DENTAL CARIES(Classification And Theories)

Dr. Shahzadi Tayyaba Hashmi

DNT 353

CLASSIFICATION

CLASSIFICATION BY THE RATE OF ATTACK:• Acute caries• Chronic caries• Arrested caries

CLASSIFICATION BY THE SITE OF ATTACK:• Pits and fissure caries• Smooth surface caries• Root caries (cemental caries)• Recurrent caries

CLASSIFICATION

BLACK'S CLASSIFICATION:• Class I• Class II• Class III• Class IV• Class V• Class VICLASSIFICATION BASED ON VIRGINITY OF LESIONS:• Primary caries (initial)• Secondary caries (recurrent )

CLASSIFICATION

CLASSIFICATION BASED ON NUMBER OF TOOTH SURFACE INVOLVED:

• Simple• Compound• ComplexEARLY CHILDHOOD CARIES :• Rampant caries (nursing bottle caries)

CLASSIFICATION BY THE RATE OF ATTACK

Acute caries:• Most common in young patients because they have teeth with large pulp

chambers and short dentinal tubules with no or little sclerosis• Caused by diet rich in refined carbohydrates and less than adequate oral

hygiene• Multiple advanced carious lesion develops simultaneously that reaches the

pulp and cause severe pain

CLASSIFICATION BY THE RATE OF ATTACK

Chronic caries:• Most common in older patients whose teeth have small

pulp chambers with additional deposits of dense tubular dentin on the pulpal walls known as tertiary dentin

• They have significant degrees of sclerosis which provides resistance to the progression of dental caries

• Less pain occurs

Arrested caries:• Enamel, dentine or root caries that become static and slower• No tendency for further progress

Acute caries in a child

Chronic caries

Arrested caries

CLASSIFICATION BY THE SITE OF ATTACK

Pits and fissure caries:• Most common type of caries• Appears at an early age on the occlusal and

buccal surfaces of molars of the primary and secondary dentition

• This form of caries is most destructive because it goes deeply into dentin and clinically appears as a large cavity which is painful

CLASSIFICATION BY THE SITE OF ATTACK

Smooth surface caries:• Less common• Occurs on the interproximal contact areas of

teeth that are not self cleansing• Cervical regions of the buccal and lingual surfaces of teeth are involved

CLASSIFICATION BY THE SITE OF ATTACK

Root caries (cemental caries):• Always found in old people who have roots exposed to

oral environment as a result of gingival recession• This form of caries initiates differently than enamel and

dentin caries, because root surfaces are soft and thin and can be traumatized by abrasive action during tooth brushing

• Cementum is readily decalcified and presents little barrier to infection

• Saucer shaped shallow cavity is formed with ill defined boundaries

ROOT CARIES ROOT CARIES IN LOWER PREMOLARS

ROOT CARIES AS A RESULT OF AGINGROOT CARIES DIFFICULT TO DETECT CLINICALLY, BECAUSE THEY ARE FREQUENTLY HIDDEN BY GINGIVA

CLASSIFICATION BY THE SITE OF ATTACK

Recurrent Caries: Caries that arises around an existing restoration Lesions arises as a result of alteration in the integrity of a

restoration results in marginal leakage It causes accumulation of food and bacteria around the

tooth where oral hygiene restricts the removal of those bacteria and food

Carious lesions progress according to patients diet and oral hygiene habits

BLACK’S CLASSIFICATIONCLASS I:• Class I cavity is that in which Caries affect pits and fissures on

occlusal surfaces of posterior teeth (molars and premolars) , lingual or buccal pits of posterior teeth and Lingual pit of incisors

CLASS II:• Class II cavity is one in which carious process affects approximal

(mesial or distal ) surfaces of posterior teeth

CLASS III:• Class III cavity is one which is present in the approximal surface

of the anterior teeth but does not involve the incisal edge

BLACK’S CLASSIFICATION

CLASS IV:• Class IV Caries affecting proximal surfaces including incisal

edges of anterior teeth

CLASS V:• Class V Caries is one in which carious process creates

defects in the cervical third of any tooth

CLASS VI:• Class VI Cavity is one in which the cusp tips or the incisal

edges are involved in carious process

CLASS I CLASS II

CLASS III

CLASS IV CLASS V

CLASS VI

BLACK’S CLASSIFICATION

CLASS I CLASS IICASS III CLASS V

EARLY CHILHOOD CARIES

Rampant caries (nursing bottle caries):• Present on the labial surfaces of the primary teeth of

infants• Caused by a habit of leaving the feeding bottle • containing milk or juice in the infants mouth when sleeping

THEORIES OF DENTAL CARIES

There are different theories about the progress of dental caries,

a. Acidogenic theory (miller’s theory)b. Proteolytic theoryc. Proteolytic chelation theory

Acidogenic theory

• Proposed by W.D Miller in 1882• Miller proved after certain experiments that certain

bacteria present in mouth, produce acids from carbohydrates which causes demineralization of the dental tissues

• Consumption of more refined carbohydrates was associated with more caries

• Frequency of carbohydrate foods (snacks and drinks) also contribute to incidence of dental caries• Widely accepted theory

Proteolytic theory

• Proposed by Gottlieb • According to this theory, the organic or protein elements of

tooth are the initial pathways of invasion by microorganismsAnd, caries is essentially a Proteolytic process , in which the microorganisms invade the organic pathways and destroy them while advancing through them by forming acids

• Hence certain structures of enamel having high organic material composition, like enamel lamellae and enamel rod sheaths, could serve as a pathway for microorganism invasion through the enamel

Proteolytic chelation theory

• It was postulated that certain chelate compounds are present in the carious lesion

• These types of compounds have a secondary role in the carious process

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