Given the practicality of acquiring the requisite sample size from 5, 12 and 15-year-old children, schools emerge as the ideal setting for this investigation. Employing simple random sampling, ten schools were included in the study, underscoring the relevance of this research in enhancing our understanding of caries prevalence and progression in the specified age groups. In the current study, children classified with CAST codes 3 and 4 underwent a reevaluation in order to improve examiner precision and consensus. The reproducibility of the CAST tool in the deciduous dentition was reported in a study by De Souza et al., showing levels of agreement ranging from "substantial" to "almost perfect." Reproducibility in the permanent dentition of people between the ages of 19 and 30 was described as "almost perfect". [ 9 ] Every dental examination followed Frencken et al.'s CAST recommendation. [ 6 ] Both of the caries assessment systems used the same instrumentation. Most remarkably, the CAST index was documented in this investigation without the use of diagnostic adjuncts, such as brushing and drying teeth beforehand. Assaf et al. discovered that, when compared to conventional examinations, all epidemiological examinations consistently overestimated non-cavitated lesions, even when auxiliary instruments improving visual investigation—such as air drying and brushing—were incorporated. [ 13 ] The elevated incidence of enamel caries and the diminished occurrence of sealants in both age cohorts suggest an elevated susceptibility to future caries occurrences. This observation aligns with previous investigations conducted by R Nagarajappa et al, Dorenia et al, & Babaei et al, which similarly stated a limited occurrence of fissure sealant application among children. [ 14 – 16 ] In accordance with a recent directive pertaining to fissure sealants, it is emphatically advised that the application of sealants be contemplated for permanent molars exhibiting intact occlusal surfaces, as well as non-cavitated occlusal carious lesions, in the pediatric and adolescent demographic. [ 17 ] The superiority of the CAST index over the WHO criteria lies in its ability to be expressed in two distinct manners. It quantifies the ratio of 'healthy' dentition (coded 0–2) to 'diseased' dentition (coded 3–7). Within the 'diseased' category, further distinctions are made: Dentition with morbidity (codes 4 and 5), serious morbidity (codes 6 and 7), reversible premorbidity stage (code 3), and dentition with mortality (code 8). The alternative reporting technique is focused on providing the targeted group with the necessary curative and preventive care. Consequently, the CAST index facilitates precise treatment planning efficiently, in contrast to the limitation of specific treatment planning inherent in the WHO criteria for DMFT. [ 6 ] The present study demonstrated a noteworthy disparity in caries prevalence as evaluated through the CAST index and the World Health Organization (WHO) criteria. This dissimilarity is attributed to the heightened capability of the CAST index codes in identifying incipient and non-cavitated carious lesions, surpassing the diagnostic capacity of the WHO criteria. A research conducted by De Souza et al. focused on the 6–11 age group and yielded analogous outcomes when comparing caries experience as determined by the CAST index & WHO criteria. [ 10 ] In our study, besides addressing the primary objectives, we also conducted a comparative analysis of the time required for carrying out the CAST index & WHO criteria for caries assessment. Our results revealed notable disparities in examination duration between the two caries assessment methodologies. Specifically, the mean examination time was observed to be significantly prolonged for the CAST index in contrast to the WHO criteria, applicable to both primary and permanent dentition. This discrepancy in examination time contradicts the findings of a research conducted by De Souza et al, which asserted that the interval expended during the examination of children using both caries assessment approaches was equivalent [ 10 ] . Moreover, a research by Reddy et al concurred with our observations, indicating that both the ICDAS & CAST systems entail considerable time investments compared to the DMFT/deft (decayed- extracted-filled teeth) system. [ 18 ] The consistency of our findings with the latter study underscores the resource-intensive nature of the ICDAS and CAST methodologies in comparison to traditional dental caries assessment approaches. Limitation The study employed the CAST index, a metric recognized for its intricacy compared to the DMFT/dmft index. Consequently, the calibration procedure proved to be time-intensive, requiring additional time for consensus attainment. Nonetheless, the utilization of a visual aid facilitated the process. Conclusion The assessment of caries experience utilizing the CAST index & WHO criteria yielded statistically significant differences in both age cohorts. Despite the lengthier examination duration associated with the CAST index, its capacity to furnish comprehensive insights into the various stages of dental caries renders it a more suitable tool for epidemiological surveys. The utilization of the CAST index allows for a holistic depiction of the dental caries landscape, thereby offering an accurate representation of the disease burden within a community. This comprehensive understanding