UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3650
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3650
Perceptions on using the International Caries Detection and
Assessment System (ICDAS) among Malaysian private dentists:
a qualitative study
Percepções sobre o uso do Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS) entre dentistas privados da
Malásia: um estudo qualitativo
Wen Wu TAN
1
, Galvin Sim Siang LIN
2
, Hasnah HASHIM
1
1 - Asian Institute of Medicine, Science and Technology (AIMST), Faculty of Dentistry, Department of Dental Public Health. Bedong,
Kedah, Malaysia.
2 - Asian Institute of Medicine, Science and Technology (AIMST), Faculty of Dentistry, Department of Dental Materials. Bedong, Kedah,
Malaysia.
How to cite: Tan WW, Lin GSS, Hashim H. Perceptions on using the International Caries Detection and Assessment System (ICDAS)
among Malaysian private dentists: a qualitative study. Braz Dent Sci. 2023;26(2):e3650. https://doi.org/10.4322/bds.2023.e3650
ABSTRACT
Objective: to explore the perceptions of Malaysian private dentists on the use of the International Caries Detection
and Assessment System (ICDAS) in their dental practice. Material and Methods: this qualitative study involved
individual interviews with twelve general dental practitioners working in the private sector, who has been
exposed to ICDAS training during their undergraduate study. Purposive sampling was carried out among private
dentists in Malaysia from various states to reect diversity. The interviews were recorded and transcribed. Data
analysis was conducted by thematic analysis. Results: ve main barriers were identied through the coding
process, namely time factors, lack of training, having no effect on treatment planning, charting difculties, and
low patient awareness on prevention. Better training and a strong requirement by the authorities to use this
system were identied as the enabling factors. Conclusion: private dentists in Malaysia encountered a myriad
of challenges in adopting the ICDAS index. Hence, it is necessary to provide adequate training and assistance in
understanding the benets of utilizing the ICDAS system, and computerization of data input.
KEYWORDS
Dental caries; Dental education; Dentists; Patient care; Qualitative research.
RESUMO
Objetivo: explorar as percepções de dentistas particulares da Malásia sobre o uso do Sistema Internacional de
Detecção e Avaliação de Cárie (ICDAS) em sua prática odontológica. Material e Métodos: este estudo qualitativo
envolveu entrevistas individuais com doze clínicos gerais que trabalham no setor privado, que foram expostos
ao treinamento ICDAS durante seu estudo de graduação. Uma amostra intencional foi realizada com dentistas
particulares na Malásia de vários estados com intuito de reetir a diversidade. As entrevistas foram gravadas
e transcritas. A análise dos dados foi realizada pela análise temática. Resultados: cinco barreiras principais
foram identicadas durante o processo de codicação, ou seja, fatores como o tempo, falta de treinamento, o
não planejamento do tratamento, diculdades de registro e baixa conscientização do paciente sobre prevenção.
Foram identicados como fatores facilitadores um melhor treinamento e uma forte exigência das autoridades
para usar este sistema. Conclusão: dentistas particulares na Malásia encontraram uma innidade de desaos
na adoção do índice ICDAS. Portanto, é necessário fornecer treinamento e assistência adequados para entender
os benefícios da utilização do sistema ICDAS e da informatização da entrada de dados.
PALAVRAS-CHAVE
Cárie dentária; Educação odontológica; Dentistas; Atendimento ao paciente; Pesquisa qualitativa.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3650
Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
INTRODUCTION
Dental caries is one of the most common
oral diseases that afflict adults and children
worldwide. According to the Global Burden of
Disease Study 2019, 2 billion individuals suffered
from caries of permanent teeth and more than
520 million children suffered from caries of
deciduous teeth [1]. Several caries detection and
evaluation techniques have been proposed across
the globe, but no single standard system has yet
to be agreed upon and practised among dentists
and researchers [2]. This has rendered comparing
caries detection outcomes in epidemiological
and clinical investigations challenging. To date,
the decayed, missing, and lled (DMF) index
developed by Klein, Palmer and Knuston in
1938 remains the most widely used index in
epidemiological studies due to its simplicity and
acceptability worldwide [3,4]. Nonetheless, the
DMF index has a number of flaws, including
equal weighting for decayed (D), missing (M),
and lled (F) teeth, failure to account for tooth
loss for reasons other than decay, and a lack
of emphasis on non-cavitated teeth at risk of
developing caries [3,5].
