CLASSIFICATION OF CLASSIFICATION OF DENTAL CARIESDENTAL CARIES

Dr shabeel pn Dr shabeel pn

DENTAL CARIES IS AN IRREVERSIBLE DENTAL CARIES IS AN IRREVERSIBLE MICROBIAL DISEASE OF THE MICROBIAL DISEASE OF THE CALCIFIED TISSUES OF THE TEETH, CALCIFIED TISSUES OF THE TEETH, CHARECTERIZED BY CHARECTERIZED BY DEMINERALIZATION OF THE DEMINERALIZATION OF THE INORGANIC PORTION AND INORGANIC PORTION AND DESTRUCTION OF THE ORGANIC DESTRUCTION OF THE ORGANIC SUBSTANCE OF THE TOOTH , WHICH SUBSTANCE OF THE TOOTH , WHICH OFTEN LEADS TO CAVITATION OFTEN LEADS TO CAVITATION

DEFINITIONDEFINITION

1.BASED ON 1.BASED ON ANATOMICALANATOMICAL SITE SITE

2.BASED ON 2.BASED ON PROGRESSIONPROGRESSION

3.BASED ON 3.BASED ON VIRGINITYVIRGINITY OF LESION OF LESION

4.BASED ON 4.BASED ON EXTENDEXTEND OF CARIES OF CARIES

5.BASED ON 5.BASED ON TISSUETISSUE INVOLVEMENT INVOLVEMENT

6.BASED ON 6.BASED ON PATHWAYPATHWAY OF CARIES OF CARIES SPREAD SPREAD

7. BASED ON 7. BASED ON NUMBERNUMBER OF TOOTH OF TOOTH SURFACE INVOLVEDSURFACE INVOLVED

8. BASED ON 8. BASED ON CHRONOLOGYCHRONOLOGY

9 .BASED ON WHETHER CARIES IS 9 .BASED ON WHETHER CARIES IS COMPLETLY REMOVEDCOMPLETLY REMOVED OR NOT OR NOT DURING TREATMENT DURING TREATMENT

10.BASED ON 10.BASED ON TOOTH SURFACETOOTH SURFACE TO BE TO BE RESTORED RESTORED

11.BLACK’S CLASSIFICATION11.BLACK’S CLASSIFICATION

12.WHO SYSTEM12.WHO SYSTEM

1.BASED ON ANATOMICAL SITE1.BASED ON ANATOMICAL SITE

OCCLUSAL

(PIT AND FISSURE)

ROOT CARIES

SMOOTH SURFACE CARIES(PROXIMAL AND CERVICAL CARIES)

LINEAR ENAMEL CARIES

PIT AND FISSURE CARIESPIT AND FISSURE CARIES Highest prevalanceHighest prevalance of all caries bacteria rapidly of all caries bacteria rapidly

colonize the pits and fissures of the newly colonize the pits and fissures of the newly erupted teeth erupted teeth

These early colonizers form a “bacterial plug” These early colonizers form a “bacterial plug” that remains in the site for long time ,perhaps that remains in the site for long time ,perhaps even the life of the tooth even the life of the tooth

Type & nature of the organisms prevalent in the Type & nature of the organisms prevalent in the oral cavity determine the type of organisms oral cavity determine the type of organisms colonizing the pit & fissurecolonizing the pit & fissure

Numerous gram positive cocci, especially Numerous gram positive cocci, especially dominated by dominated by s.sanguiss.sanguis are found in the newly are found in the newly erupted teeth.erupted teeth.

The appearance ofThe appearance of s.mutans s.mutans in pits and fissures in pits and fissures is usually followed by caries 6 to 24 months is usually followed by caries 6 to 24 months later.later.

Sealing of pits and fissures just after tooth Sealing of pits and fissures just after tooth eruption may be the most important event in eruption may be the most important event in their resistance to caries.their resistance to caries.

Shape, morphological variation and depth of pit Shape, morphological variation and depth of pit and fissures contributes to their high and fissures contributes to their high susceptibility to caries.susceptibility to caries.

Caries expand as it penetrates in to the enamel.Caries expand as it penetrates in to the enamel.

MORPHOLOGY OF FISSURESMORPHOLOGY OF FISSURES

NANGO (1960):Based on the NANGO (1960):Based on the alphabetical description of shape– 4 alphabetical description of shape– 4 typestypes

V&U type: self cleansing and somewhat V&U type: self cleansing and somewhat caries resistantcaries resistant

U type: narrow slit like opening with a U type: narrow slit like opening with a larger base as it extend towards larger base as it extend towards DEJ .Caries susceptible; also have a DEJ .Caries susceptible; also have a number of different branchesnumber of different branches

K type: also very susceptible to cariesK type: also very susceptible to caries

Entry site may appear much Entry site may appear much smaller than actual lesion, making smaller than actual lesion, making clinical diagnosis difficult.clinical diagnosis difficult.