is instrumental in aiding health care planners in formulating efficacious strategies for preventive and curative care planning. Declarations Conflicts of interest: None Compliance with Ethical Standards as follows: Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Regional Dental College , Guwahati, Assam. Informed consent: Written Informed consent was obtained from legal guardians. Funding: No funding was received for conducting this study. Authors’ contribution: Indrani Barman, Alpana Talukdar, Antarika Gogoi & Maruf Hussain Barbhuiya contributed to the study conception and design. Data collection was performed by Antarika Gogoi. Statistical analyses were made by Bhaskarjyoti Talukdar. Maruf Hussain Barbhuiya written the first draft of the paper. Data interpretation and figures were done by Rishba Singh. All authors discussed the results and written, read and approved the final manuscript. References World Health Organization: Oral health survey, Basic methods. 5TH edition. Geneva: World health organization; 2013. Available from: https://www.who.int/publications/i/ item/9789241548649 Benigeri M, Payette M, Brodeur JM. Comparison between the DMF indices and two alternative composite indicators of dental health. Community Dent Oral Epidemiol. 1998;26:303-309. Namal N, Vehid S, Sheiham A. Ranking countries by dental status using the DMFT and FS-T indices. Int Dent J. 2005;55:373-376. Frencken JE, de Amorim RG, Faber J, Leal SC. The Caries Assessment Spectrum and Treatment (CAST) index: rationale and development. Int Dent J. 2011;61:117-123. Siraj ES, Sagarkar AR, Pushpanjali K. Comparative evaluation of dental caries experience using CAST index and WHO criteria among 5 and 15-year-old schoolchildren. Medicine and Pharmacy Reports. 2023 Apr;96(2):192. Frencken JE, de Souza AL, van der Sanden WJ, Bronkhorst EM, Leal SC. The Caries Assessment Spectrum and Treatment (CAST) instrument. Community Dent Oral Epidemiol 2013;41:e71-e77. 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;62:270-276. de Souza AL, Leal SC, Chaves SB, Bronkhorst EM, Frencken JE, Creugers NHJ. The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation. Eur J Oral Sci. 2014;122:149-153. 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;64:187-194. 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. https://education.assam.gov.in/information-services/list-of-schools Featherstone JD. Caries prevention and reversal based on the caries balance. Pediatr Dent. 2006;28:128-132; discussion 192-198. Assaf AV, Meneghim Mde C, Zanin L, Mialhe FL, Pereira AC, Ambrosano GM. Assessment of different methods for diagnosing dental caries in epidemiological surveys. Community Dent Oral Epidemiol. 2004;32: 418–425. Nagarajappa R, Naik, D, Satyarup D, Dalai RP. Risk factors and patterns related to dental caries evaluated with caries assessment spectrum and treatment (cast) among schoolchildren of Bhubaneswar, India. Rocz Panstw Zakl Hig. 2020;71:113-122. Doneria D, Thakur S, Singhal P, Chauhan D, Jayam C, Uppal A. Comparative Evaluation of Caries Status in Primary and Permanent Molars in 7–8-year-old Schoolchildren of Shimla Using Caries Assessment Spectrum and Treatment Index.. Contemp Clin Dent. 2017;8:128–133. Babaei A, Pakdaman A, Hessari H, Shamshiri AR. Oral health of 6-7 year-old children according to the Caries Assessment Spectrum and Treatment (CAST) index. BMC Oral Health. 2019;19:20. Wright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence- based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147:672–82. Reddy ER, Rani ST, Manjula M, Kumar LV, Mohan TA, Radhika E. Assessment of caries status among schoolchildren according to decayed-missing-filled teeth/decayed-extract- filled teeth index, International Caries Detection and Assessment System, and Caries Assessment Spectrum and Treatment criteria. Indian J Dent Res. 2017;28:487-492. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5652170","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":391874323,"identity":"023c9aa7-fd51-4bf1-958c-fc3ef0d4bcd7","order_by":0,"name":"Maruf Hussain Barbhuiya","email":"","orcid":"","institution":"State Cancer Institite, Guwahati","correspondingAuthor":false,"prefix":"","firstName":"Maruf","middleName":"Hussain","lastName":"Barbhuiya","suffix":""},{"id":391874324,"identity":"346195d1-50de-42b5-afef-fd8276819cee","order_by":1,"name":"Indrani Barman","email":"","orcid":"","institution":"Fakhruddin Ali Ahmed Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Indrani","middleName":"","lastName":"Barman","suffix":""},{"id":391874326,"identity":"bddd6039-aa73-4eed-849a-87ae6a2a137a","order_by":2,"name":"Alpana Talukdar","email":"","orcid":"","institution":"Nalbari Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alpana","middleName":"","lastName":"Talukdar","suffix":""},{"id":391874328,"identity":"e97a4e5e-d118-46ce-b1f7-e341df35511a","order_by":3,"name":"Rishba Singh","email":"","orcid":"","institution":"MDS 3 rd Year, I.T.S - C.D.S.R","correspondingAuthor":false,"prefix":"","firstName":"Rishba","middleName":"","lastName":"Singh","suffix":""},{"id":391874332,"identity":"5b262b9b-c391-4339-937f-0fee77433bbc","order_by":4,"name":"Antarika Gogoi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYNACgwQInVABJJiZGwgoZ0bWcgYkwEiMFgaoFsY2MIlfC//s/oOfKwrS5OXd2y8+eDivNpq/HajlR8U2nFok7hxmljxjkGO48cyZYoPEbcdzZxxmbGDsOXMbtzU3khkkGwwqGDfOyEmTSNx2LLcBqIWZsQ23Fvkbycw/gVrsIVrmHMudT0iLwY1kNqAtOYnzJdKPSSQ21ORuIKTF8EaymWWDQVryBp4zzAYJxw7kbgRqOYjPL3I3Eh/fbPiTbDu/vf3hwx81dbnzzh8++OBHBR7vw114gMcASB0Gcw4QVg8E8g3sD4BUHVGKR8EoGAWjYGQBADXCYKSFGRI6AAAAAElFTkSuQmCC","orcid":"","institution":"Government