classificationofdentalcaries-090721094719-phpapp02

8/7/2019 classificationofdentalcaries-090721094719-phpapp02

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CLASSIFICATION OFCLASSIFICATION OF

DENTAL CARIESDENTAL CARIESDr shabeel pnDr shabeel pn


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DENTAL CARIES IS ANDENTAL CARIES IS ANIRREVERSIBLE MICROBIAL DISEASEIRREVERSIBLE MICROBIAL DISEASE

OF THE CALCIFIED TISSUES OF THEOF THE CALCIFIED TISSUES OF THETEETH, CHARECTERIZED BYTEETH, CHARECTERIZED BYDEMINERALIZATION OF THEDEMINERALIZATION OF THEINORGANIC PORTION ANDINORGANIC PORTION AND

DESTRUCTION OF THE ORGANICDESTRUCTION OF THE ORGANICSUBSTANCE OF THE TOOTH ,SUBSTANCE OF THE TOOTH ,WHICH OFTEN LEADS TOWHICH OFTEN LEADS TOCAVITATIONCAVITATION

DEFINITIONDEFINITION


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11..BASED ONBASED ON ANATOMICALANATOMICAL SITESITE

22..BASED ONBASED ON PROGRESSIONPROGRESSION33..BASED ONBASED ON VIRGINITYVIRGINITY OF LESIONOF LESION

44..BASED ONBASED ON EXTENDEXTEND OF CARIESOF CARIES

55..BASED ONBASED ON TISSUETISSUE INVOLVEMENTINVOLVEMENT

66..BASED ONBASED ON PATHWAYPATHWAY OF CARIESOF CARIESSPREADSPREAD

77.. BASED ONBASED ON NUMBERNUMBER OF TOOTHOF TOOTHSURFACE INVOLVEDSURFACE INVOLVED


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88.. BASED ONBASED ON CHRONOLOGYCHRONOLOGY

99 ..BASED ON WHETHER CARIES ISBASED ON WHETHER CARIES ISCOMPLETLY REMOVEDCOMPLETLY REMOVED OR NOTOR NOTDURING TREATMENTDURING TREATMENT

1010..BASED ONBASED ON TOOTH SURFACETOOTH SURFACE TOTOBE RESTOREDBE RESTORED

1111..BLACKS CLASSIFICATIONBLACKS CLASSIFICATION

1212..WHO SYSTEMWHO SYSTEM


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11.BASED ON ANATOMICAL SITE.BASED ON ANATOMICAL SITE

OCCLUSAL

(PIT AND

FISSURE)

ROOT

CARIES

SMOOTH

SURFACECARIES

(PROXIMAL

AND CERVICAL

CARIES)

LINEAR

ENAMEL

CARIES


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PIT AND FISSURE CARIESPIT AND FISSURE CARIES

Highest prevalanceHighest prevalance of all caries bacteriaof all caries bacteriarapidly colonize the pits and fissures of therapidly colonize the pits and fissures of thenewly erupted teethnewly erupted teeth

These early colonizers form a bacterial plugThese early colonizers form a bacterial plugthat remains in the site for long timethat remains in the site for long time,perhaps even the life of the tooth,perhaps even the life of the tooth

Type & nature of the organisms prevalent inType & nature of the organisms prevalent inthe oral cavity determine the type ofthe oral cavity determine the type oforganisms colonizing the pit & fissureorganisms colonizing the pit & fissure

Numerous gram positive cocci, especiallyNumerous gram positive cocci, especiallydominated bydominated by s.sanguiss.sanguis are found in theare found in thenewly erupted teeth.newly erupted teeth.


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The appearance ofThe appearance ofs.mutanss.mutans in pits andin pits and

fissures is usually followed by cariesfissures is usually followed by caries 66 toto2424 months later.months later.

Sealing of pits and fissures just afterSealing of pits and fissures just aftertooth eruption may be the mosttooth eruption may be the most

important event in their resistance toimportant event in their resistance tocaries.caries.

Shape, morphological variation andShape, morphological variation anddepth of pit and fissures contributes todepth of pit and fissures contributes totheir high susceptibility to caries.their high susceptibility to caries.

Caries expand as it penetrates in to theCaries expand as it penetrates in to theenamel.enamel.


