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DENTAL CARIES IS AN IRREVERSIBLE MICROBIAL DISEASE OF THE CALCIFIED TISSUES OF THE TEETH, CHARECTERIZED 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 EXTEND OF CARIES 5.BASED ON TISSUE INVOLVEMENT 6.BASED ON PATHWAY OF CARIES SPREAD 7. BASED ON NUMBER OF TOOTH SURFACE INVOLVED
WHO SYSTEM .8. BASED ON CHRONOLOGY 9 .BLACK‟S CLASSIFICATION 12.BASED ON TOOTH SURFACE TO BE RESTORED 11.BASED ON WHETHER CARIES IS COMPLETLY REMOVED OR NOT DURING TREATMENT 10.
BASED ON ANATOMICAL SITE OCCLUSAL SMOOTH SURFACE CARIES (PROXIMAL AND CERVICAL CARIES) (PIT AND FISSURE) LINEAR ENAMEL CARIES ROOT CARIES .1.
sanguis are found in the newly erupted teeth.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.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 . . especially dominated by s.
. The appearance of s. morphological variation and depth of pit and fissures contributes to their high susceptibility to caries. Caries expand as it penetrates in to the enamel.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.
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 . also have a number of different branches K type: also very susceptible to caries .Caries susceptible.
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. . making clinical diagnosis difficult. Carious lesion of pits and fissures develop from attack on their walls.Entry site may appear much smaller than actual lesion. In cross section.
In very young patients the gingival papilla completely fills the interproximal space under a proximal contact and is termed as col. usually attaches on the smooth surface that are near the gingiva or are under proximal contact. Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists. Also crevicular spaces in them are less favorable habitats for s. .Smooth surface caries Less favorable site for plaque attachment.mutans..
Lesion have a broad area of origin and a conical. After caries penetrate the DEJ softening of dentin spread rapidly and pulpally . or pointed extension towards DEJ. V shape with apex directed towards DEJ. 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.
leading to gross destruction of the labial surface of the teeth. The line.Linear enamel caries Linear enamel caries ( odontoclasia ) is seen to occur in the region of the neonatal line of the maxillary anterior teeth. Morphological aspects of this type of caries are atypical and results in gross destruction of the labial surfaces incisor teeth . which represent a metabolic defect such as hypocalcemia or trauma of birth. may predispose to caries.
Caries originating on the root is alarming because 1. such as flossing. it has a comparatively rapid progression 2. These conditions. often is unaffected by the action of hygiene procedures. particularly near the cervical line. favor the formation of mature.ROOT SURFACE CARIES The proximal root surface. cariesproducing plaque and proximal root-surface caries. Root-surface caries is more common in older patients. when coupled with exposure to the oral environment (as a result of gingival recession). because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel. it is more difficult to restore . it is closer to the pulp 4. it is often asymptomatic 3.
tend to be U-shaped in cross sections. The cementum covering the root surface is extremely thin and provides little resistance to caries attack. The root surface is refer the enamel and readily allows plaque formation in the absence of good oral hygiene. and progress more rapidly because of the lack of protection from and enamel covering. . Root caries lesions have less well-defined margins.
2.BASED ON PROGRESSION ACUTE CARIES ARRESTED CARIES CHRONIC CARIES .
These lesions are lighter colored than the other types. Pulp exposures and sensitive teeth are often observed in patients with acute caries. being light brown or grey. so there are little opportunity for buffering or neutralizaton .ACUTE CARIES Acute caries is a rapid process involving a large number of teeth. It has been suggested that saliva does not easily penetrate the small opening to the carious lesion. and their caseous consistency makes the excavation difficult.
The lesions range in depth and include those that have just penetrated the enamel. affect a fewer number of teeth.CHRONIC CARIES These lesions are usually of long-standing involvement. Pain is not a common feature because of protection afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery. and are smaller than acute caries. Pulp prognosis is hopeful in that the deepest of lesions usually requires only prophylactic capping and protective bases. .
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 .
BASED ON VIRGINITY OF LESION INITIAL/PRIMARY RECURRENT/SECONDARY .3.
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.
The common locations of secondary caries are the rough or overhanging margin and fracture place in all locations of the mouth. or it may be due to inadequate extension of the restoration.SECONDARY CARIES (RECURRENT) This type of caries is observed around the edges and under restorations. In addition caries may remain if there has not been complete excavation of the original lesion. . which allows for a marginal leakage. which later may appear as a residual or recurrent caries. It may be result of poor adaptation of a restoration.