Dental College, Dibrugarh","correspondingAuthor":true,"prefix":"","firstName":"Antarika","middleName":"","lastName":"Gogoi","suffix":""},{"id":391874333,"identity":"45b82149-6e41-4f91-95e7-ba2f62a27768","order_by":5,"name":"Bhaskarjyoti Talukdar","email":"","orcid":"","institution":"Cotton University","correspondingAuthor":false,"prefix":"","firstName":"Bhaskarjyoti","middleName":"","lastName":"Talukdar","suffix":""}],"badges":[],"createdAt":"2024-12-16 09:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5652170/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5652170/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72361394,"identity":"9be76817-f43e-4544-9a0b-4a3fd59c4530","added_by":"auto","created_at":"2024-12-26 06:07:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97046,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of caries experience proportions by each index\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-5652170/v1/7b451725ca5d386ba938a9ab.png"},{"id":72363321,"identity":"aab7ee21-8392-4042-93c9-351f52296dde","added_by":"auto","created_at":"2024-12-26 06:15:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":96645,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDifference in Caries Experience by age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-5652170/v1/9bcde7c7e003088249c15f42.png"},{"id":73719754,"identity":"fdf27bb9-4bf8-4a91-b652-019e23158804","added_by":"auto","created_at":"2025-01-14 02:16:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":905844,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5652170/v1/56240d58-5a14-4039-a12d-b5b635cb6b68.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Efficacy in Dental Caries Assessment: Insights from a CAST-WHO Comparative Study in Dibrugarh, Assam","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCaries, a dynamic disease, evolves across enamel and dentine, amenable to control through various measures such as dietary restrictions, fluoride applications, and timely restorations. It remains a prevalent chronic disease, significantly impacting global oral health. Over time, various indices have been developed to assess caries experience in field studies, each attempting to capture the multifaceted nature of this condition. With acknowledged limitations, the widely used Decayed, Missing, and Filled Teeth (DMFT) index has been a cornerstone in assessing the status of caries in individuals and groups, as recommended by the World Health Organization. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCriticism of the DMFT index has centered around its failure to discern between enamel \u0026amp; dentine carious lesions, hampering targeted treatment planning. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Additionally, its equal weighting of missing, untreated decay, and restored teeth often masks variations in individuals' dental health status. \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e While efforts to address these shortcomings led to the development of alternative indices like ICDAS, PUFA, and FS-T, none have fully supplanted the DMFT index due to their own set of limitations. \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRecognizing the dynamic nature of dental caries and the need for early identification of non-cavitated lesions, the Caries Assessment Spectrum and Treatment (CAST) index emerged in 2011.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e This hierarchical instrument presents a comprehensive spectrum of carious conditions, encompassing lesions from enamel to dentine, and progression to pulp involvement and tissue- related complications, offering a more nuanced evaluation than its predecessors.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Extensive validation studies have demonstrated its heightened sensitivity, specificity, and reliability in epidemiological surveys. \u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the advancements, the comparability of CAST with WHO criteria across diverse populations and age groups remains underexplored. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Limited studies have contrasted these indices based on mean dmf/DMF scores and caries prevalence, warranting deeper investigation, particularly in WHO-recommended age groups of 5, 12 and 15 years. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aims to fill the gap by comprehensively comparing the CAST index with WHO criteria among 5, 12 and 15-year-old school children. By examining caries experiences and assessment times, this research seeks to shed light on the efficacy of CAST in capturing the diverse spectrum of carious conditions, thereby informing more precise interventions and policy decisions for improved oral health outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv\u003e\n \u003cp\u003eA cross-sectional study was led in Dibrugarh district, Assam, India, to compare dental caries experiences in school children aged 5, 12 and 15 years using the CAST index \u0026amp; WHO criteria. Ethics Review Board of Regional Dental College, Guwahati granted ethical clearance. The study followed STROBE guidelines and received permission from school authorities. Prevalence data from published literature guided the sample size determination.