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MORPHOLOGY OF FISSURESMORPHOLOGY OF FISSURES

NANGO (NANGO (19601960):Based on the):Based on thealphabetical description of shapealphabetical description of shape 44typestypes

V&U type: self cleansing andV&U type: self cleansing andsomewhat caries resistantsomewhat caries resistant

U type: narrow slit like opening with aU type: narrow slit like opening with a

larger base as it extend towards DEJlarger base as it extend towards DEJ.Caries susceptible; also have a.Caries susceptible; also have anumber of different branchesnumber of different branches

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


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Entry site may appear muchEntry site may appear muchsmaller than actual lesion,smaller than actual lesion,

making clinical diagnosis difficult.making clinical diagnosis difficult. Carious lesion of pits and fissuresCarious lesion of pits and fissures

develop from attack on theirdevelop from attack on their

walls.walls. In cross section, the grossIn cross section, the gross

appearance of pit and fissureappearance of pit and fissure

lesion islesion is inverted Vinverted V with a narrowwith a narrowentrance and a progressivelyentrance and a progressivelywider area of involvement closerwider area of involvement closer

to the DEJto the DEJ..


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

usually attaches on the smooth surface thatusually attaches on the smooth surface thatare near the gingiva or are underare near the gingiva or are under proximalproximalcontact..contact..

In very young patients the gingival papillaIn very young patients the gingival papillacompletely fills the interproximal spacecompletely fills the interproximal space

under a proximal contact and is termed asunder a proximal contact and is termed ascol. Also crevicular spaces in them are lesscol. Also crevicular spaces in them are lessfavorable habitats for s.mutans.favorable habitats for s.mutans.

Consequently proximal caries is less lightly toConsequently proximal caries is less lightly to

develop where this favorable soft tissuedevelop where this favorable soft tissuearchitecture exists.architecture exists.


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The proximal surfaces are particularlyThe proximal surfaces are particularlysusceptible to caries due to extra sheltersusceptible to caries due to extra shelter

provided to resident plaque owing to theprovided to resident plaque owing to theproximal contact area immediatelyproximal contact area immediatelyocclusal to plaque.occlusal to plaque.

Lesion have a broad area of origin andLesion have a broad area of origin and

a conical, or pointed extension towardsa conical, or pointed extension towardsDEJ.DEJ. V shapeV shape with apex directed towards DEJ.with apex directed towards DEJ. After caries penetrate the DEJ softeningAfter caries penetrate the DEJ softening

of dentin spread rapidly and pulpallyof dentin spread rapidly and pulpally


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

The line, which represent a metabolic defectThe line, which represent a metabolic defectsuch as hypocalcemia or trauma of birth, maysuch as hypocalcemia or trauma of birth, maypredispose to caries, leading to grosspredispose to caries, leading to grossdestruction of the labial surface of the teeth.destruction of the labial surface of the teeth.

Morphological aspects of this type of caries areMorphological aspects of this type of caries are

atypical and results in gross destruction of theatypical and results in gross destruction of thelabial surfaces incisor teethlabial surfaces incisor teeth

Linear enamel cariesLinear enamel caries


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

line, often is unaffected by the action of hygieneline, often is unaffected by the action of hygieneprocedures, such as flossing, because it may haveprocedures, such as flossing, because it may have concaveconcaveanatomic surfaceanatomic surface contours (fluting)contours (fluting) and occasionaland occasionalroughness at the termination of the enamel.roughness at the termination of the enamel.

These conditions,These conditions, when coupled with exposure to the oralwhen coupled with exposure to the oralenvironment (as a result ofenvironment (as a result ofgingival recessiongingival recession),), favor thefavor theformation of mature, cariesformation of mature, caries--producing plaque andproducing plaque andproximal rootproximal root--surface caries.surface caries.

RootRoot--surface caries is more common in older patients.surface caries is more common in older patients.

Caries originating on the root is alarming becauseCaries originating on the root is alarming because

11.. it has a comparatively rapid progressionit has a comparatively rapid progression

22.. it is often asymptomaticit is often asymptomatic33.. it is closer to the pulpit is closer to the pulp

44,, it is more difficult to restoreit is more difficult to restore


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The root surface is refer the enamelThe root surface is refer the enameland readily allows plaque formation inand readily allows plaque formation inthe absence of good oral hygiene.the absence of good oral hygiene.