To address all these problems, the
International caries detection and assessment
system (ICDAS) was developed after intensive
research and systematic review of existing
caries classication and measurement systems
by clinicians and academics across Europe and
America [6]. ICDAS introduces a novel strategy
for measuring dental caries that answers concerns
faced by earlier systems, such as which stages
of the caries process should be monitored,
how to dene each stage, how to identify each
stage clinically, and how to assure the best
examiner reliability [6]. This system has been
adopted and recommended for inclusion in the
Cariology module for undergraduate dental
students in several countries as a benchmark
for epidemiological and clinical research [6-8].
It can be inferred that clinical decision-making
may be signicantly inuenced by ICDAS for its
substantial correlation with the development of
caries. However, there is insufcient evidence
to support the adoption of ICDAS into clinical
practice and the exact number of dentists who
have undergone training in ICDAS is still unclear.
Previously published data on ICDAS has
mostly centred on establishing the index’s
reliability, reproducibility, validity, and
accuracy [9,10]. In a research of West Yorkshire
dentists’ perspectives and experiences [11], it
was discovered that dentists experienced various
hurdles in applying it, including a lack of simplicity,
financial constraints, and time limitations.
Nevertheless, study exploring the barriers faced
by clinicians and researchers in using the ICDAS
index is still scarce in the literature. Patients in
a private dental setting often receive care from
several different dentists, and the adoption of a
universal caries assessment tool makes it easier
for other dentists to monitor the patient’s progress
or manage any complications that arise later.
Additionally, as air drying is a need for the use
of ICDAS, it would aid in the identication of
caries in the pre-cavitated stage, allowing for the
execution of preventative treatment [12]. This
is essential since private practices are gradually
shifting away from patient-centred treatment and
toward a greater emphasis on patients’ primary
complaints. Therefore, a standardized caries
detection system implementation is necessary
to improve practitioner communication and to
support the use of minimally invasive dentistry
to provide each patient with individualised dental
care [13].
To the best of our knowledge, no comparable
study has been conducted in Malaysia, and it
is critical to understand Malaysian dentists’
perceptions of the barriers to utilizing the ICDAS
index given that Malaysian dental education is
shifting from DMFT to ICDAS. Hence, to address
this gap, a qualitative study was conducted to
explore the barriers, views, and experiences of
Malaysian private dentists in using the ICDAS
index for caries detection in their dental practices.
MATERIALS AND METHODS
Study design
This qualitative study focused on exploring
the perceptions of private dentists in Malaysia
when using the ICDAS index. Ethical approval
was obtained by a local private university
research ethics committee with ethical approval
reference: AUHAE/FOD/2022/01. In the present
context, a private dentist refers to a private
dentist who is a general dental practitioner
with a professional dental license who practices
dentistry in private settings. The present study
was reported following the Consolidated Criteria
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3650
Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
for Reporting Qualitative Research (COREQ)
checklist [14].
Participants recruitment and the interview
process
After a thorough evaluation of the existing
literature [11,15,16], a topic guide was created
for this study, which was then content validated
by a dental public health specialist. Suitable
candidates were emailed participant information
sheets and requested to contact the research
team if they were interested in participating in
the study. The information sheets for participants
highlighted that participation was voluntary,
that the interview would be video-recorded, and
that individuals were allowed to withdraw from
the study at any point before the results were
published.
To represent the study’s diversity, purposive
sampling was conducted among private dentists
practicing in Malaysia from various states. Private
dentists who are registered with the Malaysia
Dental Council, have a valid annual practicing
certicate in Malaysia, and have prior exposure to
ICDAS system during their undergraduate studies
are deemed eligible for the study. A one-on-one
semi-structured interview method was selected
to explore in-depth the views and experiences of
private dentists on the usage of the ICDAS system.