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eSampling and Schools Selection:\u003c/h2\u003e\n \u003cp\u003eAccording to the published data, the prevalence of dental caries in 5-year-old, 12-year-old and 15-year-old children in Dibrugarh district was reported to be 65.3%. As a result, it was determined that the minimal sample size for children aged five \u0026amp; twelve; n\u0026thinsp;=\u0026thinsp;242 and fifteen; n\u0026thinsp;=\u0026thinsp;244; i.e.728. Information on government and private schools in Dibrugarh district was obtained from the Department of Secondary Education, Government of Assam website.\u003csup\u003e[\u003cspan\u003e11\u003c/span\u003e]\u003c/sup\u003e A total of 130 Government/ Provincialized schools were shortlisted with 5 or 15-year-old children out of 143 total schools, excluding those with less than 35 such students. Using a lottery method, ten schools were selected for the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003e1. Fewer than 35 students in a class of selected age group.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e2. Children who are going through orthodontic treatment and those in the mixed dentition phase were not included.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eExaminer Training and Calibration\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003eThe principal investigator who is Assistant professor in the Department of Public Health Dentistry trained the 2 examiners, covering theoretical aspects of the CAST index \u0026amp; WHO criteria 2013 along with a hands-on session which involved examining extracted teeth \u0026amp; scoring them. Participant scores were compared, and in instances of disparity, examiners \u0026amp; the principal investigator engaged in discussions until a consensus was reached. Calibration exercises on twenty subjects, mirroring the study\u0026apos;s age groups, assessed inter \u0026amp; intra- examiner agreement using Kappa statistics.\u003csup\u003e[\u003cspan\u003e5\u003c/span\u003e]\u003c/sup\u003e Both examiners achieved substantial to almost perfect agreement for both indices.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eDental Examination\u003c/h3\u003e\n\u003cdiv\u003e\n \u003cp\u003eTwo skilled \u0026amp; calibrated examiners conducted the examinations in well-illuminated classrooms. Examinations were performed under natural light, occasionally aided by torchlight after obtaining informed consent from parents. There were two stages of the investigation. The CAST index mentioned in Table \u003cspan\u003e1\u003c/span\u003e\u003csup\u003e[\u003cspan\u003e6\u003c/span\u003e]\u003c/sup\u003e was used initially, with tooth surfaces not air-dried as per recommendations. \u003csup\u003e[\u003cspan\u003e4\u003c/span\u003e]\u003c/sup\u003e Another examination using WHO criteria was investigated 2\u0026ndash;7 days later. Cotton rolls and CPI probes aided plaque removal, and excess saliva was managed with cotton rolls or gauzes as air drying was not recommended. \u003csup\u003e[\u003cspan\u003e4\u003c/span\u003e, \u003cspan\u003e6\u003c/span\u003e]\u003c/sup\u003e Trained assistants recorded proforma and indices. The period of each inspection was monitored, and fatigue was managed by restricting examinations to 25 children each day, with re-examinations after every seventh child.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eThe data analysis software utilized was SPSS version 20. For non-normally distributed data, descriptive statistics (mean, standard deviation, percentages) were used. Frequency and percentage distributions were shown for the CAST index codes and WHO scores at the tooth and surface levels. The codes utilized to calculate the caries experience using the WHO criteria and the CAST index are shown in Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e. The Wilcoxon signed-rank test evaluated the mean investigation time for the CAST index \u0026amp; WHO standards, while the Mc Nemar test compared caries experiences. A significant threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was established.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of CAST codes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSound\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo visible evidence of a distinct carious lesion is present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSealant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePits and /or Fissures are at least partially covered with a sealant material\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRestoration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA cavity is restored with an (in)direct restorative material\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnamel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDistinct visual change in enamel only. A clear caries related discoloration is visible, with or without localized enamel breakdown.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDentine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternal caries related discoloration in dentine. The discolored dentine is visible through enamel, which may or may not exhibit a visible localized breakdown of enamel.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDistinct cavitation into dentine. The pulp chamber is intact.