The cementum covering the rootThe cementum covering the rootsurface is extremely thin and providessurface is extremely thin and provides

little resistance to caries attack.little resistance to caries attack. Root caries lesions have less wellRoot caries lesions have less well--

defined margins, tend to be Udefined margins, tend to be U--shapedshaped

in cross sections, and progress morein cross sections, and progress morerapidly because of the lack ofrapidly because of the lack ofprotection from and enamel covering.protection from and enamel covering.


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22..BASED ONBASED ON

PROGRESSIONPROGRESSION

ACUTE CARIES

CHRONIC CARIES

ARRESTED CARIES


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ACUTE CARIESACUTE CARIES

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

These lesions are lighter colored than theThese lesions are lighter colored than the

other types, being light brown or grey, andother types, being light brown or grey, andtheir caseous consistency makes thetheir caseous consistency makes theexcavation difficult.excavation difficult.

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

It has been suggested that saliva does notIt has been suggested that saliva does noteasily penetrate the small opening to theeasily penetrate the small opening to thecarious lesion, so there arecarious lesion, so there are little opportunitylittle opportunityfor buffering or neutralizatonfor buffering or neutralizaton


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CHRONIC CARIESCHRONIC CARIES These lesions are usually ofThese lesions are usually oflonglong--standingstanding

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

Pain is not a common featurePain is not a common feature because ofbecause of

protection afforded to the pulp by secondaryprotection afforded to the pulp by secondarydentindentin

The decalcified dentin is dark brown andThe decalcified dentin is dark brown andleathery.leathery.

Pulp prognosis is hopeful in that the deepest ofPulp prognosis is hopeful in that the deepest oflesions usually requires only prophylacticlesions usually requires only prophylacticcapping and protective bases.capping and protective bases.

The lesions range in depth and include thoseThe lesions range in depth and include those

that have just penetrated the enamel.that have just penetrated the enamel.


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ARRESTED CARIESARRESTED CARIES::--

Caries which becomes stationary or staticCaries which becomes stationary or staticand doesand does nonot show any tendency fort show any tendency forfurther progressionfurther progression

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

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

marked brown pigmentation andmarked brown pigmentation and

induration of the lesion [the so calledinduration of the lesion [the so calledeburnation of dentineburnation of dentin]] Sclerosis of dentinal tubules andSclerosis of dentinal tubules and

secondary dentin formation commonlysecondary dentin formation commonlyoccuroccur


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Exclusively seen inExclusively seen incaries ofcaries ofocclusalocclusalsurfacesurface with largewith largeopen cavity in whichopen cavity in which

there is lack of foodthere is lack of foodretentionretention

Also on the proximalAlso on the proximalsurfaces of tooth insurfaces of tooth incases in which thecases in which theadjacentadjacentapproximating toothapproximating toothhas beenhas been extractedextracted


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33..BASED ON VIRGINITY OFBASED ON VIRGINITY OF

LESIONLESION

INITIAL/PRIMARY RECURRENT/SECONDARY


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PRIMARY CARIES(INITIAL)PRIMARY CARIES(INITIAL)

A primary caries is one in which theA primary caries is one in which thelesion constitutes the initial attack onlesion constitutes the initial attack onthe tooth surface.the tooth surface.

The designation of primary is basedThe designation of primary is basedon theon the initial locationinitial location of the lesion onof the lesion onthe surfacethe surface rather than the extent ofrather than the extent of

damage.damage.


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SECONDARY CARIESSECONDARY CARIES

(RECURRENT)(RECURRENT)

This type of caries is observed around the edgesThis type of caries is observed around the edgesandand under restorationsunder restorations..

The common locations of secondary caries areThe common locations of secondary caries are

the rough or overhanging margin and fracturethe rough or overhanging margin and fractureplace in all locations of the mouth.place in all locations of the mouth.

It may be result ofIt may be result ofpoor adaptationpoor adaptation of aof arestoration, which allows for a marginalrestoration, which allows for a marginalleakage, or it may be due to inadequateleakage, or it may be due to inadequateextension of the restoration.extension of the restoration.

