Health Care + ICDAS
The Japan Health Care Dental Association (JHCDA), as stated in its mission, is primarily committed to prevention of dental diseases and shares the concerns and questions raised in Rationale and Evidence of International Caries Detection and Assessment System (ICDAS II). In Japan, like in many developed countries, population of both the caries-infected and severe cases have significantly decreased, but the consensus about the treatment (or refrainment from the treatment) of mild cases is yet to be achieved. We trust that ICDAS II helps us better utilize the long term data, including the standardized oral photographs, which JHCDA strongly recommends be kept. In other words, ICDAS II does not only help improve clinical practice with a set of coding criteria, but also adds values to the clinical data accumulated over the years. This in turn may help better understand the dynamic process of caries in both epidemiological and pathological terms and scrutinize the effect of every day clinical practice including regular check-ups.
The outdated yet prevalent “drill and fill” approach towards caries need be scrutinized and updated or at least more carefully employed if its rationale is along the line with that of a backfire employed to contain a wildfire or old school firemen plucking down the houses around a fire, for there is a major difference–the tooth does not grow back or is not reconstructable (and of course the subject is [a part of] a human). Such scrutiny is yet to be established in the clinical context in Japan. One of the reasons for this is perhaps that clinical data of incipient caries without (or with attitudes toward minimizing) the drill and fill intervention or invasive treatments is limited, if there is any. With ICDAS II, we are looking to reinforce objectivity, comparability, and retrievability of our clinical data, communication with patients, and hopefully achieve a more patient-oriented health care system.