4. BASED ON EXTENT OF CARIES INCIPIENT CARIES CAVITATION OCCULT CARIES .
INCIPIENT CARIES The early caries lesion. Histologically the lesion has an apparently intact surface layer overlying subsurface demineralization. best seen on the smooth surface of teeth. Significantly may such lesion can undergo remineralization and thus the lesion per se is not an indication for restorative treatment . is visible as a „white spot‟.
Also on wetting the caries lesion disappear while the developmental defect persist . which can be differentiated by their position away from the gingival margin]. These white spot lesion may be confused initially with white developmental defects of enamel formation. their shape [unrelated to plaque accumulation] and their symmetry [they usually affect the contralateral tooth].
laser luminescence. These carious lesion seem to increase with increasing age. electrical resistance method (ERM) are used for diagnosis these occlusal lesions. It is believed that bite wing and OPG radiographs along with noninvasive adjuncts like fiber optic transillumination (FOTI). . These lesion are not associated with microorganisms different to those found in other carious lesion. Occult carious lesion are usually seen with low caries rate which is suggestive of increase fluid exposure.
and the lesions become masked by a relatively intact enamel surface. These hidden lesions are called as fluoride bombs or fluoride syndrome. 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. . Recently it is seen that occult caries may have its origin as pre-eruptive defects which are detectable only with the use of radiographs.
Thus some amount of sensitivity may be associated with this type of lesion. 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. This may be generally accompanied by cavitation CAVITATION .
5.Based on tissue involvement 1. Deep complicated caries . Initial caries 2. Superficial caries 3. Deep caries 5. Moderate caries 4.
Caries has affected the enamel layer. This stage can be reversed by fluoridation and enhanced mouth hygiene Superficial caries (Caries superficialis):Enamel caries. wedge-shaped structural defect. .Dental caries can be divided into 4 or 5 stages Initial caries: Demineralization without structural defect. but has not yet penetrated the dentin.
Caries has penetrated up to the dentin and spreads two-dimensionally beneath the enamel defect where the dentin offers little resistance. 5. Extensive structural defect. 4. Deep complicated caries (Caries profunda complicata) :Caries has led to the opening of the pulp cavity (pulpa aperta or open pulp). Moderate caries (Caries media): Dentin caries. Caries has penetrated up to the dentin layers of the tooth close to the pulp. Deep caries (Caries profunda): Deep structural defect. .3.
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. 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. The disintegrating chemicals will proceed via the substance.
So caries cone in dentin will have their base towards DEJ. . the tubules become more densely arrange with fewer interconnections. but as they approach the pulp chamber and root canal walls.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.
Wherever the caries cone in enamel is larger or at least the size as that of dentin. In addition decay can attack enamel from its dentinal side. Decay starts in enamel then it involves the dentin. it is called forward decay (pit decay) However the carious process in dentin progresses much faster than in enamel. At this stage it becomes backward decay. . so the cone in dentin tends to spread laterally creating undermined enamel.
7.BASED ON NUMBER OF TOOTH SURFACE INVOLVED Simple Compound Complex A caries involving only one tooth surface A caries involving two surfaces of tooth A caries that involves more than two surfaces of a tooth .
BASED ON CHRONOLOGY EARLY CHILDHOOD CARIES ADULT CARIES ADOLESCENT CARIES .8.
e. It has been stated that over a lifetime.11-19 and 55-65 years . caries incidence i. the number of new lesions occurring in a year. shows three peaks-at the ages 4-8.
The difference primarily exist in involvement of the teeth[ mandibular incisors ] in the carious process in rampant caries as opposed to nursing caries. . two variants: Nursing caries and rampant caries.EARLY CHILDHOOD CARIES Early childhood caries would include.
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 (SEVE RE) All teeth including mandibular incisors Causemultitude of factors .
comforter caries.SYNONYMS Nursing caries. Baby bottle tooth decay. Nursing bottle syndrome. Nursing Mouth Decay. Bottle-Propping caries. tooth cleaning neglect NEW NAME Maternally derived streptococcus mutant disease (MDSMD) . Nursing bottle mouth. Baby Bottle mouth.
NURSING CARIES Seen RAMPANT CARIES Seen in infant and toddler Affects primary dentition in all ages. including adoloscennce Affects primary and permanent dentition Mandibular incisors are Mandibular incisors are not involved also affected ETIOLOGY ETIOLOGY Improper bottle MULTIFACTORIAL feeding Pacifier dipped in honey/other sweetner Frequent snacks Sticky refined CHO Decreased salivary flow .