In addition caries may remain if there has notIn addition caries may remain if there has notbeen complete excavation of the original lesion,been complete excavation of the original lesion,which later may appear as a residual orwhich later may appear as a residual or

recurrent caries.recurrent caries.


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44.BASED ON EXTENT OF.BASED ON EXTENT OF

CARIESCARIES

INCIPIENT CARIES

OCCULT CARIES

CAVITATION


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

smooth surface of teeth, is visible as asmooth surface of teeth, is visible as awhite spotwhite spot..

Histologically the lesion has an apparentlyHistologically the lesion has an apparentlyintact surface layer overlying subsurfaceintact surface layer overlying subsurfacedemineralization.demineralization.

Significantly may such lesionSignificantly may such lesion can undergocan undergoremineralizationremineralization and thus the lesion per seand thus the lesion per seis not an indication for restorativeis not an indication for restorativetreatmenttreatment


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These white spot lesion may beThese white spot lesion may beconfused initially with whiteconfused initially with white

developmental defects of enameldevelopmental defects of enamelformation, which can be differentiatedformation, which can be differentiatedby their position away from theby their position away from thegingival margin], their shapegingival margin], their shape[unrelated to plaque accumulation][unrelated to plaque accumulation]and their symmetry [they usuallyand their symmetry [they usuallyaffect the contralateral tooth].affect the contralateral tooth].

Also on wetting the caries lesionAlso on wetting the caries lesiondisappear while the developmentaldisappear while the developmentaldefect persistdefect persist


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It is believed that bite wing and OPGIt is believed that bite wing and OPGradiographs along with noninvasive adjunctsradiographs along with noninvasive adjunctslike fiber optic transillumination (FOTI),laserlike fiber optic transillumination (FOTI),laserluminescence, electrical resistance methodluminescence, electrical resistance method(ERM) are used for diagnosis these occlusal(ERM) are used for diagnosis these occlusallesions.lesions.

These lesion are not associated withThese lesion are not associated withmicroorganisms different to those found inmicroorganisms different to those found inother carious lesion.other carious lesion.

These carious lesion seem to increase withThese carious lesion seem to increase with

increasing age.increasing age. Occult carious lesion are usually seen with lowOccult carious lesion are usually seen with low

caries rate which is suggestive of increase fluidcaries rate which is suggestive of increase fluidexposure.exposure.


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It is believed thatIt is believed that increased fluidincreased fluidexposure encourages remineralizationexposure encourages remineralization

and slow down progress of the cariesand slow down progress of the cariesin the pit and fissure enamel while thein the pit and fissure enamel while thecavitations continues in dentine, andcavitations continues in dentine, andthe lesions become masked by athe lesions become masked by arelatively intact enamel surface.relatively intact enamel surface.

These hidden lesions are called asThese hidden lesions are called asfluoride bombs or fluoridefluoride bombs or fluoride

syndrome.syndrome. Recently it is seen that occult cariesRecently it is seen that occult caries

may have its origin as premay have its origin as pre--eruptiveeruptivedefects which are detectable only withdefects which are detectable only with

the use of radiographs.the use of radiographs.


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CAVITATIONCAVITATION

Once it reaches theOnce it reaches the

dentinoenamel junction,dentinoenamel junction,the caries process has thethe caries process has thepotential to spread to thepotential to spread to thepulp along the dentinalpulp along the dentinal

tubules and also spreadtubules and also spreadin lateral direction.in lateral direction.

Thus some amount ofThus some amount ofsensitivity may besensitivity may beassociated with this typeassociated with this type

of lesion.of lesion.

This may be generallyThis may be generallyaccompanied byaccompanied bycavitationcavitation


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55.Based on tissue.Based on tissue

involvementinvolvement1.1. Initial cariesInitial caries

2.2. Superficial cariesSuperficial caries

3.3. Moderate cariesModerate caries4.4. Deep cariesDeep caries

5.5. Deep complicated cariesDeep complicated caries


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Dental caries can be divided intoDental caries can be divided into 44oror 55 stagesstages

Initial caries:Initial caries: DemineralizationDemineralizationwithout structural defect. Thiswithout structural defect. Thisstage can be reversed bystage can be reversed by

fluoridation and enhanced mouthfluoridation and enhanced mouthhygienehygiene

Superficial cariesSuperficial caries ((CariesCaries

superficialissuperficialis):):Enamel caries,Enamel caries,wedgewedge--shaped structural defect.shaped structural defect.Caries has affected the enamelCaries has affected the enamellayer, but has not yet penetratedlayer, but has not yet penetrated

the dentin.the dentin.