Carious lesion of pits and fissures Carious lesion of pits and fissures develop from attack on their walls.develop from attack on their walls.

In cross section, the gross In cross section, the gross appearance of pit and fissure appearance of pit and fissure lesion is lesion is inverted Vinverted V with a narrow with a narrow entrance and a progressively entrance and a progressively wider area of involvement closer wider area of involvement closer to the DEJto the DEJ..

Smooth surface cariesSmooth surface caries Less favorable site for plaque attachment, Less favorable site for plaque attachment,

usually attaches on the smooth surface that usually attaches on the smooth surface that are near the gingiva or are under are near the gingiva or are under proximal proximal contact..contact..

In very young patients the gingival papilla In very young patients the gingival papilla completely fills the interproximal space completely fills the interproximal space under a proximal contact and is termed as under a proximal contact and is termed as col. Also crevicular spaces in them are less col. Also crevicular spaces in them are less favorable habitats for s.mutans.favorable habitats for s.mutans.

Consequently proximal caries is less lightly to Consequently proximal caries is less lightly to develop where this favorable soft tissue develop where this favorable soft tissue architecture exists.architecture exists.

The proximal surfaces are particularly The proximal surfaces are particularly susceptible to caries due to extra shelter susceptible to caries due to extra shelter provided to resident plaque owing to the provided to resident plaque owing to the proximal contact area immediately proximal contact area immediately occlusal to plaque.occlusal to plaque.

Lesion have a broad area of origin and Lesion have a broad area of origin and a conical, or pointed extension towards a conical, or pointed extension towards DEJ.DEJ.

V shapeV shape with apex directed towards DEJ. with apex directed towards DEJ. After caries penetrate the DEJ softening After caries penetrate the DEJ softening

of dentin spread rapidly and pulpallyof dentin spread rapidly and pulpally

Linear enamel caries ( Linear enamel caries ( odontoclasiaodontoclasia ) is seen to ) is seen to occur in the region of the occur in the region of the neonatal lineneonatal line of the of the maxillary anterior teeth. maxillary anterior teeth.

The line, which represent a metabolic defect The line, which represent a metabolic defect such as hypocalcemia or trauma of birth, may such as hypocalcemia or trauma of birth, may predispose to caries, leading to gross destruction predispose to caries, leading to gross destruction of the labial surface of the teeth.of the labial surface of the teeth.

Morphological aspects of this type of caries are Morphological aspects of this type of caries are atypical and results in gross destruction of the atypical and results in gross destruction of the labial surfaces incisor teethlabial surfaces incisor teeth

Linear enamel cariesLinear enamel caries

ROOT SURFACE CARIESROOT SURFACE CARIES The proximal root surface, particularly near the cervical The proximal root surface, particularly near the cervical

line, often is unaffected by the action of hygiene line, often is unaffected by the action of hygiene procedures, such as flossing, because it may have procedures, such as flossing, because it may have concave anatomic surfaceconcave anatomic surface contours (fluting)contours (fluting) and and occasional roughness at the termination of the enamel.occasional roughness at the termination of the enamel.

These conditions, when coupled with exposure to the oral These conditions, when coupled with exposure to the oral environment (as a result of environment (as a result of gingival recessiongingival recession), favor the ), favor the formation of mature, caries-producing plaque and proximal formation of mature, caries-producing plaque and proximal root-surface caries.root-surface caries.

Root-surface caries is more common in older patients.Root-surface caries is more common in older patients. Caries originating on the root is alarming because Caries originating on the root is alarming because

1. it has a comparatively rapid progression 1. it has a comparatively rapid progression 2. it is often asymptomatic 2. it is often asymptomatic 3. it is closer to the pulp3. it is closer to the pulp 4, it is more difficult to restore4, it is more difficult to restore

The root surface is refer the enamel The root surface is refer the enamel and readily allows plaque formation in and readily allows plaque formation in the absence of good oral hygiene.the absence of good oral hygiene.

The cementum covering the root The cementum covering the root surface is extremely thin and provides surface is extremely thin and provides little resistance to caries attack.little resistance to caries attack.

