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CLASSIFICATION OF DENTAL
CARIES
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DEFINITION
DENTAL CARIES IS AN IRREVERSIBLEMICROBIAL DISEASE OF THE CALCIFIEDTISSUES OF THE TEETH, CHARACTERIZED BYDEMINERALIZATION OF THE INORGANICPORTION AND DESTRUCTION OF THEORGANIC SUBSTANCE OF THE TOOTH , WHICH
OFTEN LEADS TO CAVITATION
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8. BASED ON CHRONOLOGY
9 .BASED ON WHETHER CARIES IS COMPLETLYREMOVEDOR NOT DURING TREATMENT
10.BASED ON TOOTH SURFACETO BE
RESTORED11.BLACKS CLASSIFICATION
12.WHO SYSTEM
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1.BASED ON ANATOMICAL SITE
OCCLUSAL
(PIT AND
FISSURE)
ROOT
CARIES
SMOOTH
SURFACE
CARIES
(PROXIMAL
AND CERVICAL
CARIES)
LINEAR
ENAMEL
CARIES
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PIT AND FISSURE CARIES
Highest prevalanceof all caries bacteria rapidly colonizethe pits and fissures of the newly erupted teeth
These early colonizers form a bacterial plug that
remains in the site for long time ,perhaps even the life of
the tooth
Type & nature of the organisms prevalent in the oral
cavity determine the type of organisms colonizing the pit
& fissure
Numerous gram positive cocci, especially dominated by
s.sanguisare found in the newly erupted teeth.
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The appearance ofs.mutansin pits and fissures is
usually followed by caries 6 to 24 months later.
Sealing of pits and fissures just after tooth
eruption may be the most important event in their
resistance to caries.
Shape, morphological variation and depth of pitand fissures contributes to their high susceptibility
to caries.
Caries expand as it penetrates in to the enamel.
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MORPHOLOGY OF FISSURES
NANGO (1960):Based on the alphabeticaldescription of shape4 types
V&U type: self cleansing and somewhat caries
resistantU type: narrow slit like opening with a larger
base as it extend towards DEJ .Caries
susceptible; also have a number of differentbranches
K type: also very susceptible to caries
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Entry site may appear much smaller than
actual lesion, making clinical diagnosis
difficult. Carious lesion of pits and fissures develop
from attack on their walls.
In cross section, the gross appearance ofpit and fissure lesion is inverted Vwith a
narrow entrance and a progressively
wider area of involvement closer to theDEJ.
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The proximal surfaces are particularly susceptibleto caries due to extra shelter provided to resident
plaque owing to the proximal contact areaimmediately occlusal to plaque.
Lesion have a broad area of origin and a conical,or pointed extension towards DEJ.
V shapewith apex directed towards DEJ.
After caries penetrate the DEJ softening of dentinspread rapidly and pulpally
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Linear enamel caries
Linear enamel caries ( odontoclasia) is seen to occur in theregion of the neonatal lineof the maxillary anterior teeth.
The line, which represent a metabolic defect such ashypocalcemia or trauma of birth, may predispose to caries,leading to gross destruction of the labial surface of the teeth.
Morphological aspects of this type of caries are atypical andresults in gross destruction of the labial surfaces incisorteeth
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ROOT SURFACE CARIES The proximal root surface, particularly near the cervical line, often is
unaffected by the action of hygiene procedures, such as flossing,because it may have concave anatomic surfacecontours (fluting)andoccasional roughness at the termination of the enamel.
These conditions, when coupled with exposure to the oral environment(as a result of gingival recession), favor the formation of mature, caries-producing plaque and proximal root-surface caries.
Root-surface caries is more common in older patients.
Caries originating on the root is alarming because
1. it has a comparatively rapid progression
2. it is often asymptomatic
3. it is closer to the pulp
4, it is more difficult to restore
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The root surface is softer than the enamel and
readily allows plaque formation in the absence
of good oral hygiene. The cementum covering the root surface is
extremely thin and provides little resistance to
caries attack. Root caries lesions have less well-defined
margins, tend to be U-shaped in cross sections,
and progress more rapidly because of the lackof protection from and enamel covering.
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2.BASED ON PROGRESSION
ACUTE CARIES
CHRONIC CARIES
ARRESTED CARIES
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ACUTE CARIES
Acute caries is a rapid process involving a large numberof teeth.
These lesions are lighter colored than the other types,being light brown or grey, and their caseous consistency
makes the excavation difficult.