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulp\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInvolvement of the pulp chamber. Distinct cavitation reaching the pulp chamber or only root fragments are present.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbscess/ fistula\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA pus containing swelling or a pus releasing sinus tract related to a tooth with pulpal involvement.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLost\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe tooth has been removed because of dental caries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoes not correspond to any of the other descriptions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCaries experience calculation according to CAST index and WHO criteria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCAST index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWHO criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDecayed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCode 3\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode B, C or 1,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMissing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCode 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode E or 4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFilled\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCode 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCode D or 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaries experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCode 2\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes B-E/1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of CAST code tooth-wise in primary and permanent dentition\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCAST codes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eDentition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTreatment option\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e110 (1.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (1.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePreventive care/ Pit and fissure sealant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e58 (0.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (0.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRestoration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e424 (5.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128 (1.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRestoration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e154 (2.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (0.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEndodontic treatment/ Pulpectomy/ Extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 (0.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEndodontic treatment/ Pulpectomy/ Extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1(0.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpace maintainer / Prosthodontic treatment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCaries experience in two age groups according to CAST index and WHO criteria.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCaries experience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCast index (code 2,3\u0026ndash;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWHO criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5-year-old (n\u0026thinsp;=\u0026thinsp;242)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52% (190)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.3% (154)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000#\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12-year-old (n\u0026thinsp;=\u0026thinsp;242)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48% (198)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40% (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000#\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e15-year-old (n\u0026thinsp;=\u0026thinsp;244)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.6% (198)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7% (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000#\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e* CAST index compared with WHO criteria (McNemar test) #p \u003c 0.05\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe dispersion of CAST codes by tooth in the deciduous \u0026amp; permanent dentition, as well as the corresponding treatment choices, are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Regarding the dispersion of CAST codes by tooth, enamel lesions (CAST code 3) were found in 110 (1.51%) deciduous teeth and 138 (1.45%) permanent teeth; these teeth required sealants or preventive therapy. Furthermore, 2 (0.02%) permanent teeth and 5 (0.06%) primary teeth had CAST code 7, indicating pulpal involvement, necessitating extraction or endodontic therapy.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the CAST index and WHO standards, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e compares the prevalence of caries in 3 age sets. Using the CAST index codes 2, 3\u0026ndash;8, the caries experience was 52% for children aged 5, 48% for children aged 12 and 54.6% for those aged 15. When assessed with the WHO criteria, caries experience for all 3 age groups was 42.3%, 40% and 26.7%, respectively. The disparities in caries experience, as determined by the CAST \u0026amp; WHO criteria, were statistically significant in both age sets (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the caries experience proportions assessed by the CAST index and WHO criteria show notable differences across age groups. The variation in caries experience across the three age groups is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, highlighting the significant disparities between the indices.