CLASSIFICATION OF

DENTAL CARIES
 DEFINITION

DENTAL CARIES IS AN IRREVERSIBLE

MICROBIAL DISEASE OF THE
CALCIFIED TISSUES OF THE TEETH,
CHARACTERIZED BY
DEMINERALIZATION OF THE
INORGANIC PORTION AND
DESTRUCTION OF THE ORGANIC
SUBSTANCE OF THE TOOTH , WHICH
OFTEN LEADS TO CAVITATION
1.BASED ON ANATOMICAL SITE
2.BASED ON PROGRESSION
3.BASED ON VIRGINITY OF LESION
4.BASED ON EXTENT OF CARIES
5.BASED ON TISSUE INVOLVEMENT
6.BASED ON PATHWAY OF CARIES
SPREAD
7. BASED ON NUMBER OF TOOTH
SURFACE INVOLVED
8. BASED ON CHRONOLOGY
9 .BASED ON WHETHER CARIES IS
COMPLETLY REMOVED OR NOT
DURING TREATMENT
10.BASED ON TOOTH SURFACE TO
BE RESTORED
11.BLACKS CLASSIFICATION
12.WHO SYSTEM
1.BASED ON ANATOMICAL SITE

OCCLUSAL
SMOOTH
SURFACE
(PIT AND CARIES
FISSURE) (PROXIMAL LINEAR
AND CERVICAL ENAMEL
CARIES) CARIES

ROOT
CARIES
 PIT AND FISSURE CARIES
Highest prevalance of all caries bacteria rapidly
colonize the 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.sanguis are found in the newly
erupted teeth.
 The appearance of s.mutans in 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 pit
and fissures contributes to their high
susceptibility to caries.
Caries expand as it penetrates in to the enamel.
MORPHOLOGY OF FISSURES
NANGO (1960):Based on the alphabetical
description of shape 4 types
V&U type: self cleansing and somewhat
caries resistant
U type: narrow slit like opening with a
larger base as it extend towards DEJ
.Caries susceptible; also have a
number of different branches
K type: also very susceptible to caries
 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 of pit and fissure

lesion is inverted V with a narrow
entrance and a progressively
wider area of involvement closer
to the DEJ.
 Smooth surface caries
Less favorable site for plaque attachment,
usually attaches on the smooth surface that
are near the gingiva or are under proximal
contact..
In very young patients the gingival papilla
completely fills the interproximal space
under a proximal contact and is termed as
col. Also crevicular spaces in them are less
favorable habitats for s.mutans.
Consequently proximal caries is less lightly to
develop where this favorable soft tissue
architecture exists.
 The proximal surfaces are particularly
susceptible to caries due to extra shelter
provided to resident plaque owing to the
proximal contact area immediately
occlusal to plaque.
Lesion have a broad area of origin and
a conical, or pointed extension towards
DEJ.
V shape with apex directed towards DEJ.
After caries penetrate the DEJ softening
of dentin spread rapidly and pulpally
 Linear enamel caries
Linear enamel caries ( odontoclasia ) is seen to
occur in the region of the neonatal line of the
maxillary anterior teeth.
The line, which represent a metabolic defect
such as hypocalcemia 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 and results in gross destruction of the
labial surfaces incisor teeth
 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 surface contours (fluting) and
occasional 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
 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 lack of protection from
and enamel covering.
 2.BASED ON
PROGRESSION

ACUTE CARIES ARRESTED CARIES

CHRONIC CARIES
 ACUTE CARIES
Acute caries is a rapid process involving a large
number of 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 teeth are often
observed in patients with acute caries.
It has been suggested that saliva does not
easily penetrate the small opening to the
carious lesion, so there are little opportunity for
buffering or neutralizaton
 CHRONIC CARIES
These lesions are usually of long-standing
involvement, affect a fewer number of teeth, and
are smaller than acute caries.
Pain is not a common feature because 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.
 ARRESTED CARIES:-
Caries which becomes stationary or static
and does not 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
dentin formation commonly occur
 Exclusively seen in
caries of occlusal
surface with large
open cavity in which
there is lack of food
retention
Also on the proximal
surfaces of tooth in
cases in which the
adjacent
approximating tooth
has been extracted
 3.BASED ON VIRGINITY OF

LESION

INITIAL/PRIMARY RECURRENT/SECONDARY
 PRIMARY CARIES(INITIAL)
A primary caries is one in which the
lesion constitutes the initial attack on
the tooth surface.
The designation of primary is based
on the initial location of the lesion on
the surface rather than the extent of
damage.
 SECONDARY CARIES
(RECURRENT)
This type of caries is observed around the edges and
under restorations.
The common locations of secondary caries are the
rough or overhanging margin and fracture place in all
locations of the mouth.
It may be 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.
 4. BASED ON EXTENT OF
CARIES