Root caries lesions have less well-Root caries lesions have less well-defined margins, tend to be U-shaped defined margins, tend to be U-shaped in cross sections, and progress more in cross sections, and progress more rapidly because of the lack of rapidly because of the lack of protection from and enamel covering.protection from and enamel covering.

2.BASED ON 2.BASED ON PROGRESSIONPROGRESSION

ACUTE CARIES

CHRONIC CARIES

ARRESTED CARIES

ACUTE CARIESACUTE CARIES

Acute caries is a rapid process involving a Acute caries is a rapid process involving a large number of teeth.large number of teeth.

These lesions are lighter colored than the These lesions are lighter colored than the other types, being light brown or grey, and other types, being light brown or grey, and their caseous consistency makes the their caseous consistency makes the excavation difficult.excavation difficult.

Pulp exposures and sensitive teethPulp exposures and sensitive teeth are often are often observed in patients with acute caries.observed in patients with acute caries.

It has been suggested that saliva does not It has been suggested that saliva does not easily penetrate the small opening to the easily penetrate the small opening to the carious lesion, so there are carious lesion, so there are little opportunity little opportunity for buffering or neutralizatonfor buffering or neutralizaton

CHRONIC CARIESCHRONIC CARIES These lesions are usually ofThese lesions are usually of long-standing long-standing

involvement, affect a fewer number of teeth, and involvement, affect a fewer number of teeth, and are smaller than acute caries.are smaller than acute caries.

Pain is not a common featurePain is not a common feature because of protection because of protection afforded to the pulp by secondary dentinafforded to the pulp by secondary dentin

The decalcified dentin is dark brown and leathery.The decalcified dentin is dark brown and leathery. Pulp prognosis is hopeful in that the deepest of Pulp prognosis is hopeful in that the deepest of

lesions usually requires only prophylactic capping lesions usually requires only prophylactic capping and protective bases.and protective bases.

The lesions range in depth and include those that The lesions range in depth and include those that have just penetrated the enamel.have just penetrated the enamel.

ARRESTED CARIESARRESTED CARIES:-:-

Caries which becomes stationary or static Caries which becomes stationary or static and does and does nonot show any tendency for t show any tendency for further further progressionprogression

Both deciduous and permanent affected Both deciduous and permanent affected With the shift in the oral conditions, even With the shift in the oral conditions, even

advanced lesions may become arrested .advanced lesions may become arrested . Arrested caries involving dentin shows a Arrested caries involving dentin shows a

marked brown pigmentation and induration marked brown pigmentation and induration of the lesion [the so called of the lesion [the so called ‘eburnation of ‘eburnation of dentindentin’]’]

Sclerosis of dentinal tubules and secondary Sclerosis of dentinal tubules and secondary dentin formation commonly occur dentin formation commonly occur

Exclusively seen in Exclusively seen in caries of caries of occlusal occlusal surfacesurface with large with large open cavity in which open cavity in which there is lack of food there is lack of food retentionretention

Also on the proximal Also on the proximal surfaces of tooth in surfaces of tooth in cases in which thecases in which the adjacentadjacent approximating tooth approximating tooth has been has been extracted extracted

3.BASED ON VIRGINITY OF 3.BASED ON VIRGINITY OF

LESIONLESION

INITIAL/PRIMARY RECURRENT/SECONDARY

PRIMARY CARIES(INITIAL)PRIMARY CARIES(INITIAL)

A primary caries is one in which the A primary caries is one in which the lesion constitutes the initial attack on lesion constitutes the initial attack on the tooth surface.the tooth surface.

The designation of primary is based The designation of primary is based on the on the initial locationinitial location of the lesion on of the lesion on the surface the surface rather than the extent of rather than the extent of damage.damage.

SECONDARY CARIES SECONDARY CARIES (RECURRENT) (RECURRENT)

This type of caries is observed around the edges and This type of caries is observed around the edges and under restorationsunder restorations..

The common locations of secondary caries are the The common locations of secondary caries are the rough or overhanging margin and fracture place in all rough or overhanging margin and fracture place in all locations of the mouth.locations of the mouth.

It may be result of It may be result of poor adaptationpoor adaptation of a restoration, of a restoration, which allows for a marginal leakage, or it may be due which allows for a marginal leakage, or it may be due to inadequate extension of the restoration.to inadequate extension of the restoration.

In addition caries may remain if there has not been In addition caries may remain if there has not been complete excavation of the original lesion, which later complete excavation of the original lesion, which later may appear as a residual or recurrent caries.may appear as a residual or recurrent caries.

