Classification Of

Caries/Cavities
INDEX:
1. INTRODUCTION
2. DEFINITION
3. ETIOLOGY
4. CLASSIFICATIONS
NTRODUCTION:
. Dental caries is the most prevalent disease affecting
the human race

. The word “CARIES” is derived from the Latin word

meaning “rot” or “decay”

. It is also akin to the Greek word “ker” for “death”

Definiti
on:
. Dental caries is a microbial disease of mineralized tissues
.
of the teeth, characterized by the demineralization of the
inorganic portion & destruction of the organic substances
of the tooth

. Ostrom(1980) has defined it as a process of enamel or dentin

dissolution that is caused by microbial action at tooth surface
& is mediated by physiochemical flow of water dissolved ions

. Hume(1993) states that caries is essentially a progressive

loss by acid dissolution of the apetite (mineral) component of
the enamel, then the dentin, or of the cementum then dentin
Etiology:
A. Endogenous theories--
(a) Humoral theory
(b) Vital theory

--B. Exogenous theories

(a) Chemical theory
(b) Parasitic theory
(c) Miller’s chemico-parasitic theory
(Acidogenic theory) W.D. Miller(1890)
(d) Proteolytic theory  Gottelib(1944)
(e) Proteolytic-chelation theory  Schatz & Martin(1955)
(f) Sulfatase theory
(g) Complexing & phosphorylating theory  Lura(1967)
(h) Burch & Jackson hypothesis
(Autoimmune theory)
Classification:
A] BASED ON ANATOMIC SITE:

Crown caries Root caries

Pit & Fissure Smooth surface

Caries Caries
 PIT AND FISSURE CARIES:
. Pit & fissures occurs on occlusal surface of posterior teeth, buccal &
lingual surface of molars & lingual surface of maxillary molars
. The morphology of pit & fissures is considerably variable as some pit &
fissures contribute to there high susceptibility to caries because in these
structures, bacteria & food debris are packed
. It results in fermentation of this of food by bacteria & acids is produced
& caries is initiated

Clinical Manifestation:
a) Initially, caries of pit & fissures appears brown or black in color & with
fine explorer , it will feel soft & a catch is felt
b) The enamel which borders the pit & fissures appears opaque bluish
white
 SMOOTH SURFACE CARIES:

. Smooth surface caries occurs on the

gingival third of the buccal, lingual &
proximal surfaces

. On proximal surface, caries begins below

the contact area & in early stage this
appear as a faint white opacity of enamel
without loss of continuity of surface

. As caries progresses, it appears bluish

white in later stage

. Caries in cervical area are in the form of

crescent shaped cavities

. It appear as a slightly roughened, chalky

area which gradually becomes
deeper
 ROOT CARIES:

. It is seen in older age groups

. The predisposing factors for the

occurrence appears to be the recession of
the gingival margin

Root caries based on the extent of the

lesion :
Grade I ( Initial )
Grade II ( Shallow )
Grade III ( cavitation )
Grade IV ( pulpal )
BASED ON THE PROGRESSION OF THE LESION

Progressive caries Arrested caries

Rapidly progressive Slowly progressive

Nursing caries Radiation caries

NURSING CARIES:
Nursing caries can also be called as:-
1. Nursing bottle caries
2. Nursing bottle syndrome
3. Milk bottle syndrome
4. Baby bottle tooth decay
5. Early childhood caries
 The new name given for early childhood caries is “maternally derived
streptococcus mutans disease (MDSMD)”
. This is the type of acute carious lesion, which occurs among those children
who take milk or fruit juices by nursing bottle, for a considerably longer
duration of time, preferably during sleep
. As the child takes larger amount of easily fermentable sugars along with the
milk, the sugar facilitates the cariogenic bacteria to produce caries at a rapid
pace by fermenting those sugars
 NURSING BOTTLE CARIES

