ARTICLE 1 COVER STORY  The American Dental Association Caries Classification System for Clinical Practice A report of the American Dental Association Council on Scientific Affairs Douglas A. Young, DDS, EdD, MBA, MS; Brian B. Nový, DDS; Gregory G. Zeller, DDS, MS; Robert Hale, DDS; Thomas C. Hart, DDS, PhD; Edmond L. Truelove, DDS, MSD; American Dental Association Council on Scientific Affairs D ental caries remains a common chronic dis- ease and, in the absence of treatment, it may progress until the tooth is destroyed. Despite advances in restorative materials and the implementation of various preventive approaches, more than 90% of adults in the United States have experienced dental caries before 30 years of age. 1,2 Dental caries is a multifactorial disease involving many complex risk and protective factors. 3 The clinical presentation of caries disease is a caries lesion; the severity of the disease and of individual caries lesions is the result of complex personal, biological, behavioral, and environmental factors. Some factors are protective, such as the presence of fluoride in the biofilm, whereas others lead to hard tissue destruction, such as lower plaque pH. 4-6 Caries risk assessment is the organized process of evaluating these protective and pathogenic factors and provides the foundation 7-9 for selecting treatment interventions. The dental profession continues to implement a more interceptive nonsurgical therapeutic model to prevent, treat, and reverse caries lesions, particularly in the early stages. Despite progress, the profession still This article has an accompanying online continuing education activity available at: http://jada.ada.org/ce/home. Copyright ª 2015 American Dental Association. All rights reserved. ABSTRACT Background. The caries lesion, the most commonly observed sign of dental caries disease, is the cumulative result of an imbalance in the dynamic demineralization and remineralization process that causes a net mineral loss over time. A classification system to categorize the location, site of origin, extent, and when possible, activity level of caries lesions consistently over time is necessary to determine which clinical treatments and therapeutic interventions are appropriate to control and treat these lesions. Methods. In 2008, the American Dental Association (ADA) convened a group of experts to develop an easy-to- implement caries classification system. The ADA Council on Scientific Affairs subsequently compiled information from these discussions to create the ADA Caries Classifi- cation System (CCS) presented in this article. Conclusions. The ADA CCS offers clinicians the capa- bility to capture the spectrum of caries disease pre- sentations ranging from clinically unaffected (sound) tooth structure to noncavitated initial lesions to extensively cavitated advanced lesions. The ADA CCS supports a broad range of clinical management options necessary to treat both noncavitated and cavitated caries lesions. Practical Implications. The ADA CCS is available for implementation in clinical practice to evaluate its usability, reliability, and validity. Feedback from clinical practi- tioners and researchers will allow system improvement. Use of the ADA CCS will offer standardized data that can be used to improve the scientific rationale for the treatment of all stages of caries disease. Key Words. Caries classification system; caries lesion classification; caries location; caries extent; caries activity; caries management. JADA 2015:146(2):79-86 http://dx.doi.org/10.1016/j.adaj.2014.11.018 ORIGINAL CONTRIBUTIONS JADA 146(2) http://jada.ada.org February 2015 79