4. BASED ON EXTENT OF 4. BASED ON EXTENT OF CARIESCARIES

INCIPIENT CARIES

OCCULT CARIES

CAVITATION

INCIPIENT CARIESINCIPIENT CARIES The early caries lesion, best seen on the The early caries lesion, best seen on the

smooth surface of teeth, is visible as a smooth surface of teeth, is visible as a ‘‘white spotwhite spot’.’.

Histologically the lesion has an apparently Histologically the lesion has an apparently intact surface layer overlying subsurface intact surface layer overlying subsurface demineralization.demineralization.

Significantly may such lesion Significantly may such lesion can undergo can undergo remineralizationremineralization and thus the lesion per se and thus the lesion per se is not an indication for restorative is not an indication for restorative treatmenttreatment

These white spot lesion may be These white spot lesion may be confused initially with white confused initially with white developmental defects of enamel developmental defects of enamel formation, which can be differentiated formation, which can be differentiated by their position away from the by their position away from the gingival margin], their shape gingival margin], their shape [unrelated to plaque accumulation] [unrelated to plaque accumulation] and their symmetry [they usually and their symmetry [they usually affect the contralateral tooth].affect the contralateral tooth].

Also on wetting the caries lesion Also on wetting the caries lesion disappear while the developmental disappear while the developmental defect persist defect persist

It is believed that bite wing and OPG radiographs It is believed that bite wing and OPG radiographs along with noninvasive adjuncts like fiber optic along with noninvasive adjuncts like fiber optic transillumination (FOTI),laser luminescence, transillumination (FOTI),laser luminescence, electrical resistance method (ERM) are used for electrical resistance method (ERM) are used for diagnosis these occlusal lesions.diagnosis these occlusal lesions.

These lesion are not associated with These lesion are not associated with microorganisms different to those found in other microorganisms different to those found in other carious lesion. carious lesion.

These carious lesion seem to increase with These carious lesion seem to increase with increasing age.increasing age.

Occult carious lesion are usually seen with low Occult carious lesion are usually seen with low caries rate which is suggestive of increase fluid caries rate which is suggestive of increase fluid exposure.exposure.

It is believed that It is believed that increased fluid exposure increased fluid exposure encourages remineralizationencourages remineralization and slow and slow down progress of the caries in the pit and down progress of the caries in the pit and fissure enamel while the cavitations fissure enamel while the cavitations continues in dentine, and the lesions continues in dentine, and the lesions become masked by a relatively intact become masked by a relatively intact enamel surface.enamel surface.

These hidden lesions are called as These hidden lesions are called as fluoride bombs or fluoride syndrome.fluoride bombs or fluoride syndrome.

Recently it is seen that occult caries may Recently it is seen that occult caries may have its origin as pre-eruptive defects have its origin as pre-eruptive defects which are detectable only with the use of which are detectable only with the use of radiographs.radiographs.

CAVITATIONCAVITATION

Once it reaches the Once it reaches the dentinoenamel junction, dentinoenamel junction, the caries process has the the caries process has the potential to spread to the potential to spread to the pulp along the dentinal pulp along the dentinal tubules and also spread tubules and also spread in lateral direction.in lateral direction.

Thus some amount of Thus some amount of sensitivity may be sensitivity may be associated with this type associated with this type of lesion.of lesion.

This may be generally This may be generally accompanied by accompanied by cavitationcavitation

5.Based on tissue 5.Based on tissue involvementinvolvement

1.1. Initial cariesInitial caries

2.2. Superficial caries Superficial caries

3.3. Moderate caries Moderate caries

4.4. Deep cariesDeep caries

5.5. Deep complicated cariesDeep complicated caries

Dental caries can be divided into 4 Dental caries can be divided into 4 or 5 stagesor 5 stages

Initial caries: Initial caries: DemineralizationDemineralization without structural defect. This stage without structural defect. This stage can be reversed by fluoridation and can be reversed by fluoridation and enhanced mouth hygieneenhanced mouth hygiene

Superficial cariesSuperficial caries ( (Caries Caries superficialissuperficialis):):Enamel caries, wedge-Enamel caries, wedge-shaped structural defect. Caries has shaped structural defect. Caries has affected the enamel layer, but has not affected the enamel layer, but has not yet penetrated the dentin. yet penetrated the dentin.

3. 3. Moderate cariesModerate caries ( (Caries mediaCaries media): Dentin ): Dentin caries. Extensive structural defect. Caries caries. Extensive structural defect. Caries has penetrated up to the dentin and spreads has penetrated up to the dentin and spreads two-dimensionally beneath the enamel two-dimensionally beneath the enamel defect where the dentin offers little defect where the dentin offers little resistance. resistance.

