Classification and etiology of caries review

Classification and Classification and Etiology of CariesEtiology of Caries

What causes caries?What causes caries?

HostResistanceResistance


BacterialPlaque


DietDiet(sugars)


Time

Host

Bacterialplaque

Hostresistance

Time

Diet

Bacteria implicated in Bacteria implicated in caries infectioncaries infection

� Mutans streptococcus�Primary initiator�Primary initiator

� Lactobacillus�Responsible for progression

What Mutans streptococcus What Mutans streptococcus looks like…looks like…

Progression of cariesProgression of caries

� Acids from bacterial plaque-demineralization

� Bacterial invasionDemineralization proceeds to � Demineralization proceeds to cavitation (in enamel)

� Demineralization proceeds to root softening (cementum/dentin)

Classification of carious lesions and Classification of carious lesions and tooth preparationstooth preparations

� Systemic groupings first described by G.V. Black, the father of operative dentistry �Classification according to locations in �Classification according to locations in

permanent teeth

� Classifies according to number of surfaces prepared

� Classifies by location tooth preparation surfaces

Black’s classificationBlack’s classification

� Class 1 (I)� Class 2 (II)� Class 3 (III)� Class 4 (IV)� Class 5 (V)According to Schlutz� Class 6 (VI)

Number of surfaces preparedNumber of surfaces prepared

� Simple- involving one surface of a tooth

� Compound- involving two surfaces of a toothof a tooth

� Complex- involving three of more surfaces of a tooth

Location of tooth preparationLocation of tooth preparation

EXAMPLES� O- occlusal� MO- mesio-occlusal� DO- disto-occlusal� DO- disto-occlusal� MOD- mesio-occlusodistal� F- facial� DL- disto-lingual� MID- mesioincisodistal� DF- distofacial

Class I: pit and fissure caries to Class I: pit and fissure caries to include posterior occlusal surfaces, include posterior occlusal surfaces, facial and lingual surfaces; buccal facial and lingual surfaces; buccal pits of molars; lingual pits of anterior pits of molars; lingual pits of anterior teethteeth

Class I: pit and fissure caries to Class I: pit and fissure caries to include posterior occlusal surfaces, include posterior occlusal surfaces, facial and lingual surfaces; buccal facial and lingual surfaces; buccal pits of molars; lingual pits of anterior pits of molars; lingual pits of anterior teethteeth

Pit or fissure

DEJ

Pit or fissureProgression ofcaries are twocones base tobase

CLASS ICLASS I--OCCLUSAL PIT AND FISSUREOCCLUSAL PIT AND FISSURE

Caries Lesion ContinuumCaries Lesion Continuum

Sound

< ½ thicknessRadiographic evidence

Definite dentinal caries

(radiographically);Enamel surface intact

SoundTooth

No caries

Histologicalevidence of caries

Definite enamel caries(radiographically);Dentin affected histologically;

Enamel surface intact

Slight enamelSurface cavitation

RESTORATIONINDICATED

remineralization demineralization

Adapted from Suddick et al, Caries activity estimates and implications:insights into risk vs activity. J Dent Educ 61:876-884, 1997)

Caries Management ParadigmCaries Management Paradigmclassifying lesions by appropriate careclassifying lesions by appropriate care

Lesions into pulp

Clinically detectableLesions into dentin(open and closed)

Preventive andOperative care

Progressive/cavitatedStable/non-cavitated

Clinically detectable“cavities” limited to enamel

Clinically detectable enamel lesionsWith intact surfaces

Lesions detectable with additional Diagnostic aids (transillumination and radiographs)

Sub-clinical initial lesions in a dynamicState of progression/regression

Preventivecare advised

No activecaries

Caries extension = preparationCaries extension = preparation

Caries diagnosed extension into

pits and fissures = preparation

composite resin or amalgam

Occlusal caries Extension to avoid unsupported enamel and caries removal

Caries removal

Caries extension = preparationCaries extension = preparation

Diagnosed expected caries extension

bitewing x-ray + pits and fissures = preparation

Radiographicdiagnosis

Clinical appearanceAnd diagnosis

Class IClass Ilingual or buccal pitlingual or buccal pit

Class II: smooth surface caries on Class II: smooth surface caries on the proximal surfaces of posterior the proximal surfaces of posterior teethteeth

Progression ofcaries are twocones tip tobase

Class II: smooth surface caries on the Class II: smooth surface caries on the proximal surfaces of posterior teethproximal surfaces of posterior teeth

DEJEnamel

DEJ

Smooth surface


CLASS IICLASS II--interproximal cariesinterproximal caries

CLASS IICLASS II--interproximal caries; occlusal no interproximal caries; occlusal no caries not caries susceptiblecaries not caries susceptible

Class IIamalgam

Radiographic appearance of Class II caries

Radiographic appearance of Class II amalgam restorations and caries

Class IIcaries

Well contoured and carved Class II amalgam gingival margin

caries

Radiographic appearance of Class II amalgam restorations

Do you see any problems?