Open-ended questions were asked:
• Are you currently using ICDAS index system
in your daily dental practice. If yes/no, why?
• How would you perceive the dental charting
system that you are currently practicing as
compared to the ICDAS system?
• Do you think that there will be a cultural shift
from your normal caries diagnosis practice
to using ICDAS?
• Is there any concern or difculty arise when
employing the ICDAS system in your daily
dental practice?
• Do you think that ICDAS should be
implemented in your practice? If yes/no,
why?”
A total of sixteen invitations were sent
to eligible participants and twelve of them
responded. Verbal and written consent were
obtained from the twelve participants who agreed
to take part in this study. Before the interview
began, the participants were given the chance
to clarify any doubts with the researchers.
The interview took place using Zoom Video
Communication Software from March 2022 to
May 2022. Participants were allowed to join
the virtual interview session at any location
convenient to them. Each session lasted for around
20 to 30 minutes and the nal audio recordings
were anonymized and transcribed verbatim.
Two facilitators who had prior experience in
qualitative research were present during each of
the sessions, with WWT leading the discussion
and GSSL providing inputs. The facilitators were
not known to the participants prior to the study.
Data collection
The researchers met often during the data
collection period to discuss the recurrent themes
identied during the interview sessions. When
all the researchers reached the conclusion that
no new themes were emerging, data collection
was halted. Data saturation was achieved after
interviewing 12 participants.
Data synthesis
Phenomenology was selected as the
methodology for this study as it involved the
exploration and identification of people’s
experiences [17]. The data was analysed using
thematic analysis. Preliminary coding was carried
out by one investigator (WWT) using NVIVO
12 software. A discussion was carried out with
other members of the research team (GSSL,
HH) to further develop and refine the codes.
Any inconsistencies in the coding process were
resolved through discussion and verification
among all members of the research team.
RESULTS
The characteristics of the study participants
are listed in Table I. Five main themes were
developed inductively through the coding process
namely
time factors
,
lack of training
,
no effect
on treatment planning
,
charting difculties
, and
low patient awareness on prevention
. In a Venn
diagram [18], these ve themes were linked with
an explanatory model to form the conceptual
framework of the present study (Figure 1).
Theme 1: Time factors
Most participants mentioned that time factor
was the main reason for not using the ICDAS
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Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
index in their private practice. The time factor
was highlighted in two contexts: time-consuming
to use the system and time constraints in the
practice. The ICDAS was deemed too time-
consuming by the participants.
Participant 5:
“I think ICDAS is more time-
consuming also, because you have to air dry
every single tooth.”
Participant 6:
“It’s
[ICDAS]
a waste of time to
air blow all faces … if you’re considering class
one or class two code (code 1 or code 2).”
Participant 11:
“I think it’s
[ICDAS]
a
burden.... If you have to code every single
caries in this coding, I think it might be a
time-consuming issue.”
Few participants claimed that they were
unable to practise the ICDAS index due to time
constraints in their practice. This was observed
at peak hours or when they had a larger number
of patients to attend to.
Participant 1:
“Sometimes for the peak hour,
the patient will come back to back. So it’s
Table I - Participant’s characteristics
Participants Sex Years in Private Practice Location of Practice
Participant 1 M 7 months Johor
Participant 2 F 3 years Kuala Lumpur
Participant 3 M 1 year Johor
Participant 4 M 2 years Sarawak
Participant 5 F 5 months Kedah
Participant 6 F 3 years Kuala Lumpur
Participant 7 F 1 year Sabah
Participant 8 F 1 year Sarawak
Participant 9 F 1 year Selangor
Participant 10 F 3 years Johor
Participant 11 M 1 year Johor
Participant 12 F 2 years Johor
Figure 1 - Conceptual framework of themes with barriers to implementing the ICDAS index among Malaysian private dentists
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Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
really impossible for me to jot down every
single moment.”
Participant 9:
“…when I have more patients
or when I have some time limitation, I will
switch back to using blacks classication,
which is a bit more straight forward and
yeah, fast for me.”