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33..Moderate cariesModerate caries ((Caries mediaCaries media): Dentin): Dentincaries. Extensive structural defect. Cariescaries. Extensive structural defect. Caries

has penetrated up to the dentin andhas penetrated up to the dentin andspreads twospreads two--dimensionally beneath thedimensionally beneath theenamel defect where the dentin offers littleenamel defect where the dentin offers littleresistance.resistance.

44..Deep cariesDeep caries ((Caries profundaCaries profunda)):: DeepDeepstructural defect. Caries has penetrated upstructural defect. Caries has penetrated upto the dentin layers of the tooth close toto the dentin layers of the tooth close tothe pulp.the pulp.

55..Deep complicated cariesDeep complicated caries (Caries(Cariesprofunda complicataprofunda complicata)) ::Caries has led to theCaries has led to theopening of the pulp cavity (opening of the pulp cavity (pulpa apertapulpa aperta ororopen pulp).open pulp).


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66..BASED ON PATHWAY OFBASED ON PATHWAY OF

CARIESCARIES SPREADSPREAD

1.FORW

ARD CARIES2

.BACKW

ARD CARIES


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ForwardForward--backward classification isbackward classification isconsidered as graphical representation ofconsidered as graphical representation of

the pathway of dental caries.the pathway of dental caries.ENAMELENAMEL

First component of enamel to be involvedFirst component of enamel to be involvedin carious process is thein carious process is the interprismaticinterprismatic

substancesubstance. The disintegrating chemicals. The disintegrating chemicalswill proceed via the substance, causing thewill proceed via the substance, causing theenamel prism to be undermined.enamel prism to be undermined.

The resultant caries involvement in enamelThe resultant caries involvement in enamelwill 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.


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

isis protoplasmic extensionprotoplasmic extension within thewithin thedentinal tubules.dentinal tubules.

These protoplasmic extension have theirThese protoplasmic extension have theirmaximum space at the DEJ, but as theymaximum space at the DEJ, but as theyapproach the pulp chamber and rootapproach the pulp chamber and rootcanal walls, thecanal walls, the tubules become moretubules become more

densely arrange with fewerdensely arrange with fewerinterconnectionsinterconnections..

So caries cone in dentin will have theirSo caries cone in dentin will have their

base towards DEJ.base towards DEJ.


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Decay starts in enamel then it involvesDecay starts in enamel then it involvesthe dentin. Wherever the caries conethe dentin. Wherever the caries conein enamel is larger or at least the sizein enamel is larger or at least the sizeas that of dentin, it is called forwardas that of dentin, it is called forwarddecay (pit decay)decay (pit decay)

However the carious process in dentinHowever the carious process in dentinprogresses much faster than inprogresses much faster than inenamel, so the cone in dentin tends toenamel, so the cone in dentin tends to

spread laterally creating underminedspread laterally creating underminedenamel. In addition decay can attackenamel. In addition decay can attackenamel from its dentinal side. At thisenamel from its dentinal side. At thisstage it becomes backward decay.stage it becomes backward decay.


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77.BASED ON NUMBER OF.BASED ON NUMBER OF

TOOTH SURFACE INVOLVEDTOOTH SURFACE INVOLVED

SimpleSimple

CompoundCompound

ComplexComplex

A caries involving only oneA caries involving only onetooth surfacetooth surface

A caries involving twoA caries involving twosurfaces of toothsurfaces of tooth

A caries that involvesA caries that involves

more than two surfacesmore than two surfacesof a toothof a tooth


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88.BASED ON CHRONOLOGY.BASED ON CHRONOLOGY

EARLY CHILDHOOD CARIES

ADOLESCENT CARIES

ADULT CARIES


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It has been stated that over aIt has been stated that over alifetime, caries incidence i.e. thelifetime, caries incidence i.e. thenumber of new lesions occurring in anumber of new lesions occurring in ayear, shows three peaksyear, shows three peaks--at the agesat the ages44--88,,1111--1919 andand 5555--6565 yearsyears


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EARLY CHILDHOOD CARIESEARLY CHILDHOOD CARIES

Early childhood cariesEarly childhood carieswould include, twowould include, twovariants: Nursingvariants: Nursingcaries and rampantcaries and rampantcaries.caries.