4. 4. Deep cariesDeep caries ( (Caries profundaCaries profunda)): : Deep Deep structural defect. Caries has penetrated up structural defect. Caries has penetrated up to the dentin layers of the tooth close to the to the dentin layers of the tooth close to the pulp.pulp.

5. 5. Deep complicated cariesDeep complicated caries (Caries profunda (Caries profunda complicatacomplicata)) : :Caries has led to the opening of Caries has led to the opening of the pulp cavity (the pulp cavity (pulpa apertapulpa aperta or open pulp). or open pulp).

6.BASED ON PATHWAY OF CARIES 6.BASED ON PATHWAY OF CARIES SPREAD SPREAD

1.FORWARD CARIES 2.BACKWARD CARIES

““Forward-backward” classification is Forward-backward” classification is considered as graphical representation of considered as graphical representation of the pathway of dental caries.the pathway of dental caries.

ENAMELENAMEL First component of enamel to be involved in First component of enamel to be involved in

carious process is the carious process is the interprismatic interprismatic substancesubstance. The disintegrating chemicals will . The disintegrating chemicals will proceed via the substance, causing the proceed via the substance, causing the enamel prism to be undermined.enamel prism to be undermined.

The resultant caries involvement in enamel The resultant caries involvement in enamel will have cone shape.will have cone shape.

In concave surface (pit and fissures) In concave surface (pit and fissures) base towards DEJ.base towards DEJ.

In convex surfaces (smooth surface) In convex surfaces (smooth surface) base away from DEJ.base away from DEJ.

DENTINDENTIN First component to be involved in dentin is First component to be involved in dentin is

protoplasmic extensionprotoplasmic extension within the dentinal within the dentinal tubules.tubules.

These protoplasmic extension have their These protoplasmic extension have their maximum space at the DEJ, but as they maximum space at the DEJ, but as they approach the pulp chamber and root canal approach the pulp chamber and root canal walls, the walls, the tubules become more densely tubules become more densely arrange with fewer interconnectionsarrange with fewer interconnections..

So caries cone in dentin will have their So caries cone in dentin will have their base towards DEJ.base towards DEJ.

Decay starts in enamel then it involves Decay starts in enamel then it involves the dentin. Wherever the caries cone in the dentin. Wherever the caries cone in enamel is larger or at least the size as enamel is larger or at least the size as that of dentin, it is called forward decay that of dentin, it is called forward decay (pit decay)(pit decay)

However the carious process in dentin However the carious process in dentin progresses much faster than in enamel, progresses much faster than in enamel, so the cone in dentin tends to spread so the cone in dentin tends to spread laterally creating undermined enamel. laterally creating undermined enamel. In addition decay can attack enamel In addition decay can attack enamel from its dentinal side. At this stage it from its dentinal side. At this stage it becomes backward decay.becomes backward decay.

7.BASED ON NUMBER OF 7.BASED ON NUMBER OF TOOTH SURFACE INVOLVEDTOOTH SURFACE INVOLVED

Simple Simple

Compound Compound

Complex Complex

A caries involving only one A caries involving only one tooth surfacetooth surface

A caries involving two A caries involving two surfaces of toothsurfaces of tooth

A caries that involves A caries that involves more than two surfaces more than two surfaces of a toothof a tooth

8. BASED ON CHRONOLOGY8. BASED ON CHRONOLOGY

EARLY CHILDHOOD CARIES

ADOLESCENT CARIES

ADULT CARIES

It has been stated that over a It has been stated that over a lifetime, caries incidence i.e. the lifetime, caries incidence i.e. the number of new lesions occurring in a number of new lesions occurring in a year, shows three peaks-at the ages year, shows three peaks-at the ages 4-8,11-19 and 55-65 years4-8,11-19 and 55-65 years

EARLY CHILDHOOD CARIESEARLY CHILDHOOD CARIES Early childhood caries Early childhood caries

would include, two would include, two variants: Nursing variants: Nursing caries and rampant caries and rampant caries.caries.

The difference The difference primarily exist in primarily exist in involvement of the involvement of the teeth[ mandibular teeth[ mandibular incisors ] in the incisors ] in the carious process in carious process in rampant caries as rampant caries as opposed to nursing opposed to nursing caries. caries.

