{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:05:51Z","timestamp":1780067151431,"version":"3.54.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Saudi Dent. J."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To critically examine the structural limitations of the classical Decayed\u2013Missing\u2013Filled Teeth (DMFT) index and to propose a biologically structured, severity-adjusted conceptual framework through the Weighted DMFT (W-DMFT) model. This study presents a conceptual\u2013analytic framework without quantitative field data. The methodological constraints of the DMFT index were examined across four domains: biological progression, functional impact, radiographic detectability, and restorative assessment. Based on the enamel\u2013dentin\u2013pulp hierarchy, a structured weighting system (0\u20133) was developed to reflect increasing biological invasion and functional consequences.The W-DMFT score is expressed as a severity-adjusted mean value per tooth. The classical DMFT index applies uniform scoring that does not differentiate lesion depth or functional severity. In contrast, the W-DMFT model introduces hierarchical weighting to capture biological progression, incorporates radiographically detectable dentinal involvement, and numerically represents functional impairment. The model provides a theoretically enhanced framework for severity-sensitive caries assessment. The W-DMFT model offers a structured conceptual extension of the classical DMFT by integrating lesion depth and functional considerations into epidemiological scoring. While biologically grounded, empirical validation studies are required to assess reliability, reproducibility, and population-level performance.<\/jats:p>","DOI":"10.1007\/s44445-026-00161-z","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:19:57Z","timestamp":1778743197000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The weighted DMFT (W-DMFT) model: A conceptual framework for severity-adjusted caries assessment in epidemiology"],"prefix":"10.1007","volume":"38","author":[{"given":"Necmi","family":"Namal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"issue":"1","key":"161_CR1","first-page":"3","volume":"22","author":"RA Bagramian","year":"2009","unstructured":"Bagramian RA, Garcia-Godoy F, Volpe AR (2009) The global increase in dental caries: a pandemic public health crisis. Am J Dent 22(1):3\u20138","journal-title":"Am J Dent"},{"issue":"4","key":"161_CR2","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1159\/000217855","volume":"43","author":"MM Braga","year":"2009","unstructured":"Braga MM, Oliveira LB, Bonini GAVC, B\u00f6necker M, Mendes FM (2009) Feasibility of the International Caries Detection and Assessment System (ICDAS-II) in epidemiological surveys and comparability with standard World Health Organization criteria. Caries Res 43(4):245\u2013249. https:\/\/doi.org\/10.1159\/000217855","journal-title":"Caries Res"},{"issue":"6","key":"161_CR3","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1111\/j.1600-0528.2005.00259.x","volume":"33","author":"JM Broadbent","year":"2005","unstructured":"Broadbent JM, Thomson WM (2005) For debate: problems with the DMF index pertaining to data analysis. Community Dent Oral Epidemiol 33(6):400\u2013409","journal-title":"Community Dent Oral Epidemiol"},{"issue":"3","key":"161_CR4","doi-asserted-by":"publisher","first-page":"225","DOI":"10.2341\/06-58","volume":"32","author":"KR Ekstrand","year":"2007","unstructured":"Ekstrand KR, Martignon S, Ricketts DJ, Qvist V (2007) Detection and control of undermined enamel caries lesions: a methodological study. Oper Dent 32(3):225\u2013235. https:\/\/doi.org\/10.2341\/06-58","journal-title":"Oper Dent"},{"issue":"7","key":"161_CR5","doi-asserted-by":"publisher","first-page":"887","DOI":"10.14219\/jada.archive.2000.0307","volume":"131","author":"JD Featherstone","year":"2000","unstructured":"Featherstone JD (2000) The science and practice of caries prevention. J Am Dent Assoc 131(7):887\u2013899. https:\/\/doi.org\/10.14219\/jada.archive.2000.0307","journal-title":"J Am Dent Assoc"},{"issue":"3","key":"161_CR6","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.1875-595X.2011.00022.x","volume":"61","author":"JE Frencken","year":"2011","unstructured":"Frencken JE, de Amorim RG, Faber J, Leal SC (2011) The caries assessment spectrum and treatment (CAST) index: rational and development. Int Dent J 61(3):117\u2013123. https:\/\/doi.org\/10.1111\/j.1875-595X.2011.00022.x","journal-title":"Int Dent J"},{"issue":"4","key":"161_CR7","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/0022034520908533","volume":"99","author":"GBD 2017 Oral Disorders Collaborators","year":"2020","unstructured":"GBD 2017 Oral Disorders Collaborators (2020) Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the Global Burden of Disease 2017 Study. J Dent Res 99(4):362\u2013373. https:\/\/doi.org\/10.1177\/0022034520908533","journal-title":"J