The presence of a large pulp chamber adds to the woes. The caries is also described to be of a rapidly burrowing type.TEENAGE CARIES (ADOLESCENT CARIES) This type of caries is a variant of rampant caries where the teeth generally considered immune to decay are involved. causing early pulp involvement . with a small enamel opening.
the third peak of caries is observed.ADULT CARIES With the recession of the gingiva and sometimes decreased salivary function due to atrophy. Root caries and cervical caries are more commonly found in this group. at the age of 55-60 years. Sometime they are also associated with a partial denture clasp. .
either by accident.9. Sometimes a small amount of acutely carious dentin close to the pulp is covered with a specific capping material to stimulate dentin deposition. neglect or intention.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. . isolating caries from pulp. The carious dentin can be removed at a later time.
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.10. such as MOD –for mesio-occluso-distal surfaces. .
Locations include Occlusal surface of molars and premolars. Lingual surfaces of anterior tooth. occlusal two thirds of buccal and lingual surfaces of molars and premolars.BLACK’S CLASSIFICATION Class 1 lesions: Lesions that begin in the structural defects of teeth such as pits. .11. Class 2 lesions: They are found on the proximal surfaces of the bicuspids and molars. fissures and defective grooves.
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 5 lesions: Lesions that are found at the gingival third of the facial and lingual surfaces of anterior and posterior teeth. Class 6 (Simon‟s modification): Lesions involving cuspal tips and incisal edges of teeth. . Class 4 lesions: Lesions found on the proximal surfaces of anterior teeth that involve the incisal angle.
Clinically detectable cavities in dentin D4. Clinically detectable cavities limited to enamel D3. clinically detectable enamel lesions with intact (non cavitated) surfaces D2. Lesions extending into the pulp .12.World health organization (WHO) system In this classification the shape and depth of the caries lesion scored on a four point scale D1.
. including the significance of saliva in preventing caries.an increase in viscosity and low PH This and other causes of decreased salivary secretion may lead to a rampant form of caries.RADIATION CARIES Radiography is frequently associated with xerostomia due to decreased salivary secretion.
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
Lingual surfaces of anterior tooth. fissures and defective grooves.1. Class 2 restoration : They are found on the proximal surfaces of the bicuspids and molars. .BASED ON TREATMENT&RESTORATION DESIGN(BLACK’S) Class 1 restoration: include the structural defects of teeth such as pits. Locations include Occlusal surface of molars and premolars. occlusal two thirds of buccal and lingual surfaces of molars and premolars.
Class 6 (Simon’s modification): restoration involving cuspal tips and incisal edges of teeth. . Class 4 restoration : restoration on the proximal surfaces of anterior teeth that involve the incisal angle.Class 3 restoration : restoration on the proximal surfaces of anterior teeth that do not involve or necessitate the removal of the incisal angle. Class 5 restoration : restoration at the gingival third of the facial and lingual surfaces of anterior and posterior teeth.
Other modifications cavity on single proximal surface of bicuspids and molars 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.Charbeneu’s modification: a) Class 2: b) Class 6: 2. . d) Any other unusually located pit or fissure involved with decay.
Sturdevant’s classification Cavity Simple cavity Compound cavity Complex cavity Feature A cavity involving only one tooth surface A cavity involving two surfaces of tooth A cavity that involves more than two surfaces of a tooth .3.
4. Class 3: cavities involving proximal surfaces of anterior teeth which may or may not involve a labial or a lingual extension .Finn’s modification of Black’s 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.
. including proximal surface where the marginal ridge is not included in the cavity preparation.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.
Pit and fissure cavities b). Smooth surface cavities .5.Baume’s classification a).
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.6. This system is designed to utilize the healing capacity of enamel and dentine. .
the exposed root .The three sites of carious lesions: Site 1 Site 2 Site 3 Pits. fissures and enamel defects on occlusal surfaces of posterior teeth or other smooth surfaces Proximal enamel immediately below areas in contact with adjacent teeth The cervical one third of the crown or following gingival recession.
Following cavity preparation. The remaining tooth structure is sufficiently strong to support the restoration.The four sizes of carious lesions Size1:Minimal involvement of dentin just beyond treatment by remineralization alone. Size2: Moderate involvement of dentin. remaining enamel is sound. well supported by dentin and not likely to fail under normal occlusal load. .
. or are likely to fail or left exposed to occlusal or incisal load. Size4: Extensive caries with bulk loss of tooth structure has already occurred.Size 3: the cavity is enlarged beyond moderate. the cavity needs to be further enlarged so that the restoration can be designed to provide support and protection to the remaining tooth structure. The remaining tooth structure is weakened to the extent that cups or incisal edges are split.
3 1.3 3.4 2.3 2.2 1.2 2.4 .Site Size Minimal 1 Moderate 2 Enlarged 3 Extensive 4 Pit/fissure 1 1.1 3.2 3.1 Cervical 3 3.4 Contact area 2 2.1 1.