Table 3.

Staging and grading in DMFS160 index and treatment recommendations

Staging and grading based on clinical presentation and extent of RRC
Stage	Visual changes		Grade		The extent of tooth involvement
1	Early decalcification (chalky white or brown decalcification lines)		1		<25% of teeth affected by the worst stage
2	Cervical decay and/or incisal/cusp tip decay		2		Between 25%-50% of teeth affected by the worst stage
3	Enamel delamination		3		Between 50%-75% of teeth affected by the worst stage
4	Crown amputation		4		>75% of teeth affected by the worst stage
Treatment recommendations based on the stage and grade of RRC
Stage	Stage 1	Stage 2	Stage 3	Stage 3	Stage 4	Stage 4
Grade	Any grade	Any grade	Grade 1-3	Grade 4	Grade 1-2	Grade 3-4
Treatment recommendations	Oral hygiene instructions Daily application of topical fluoride Oral hygiene assessment every 3-4 months initially, after every 6 months on achieving stability	As per Stage 1 Avoid restoring teeth that are cleansable and are able to remineralize through use of topical fluoride SDF should be considered for circumferential lesions or root lesions Restorations to be done where appropriate, favoring amalgam, composite resin or resin-modified GIC in patients compliant with topical fluoride regimens, convention GIC to be given in noncomplaint patients	As per Stage 1 and 2 and In motivated patients and congenital conditions involving the enamel/dentin to teeth with enamel delamination, consider application of restorative techniques from pediatric dentistry Extraction of nonrestorable teeth in fields >50 Gy Within high-dose fields (>50 Gy), prophylactic endodontics and/or extractions	Consider use of SDF to maintain teeth as long as possible for mastication Extraction of nonrestorable teeth in fields below 50 Gy Within high-dose fields (>50 Gy), consider prophylactic endodontics and/or extractions as teeth become symptomatic	Maintain teeth with Stage 1, 2 or 3 lesions as per above Extraction of nonrestorable teeth in fields below 50 Gy Within high-dose fields (>50 Gy), consider prophylactic endodontics and/or extractions as teeth become symptomatic	Extraction of nonrestorable teeth in fields below 50 Gy Within high-dose fields (>50 Gy), consider prophylactic endodontics and/or extractions as teeth become symptomatic. Consider removable prosthodontic rehabilitation in motivated patients

GIC: Glass ionomer cements, SDF: Silver diamine fluoride, RRC: Radiation-related caries