\u003c/p\u003e \u003cp\u003eThe average period required for applying the CAST index \u0026amp; WHO criteria during the assessment of deciduous dentition was found to be 94.12\u0026thinsp;\u0026plusmn;\u0026thinsp;23.68 seconds and 60.56\u0026thinsp;\u0026plusmn;\u0026thinsp;16.48 seconds, respectively. In the case of permanent dentition, the average investigation period for implementing the CAST index \u0026amp; WHO criteria was computed as 107.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39 seconds and 59.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22 seconds, respectively. A statistical analysis using the Wilcoxon signed rank test revealed that the application of the CAST index took a significantly lengthier period compared to the WHO criteria for both deciduous and permanent dentition (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDental caries, now acknowledged as a wholly reversible and avoidable ailment affecting dental hard tissues, exhibits optimal manageability when identified at an initial non-cavitated stage. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e While the DMFT index stands as the widely accepted caries assessment system, its drawback lies in the omission of preliminary carious lesions. Recognizing the imperative for a comprehensive caries assessment instrument encompassing all phases of the condition, the CAST instrument was developed. This study marks a noteworthy contribution by presenting a comparative analysis of the CAST index \u0026amp; WHO criteria 2013 in the context of 5, 12 and 15- year-old schoolchildren in Dibrugarh District, Assam, India, an area where limited studies on the practical application of the CAST index in field settings have been reported.\u003c/p\u003e \u003cp\u003eThe age groups of 5, 12 and 15 years, as suggested by the WHO for global caries monitoring, facilitate international comparisons and trend monitoring for both primary and permanent teeth. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Given the practicality of acquiring the requisite sample size from 5, 12 and 15-year-old children, schools emerge as the ideal setting for this investigation. Employing simple random sampling, ten schools were included in the study, underscoring the relevance of this research in enhancing our understanding of caries prevalence and progression in the specified age groups.\u003c/p\u003e \u003cp\u003eIn the current study, children classified with CAST codes 3 and 4 underwent a reevaluation in order to improve examiner precision and consensus. The reproducibility of the CAST tool in the deciduous dentition was reported in a study by De Souza et al., showing levels of agreement ranging from \"substantial\" to \"almost perfect.\" Reproducibility in the permanent dentition of people between the ages of 19 and 30 was described as \"almost perfect\". \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEvery dental examination followed Frencken et al.'s CAST recommendation. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBoth of the caries assessment systems used the same instrumentation. Most remarkably, the CAST index was documented in this investigation without the use of diagnostic adjuncts, such as brushing and drying teeth beforehand. Assaf et al. discovered that, when compared to conventional examinations, all epidemiological examinations consistently overestimated non-cavitated lesions, even when auxiliary instruments improving visual investigation\u0026mdash;such as air drying and brushing\u0026mdash;were incorporated.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe elevated incidence of enamel caries and the diminished occurrence of sealants in both age cohorts suggest an elevated susceptibility to future caries occurrences. This observation aligns with previous investigations conducted by R Nagarajappa et al, Dorenia et al, \u0026amp; Babaei et al, which similarly stated a limited occurrence of fissure sealant application among children.\u003csup\u003e[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e In accordance with a recent directive pertaining to fissure sealants, it is emphatically advised that the application of sealants be contemplated for permanent molars exhibiting intact occlusal surfaces, as well as non-cavitated occlusal carious lesions, in the pediatric and adolescent demographic.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe superiority of the CAST index over the WHO criteria lies in its ability to be expressed in two distinct manners. It quantifies the ratio of 'healthy' dentition (coded 0\u0026ndash;2) to 'diseased' dentition (coded 3\u0026ndash;7). Within the 'diseased' category, further distinctions are made: Dentition with morbidity (codes 4 and 5), serious morbidity (codes 6 and 7), reversible premorbidity stage (code 3), and dentition with mortality (code 8). The alternative reporting technique is focused on providing the targeted group with the necessary curative and preventive care.