. Nursing bottle caries commonly occurs in the upper anterior teeth (as
these are constantly coming in contact with the sweetened milk); while
the lower teeth are not usually affected as they remain under the cover
of the tongue
RADIATION CARIES:-
. Radiotherapy is frequently associated with xerostomia due to decreased
salivary secretion
. This and other cause of decreased salivation may lead to a rampant form of
caries, indicating the significance of saliva in preventing caries
ARRESTED CARIES:-
. When the caries process after initiation & actual disintegration of tooth
surface do not proceed further & is arrested because the area becomes self
cleansing, it is called “arrested caries”
. This type of caries is relatively uncommon & does not have any tendency
for further progression as it becomes static or stationary.
It occurs in both deciduous & permanent dentition
. Arrested caries usually occurs on occlusal & proximal surfaces & is
characterized by shallow, large, open, saucer shaped cavity with smooth &
shiny surface which does not retain food
. On occlusal surface, dentin is superficially softened & decalcified, which
is gradually burnished until it takes on a brown stained, polished, shiny
appearance & is hard
This type of dentin is referred to as “eburnation of dentin”
 [C] BASED ON THE SEVERITY:

Incipient Caries Occult Caries Cavitation

(Hidden Caries)

INCIPIENT CARIES:
. The early caries lesion best seen on the smooth surfaces of the teeth, is
visible as a ‘White Spot’
. Histologically, the lesion has an apparently intact surface layer overlying
subsurface demineralization
. Significantly many such lesions can under go remineralization & thus the
lesion is not an indication for restorative treatment
 OCCULT CARIES:
. Occult or hidden caries is used to describe such lesion, which is not
clinically diagnosed but detected only on radiographs
. It is believed that bitewing & OPG radiographs along with other noninvasive
adjuncts like fibrooptic transillumination (FOTI), LASER luminescence,
electrical resistance method(ERM) are used for diagnosing these occlusal
lesions
. These hidden lesions are called as ‘Fluoride Bomb’ or ‘Fluoride Syndrome’

CAVITATION:
. Once caries reaches the DEJ, the caries 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
[D] BASED ON TISSUE INVOLVED:

Enamel Caries Dentinal Caries Cemental Caries

[E] BASED ON TYPE OF DENTITION:

Caries in primary Caries in mixed Caries in permanent

dentition dentition dentition
 CARIES IN DECIDUOUS DENTITION:

. In the deciduous dentition, the attack of caries follows a specific

pattern:
.Mandibular molars
.Maxillary molars &
.Maxillary anterior teeth

. The maxillary anterior teeth or the facial & lingual surfaces of

the deciduous teeth are only involved in rampant nursing caries

. The second deciduous molars in both the maxillary & mandibular

arches are more susceptible to dental caries because the
occlusal surface of the teeth has deeper, less completely
coalesced pits & fissures
 CARIES IN THE MIXED DENTITION:

. After the eruption of the first permanent molars ,the mandibular first
permanent molars are first to decay & caries occurrence is higher than
their maxillary counterparts

. The maxillary permanent central & lateral incisors are not susceptible
to attack of caries

. It is mostly found in children with rampant caries caused by poor oral

hygiene , breathing through mouth , high carbohydrate diet or salivary
deficiency
 CARIES IN THE YOUNG PERMANENT DENTITION:

.With the eruption of the second permanent molars & premolars ,a rise
in the caries attack rate continues

.The first & second permanent molars have a higher occlusal surface
attack rate than their maxillary counterparts

.These teeth require careful attention to prevent rapid caries penetration

of the underlying dentin & pulp exposure

.Dental caries can be prevented by the topical application of fluoride &

sealants
 [F] BASED ON THE VIRGINITY OF THE
LESION:

Primary Caries Secondary or Recurrent

. Caries

Recurrent caries is that occuring immediately next to a restoration .It may be

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

In addition , caries may remain if there has not been complete excavation of
the original lesion, which later may appear as a residual or recurrent caries.
RECURRENT CARIES
 [G] BASED ON CHRONOLOGY:

Early childhood Caries Teenage Caries Adult Caries

(Adolescent )

EARLY CHILDHOOD CARIES:

. Early childhood caries would include two
variants – Nursing caries & Rampant caries

. Linear enamel caries (Odontoclasia ) is seen to

occur in the region of the neonatal line of the
maxillary anterior primary teeth. The line,which
represents a metabolic defect due to the trauma
of birth , may predispose to caries , leading to
gross destruction of the labial surfaces of the teeth
 TEENAGE (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 rapidly burrowing type , with a small

enamel opening

ADULT CARIES:

