Under the lens: Critical review of dental caries indices

Dental caries remains a highly prevalent chronic disease globally. Accurate measurement of caries experience and severity is fundamental for surveillance, planning, and evaluation of oral health interventions. Numerous dental caries indices have been developed over time, reflecting evolving concepts of caries as a dynamic and multifactorial process. However, variability in diagnostic thresholds and scope limits comparability across studies. The objective of the article is to critically review and compare major dental caries indices and evaluate their strengths, limitations, and applicability in clinical, epidemiological, and public health contexts. A narrative review of conventional and contemporary dental caries indices was undertaken. Indices were analyzed based on diagnostic sensitivity, ability to detect early lesions, and disease activity, feasibility, and suitability for different applications. Traditional indices such as decayed, missing, and filled teeth/decayed, missing, filled surfaces and (def/defs) remain widely used for population-level surveillance due to their simplicity and historical continuity, but they underestimate disease burden by excluding early lesions and activity status. Contemporary systems, including the international caries detection and assessment system II and Nyvad’s criteria, provide detailed staging and activity assessment but are resource-intensive and technique-sensitive. Indices such as caries assessment spectrum and treatment offer an integrated continuum of caries progression and treatment needs, while pulpal involvement, ulceration, fistula, abscess highlight the consequences of untreated disease. The Significant caries index effectively identifies high-risk subgroups but lacks diagnostic value. No single index comprehensively captures caries initiation, progression, activity, and consequences. Index selection should be guided by study objectives and resource availability. Future research should focus on developing integrated, standardized frameworks that balance diagnostic sensitivity with feasibility to enhance comparability and translational value across settings.