Theme 2: Lack of training
Most participants interviewed for this study
showed varying degrees of understanding of the
ICDAS index. Many expressed their concern for
not completely understanding the system: from
assessing caries to differentiating each individual
code, as well as difculty in communicating with
other colleagaues due to lack of training.
Participant 1:
“Maybe the scoring system, I
am not really familiar about that
[ICDAS]
.”
Participant 2:
“Enamel caries is harder to
differentiate between 1, 2 and 3……. 1 and
2
[ICDAS codes]
is a bit ambiguous.”
Participant 10:
“Especially between one
and two
[ICDAS codes],
I assume. Yeah.
Yeah. The ones that are a bit... a bit... vague
area….”
Participants also remarked on the system’s
complexity and the resulting confusion when
utilizing it.
Participant 7:
“ICDAS is a bit confusing …...
because it’s too detailed to describe ... when
I was learning ICDAS, the categorization is
a bit confusing.”
Participant 9:
“There’s
[ICDAS]
two digits,
right? ….. I think that part is quite confusing.”
Communication issue among colleagues was
cited as a big challenge when using the ICDAS
index as some dentists and dental nurses were
not trained in using the index.
Participant 9:
“When I use ICDAS …… I do
have colleagues coming to me to ask me
what does the code mean. And also my nurse
is not trained in ICDAS ……. and they don’t
really understand.”
Participant 11:
“For us to simplify
our communication and avoid any
miscommunication with the... staff or
with... the older dentist, we better use a …...
universal system instead of trying to use the
new coding and make people confuse.”
Theme 3: No effect on treatment planning
Most participants believed that using the
ICDAS index would have little inuence on their
treatment planning. As a result, many people
have decided not to adopt it in their practice.
Participant 2:
“If it’s code 3,4,5
[ICDAS]
we
still do the same treatment… in terms of
treatment planning, I don’t think it makes
that much of a difference.”
Participant 3:
“So actually there’s not much
difference for code 3 and code 4
[ICDAS]
the treatment plans.”
Participant 5:
“If based on just treatment
planning, I would say it wouldn’t really affect
much …...”
Participants also did not fully understand the
rationale for using the ICDAS index. They felt that
regardless of the score, the management would
be the same for dental caries.
Participant 1:
“If you suddenly want me
to use the ICDAS score, I feel why? Why
should I? Can you tell me the exact reason
of using it?”
Participant 7:
“The ICDAS codes from one
to six, doesn’t really matter to us actually.
As long as it’s a caries, we need to ll it.”
Theme 4: Charting difculties
The use of the ICDAS index by private
dentists was further hampered by an issue with
an out-of-date dental chart. Participants indicated
that using the ICDAS index would leave them
with insufcient space to insert all the codes.
Participant 2:
“I don’t think there is any
dental charting diagram that allows ICDAS
coding.”
Participant 5:
“…our charting form, there
is no space to write numbers. There’s only
the tooth surface. So it was just caries or no
caries. So if we want to use ICDAS …… will
become more messy.”
The ICDAS index was not included in the
program for individuals who used a computerized
system.
Participant 1: “The software we are using
now …. didn’t include such ICDAS coding
in the system.”
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Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
Theme 5: Low patient awareness on
prevention
The poor understanding of the ICDAS index
among patients also impeded its usage by
private dentists. The majority of patients
were unconcerned about early preventative
treatment and merely wanted their primary
problem addressed. As a result, many
dentists were put off by the ICDAS index
and decided not to utilize it in their practice.
Participant 4:
“When the patient doesn’t
care, then the dentist won’t use it
[ICDAS]
…”
Participant 5:
“…when we do ICDAS, maybe
the patients sometimes they’re not very
concerned when you tell them about white
spot lesion….”
Participant 12:
“… if you were to propose,
say fluoride treatment for a white spot
lesion, the patients here won’t take it…”
Participant 10:
“…patient is not keen to do
any of the treatment that you are proposing
according to your code
[ICDAS]
.”
Potential facilitators on the use of ICDAS
index
Apart from expressing their views on the
barriers to using the ICDAS index, participants
also provided suggestions to increase the uptake
of such an index among private dentists in their
daily dental practice. Few participants claimed
that providing more training for the dental team
would help to overcome the barriers and enable
them to understand the benets of the ICDAS
index.
