The Caries Assessment and Treatment (CAST) instrument

Abstract

Objectives To describe the ‘Caries Assessment Spectrum and Treatment’ (CAST) instrument, its origin and content, and to provide an example of how results can be reported. Methods The CAST instrument covers the complete range of stages of carious lesion progression: from no carious lesion, through caries protection (sealant) and lesion care (restoration) to lesions in enamel and dentine, the advanced stages of carious lesion progression in pulpal and its consequences on tooth‐surrounding tissue and tooth loss due to caries. Using the RAND modified e‐Delphi consensus method two independent panels, comprising a total of 56 epidemiologists from 27 countries, determined the face and content validity of CAST. Panellists assessed 17 statements related to the content, description, suitability and international use of CAST. Agreement of 75% or higher was required for reaching consensus on a statement. Construct validity and reliability testing of CAST have been carried out, but results are not yet available. Results All 17 statements were approved by the panellists, who found the RAND modified e‐Delphi consensus method suitable for achieving consensus. The CAST codes were ordered hierarchically. External validity was obtained. Reporting using CAST can be performed for orally healthy dentitions and those having morbidity and mortality. A DMF score can easily be calculated from the CAST codes, thereby enabling retention of the use of existing DMF scores. Conclusion The CAST instrument for use in epidemiological surveys is very promising. Face and content validation is obtained. Construct validity and reliability testing will be completed soon. A structure for reporting results in a comprehensive, pragmatic and easily understood way is being developed.

Face and Content Validation of Caries Assessment Spectrum and Treatment Index among Few Subject Matter Experts in India

“…According to the recent article on CAST Index which was published after the commencement of this study, it stated that if a tooth with secondary caries around sealant is present then the more severe code should be considered i.e., caries (Code 3) over sealant (Code 1). [19] Code 2 (Restoration) was acceptable because it gave a treatment status of the tooth and helped in calculating the "F" component of DMFT index. Many SME's found that, if a tooth which was filled also had caries on another surface it would lead to a problem in CAST scoring.…”

“…Many SME's found that, if a tooth which was filled also had caries on another surface it would lead to a problem in CAST scoring. This issue was sorted in the CAST Index article, [19] which stated that if a tooth with secondary caries with restoration was present then the more severe code was considered i.e., caries (code 3) over restoration (code 2). [19] The only controversy was regarding the designation of in (direct) restorations as it confused many SME's.…”

“…This issue was sorted in the CAST Index article, [19] which stated that if a tooth with secondary caries with restoration was present then the more severe code was considered i.e., caries (code 3) over restoration (code 2). [19] The only controversy was regarding the designation of in (direct) restorations as it confused many SME's. The index needs to be more specific in describing the in (direct) restorative materials like Inlays, on-lays, crowns and temporary crowns.…”

“…The index needs to be more specific in describing the in (direct) restorative materials like Inlays, on-lays, crowns and temporary crowns. The recent manuscript on CAST Index [19] did not specify the details about the in (direct) restorations.…”

“…There were two similar studies conducted by Dr. Frencken which included 15 and 27 countries that included all codes and was done using On-line Rand modified e-Delphi consensus method [11,12,19] Furthermore, the recent article on CAST published in 2013 [19] stated various changes in the index. i.e., in cases where two codes are assigned consider the severity of the condition that comes first and code accordingly.…”