INCIPIENT CARIES
CAVITATION

OCCULT CARIES
 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
remineralization and thus the lesion per se
is not an indication for restorative
treatment
 These white spot lesion may be
confused initially with white
developmental defects of enamel
formation, which can be differentiated
by 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
 It is believed that bite wing and OPG radiographs
along with noninvasive adjuncts like fiber optic
transillumination (FOTI),laser luminescence,
electrical resistance 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.
 It is believed that increased fluid exposure
encourages remineralization and slow down
progress of the caries in the pit and fissure
enamel while the cavitations continues in
dentine, and the lesions become masked
by a relatively intact enamel surface.
These hidden lesions are called as fluoride
bombs or fluoride syndrome.
Recently it is seen that occult caries may
have its origin as pre-eruptive defects
which are detectable only with the use of
radiographs.
 Once it reaches the
dentinoenamel junction,
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.
This may be generally
accompanied by
cavitation
 5.Based on tissue
involvement
1. Initial caries
2. Superficial caries
3. Moderate caries
4. Deep caries
5. Deep complicated caries
Dental caries can be divided into 4 or
5 stages
Initial caries: Demineralization
without structural defect. This stage
can be reversed by fluoridation and
enhanced mouth hygiene
Superficial caries (Caries
superficialis):Enamel caries, wedge-
shaped structural defect. Caries has
affected the enamel layer, but has not
yet penetrated the dentin.
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 the tooth close to the
pulp.
5. Deep complicated caries (Caries profunda
complicata) :Caries has led to the opening of
the pulp cavity (pulpa aperta or open pulp).
6.BASED ON PATHWAY OF CARIES
SPREAD

1.FORWARD CARIES 2.BACKWARD CARIES

 Forward-backward classification is
considered as graphical representation of the
pathway of dental caries.
ENAMEL
First component of enamel to be involved in
carious process is the interprismatic substance.
The disintegrating chemicals will proceed via
the substance, causing the enamel prism to be
undermined.
The resultant caries involvement in enamel will
have cone shape.
In concave surface (pit and fissures) base
towards DEJ.
In convex surfaces (smooth surface) base
away from DEJ.
 DENTIN
First component to be involved in dentin is
protoplasmic extension within the dentinal
tubules.
These protoplasmic extension have their
maximum space at the DEJ, but as they
approach the pulp chamber and root canal
walls, the tubules become more densely
arrange with fewer interconnections.
So caries cone in dentin will have their base
towards DEJ.
 Decay starts in enamel then it involves
the dentin. Wherever the caries cone in
enamel is larger or at least the size as
that of dentin, it is called forward decay
(pit decay)
However the carious process in dentin
progresses much faster than in enamel, so
the cone in dentin tends to spread
laterally creating undermined enamel. In
addition decay can attack enamel from its
dentinal side. At this stage it becomes
backward decay.
 7.BASED ON NUMBER OF
TOOTH SURFACE INVOLVED

Simple A caries involving only one

tooth surface
A caries involving two
Compound surfaces of tooth

Complex A caries that involves

more than two surfaces
of a tooth
 8. BASED ON CHRONOLOGY

EARLY CHILDHOOD CARIES

ADULT CARIES

ADOLESCENT CARIES
 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
 EARLY CHILDHOOD CARIES
Early childhood caries
would include, two
variants: Nursing
caries and rampant
caries.
The difference
primarily exist in
involvement of the
teeth[ mandibular
incisors ] in the
carious process in
rampant caries as
opposed to nursing
caries.
 CLASSIFICATION OF EARLY CHILDHOOD
CARIES
TypeI Involves molars and incisors
(MILD ) Seen in 2-5 years
Causecariogenic semisolid food +lack
of oral hygeine
TypeII Unaffected
mandibular incisors
(MODE Soon after first tooth erupts
RATE)
Causeinappropriate feeding +lack of
oral hygeine

TypeIII All
teeth including mandibular incisors
(SEVE Causemultitude of factors
RE)
SYNONYMS

Nursing caries, Nursing bottle mouth,

Nursing bottle syndrome, Bottle-Propping
caries, comforter caries, Baby Bottle
mouth, Nursing Mouth Decay, Baby bottle
tooth decay, tooth cleaning neglect