Radiographic appearance of Class II amalgam restorations

Did you See theClass II

Amalgam restorations with overhangs.

Class IIcaries

Radiographic appearance of Class II caries-note the Caries on the primary molars

Erupting Permanent1st premolar

Class III: smooth surface caries on the Class III: smooth surface caries on the proximal surfaces of anterior teethproximal surfaces of anterior teeth


Class III: smooth surface caries on the Class III: smooth surface caries on the proximal surfaces of anterior teethproximal surfaces of anterior teeth

DEJ Enamel

Smooth surface


Radiographic appearance of lesion

� Visible, invasive to <1/2 thickness of enamel

� Definite enamel caries (radiographically); dentin affected histologically;

CLASS IIICLASS III-- Proximal cariesProximal caries

affected histologically; enamel surface intact

� Definite dentinal caries; enamel surface intact

� Dentinal caries with enamel cavitation

radiographdemonstratesClass III lesion

on mesial surface of Maxillary lateral incisor.

Clinical appearance� Discolored with no cavitation;

depth within the enamel as seen through light transillumination

� Non-cavitated but visible with

CLASS IIICLASS III-- Proximal cariesProximal caries

� Non-cavitated but visible with transillumination as being through enamel into the dentin

� Clinically cavitated verified with explorer

TransilluminationdemonstratesClass III lesion

on mesial surface of Mandibular incisor.

Class IIIClass IIIcaries or defective restorationcaries or defective restoration

Class IV: lesions on the Class IV: lesions on the proximal surface of anterior proximal surface of anterior teeth that include the incisal teeth that include the incisal edgeedge

Usually dueto traumaticfracture

Class IV: lesions on the Class IV: lesions on the proximal surface of anterior proximal surface of anterior teeth that include the incisal teeth that include the incisal edgeedge

Class IV Class IV incisal edge with proximal surfaceincisal edge with proximal surface

Class IVClass IVcaries or defective restorationscaries or defective restorations

Traumatic fracture with Traumatic fracture with pulpal exposurepulpal exposure

Whenever restoring Class IV fractures, occlusal considerations will provide important information regarding tooth preparation before restoration.

Class IV restoration and Class IV restoration and its relationship to occlusionits relationship to occlusion

This restoration has fractured two previous times over a period of 4 months. Note the edge to edge occlusion that must be changed to expect a more

durable long lasting restoration.

Class V caries: smooth surface caries on Class V caries: smooth surface caries on the facial or lingual surfaces of both the facial or lingual surfaces of both anterior and posterior teeth at the anterior and posterior teeth at the gingival third; may involve cementum or gingival third; may involve cementum or dentin as well as enamel surfacesdentin as well as enamel surfaces


Class V caries: smooth surface caries on Class V caries: smooth surface caries on the facial or lingual surfaces of both the facial or lingual surfaces of both anterior and posterior teeth at the anterior and posterior teeth at the gingival third; may involve cementum or gingival third; may involve cementum or dentin as well as enamel surfacesdentin as well as enamel surfaces

DEJSmooth surface

EnamelDEJSmooth surface

Facial or lingual


Root Surface Caries MorphologyRoot Surface Caries Morphology

Carious lesion is a softening of the root surface that progresses following the

paths of the dentinal tubules

Root surface demineralization Root surface demineralization with softeningwith softening

Class V also describes nonClass V also describes non--carious smooth surface loss of carious smooth surface loss of tooth substance lesions on tooth substance lesions on facial and lingual surfacesfacial and lingual surfaces

� Erosion

NonNon--carious Class V lesionscarious Class V lesions

� Abrasion� Abfraction

Root surface demineralization Root surface demineralization with softeningwith softening

Erosive lesionbecomes carious

Restorative interventionRestorative interventionClass V caries, nonClass V caries, non--esthetic zoneesthetic zone

Class V cariesClass V caries

DiagnosisDiagnosis

Calculus, teeth must be cleaned for definitive diagnosis

Class VI: lesions are pit or wear Class VI: lesions are pit or wear defects on the incisal edges of defects on the incisal edges of anterior teeth or cusp tips of anterior teeth or cusp tips of posterior teeth; posterior teeth; lesions can be caries but don’t lesions can be caries but don’t have to behave to behave to behave to be

Class VI: lesions are pit or wear Class VI: lesions are pit or wear defects on the incisal edges of defects on the incisal edges of anterior teeth or cusp tips of anterior teeth or cusp tips of posterior teeth; posterior teeth; lesions can be caries but don’t lesions can be caries but don’t lesions can be caries but don’t lesions can be caries but don’t have to behave to be

Class VI: WearClass VI: Wear

Class VI: CariesClass VI: Caries

ReviewReview

� Class 1� Class 2� Class 3� Class 3� Class 4� Class 5� Class 6

Classification and etiology of caries review

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