Table 3.

Changes in codes and descriptions from the start of the process, when the index was termed ‘CAS’, to Round 3 and the final validation of the Caries Assessment Spectrum and Treatment (CAST) index

CAST index versions
Started as CAS		After Round 3		Final version
Code	Description	Code	Description	Code	Description
0 Sound	There should be no evidence of dental caries	0 Sound	No visible evidence of a distinct carious lesion is present	0 Sound	No visible evidence of a distinct carious lesion is present
1 Enamel	Distinct visual change in enamel. A clear carious opacity (white or brown in colour) is visible under dry or wet circumstances, including localised enamel breakdown without clinical visual signs of dentinal involvement	1 Sealed	Pits and fissures have been at least partially sealed with a sealant material	1 Sealed	Pits and/or fissures are at least partially covered with a sealant material
2 Dentine	Internal caries-related discolouration in dentine. The lesion appears as shadows of discoloured dentine visible through an apparently intact enamel which may or may not exhibit localised breakdown	2 Restored	A cavity has been restored with an (in)direct restorative material currently without a dentine carious lesion and no fistula/abscess present	2 Restored	A cavity is restored with an (in)direct restorative material
3 Dentine	Distinct cavity with or without visible dentine. No (expected) pulpal involvement. Cavitation in opaque or discoloured enamel exposing the dentine beneath, no (expected) pulpal involvement	3 Enamel	Distinct visual change in enamel. A clear carious related discolouration (white or brown in colour) is visible, with or without localised enamel breakdown without clinical signs of dentinal involvement	3 Enamel	Distinct visual change in enamel only. A clear caries-related discolouration is visible, with or without localised enamel breakdown
4 Pulp	Pulpal involvement. The opening of the pulp chamber is visible or the coronal tooth structures have been destroyed by the caries process and only root fragments are left	4 Dentine	Internal caries-related discolouration in dentine. The lesion appears as shadows of discoloured dentine through enamel which may or may not exhibit a visible localised breakdown	4 Dentine	Internal caries-related discolouration in dentine. The discoloured dentine is visible through enamel which may or may not exhibit a visible localised breakdown of enamel
5 Pulp	Abscess/fistula. A pus-containing swelling or a pus-releasing sinus tract related to a tooth with pulpal involvement due to dental caries is present	5 Dentine	Distinct cavitation into dentine. No (expected) pulpal involvement	5 Dentine	Distinct cavitation into dentine. The pulp chamber is intact
6 Missing	Tooth has been extracted because of dental caries	6 Pulp	Involvement of the pulp chamber. Distinct cavitation reaching the pulp chamber or only root fragments are present	6 Pulp	Involvement of the pulp chamber. Distinct cavitation reaching the pulp chamber or only root fragments are present
7 Filled	A tooth cavity has been restored with a longlasting restorative material without a dentine carious lesion associated with it and no fistula/abscess present	7 Abscess/fistula	A pus-containing swelling or a pus-releasing sinus tract related to a tooth with pulpal involvement due to caries is present	7 Abscess/fistula	A pus-containing swelling or a-pus-releasing sinus tract related to a tooth with pulpal involvement
9	Unable to diagnose	8 Lost	The tooth has been removed because of dental caries	8 Lost	The tooth has been removed because of dental caries
		9	Does not match to any of the other descriptions	9	Does not correspond to any of the other descriptions