clasificare carii dentare otr cariologie an III

8/14/2019 clasificare carii dentare otr cariologie an III

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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

clasificare carii dentare otr cariologie an III

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