NEW NAME
Maternally derived streptococcus mutant
disease (MDSMD)
NURSING CARIES RAMPANT CARIES
Seen in infant and Seen in all ages,
toddler including
Affects primary adoloscennce
dentition Affects primary and
permanent dentition
Mandibular incisors are Mandibular incisors
not involved are
ETIOLOGY also affected
Improper bottle ETIOLOGY
feeding MULTIFACTORIAL

Pacifier Frequent snacks

dipped in
Sticky refined CHO
honey/other sweetner Decreased salivary
flow
Genetic background
 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
rapidly burrowing type, with a small
enamel opening.
The presence of a large pulp chamber
adds to the woes, causing early pulp
involvement
 ADULT CARIES
With the recession of
the gingiva and
sometimes decreased
salivary function due to
atrophy, at the age of
55-60 years, the third
peak of caries is
observed.
Root caries and cervical
caries are more
commonly found in this
group.
Sometime they are also
associated with a
partial denture clasp.
 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.
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

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
of molars and premolars.
Lingual surfaces of anterior tooth.
Class 2 lesions:
They are found on the proximal surfaces of
the bicuspids and molars.
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.
 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) surfaces
D2. Clinically detectable cavities limited to
enamel
D3. Clinically detectable cavities in dentin
D4. Lesions extending into the pulp
 Radiography is frequently associated with
xerostomia due to decreased salivary
secretion,an increase in viscosity and low PH

RADIATION CARIES
This and other causes of decreased salivary
secretion may lead to a rampant form of caries,
including the significance of saliva in preventing
caries.
 Three types of defects due to
irradiation
1. Lesion usually encircling the neck of
teeth amputation of crowns may
occur
2. Begins as brown to black
discolouration of tooth .occlusal
surface and incisal edges wear away
3. Spot depression which spreads from
any surface
CLASSIFICATIONS
OF CAVITY
PREPARATION
1.BASED ON TREATMENT&RESTORATION
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 of
molars and premolars.
Lingual surfaces of anterior tooth.
Class 2 restoration :
They are found on the proximal surfaces of
the bicuspids and molars.
Class 3 restoration :
restoration on the proximal surfaces of anterior teeth
that do not involve or necessitate the removal of the
incisal angle.
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.
 2.Other modifications
Charbeneus modification:
a) Class 2:
cavity on single proximal surface of bicuspids
and molars
b) Class 6:
Cavities on both mesial and distal proximal
surfaces of posterior teeth that will share a
common occlusal isthmus
c) Lingual surfaces of upper anterior teeth.
d) Any other unusually located pit or fissure
involved with decay.
 3.Sturdevants classification
Cavity Feature
Simple cavity A cavity involving only one
tooth surface
Compound A cavity involving two
cavity surfaces of tooth

Complex A cavity that involves more

cavity
than two surfaces of a tooth
 4.Finns modification of Blacks
cavity preparation for primary teeth
Class1 : Cavities involving the pits and
fissures of molar teeth and the
buccal and lingual pits of all teeth.
Class 2: cavities involving proximal surface of
molar teeth will access established
from the occlusal surface.
Class 3: cavities involving proximal surfaces of
anterior teeth which may or may not
involve a labial or a lingual extension
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.
 5.Baumes classification
a). Pit and fissure cavities
b). Smooth surface cavities
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:
Site 1 Pits, fissures and enamel defects on occlusal
surfaces of posterior teeth or other smooth
surfaces
Site 2 Proximal enamel immediately below areas in
contact with adjacent teeth
The cervical one third of the crown or following
Site 3
gingival recession, the exposed root
 The four sizes of carious lesions
Size1:Minimal involvement of dentin just
beyond treatment by remineralization
alone.
Size2: Moderate involvement of dentin.
Following cavity preparation, remaining
enamel is sound, well supported by
dentin and not likely to fail under normal
occlusal load. The remaining tooth
structure is sufficiently strong to support
the restoration.
Size 3: the cavity is enlarged beyond moderate.
The remaining tooth structure is
weakened to the extent that cups or
incisal edges are split, or are likely to fail
or left exposed to occlusal or incisal
load. the cavity needs to be further
enlarged so that the restoration can be
designed to provide support and
protection to the remaining tooth
structure.
Size4: Extensive caries with bulk loss of tooth
structure has already occurred.
Site Size
Minimal 1 Moderate 2 Enlarged 3 Extensive 4
Pit/fissure 1 1.1 1.2 1.3 1.4
Contact area 2 2.1 2.2 2.3 2.4

Cervical 3 3.1 3.2 3.3 3.4

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