Pulp exposures and sensitive teethare often observed inpatients with acute caries.
It has been suggested that saliva does not easily
penetrate the small opening to the carious lesion, sothere are little opportunity for buffering or neutralizaton
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CHRONIC CARIES
These lesions are usually oflong-standinginvolvement,affect a fewer number of teeth, and are smaller than acute
caries.
Pain is not a common featurebecause of protection
afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery.
Pulp prognosis is hopeful in that the deepest of lesions
usually requires only prophylactic capping and protective
bases. The lesions range in depth and include those that have just
penetrated the enamel.
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ARRESTED CARIES:-
Caries which becomes stationary or static and doesnot show any tendency for further progression
Both deciduous and permanent affected
With the shift in the oral conditions, even advanced
lesions may become arrested . Arrested caries involving dentin shows a marked
brown pigmentation and induration of the lesion[the so called eburnation of dentin]
Sclerosis of dentinal tubules and secondary dentinformation commonly occur
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Exclusively seen in cariesof occlusal surfacewithlarge open cavity in whichthere is lack of food
retention Also on the proximal
surfaces of tooth in casesin which theadjacentapproximating tooth has
been extracted
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3.BASED ON VIRGINITY OF
LESION
INITIAL/PRIMARY RECURRENT/SECONDARY
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SECONDARY CARIES
(RECURRENT)
This type of caries is observed around the edges and underrestorations.
The common locations of secondary caries are the rough or
overhanging margin and fracture place in all locations of themouth.
It may be result of poor adaptationof a restoration, whichallows for a marginal leakage, or it may be due toinadequate extension of the restoration.
In addition caries may remain if there has not beencomplete excavation of the original lesion, which later mayappear as a residual or recurrent caries.
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4. BASED ON EXTENT OF CARIES
INCIPIENT CARIES
OCCULTCARIES
CAVITATION
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INCIPIENT CARIES The early caries lesion, best seen on the smooth
surface of teeth, is visible as a white spot.
Histologically the lesion has an apparently intact
surface layer overlying subsurface demineralization.
Significantly may such lesion can undergo
remineralizationand thus the lesion per se is not an
indication for restorative treatment
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These white spot lesion may be confusedinitially with white developmental defects of
enamel formation, which can be differentiatedby their position away from the gingival margin],their shape [unrelated to plaque accumulation]and their symmetry [they usually affect the
contralateral tooth]. Also on wetting the caries lesion disappear
while the developmental defect persist
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It is believed that bite wing and OPG radiographs along
with noninvasive adjuncts like fiber optic
transillumination (FOTI),laser luminescence, electricalresistance method (ERM) are used for diagnosis these
occlusal lesions.
These lesion are not associated with microorganisms
different to those found in other carious lesion. These carious lesion seem to increase with increasing age.
Occult carious lesion are usually seen with low caries rate
which is suggestive of increase fluid exposure.
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It is believed that increased fluid exposure
encourages remineralizationand slow down
progress of the caries in the pit and fissureenamel while the cavitations continues in
dentine, and the lesions become masked by a
relatively intact enamel surface.
These hidden lesions are called asfluoride
bombs or fluoride syndrome.
Recently it is seen that occult caries may have its
origin as pre-eruptive defects which aredetectable only with the use of radiographs.
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Once it reaches the
dentinoenamel junction, thecaries process has the potential
to spread to the pulp along the
dentinal tubules and also spread
in lateral direction.
Thus some amount of sensitivity
may be associated with this
type of lesion.
This may be generally
accompanied by cavitation
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5.Based on tissue involvement
1. Initial caries
2. Superficial caries
3. Moderate caries
4. Deep caries
5. Deep complicated caries
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Dental caries can be divided into 4 or 5 stages
Initial caries: Demineralization without
structural defect. This stage can be reversedby fluoridation and enhanced mouth
hygiene
Superficial caries(Cariessuperficialis):Enamel caries, wedge-shaped
structural defect. Caries has affected the
enamel layer, but has not yet penetrated the
dentin.
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3. Moderate caries(Caries media): Dentin caries.
Extensive structural defect. Caries has penetrated up
to the dentin and spreads two-dimensionally beneath
the enamel defect where the dentin offers little
resistance.
4. Deep caries(Caries profunda): Deep structural defect.
Caries has penetrated up to the dentin layers of thetooth close to the pulp.