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

. Root caries and cervical caries are more commonly found in this group
 [H] BASED ON RAPIDITY OF
PROGRESSION:-

Acute Dental Caries Chronic Dental Caries

ACUTE DENTAL CARIES:
. Acute dental caries follows a rapid clinical course & results in early pulp
involvement
. Due to open & large dentinal tubules & absence of sclerosis in children &
young adults,it mostly involves younger age groups

. In acute dental caries ; entrance is small & acid , which is produced by

bacteria, is not easily neutralized by saliva,which leads to rapid progression
of caries

. Pain is a common feature of acute caries

e.g.-nursing bottle caries
ACUTE DENTAL CARIES
CHRONIC DENTAL CARIES-
. Chronic dental type of caries progresses slowly & tends to
involve the pulp much later
. It is common in adults
. Due to slow progression of carious process,there is sufficient
time for sclerosis of dentin & formation of reparative response
to the adverse irritation
. In chronic dental caries, entrance is larger.
Therefore, less food is retained & acids which are produced
by micro-organisms are neutralized by saliva
. Usually there is no pain in chronic caries because there is
sufficient time for the pulp to protect itself by sclerosis & for
formation of reparative dentin
[I] ACCORDING TO SITE & SIZE:
Mount G.J. (1997) classified dental caries based on site & size.
1.SITE --
SITE 1 : Includes lesions on the pit & fissures of the posterior teeth &
on other surfaces

SITE 2 : Includes lesions in the contact areas of posterior & anterior

teeth

SITE 3: Includes lesions originating in the gingival third of all teeth

2.SIZE--
SIZE 1(MILD): Includes lesions which have progressed just beyond
remineralization

SIZE 2(MODERATE): Includes larger lesions with adequate tooth structure

to support the restoration

SIZE 3(ENLARGED): Includes lesions in which the tooth structure & the
restoration are susceptible to fracture

SIZE 4(SEVERE): Includes lesions which have destroyed a major portion of

the tooth structure
[J] G.V. BLACK CLASSIFICATION:
CLASS 1: pit and fissure cavities that occur in the occlusal surfaces of bicuspids
and molars,the occlusal two thirds of the buccal and lingual surfaces of the
molars,and the lingual surfaces of incisors. Cavities beginning in structural
defects that occasionally occur on the occlusal or incisal two third of all teeth

CLASS 2: cavities in the proximal surfaces of bicuspids and molars

CLASS 3: Cavities in the proximal surfaces of incisors and cuspids, not involving
the incisal angle

CLASS 4: Cavities in the proximal surfaces of incisors and cuspids involving the
incisal angle
CLASS 5: Cavities in the gingival third, not pit and fissures cavities, of the labial,
buccal and lingual surfaces of all teeth

CLASS 6: Cavities on both mesial and distal proximal surfaces of bicuspid and
molars that when restored will share a common isthmus; or cavities on the incisal
edges of anterior or cusp tip of posterior teeth
 [k] FINN MODIFICATIONS OF
G.V.BLACK’S CLASSIFICATION:-
Class 1:-Pits and fissures on the occlusal surfaces of molar
teeth and the buccal and lingual pits of all teeth.
Class 2:-All proximal surfaces of molar teeth with access
established from occlusal surface.
Class 3:-All proximal surfaces of anterior teeth which may or
may not involve a labial or lingual extension
Class 4:-A restoration of the proximal of an anterior tooth
which involves the restoration of an incisal angle.
Class 5:-On the cervical third of all teeth,imcluding the
proximal surface where the marginal ridge is not included
in cavity preparation (Spot Filling) .
REFERANCES:
1. TEXTBOOK OF PEDODONTICS– Shobha Tandon (first edition)

2. TEXTBOOK OF PEDODONTICS– Satish chandra (first edition)

3. TEXTBOOK OF PEDIATRIC DENTISTRY-- S.G.Damle (second edition)

4. HANDBOOK OF PEDIATRIC DENTISTRY– Angus C Cameron (second edition)

5. RESTORATIVE TECHNIQUES IN PEDIATRIC DENTISTRY– M S Duggal

(second edition)