\u003c/p\u003e \u003cp\u003eConsequently, the CAST index facilitates precise treatment planning efficiently, in contrast to the limitation of specific treatment planning inherent in the WHO criteria for DMFT.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study demonstrated a noteworthy disparity in caries prevalence as evaluated through the CAST index and the World Health Organization (WHO) criteria. This dissimilarity is attributed to the heightened capability of the CAST index codes in identifying incipient and non-cavitated carious lesions, surpassing the diagnostic capacity of the WHO criteria. A research conducted by De Souza et al. focused on the 6\u0026ndash;11 age group and yielded analogous outcomes when comparing caries experience as determined by the CAST index \u0026amp; WHO criteria. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our study, besides addressing the primary objectives, we also conducted a comparative analysis of the time required for carrying out the CAST index \u0026amp; WHO criteria for caries assessment. Our results revealed notable disparities in examination duration between the two caries assessment methodologies. Specifically, the mean examination time was observed to be significantly prolonged for the CAST index in contrast to the WHO criteria, applicable to both primary and permanent dentition. This discrepancy in examination time contradicts the findings of a research conducted by De Souza et al, which asserted that the interval expended during the examination of children using both caries assessment approaches was equivalent \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Moreover, a research by Reddy et al concurred with our observations, indicating that both the ICDAS \u0026amp; CAST systems entail considerable time investments compared to the DMFT/deft (decayed- extracted-filled teeth) system. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e The consistency of our findings with the latter study underscores the resource-intensive nature of the ICDAS and CAST methodologies in comparison to traditional dental caries assessment approaches.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study employed the CAST index, a metric recognized for its intricacy compared to the DMFT/dmft index. Consequently, the calibration procedure proved to be time-intensive, requiring additional time for consensus attainment. Nonetheless, the utilization of a visual aid facilitated the process.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe assessment of caries experience utilizing the CAST index \u0026amp; WHO criteria yielded statistically significant differences in both age cohorts. Despite the lengthier examination duration associated with the CAST index, its capacity to furnish comprehensive insights into the various stages of dental caries renders it a more suitable tool for epidemiological surveys. The utilization of the CAST index allows for a holistic depiction of the dental caries landscape, thereby offering an accurate representation of the disease burden within a community. This comprehensive understanding is instrumental in aiding health care planners in formulating efficacious strategies for preventive and curative care planning.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest: None\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards as follows:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Regional Dental College , Guwahati, Assam.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eInformed consent:\u003c/strong\u003e Written\u0026nbsp;Informed consent was obtained from legal guardians.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026nbsp;Funding:\u0026nbsp;\u003c/strong\u003eNo funding was received for conducting this study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution:\u0026nbsp;\u003c/strong\u003eIndrani Barman, Alpana Talukdar, Antarika Gogoi \u0026amp; Maruf Hussain Barbhuiya contributed to the study conception and design. Data collection was performed by Antarika Gogoi. Statistical analyses were made by Bhaskarjyoti Talukdar. Maruf Hussain Barbhuiya written the first draft of the paper. Data interpretation and figures were done by Rishba Singh. All authors discussed the results and written, read and approved the final manuscript.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization: Oral health survey, Basic methods. 5TH edition. Geneva: World health organization; 2013. Available from: https://www.who.int/publications/i/ item/9789241548649\u003c/li\u003e\n\u003cli\u003eBenigeri M, Payette M, Brodeur JM. Comparison between the DMF indices and two alternative composite indicators of dental health. Community Dent Oral Epidemiol. 1998;26:303-309.\u003c/li\u003e\n\u003cli\u003eNamal N, Vehid S, Sheiham A. Ranking countries by dental status using the DMFT and FS-T indices. Int Dent J. 2005;55:373-376.\u003c/li\u003e\n\u003cli\u003eFrencken JE, de Amorim RG, Faber J, Leal SC. The Caries Assessment Spectrum and Treatment (CAST) index: rationale and development. Int Dent J. 2011;61:117-123.\u003c/li\u003e\n\u003cli\u003eSiraj ES, Sagarkar AR, Pushpanjali K. Comparative evaluation of dental caries experience using CAST index and WHO criteria among 5 and 15-year-old schoolchildren. Medicine and Pharmacy Reports. 2023 Apr;96(2):192.\u003c/li\u003e\n\u003cli\u003eFrencken JE, de Souza AL, van der Sanden WJ, Bronkhorst EM, Leal SC. The Caries Assessment Spectrum and Treatment (CAST) instrument. Community Dent Oral Epidemiol 2013;41:e71-e77.