CLASSIFICATION OF EARLY CHILDHOOD CARIESTypeI(MILD )

Involves molars and incisorsSeen in 2-5 yearsCausecariogenic semisolid food +lack of oral hygeine

TypeII (MODERATE)

Unaffected mandibular incisorsSoon after first tooth eruptsCauseinappropriate feeding +lack of oral hygeine

TypeIII

(SEVERE)

All teeth including mandibular incisorsCausemultitude of factors

SYNONYMS

Nursing caries, Nursing bottle mouth, Nursing bottle syndrome, Bottle-Propping caries, comforter caries, Baby Bottle mouth, Nursing Mouth Decay, Baby bottle tooth decay, tooth cleaning neglect

NEW NAME

Maternally derived streptococcus mutant disease (MDSMD)

NURSING CARIES

Seen in infant and

toddlerAffects primary dentition

Mandibular incisors are

not involved

ETIOLOGYImproper bottle

feeding Pacifier dipped in honey/other sweetner

RAMPANT CARIES

Seen in all ages,including adoloscennceAffects primary and

permanent dentitionMandibular incisors are

also affected

ETIOLOGYMULTIFACTORIAL Frequent snacks

Sticky refined CHO

Decreased salivary

flow

Genetic background

TEENAGE CARIES TEENAGE CARIES (ADOLESCENT CARIES(ADOLESCENT CARIES))

This type of caries is a variant of rampant This type of caries is a variant of rampant caries where the teeth generally caries where the teeth generally considered immune to decay are involved.considered immune to decay are involved.

The caries is also described to be of a The caries is also described to be of a rapidly burrowing type, with a small rapidly burrowing type, with a small enamel opening.enamel opening.

The presence of a large pulp chamber The presence of a large pulp chamber adds to the woes, causing early pulp adds to the woes, causing early pulp involvementinvolvement

ADULT CARIESADULT CARIES With the recession of With the recession of

the gingiva and the gingiva and sometimes decreased sometimes decreased salivary function due to salivary function due to atrophy, at the age of atrophy, at the age of 55-60 years, the third 55-60 years, the third peak of caries is peak of caries is observed.observed.

Root caries and cervical Root caries and cervical caries are more caries are more commonly found in this commonly found in this group.group.

Sometime they are also Sometime they are also associated with a associated with a partial denture clasp.partial denture clasp.

9.BASED ON WHETHER CARIES IS 9.BASED ON WHETHER CARIES IS COMPLETLY REMOVED OR NOT COMPLETLY REMOVED OR NOT

DURING TREATMENTDURING TREATMENT

RESIDUAL CARIESRESIDUAL CARIES Residual caries is that which is not removed Residual caries is that which is not removed

during a restorative procedure, either by during a restorative procedure, either by accident, neglect or intention.accident, neglect or intention.

Sometimes a small amount of acutely carious Sometimes a small amount of acutely carious dentin close to the pulp is covered with a dentin close to the pulp is covered with a specific capping material to stimulate dentin specific capping material to stimulate dentin deposition, isolating caries from pulp.deposition, isolating caries from pulp.

The carious dentin can be removed at a later The carious dentin can be removed at a later time.time.

10.BASED ON SURFACES TO BE 10.BASED ON SURFACES TO BE RESTORED RESTORED

Most widespread clinical utilization Most widespread clinical utilization

O for occlusal surfacesO for occlusal surfaces

M for mesial surfacesM for mesial surfaces

D for distal surfacesD for distal surfaces

F for facial surfacesF for facial surfaces

B for buccal surfacesB for buccal surfaces

L for lingual surfaceL for lingual surface

Various combinations are also possible, such Various combinations are also possible, such as MOD –for mesio-occluso-distal surfaces.as MOD –for mesio-occluso-distal surfaces.

11.BLACK’S CLASSIFICATION11.BLACK’S CLASSIFICATION

Class 1 lesionsClass 1 lesions:: Lesions that begin in the structural defects of Lesions that begin in the structural defects of

teeth such as pits, fissures and defective grooves.teeth such as pits, fissures and defective grooves.Locations includeLocations include Occlusal surface of molars and premolars.Occlusal surface of molars and premolars. occlusal two thirds of buccal and lingual surfaces occlusal two thirds of buccal and lingual surfaces

of molars and premolars. of molars and premolars. Lingual surfaces of anterior tooth.Lingual surfaces of anterior tooth.

Class 2 lesions:Class 2 lesions: TheyThey are found on the proximal surfaces of the are found on the proximal surfaces of the

bicuspids and molars.bicuspids and molars.

Class 3 lesions:Class 3 lesions: Lesions found on the proximal surfaces of anterior Lesions found on the proximal surfaces of anterior

teeth that do not involve or necessitate the removal of teeth that do not involve or necessitate the removal of the incisal angle.the incisal angle.