The differenceThe differenceprimarily exist inprimarily exist ininvolvement of theinvolvement of theteeth[ mandibularteeth[ mandibularincisors ] in theincisors ] in the

carious process incarious process inrampant caries asrampant caries asopposed to nursingopposed to nursingcaries.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(MODE

RATE)

Unaffected mandibular incisorsSoon after first tooth erupts

Causeinappropriate feeding +lack of

oral hygeine

TypeIII

(SEVE

RE)

All teeth including mandibular incisors

Causemultitude of factors


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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 derivedstreptococcusmutant

disease (MDSMD)

NURSING CARIES RAMPANT CARIES


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NURSING CARIES

Seen in infant and

toddler

Affects primary

dentition

Mandibular incisors arenot involved

ETIOLOGY

Improper bottlefeeding

Pacifier dipped in

honey/other sweetner

RAMPANT CARIES

Seen in all ages,

including

adoloscennce

Affects primary and

permanent dentition

Mandibular incisorsare

also affected

ETIOLOGY

MULTIFACTORIAL

Frequent snacks

Sticky refined CHO

Decreased salivary

flow


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TEENAGE CARIESTEENAGE CARIES

(ADOLESCENT CARIES(ADOLESCENT CARIES)) This type of caries is a variant of rampantThis type of caries is a variant of rampant

caries where the teeth generallycaries where the teeth generallyconsidered immune to decay are involved.considered immune to decay are involved.

The caries is also described to be of aThe caries is also described to be of arapidly burrowing type, with a smallrapidly burrowing type, with a smallenamel opening.enamel opening.

The presence of a large pulp chamberThe presence of a large pulp chamberadds to the woes, causing early pulpadds to the woes, causing early pulpinvolvementinvolvement


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ADULT CARIESADULT CARIES

With the recession ofWith the recession ofthe gingiva andthe gingiva andsometimes decreasedsometimes decreasedsalivary function due tosalivary function due toatrophy, at the age ofatrophy, at the age of

5555--6060 years, the thirdyears, the thirdpeak of caries ispeak of caries isobserved.observed.

Root caries and cervicalRoot caries and cervicalcaries are morecaries are morecommonly found in thiscommonly found in this

group.group. Sometime they are alsoSometime they are also

associated with aassociated with apartial denture clasp.partial denture clasp.


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99..BASED ON WHETHER CARIES ISBASED ON WHETHER CARIES IS

COMPLETLY REMOVED OR NOTCOMPLETLY REMOVED OR NOT

DURING TREATMENTDURING TREATMENT

RESIDUAL CARIESRESIDUAL CARIES

Residual caries is that which is not removedResidual caries is that which is not removedduring a restorative procedure, either byduring a restorative procedure, either byaccident, neglect or intention.accident, neglect or intention.

Sometimes a small amount of acutely cariousSometimes a small amount of acutely cariousdentin close to the pulp is covered with adentin close to the pulp is covered with aspecific capping material to stimulate dentinspecific capping material to stimulate dentindeposition, isolating caries from pulp.deposition, isolating caries from pulp.

The carious dentin can be removed at a laterThe carious dentin can be removed at a latertime.time.


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1010..BASED ON SURFACES TO BEBASED ON SURFACES TO BE

RESTOREDRESTORED

Most widespread clinical utilizationMost 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 surfaceVarious combinations are also possible, suchVarious combinations are also possible, such

as MODas MOD for mesiofor mesio--occlusooccluso--distaldistalsurfaces.surfaces.


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1111.BLACKS CLASSIFICATION.BLACKS CLASSIFICATION

ClassClass 11 lesionslesions:: Lesions that begin in the structural defects ofLesions that begin in the structural defects of

teeth such as pits, fissures and defectiveteeth such as pits, fissures and defectivegrooves.grooves.