Dent Res"},{"issue":"Suppl 1","key":"161_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6831-15-S1-S9","volume":"15","author":"AI Ismail","year":"2015","unstructured":"Ismail AI, Pitts NB, Tellez M (2015) The International Caries Classification and Management System (ICCMS\u2122): an example of a caries management pathway. BMC Oral Health 15(Suppl 1):S9. https:\/\/doi.org\/10.1186\/1472-6831-15-S1-S9","journal-title":"BMC Oral Health"},{"issue":"19","key":"161_CR9","doi-asserted-by":"publisher","first-page":"751","DOI":"10.2307\/4582532","volume":"53","author":"H Klein","year":"1938","unstructured":"Klein H, Palmer CE, Knutson JW (1938) Studies on dental caries: I. Dental status and dental needs of elementary school children. Public Health Rep 53(19):751\u2013765","journal-title":"Public Health Rep"},{"issue":"1","key":"161_CR10","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/j.1600-0528.1996.tb00809.x","volume":"24","author":"JM Lewis","year":"1996","unstructured":"Lewis JM (1996) Improving dental health status indicators for evaluation. Community Dent Oral Epidemiol 24(1):32\u201336","journal-title":"Community Dent Oral Epidemiol"},{"issue":"6","key":"161_CR11","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1111\/j.1600-0528.1993.tb01102.x","volume":"21","author":"WS Marcenes","year":"1993","unstructured":"Marcenes WS, Sheiham A (1993) Composite indicators of dental health: total dental health (T-health). Community Dent Oral Epidemiol 21(6):374\u2013378","journal-title":"Community Dent Oral Epidemiol"},{"issue":"3","key":"161_CR12","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1159\/000077752","volume":"38","author":"TM Marthaler","year":"2004","unstructured":"Marthaler TM (2004) Changes in dental caries 1953\u20132003. Caries Res 38(3):173\u2013181. https:\/\/doi.org\/10.1159\/000077752","journal-title":"Caries Res"},{"issue":"1","key":"161_CR13","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1111\/j.1600-0528.2009.00514.x","volume":"38","author":"B Monse","year":"2010","unstructured":"Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W (2010) PUFA\u2014an index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 38(1):77\u201382. https:\/\/doi.org\/10.1111\/j.1600-0528.2009.00514.x","journal-title":"Community Dent Oral Epidemiol"},{"issue":"2","key":"161_CR14","first-page":"103","volume":"25","author":"N Namal","year":"2008","unstructured":"Namal N, Sheiham A (2008) Comparison of ranking dental status using the DMFT index and sound teeth index. Community Dent Health 25(2):103\u2013106","journal-title":"Community Dent Health"},{"issue":"6","key":"161_CR15","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/j.1875-595X.2005.tb00049.x","volume":"55","author":"N Namal","year":"2005","unstructured":"Namal N, Vehid S, Sheiham A (2005) Ranking countries by dental status using the DMFT and FS-T indices. Int Dent J 55(6):373\u2013376","journal-title":"Int Dent J"},{"issue":"1","key":"161_CR16","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/cdoe.12000","volume":"41","author":"NB Pitts","year":"2013","unstructured":"Pitts NB, Ekstrand KR (2013) International caries detection and assessment system (ICDAS) and its integration with other methods for caries detection and assessment. Community Dent Oral Epidemiol 41(1):41\u201352. https:\/\/doi.org\/10.1111\/cdoe.12000","journal-title":"Community Dent Oral Epidemiol"},{"key":"161_CR17","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.30","volume":"3","author":"NB Pitts","year":"2017","unstructured":"Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F et al (2017) Dental caries. Nat Rev Dis Primers 3:17030. https:\/\/doi.org\/10.1038\/nrdp.2017.30","journal-title":"Nat Rev Dis Primers"},{"issue":"4","key":"161_CR18","first-page":"407","volume":"4","author":"A Sheiham","year":"1987","unstructured":"Sheiham A, Maizels J (1987) New composite indicators of dental health. Community Dent Health 4(4):407\u2013414","journal-title":"Community Dent Health"}],"container-title":["The Saudi Dental Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44445-026-00161-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44445-026-00161-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44445-026-00161-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:29:21Z","timestamp":1780064961000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44445-026-00161-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["161"],"URL":"https:\/\/doi.org\/10.1007\/s44445-026-00161-z","relation":{},"ISSN":["1013-9052","2524-1702"],"issn-type":[{"value":"1013-9052","type":"print"},{"value":"2524-1702","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"7 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was not required, as this study involved no human participants, clinical data, or patient-level information.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"71"}}