Class 4 lesions:Class 4 lesions: Lesions found on the proximal surfaces of anterior Lesions found on the proximal surfaces of anterior

teeth that involve the incisal angle.teeth that involve the incisal angle.

Class 5 lesionsClass 5 lesions:: Lesions that are found at the gingival third of the facial Lesions that are found at the gingival third of the facial

and lingual surfaces of anterior and posterior teeth.and lingual surfaces of anterior and posterior teeth.

Class 6 (Simon’s modificationClass 6 (Simon’s modification):): Lesions involving cuspal tips and incisal edges Lesions involving cuspal tips and incisal edges

of teethof teeth..

12.World health organization 12.World health organization (WHO) system(WHO) system

In this classification the shape and depth of In this classification the shape and depth of the caries lesion scored on a four point the caries lesion scored on a four point scalescale

D1. clinically detectable enamel lesions with D1. clinically detectable enamel lesions with intact (non cavitated) surfacesintact (non cavitated) surfaces

D2. Clinically detectable cavities limited to D2. Clinically detectable cavities limited to enamelenamel

D3. Clinically detectable cavities in dentinD3. Clinically detectable cavities in dentin

D4. Lesions extending into the pulpD4. Lesions extending into the pulp

RADIATION CARIES

Radiography is frequently associated with xerostomia due to decreased salivary secretion,an increase in viscosity and low PH

This and other causes of decreased salivary secretion may lead to a rampant form of caries, including the significance of saliva in preventing caries.

ThreeThree types of defects due to types of defects due to irradiationirradiation

1.1. Lesion usually encircling the neck of Lesion usually encircling the neck of teeth amputation of crowns may teeth amputation of crowns may occur occur

2.2. Begins as brown to black Begins as brown to black discolouration of tooth .occlusal discolouration of tooth .occlusal surface and incisal edges wear awaysurface and incisal edges wear away

3.3. Spot depression which spreads from Spot depression which spreads from any surface any surface

CLASSIFICATIONS OF CAVITY

PREPARATION

1.1.BASED ON TREATMENT&RESTORATION BASED ON TREATMENT&RESTORATION

DESIGN(BLACK’SDESIGN(BLACK’S))Class 1 restorationClass 1 restoration::

include the structural defects of teeth such as pits, include the structural defects of teeth such as pits, fissures and defective grooves.fissures and defective grooves.

Locations includeLocations includeOcclusal surface of molars and premolars.Occlusal surface of molars and premolars. occlusal two thirds of buccal and lingual surfaces of occlusal two thirds of buccal and lingual surfaces of molars and premolars. molars and premolars. Lingual surfaces of anterior tooth.Lingual surfaces of anterior tooth.

Class 2 restoration :Class 2 restoration :TheyThey are found on the proximal surfaces of the are found on the proximal surfaces of the bicuspids and molars.bicuspids and molars.

Class 3 restoration :Class 3 restoration :restoration on the proximal surfaces of anterior teeth restoration on the proximal surfaces of anterior teeth that do not involve or necessitate the removal of the that do not involve or necessitate the removal of the incisal angle.incisal angle.

Class 4 Class 4 restorationrestoration : :restoration on the proximal surfaces of anterior teeth restoration on the proximal surfaces of anterior teeth that involve the incisal angle.that involve the incisal angle.

Class 5 restoration Class 5 restoration ::restoration at the gingival third of the facial and lingual restoration at the gingival third of the facial and lingual surfaces of anterior and posterior teeth.surfaces of anterior and posterior teeth.

Class 6 (Simon’s modificationClass 6 (Simon’s modification):):restoration involving cuspal tips and incisal edges of restoration involving cuspal tips and incisal edges of teethteeth..

2.Other modifications2.Other modificationsCharbeneu’s modificationCharbeneu’s modification::a)a) Class 2:Class 2: cavity on single proximal surface of bicuspids cavity on single proximal surface of bicuspids

and molarsand molars

b) Class 6:b) Class 6: Cavities on both mesial and distal proximal Cavities on both mesial and distal proximal

surfaces of posterior teeth that will share a surfaces of posterior teeth that will share a common occlusal isthmuscommon occlusal isthmus

c) Lingual surfaces of upper anterior teethc) Lingual surfaces of upper anterior teeth ..

d) Any other unusually located pit or fissure d) Any other unusually located pit or fissure involved with decay.involved with decay.