Locations includeLocations include Occlusal surface of molars and premolars.Occlusal surface of molars and premolars. occlusal two thirds of buccal and lingualocclusal two thirds of buccal and lingual

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

ClassClass 22 lesions:lesions: TheyThey are found on the proximal surfaces ofare found on the proximal surfaces of

the bicuspids and molars.the bicuspids and molars.


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ClassClass 33 lesions:lesions: Lesions found on the proximal surfaces of anteriorLesions found on the proximal surfaces of anterior

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

ClassClass 44 lesions:lesions: Lesions found on the proximal surfaces of anteriorLesions found on the proximal surfaces of anterior

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

ClassClass 55 lesionslesions:: Lesions that are found at the gingival third of theLesions that are found at the gingival third of the

facial and lingual surfaces of anterior and posteriorfacial and lingual surfaces of anterior and posterior

teeth.teeth.

ClassClass 66 (Simons modification(Simons modification):): Lesions involving cuspal tips and incisalLesions involving cuspal tips and incisal

edges of teethedges of teeth..


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1212.World health organization.World health organization

(WHO) system(WHO) system

In this classification the shape and depth ofIn this classification the shape and depth ofthe caries lesion scored on a four pointthe caries lesion scored on a four pointscalescale

DD11. clinically detectable enamel lesions with. clinically detectable enamel lesions withintact (non cavitated) surfacesintact (non cavitated) surfaces

DD22. Clinically detectable cavities limited to. Clinically detectable cavities limited toenamelenamel

DD33. Clinically detectable cavities in dentin. Clinically detectable cavities in dentin

DD44. Lesions extending into the pulp. Lesions extending into the pulp


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RADIATION CARIES

Radiography is frequently associated withxerostomia due to decreased salivary

secretion,an increase in viscosity and low PH

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

caries.


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ThreeThree types of defects due totypes of defects due toirradiationirradiation

1.1. Lesion usually encircling the neckLesion usually encircling the neckof teeth amputation of crowns mayof teeth amputation of crowns mayoccuroccur

2.2. Begins as brown to blackBegins as brown to blackdiscolouration of tooth .occlusaldiscolouration of tooth .occlusalsurface and incisal edges wearsurface and incisal edges wear

awayaway3.3. Spot depression which spreadsSpot depression which spreads

from any surfacefrom any surface


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CLASSIFICATIONS

OF CAVITY

PREPARATION


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11..BASED EATMENT&RESTORATIO BASEDONTREATMENT&RESTORATIO

DESI N(BLACKSDESI N(BLACKS))ClassClass 11 restorationrestoration::

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 ofocclusal two thirds of buccal and lingual surfaces ofmolars and premolars.molars and premolars.

Lingual surfaces of anterior tooth.Lingual surfaces of anterior tooth.

ClassClass 22 restoration :restoration :TheyThey are found on the proximal surfaces of theare found on the proximal surfaces of thebicuspids and molars.bicuspids and molars.


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ClassClass 33 restoration :restoration :restoration on the proximal surfaces of anterior teethrestoration on the proximal surfaces of anterior teeth

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

ClassClass 44restorationrestoration ::restoration on the proximal surfaces of anterior teethrestoration on the proximal surfaces of anterior teeth

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

ClassClass 55 restorationrestoration ::restoration at the gingival third of the facial and lingualrestoration at the gingival third of the facial and lingualsurfaces of anterior and posterior teeth.surfaces of anterior and posterior teeth.

ClassClass 66 (Simons modification(Simons modification):):restoration involving cuspal tips and incisal edges ofrestoration involving cuspal tips and incisal edges ofteethteeth..


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22..Other modificationsOther modifications

CharbeneusmodificationCharbeneusmodification::a)a) ClassClass 22::

cavity on single proximal surface of bicuspidscavity on single proximal surface of bicuspidsand molarsand molars

b) Classb) Class 66::Cavities on both mesial and distal proximalCavities on both mesial and distal proximalsurfaces of posterior teeth that will share asurfaces of posterior teeth that will share acommon occlusal isthmuscommon occlusal isthmus

c) Lingual surfaces of upper anterior teethc) Lingual surfaces of upper anterior teeth..d) Any other unusually located pit or fissured) Any other unusually located pit or fissureinvolved with decay.involved with decay.