Participant 6:
“Maybe we can conduct more
workshops to let the dentists know, the
importance of ICDAS codes...”
Participant 4:
“What you can do is just to …
keep educating the dentists regarding the
system...and provide training.”
Participant 3:
“I think they
[dentists]
need
more training.”
It was also highlighted that a strong
government execution is required to ensure that
this system will be adopted by private dentists
in Malaysia.
Participant 3:
“Government needs a strong
implementation for this
[ICDAS]
in every
clinic in Malaysia.”
Participant 7:
“…when they make it
[ICDAS],
a compulsory thing, only we will use...”
Participant 12:
“…if they make it into black
and white and legally, we have to use it
[ICDAS]
…”
DISCUSSION
The aim of the present study was to explore
the perceptions of the use of ICDAS index among
Malaysian private dentists. Since May 2002, the
ICDAS Coordinating Committee has gradually
improved the ICDAS system to enhance the
detection of dental caries even at the non-
cavitated stage, supporting more preventative
and less invasive caries management in general
dentistry [16]. To the best of the authors’
knowledge, the current study is the rst of its
kind to investigate the perceptions of Malaysian
private dentists in using the ICDAS index. The
present study has established ve theme barrier
categories: time factors, lack of training, no impact
on treatment planning, charting difculties, and
low patient awareness on prevention. This could
help curriculum developers gure out how to
tailor current undergraduate dental programs
for competency-based dental education in the
implementation of ICDAS index while performing
dental charting.
Time-consuming to utilize the system and
time constraints in practice were sub-themes
under time factors. Cleaning and drying the
teeth is a prerequisite to using the ICDAS system,
which is particularly useful in detecting non-
cavitated lesions [19]. One may hypothesize that
dentists may not have time to clean and dry every
tooth before dental charting in a hectic dental
clinic, especially during peak hours. However,
a previous study has refuted such a hypothesis
stating that dentists only need to spend less
than ve minutes on average on both adults and
children to assess patients’ caries status using the
ICDAS protocol including brushing and drying
time [15]. Hence, the authors postulate that time
factor may become less signicant with adequate
training and experience among dentists.
ICDAS assessment is a new approach for
most dental practitioners. Despite the fact that the
majority of the respondents were junior dentists
with less than three years of private practice
experience, several acknowledged not utilizing
ICDAS since they did not obtain explicit guidance
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Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
during their undergraduate studies [11]. In
tandem, Al Dhubayb et al. [20] discovered that
only 23% of the 100 private dentists surveyed
used the ICDAS code in their practice, citing a
lack of training as a contributing issue. Although
ICDAS was established in the early to mid-2000s,
several Malaysian dental schools just started using
it to replace the DMF index in the curriculum less
than 10 years ago [8]. It is heartening, though,
that the vast majority of nal-year undergraduate
dental students in the country felt confident
in employing the system in clinical practice,
according to recent research [22].
Nevertheless, the ambiguous goal of
implementing ICDAS in the clinic could possibly
add to the hesitancy among dentists. Several
respondents believed that the index would have
no inuence on the treatment plan if the dental
problem was unrelated to the patient’s primary
complaint. Indeed, a prior study among general
dental practitioners in England revealed that
a lack of nancial incentives deterred private
practitioners from utilizing ICDAS in their clinical
practice [11]. Some of the challenges to adoption
may be addressed by a clear understanding of
the system’s benets, such as identifying caries
in the pre-cavitated stage. Even though private
dentists would probably prefer to perform more
nancially rewarding treatments, many would
still advocate for preventative and conservative
procedures for their patients [23-25].
The authors believed that many of the
challenges encountered by dentists when
implementing the ICDAS code in their daily work
are the consequence of an interplay between the
theme categories discussed herein. For instance,
dentists may nd it challenging to effectively
record patients’ dental status using the index in
a timely manner due to a lack of training and
charting issues [11]. The charting concerns will
be indirectly remedied with proper training,
and the existing charts that dentists use may be
gradually improved to t the ICDAS standards.