5. Deep complicated caries(Caries profunda complicata)
:Caries has led to the opening of the pulp cavity
(pulpa apertaor open pulp).
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6.BASED ON PATHWAY OF CARIES
SPREAD
1.FORWARD CARIES 2.BACKWARD CARIES
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Forward-backward classification is considered asgraphical representation of the pathway of dentalcaries.
ENAMEL
First component of enamel to be involved in cariousprocess is the interprismatic substance. Thedisintegrating chemicals will proceed via the
substance, causing the enamel prism to beundermined.
The resultant caries involvement in enamel will havecone shape.
In concave surface (pit and fissures) base towardsDEJ.
In convex surfaces (smooth surface) base away fromDEJ.
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DENTIN
First component to be involved in dentin is
protoplasmic extensionwithin the dentinal tubules.
These protoplasmic extension have their maximum
space at the DEJ, but as they approach the pulpchamber and root canal walls, the tubules become
more densely arrange with fewer interconnections.
So caries cone in dentin will have their base towards
DEJ.
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7.BASED ON NUMBER OF TOOTH
SURFACE INVOLVED
Simple
Compound
Complex
A caries involving only one toothsurface
A caries involving two surfaces oftooth
A caries that involves more than
two surfaces of a tooth
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8. BASED ON CHRONOLOGY
EARLY CHILDHOOD CARIES
ADOLESCENT CARIES
ADULT CARIES
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It has been stated that over a lifetime, caries
incidence i.e. the number of new lesions
occurring in a year, shows three peaks-at the
ages 4-8,11-19 and 55-65 years
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EARLY CHILDHOOD CARIES
Early childhood carieswould include, twovariants: Nursing cariesand rampant caries.
The difference primarily
exist in involvement of theteeth[ mandibular incisors] in the carious process inrampant caries as opposedto nursing caries.
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CLASSIFICATION OF EARLY CHILDHOOD
CARIES
TypeI
(MILD )
Involves molars and incisors
Seen in 2-5 years
Causecariogenic semisolid food +lack of oral hygeine
TypeII(MODERA
TE)
Unaffected mandibular incisors
Soon after first tooth erupts
Causeinappropriate feeding +lack of oral hygeine
TypeIII
(SEVERE)
All teeth including mandibular incisors
Causemultitude of factors
SYNONYMS
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SYNONYMS
Nursing caries, Nursing bottle mouth,Nursing bottle syndrome, Bottle-Propping
caries, comforter caries, Baby Bottle
mouth, Nursing Mouth Decay, Baby bottletooth decay, tooth cleaning neglect
NEW NAMEMaternally derived streptococcus mutant
disease (MDSMD)
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NURSING CARIES
Seen in infant and
toddler
Affects primary dentition
Mandibular incisors are
not involved
ETIOLOGY
Improper bottle
feedingPacifier dipped in honey/other
sweetner
RAMPANT CARIES
Seen in all ages,
including adoloscennce
Affects primary and
permanent dentition
Mandibular incisors are
also affected
ETIOLOGY
MULTIFACTORIAL
Frequent snacksSticky refined CHO
Decreased salivary
flow
Genetic background
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TEENAGE CARIES
(ADOLESCENT CARIES) This type of caries is a variant of rampant caries
where the teeth generally considered immune to
decay are involved.
The caries is also described to be of a rapidlyburrowing type, with a small enamel opening.
The presence of a large pulp chamber adds to the
woes, causing early pulp involvement
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ADULT CARIES
With the recession of thegingiva and sometimesdecreased salivary functiondue to atrophy, at the age of55-60 years, the third peak ofcaries is observed.
Root caries and cervicalcaries are more commonlyfound in this group.
Sometime they are alsoassociated with a partial
denture clasp.
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9.BASED ON WHETHER CARIES IS
COMPLETLY REMOVED OR NOT DURING
TREATMENT
RESIDUAL CARIES
Residual caries is that which is not removed during a
restorative procedure, either by accident, neglect or
intention.
Sometimes a small amount of acutely carious dentin
close to the pulp is covered with a specific capping
material to stimulate dentin deposition, isolating caries
from pulp.
The carious dentin can be removed at a later time.
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10.BASED ON SURFACES TO BE
RESTORED
Most widespread clinical utilization
O for occlusal surfaces
M for mesial surfaces
D for distal surfaces
F for facial surfaces
B for buccal surfaces
L for lingual surface
Various combinations are also possible, such as MOD
for mesio-occluso-distal surfaces.