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33..Sturdevants classificationSturdevants classification

CavityCavity

Simple cavitySimple cavity

CompoundCompoundcavitycavity

ComplexComplex

cavitycavity

FeatureFeature

A cavity involving only oneA cavity involving only one

tooth surfacetooth surface

A cavity involving twoA cavity involving two

surfaces of toothsurfaces of tooth

A cavity that involves moreA cavity that involves morethan two surfaces of a tooththan two surfaces of a tooth

44 Fi difi i f Bl kFi difi i f Bl k


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44..Finns modification ofBlacksFinns modification ofBlacks

cavity preparation forcavity preparation forprimary teethprimary teeth

ClassClass11 :: Cavities involving the pits andCavities involving the pits andfissures of molar teeth and thefissures of molar teeth and the

buccal and lingual pits of all teeth.buccal and lingual pits of all teeth.

ClassClass 22:: cavities involving proximal surface ofcavities involving proximal surface of

molar teeth will access establishedmolar teeth will access established

from the occlusal surface.from the occlusal surface.

ClassClass 33:: cavities involving proximal surfaces ofcavities involving proximal surfaces of

anterior teeth which may or may notanterior teeth which may or may not

involve a labial or a lingual extensioninvolve a labial or a lingual extension


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55..Baumes classificationBaumes classification

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

b). Smooth surface cavitiesb). Smooth surface cavities

66 Cl ifi ti b M t dCl ifi ti b M t d


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66..Classification by Mount andClassification by Mount and

Hume(Hume(19981998))

G J MOUNT CLASSIFICATING J MOUNT CLASSIFICATIN

This new system defines the extent andThis new system defines the extent and

complexity of a cavity and at the samecomplexity of a cavity and at the sametime encourages a conservative approachtime encourages a conservative approach

to the preservation of natural toothto the preservation of natural tooth

structure.structure.

This system is designed to utilize theThis system is designed to utilize the

healing capacity of enamel and dentine.healing capacity of enamel and dentine.


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

SiteSite 11

SiteSite 22

SiteSite 33

Pits, fissuresPits, fissures and enamel defects on occlusaland enamel defects on occlusal

surfaces of posterior teeth or other smoothsurfaces of posterior teeth or other smooth

surfacessurfaces

Proximal enamel immediately below areas inProximal enamel immediately below areas incontactcontact with adjacent teethwith adjacent teeth

TheThe cervical one thirdcervical one third of the crown or followingof the crown or following

gingival recession, the exposed rootgingival recession, the exposed root


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The fourThe foursizessizes of carious lesionsof carious lesions

SizeSize11::MinimalMinimal involvement of dentin justinvolvement of dentin justbeyond treatment by remineralizationbeyond treatment by remineralizationalone.alone.

SizeSize22:: ModerateModerate involvement of dentin.involvement of dentin.Following cavity preparation, remainingFollowing cavity preparation, remaining

enamel is sound, well supported byenamel is sound, well supported by

dentin and not likely to fail under normaldentin and not likely to fail under normalocclusal load. The remaining toothocclusal load. The remaining toothstructure is sufficiently strong to supportstructure is sufficiently strong to support

the restoration.the restoration.


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SizeSize 33: the cavity is enlarged beyond moderate.: the cavity is enlarged beyond moderate.

The remaining tooth structure isThe remaining tooth structure isweakened to the extent that cups orweakened to the extent that cups or

incisal edges are split, or are likely to failincisal edges are split, or are likely to fail

or left exposed to occlusal or incisalor left exposed to occlusal or incisal

load. the cavity needs to be furtherload. the cavity needs to be furtherenlargedenlarged so that the restoration can beso that the restoration can be

designed to provide support anddesigned to provide support and

protection to the remaining toothprotection to the remaining toothstructure.structure.

SizeSize44:: ExtensiveExtensive caries with bulk loss of toothcaries with bulk loss of tooth

structure has already occurred.structure has already occurred.


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SiteSite SizeSize

Pit/fissure 1Pit/fissure 1

Contact area 2Contact area 2

Cervical 3Cervical 3

MinimalMinimal 11 Moderate 2Moderate 2 Enlarged 3Enlarged 3 Extensive 4Extensive 4

1.11.1 1.21.2 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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