3.Sturdevant’s classification3.Sturdevant’s classification

CavityCavitySimple cavitySimple cavity

Compound Compound cavitycavity

Complex Complex cavitycavity

FeatureFeatureA cavity involving only one A cavity involving only one

tooth surfacetooth surface

A cavity involving two A cavity involving two surfaces of toothsurfaces of tooth

A cavity that involves more A cavity that involves more than two surfaces of a tooththan two surfaces of a tooth

4.Finn’s modification of Black’s 4.Finn’s modification of Black’s cavity preparation for cavity preparation for primary teethprimary teeth

Class1 : Class1 : Cavities involving the pits and Cavities involving the pits and fissures of molar teeth and the fissures of molar teeth and the buccal and lingual pits of all teeth. buccal and lingual pits of all teeth.

Class 2: cavities involving proximal surface of Class 2: cavities involving proximal surface of molar teeth will access established molar teeth will access established from the occlusal surface.from the occlusal surface.

Class 3: cavities involving proximal surfaces of Class 3: cavities involving proximal surfaces of anterior teeth which may or may not anterior teeth which may or may not involve a labial or a lingual extension involve a labial or a lingual extension

Class 4: a restoration of the proximal Class 4: a restoration of the proximal surface of an anterior tooth which surface of an anterior tooth which involves the involves the restoration of an restoration of an incisal incisal angle.angle.

Class 5: cavities present on the cervical Class 5: cavities present on the cervical third of all teeth, including third of all teeth, including proximal surface where the proximal surface where the marginal ridge is not included in the marginal ridge is not included in the cavity preparation.cavity preparation.

5.Baume’s classification5.Baume’s classification

a). Pit and fissure cavitiesa). Pit and fissure cavities

b). Smooth surface cavitiesb). Smooth surface cavities

6.Classification by Mount and 6.Classification by Mount and Hume(1998)Hume(1998)

G J MOUNT CLASSIFICATING J MOUNT CLASSIFICATIN

This new system defines the extent and This new system defines the extent and complexity of a cavity and at the same complexity of a cavity and at the same time encourages a conservative approach time encourages a conservative approach to the preservation of natural tooth to the preservation of natural tooth structure.structure.

This system is designed to utilize the This system is designed to utilize the healing capacity of enamel and dentine.healing capacity of enamel and dentine.

The three The three sitessites of carious lesions: of carious lesions:

Site 1Site 1

Site 2Site 2

Site 3Site 3

Pits, fissuresPits, fissures and enamel defects on occlusal and enamel defects on occlusal surfaces of posterior teeth or other smooth surfaces of posterior teeth or other smooth surfacessurfaces

Proximal enamel immediately below areas in Proximal enamel immediately below areas in contact contact with adjacent teethwith adjacent teeth

The The cervical one thirdcervical one third of the crown or following of the crown or following gingival recession, the exposed rootgingival recession, the exposed root

The four The four sizessizes of carious lesions of carious lesions

Size1:Size1:MinimalMinimal involvement of dentin just involvement of dentin just beyond treatment by remineralization beyond treatment by remineralization alone. alone.

Size2: Size2: ModerateModerate involvement of dentin. involvement of dentin. Following cavity preparation, remaining Following cavity preparation, remaining enamel is sound, well supported by enamel is sound, well supported by dentin and not likely to fail under normal dentin and not likely to fail under normal occlusal load. The remaining tooth occlusal load. The remaining tooth

structure is sufficiently strong to support structure is sufficiently strong to support the restoration. the restoration.

Size 3: the cavity is enlarged beyond moderate. Size 3: the cavity is enlarged beyond moderate. The remaining tooth structure is The remaining tooth structure is weakened to the extent that cups or weakened to the extent that cups or incisal edges are split, or are likely to fail incisal edges are split, or are likely to fail or left exposed to occlusal or incisal or left exposed to occlusal or incisal load. the cavity needs to be further load. the cavity needs to be further enlargedenlarged so that the restoration can be so that the restoration can be designed to provide support and designed to provide support and protection to the remaining tooth protection to the remaining tooth structure.structure.

Size4: Size4: ExtensiveExtensive caries with bulk loss of tooth caries with bulk loss of tooth structure has already occurred.structure has already occurred.

SiteSite SizeSize

Pit/fissure 1Pit/fissure 1

Contact area 2Contact area 2

Cervical 3Cervical 3

Minimal 1Minimal 1 Moderate 2Moderate 2 Enlarged 3Enlarged 3 Extensive 4Extensive 4

1.11.1 1.2 1.2 1.31.3 1.41.4

2.12.1 2.22.2 2.32.3 2.42.4

3.13.1 3.23.2 3.33.3 3.43.4

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