\u003c/li\u003e\n\u003cli\u003ede 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;62:270-276.\u003c/li\u003e\n\u003cli\u003ede Souza AL, Leal SC, Chaves SB, Bronkhorst EM, Frencken JE, Creugers NHJ. The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation. Eur J Oral Sci. 2014;122:149-153.\u003c/li\u003e\n\u003cli\u003ede 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;64:187-194.\u003c/li\u003e\n\u003cli\u003ede 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.\u003c/li\u003e\n\u003cli\u003ehttps://education.assam.gov.in/information-services/list-of-schools\u003c/li\u003e\n\u003cli\u003eFeatherstone JD. Caries prevention and reversal based on the caries balance. Pediatr Dent. 2006;28:128-132; discussion 192-198.\u003c/li\u003e\n\u003cli\u003eAssaf AV, Meneghim Mde C, Zanin L, Mialhe FL, Pereira AC, Ambrosano GM. Assessment of different methods for diagnosing dental caries in epidemiological surveys. Community Dent Oral Epidemiol. 2004;32: 418\u0026ndash;425.\u003c/li\u003e\n\u003cli\u003eNagarajappa R, Naik, D, Satyarup D, Dalai RP. Risk factors and patterns related to dental caries evaluated with caries assessment spectrum and treatment (cast) among schoolchildren of Bhubaneswar, India. Rocz Panstw Zakl Hig. 2020;71:113-122.\u003c/li\u003e\n\u003cli\u003eDoneria D, Thakur S, Singhal P, Chauhan D, Jayam C, Uppal A. Comparative Evaluation of Caries Status in Primary and Permanent Molars in 7\u0026ndash;8-year-old Schoolchildren of Shimla Using Caries Assessment Spectrum and Treatment Index.. Contemp Clin Dent. 2017;8:128\u0026ndash;133.\u003c/li\u003e\n\u003cli\u003eBabaei A, Pakdaman A, Hessari H, Shamshiri AR. Oral health of 6-7 year-old children according to the Caries Assessment Spectrum and Treatment (CAST) index. BMC Oral Health. 2019;19:20.\u003c/li\u003e\n\u003cli\u003eWright JT, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, et al. Evidence- based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147:672\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eReddy ER, Rani ST, Manjula M, Kumar LV, Mohan TA, Radhika E. Assessment of caries status among schoolchildren according to decayed-missing-filled teeth/decayed-extract- filled teeth index, International Caries Detection and Assessment System, and Caries Assessment Spectrum and Treatment criteria. Indian J Dent Res. 2017;28:487-492.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CAST index, WHO criteria, dental caries, children, Dibrugarh","lastPublishedDoi":"10.21203/rs.3.rs-5652170/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5652170/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo examine the comparability of the CAST index with the established WHO criteria across diverse populations and age groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods and Material:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn the Dibrugarh district of Assam, India, 728 schoolchildren between the ages of 5, 12 and 15 participated in a cross-sectional survey. Examiners received calibration and training in order to apply the CAST index. The CAST index was used for the first examinations, and after a set amount of time, the WHO 2013 criteria were used for the second examination. For every exam, the amount of time required was noted. The Wilcoxon signed-rank test evaluated the mean investigation time for the CAST index \u0026amp; WHO standards, while the Mc Nemar test compared caries experiences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe caries experience of children aged 5, 12 and 15 using the CAST index (52%, 48%, 54.6%) and the WHO criteria (42.3%, 40.0%, 26.7%), statistically significant differences were found (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In comparison to the WHO standards (60.56\u0026thinsp;\u0026plusmn;\u0026thinsp;16.48 seconds and 59.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.22 seconds) for primary and permanent dentition, the average examination duration for the CAST index (94.12\u0026thinsp;\u0026plusmn;\u0026thinsp;23.68 seconds and 107.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39 seconds) was longer (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDespite the CAST index requiring an extended investigation time, it provided more precise information, aiding researchers in treatment development that encompasses prevention of early lesions, restoration \u0026amp; rehabilitation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical Relevance:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe CAST index facilitates early diagnosis and targeted treatment planning, enabling preventive interventions for early lesions and appropriate restorative care, thus improving oral health outcomes in children.\u003c/p\u003e","manuscriptTitle":"Diagnostic Efficacy in Dental Caries Assessment: Insights from a CAST-WHO Comparative Study in Dibrugarh, Assam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-26 06:07:11","doi":"10.21203/rs.3.rs-5652170/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd2eb3c5-3f3e-4b7b-948a-dd24dfcbe495","owner":[],"postedDate":"December 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-14T02:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-26 06:07:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5652170","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5652170","identity":"rs-5652170","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}