Nonetheless, ICDAS codes may now be recorded
using software, allowing for convenient data
storage and retrieval at any time [26].
The current evidence has also suggested
that caries classication using a modied ICDAS
produced favourable intra-rater consistency levels
in a cohort of Malaysian dental undergraduates,
even among students who had never used the
system before [27]. Similar results were obtained
by Ahlawat et al. [8], reporting good to excellent
intra and inter-examiner agreement among
practitioners at a private Malaysian dental school.
Moreover, the merged ICDAS with only three
categories for caries severity: initial, moderate,
and extensive was introduced in 2013 [16]. This
modication acknowledges the time constraints
in clinical practice as well as the complexity
of the complete six-stage ICDAS codes. It also
takes into account that there is little clinical
benet in distinguishing between the two earliest
stages of enamel caries (ICDAS 1 and 2), which
some practitioners reported to be challenging.
Therefore, it is not surprising that once the
modied or merged version of the ICDAS system
is used, the concern about the difficulties of
dental charting and time factor would gradually
fade among dental practitioners.
A key theme found in the present study
relating to low patient awareness of ICDAS
clinical value in caries prevention emphasizes
the importance of taking the time to explain
clinical ndings to patients. This is in line with
the patient-centred approach in healthcare, which
involves the patient in decision-making through
‘informed wishes’ [28], which is achieved by
patient engagement and clear explanation by
the healthcare practitioner [29]. The common
themes that emerged from the current research
on the facilitators of ICDAS use appear to be
twofold: greater training and strong authority
directions. Aside from training provided by
dental professional bodies, dentists can strive
to enhance their skills by utilizing online self-
learning platforms [30]. Simultaneously, the
clinic’s support staff must be capable of aiding
dentists in documenting ICDAS stages. Moreover,
mandates from government agencies to apply the
system may not be practicable or well-received
by the dental community, but continual efforts
to raise awareness and promote the system’s use
are prudent [31].
There were several flaws identified in
the present research. For instance, since the
current study utilized purposeful sampling,
the results should be interpreted carefully as
generalizability may be restricted. Furthermore,
both the interviewer’s performance and the
questions asked may have the potential to be
prejudiced. However, the authors considered
that by employing semi-structured interviews
to guide interviewer questions, the risk may be
effectively addressed. Bias may also arise during
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Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
the recruitment process as the participants who
responded and agreed to take part in the study
may be well versed with the use of the ICDAS
index. Nevertheless, the present qualitative
ndings contribute to the body of knowledge
on the ICDAS system’s adoption by lling a gap
in identifying the hurdles and facilitators to
ICDAS implementation among Malaysian private
dentists.
CONCLUSION
Private dentists in Malaysia encountered a
myriad of challenges in adopting the ICDAS index
in their primary care practices, many of which had
relatively straightforward solutions. Increasing
the acceptance of the ICDAS index among private
dentists in Malaysia may be accomplished by
offering them adequate training, assisting them
in understanding the benefits of utilizing the
system, and computerizing data input.
Author’s Contributions
WWT: Conceptualization; Methodology;
Investigation; Data curation; Writing-original
draft. GSSL: Formal analysis; Resources; Data
curation; Writing – Review & Editing. HH: Data
curation; Writing – Review & Editing.
Conict of Interest
The authors declared no conict of interest.
Funding
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
The study was approved by the Asian
Institute of Medicine, Science and Technology
(AIMST) University Human and Animal Ethics
Committee (AUHAEC) with ethical approval code
AUHAE/FOD/2022/01.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3650
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection and Assessment System (ICDAS) among Malaysian private dentists: a qualitative study
Tan WW et al.
Perceptions on using the International Caries Detection
and Assessment System (ICDAS) among Malaysian private
dentists: a qualitative study
Date submitted: 2022 Oct 10
Accept submission: 2023 Jan 31
Wen Wu Tan
(Corresponding address)
Asian Institute of Medicine, Science and Technology, Faculty of Dentistry,
Department of Dental Public Health, Bedong, Kedah, Malaysia.
Email: tan_wen@aimst.edu.my
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