11.BLACKS CLASSIFICATION
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11.BLACK S CLASSIFICATION
Class 1 lesions: Lesions that begin in the structural defects of teeth such
as pits, fissures and defective grooves.
Locations include
Occlusal surface of molars and premolars.
occlusal two thirds of buccal and lingual surfaces ofmolars and premolars.
Lingual surfaces of anterior tooth.
Class 2 lesions: Theyare found on the proximal surfaces of the
bicuspids and molars.
Class 3 lesions:
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Class 3 lesions: Lesions found on the proximal surfaces of anterior teeth that do
not involve or necessitate the removal of the incisal angle.
Class 4 lesions:
Lesions found on the proximal surfaces of anterior teeth that
involve the incisal angle.
Class 5 lesions: Lesions that are found at the gingival third of the facial and
lingual surfaces of anterior and posterior teeth.
Class 6 (Simons modification): Lesions involving cuspal tips and incisal edges of teeth.
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12 W ld h lth i ti (WHO)
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12.World health organization (WHO)
system
In this classification the shape and depth of the caries
lesion scored on a four point scale
D1. clinically detectable enamel lesions with intact (non
cavitated) surfacesD2. Clinically detectable cavities limited to enamel
D3. Clinically detectable cavities in dentin
D4. Lesions extending into the pulp
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Three types of defects due to irradiation
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Threetypes of defects due to irradiation
1. Lesion usually encircling the neck of teeth
amputation of crowns may occur2. Begins as brown to black discolouration of
tooth .occlusal surface and incisal edges
wear away3. Spot depression which spreads from any
surface
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CLASSIFICATIONS
OF CAVITY
PREPARATION
1.BASED ON TREATMENT&RESTORATION
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DESIGN(BLACKS)
Class 1 restoration: include the structural defects of teeth such as pits,
fissures and defective grooves.
Locations include Occlusal surface of molars and premolars.
occlusal two thirds of buccal and lingual surfaces ofmolars and premolars.
Lingual surfaces of anterior tooth.
Class 2 restoration :
Theyare found on the proximal surfaces of thebicuspids and molars.
Cl 3 t ti
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Class 3 restoration : restoration on the proximal surfaces of anterior teeth that
do not involve or necessitate the removal of the incisalangle.
Class 4 restoration: restoration on the proximal surfaces of anterior teeth that
involve the incisal angle.Class 5 restoration : restoration at the gingival third of the facial and lingual
surfaces of anterior and posterior teeth.
Class 6 (Simons modification):
restoration involving cuspal tips and incisal edges of teeth.
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3 Sturdevants classification
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3.Sturdevants classification
CavitySimple cavity
Compoundcavity
Complex cavity
Feature
A cavity involving only one tooth
surface
A cavity involving two surfaces oftooth
A cavity that involves more thantwo surfaces of a tooth
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Class 4: a restoration of the proximal
surface of an anterior tooth which
involves the restoration of an incisal
angle.
Class 5: cavities present on the cervical
third of all teeth, including
proximal surface where the
marginal ridge is
not included in the cavity preparation.
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6 Classification by Mount and
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6.Classification by Mount and
Hume(1998)
G J MOUNT CLASSIFICATIN
This new system defines the extent and
complexity of a cavity and at the same time
encourages a conservative approach to the
preservation of natural tooth structure.
This system is designed to utilize the healing
capacity of enamel and dentine.
The three sites of carious lesions:
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The three sitesof carious lesions:
Site 1
Site 2
Site 3
Pits, fissuresand enamel defects on occlusal surfac
of posterior teeth or other smooth surfaces
Proximal enamel immediately below areas in conta
with adjacent teethThe cervical one thirdof the crown or following
gingival recession, the exposed root
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Size 3: the cavity is enlarged beyond moderate. The
remaining tooth structure is
weakened to the extent that cups or incisaledges are split, or are likely to fail or left
exposed to occlusal or incisal load. the cavity
needs to be further enlargedso that therestoration can be designed to provide
support and protection to the remaining
tooth structure.
Size4: Extensivecaries with bulk loss of tooth
structure has already occurred.
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Site Size
Pit/fissure 1
Contact area 2
Cervical 3
Minimal 1 Moderate 2 Enlarged 3 Extensive 4
1.1 1.2 1.3 1.4
2.1 2.2 2.3 2.4
3.1 3.2 3.3 3.4