Dental Caries Classification PDF

**According to location, caries in pits and fissure. ( Occlusal caries )** occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries. Conventionally, the high incidence of caries on these surfaces has been directly related to the narrow and inaccessible pits and fissures...

**According to location, caries in pits and fissure. ( Occlusal caries )** occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries. Conventionally, the high incidence of caries on these surfaces has been directly related to the narrow and inaccessible pits and fissures on occlusal surfaces.lt is a common clinical experience that caries on occlusal surfaces does not involve the entire fissure system with the same intensity, but merely occurs as a localized phenomenon. Each tooth type in the dentition has its own specific occlusal surface anatomy, and caries is usually detected in relation to the same specific anatomical configuration in identical tooth types. It develops in the occlusal surface of molar and premolar, in the buccal and lingual surface of the molar and in the palatal surface of the maxillary incisors. In general terms, occlusal caries initiation takes place in locations where bacterial accumulations are best protected against functional wear. Thus, two factors have been considered of importance for plaque accumulation and caries initiation on occlusal surfaces: stage of eruption or functional usage of teeth, and tooth-specific anatomy. Progressive destruction of the occlusal surface is initiated by a local process in the deepest part of the groove--fossa system owing to accumulation of bacterial deposits or along the entrance to deep fissures, or both. In such areas, which already offer protection against physical wear the formation of microcavities further improves growth of oral bacteria. This accelerates demineralization and destruction, which again improves local conditions for bacterial growth. it is important to understand the process in three dimensions, as caries on occlusal surfaces most often is initiated in fossae, which are the depressions where two or more interlobal grooves meet. For this reason several surfaces are involved in the initial dissolution. Because enamel demineralization always follows the rods, it is natural that the enamel lesion initiated in a fossa gradually assumes the shape of a cone with its base towards the enamel--dentinal junction. 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. Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists. On approximal surfaces at least three macromorphological features can influence the development of caries and must be taken into consideration: The width and location of the approximal contact area. That is, approximal surfaces on tooth types with narrow contact points (front teeth) have less caries than approximal surfaces of tooth types with wide approximal surface contact areas (molar teeth). The curvature of the approximal surfaces. Certain molars in both dentitions show a degree of concavity on the approximal surfaces. The margino-segmental grooves may contribute to an uneven contact with the adjacent tooth, and the grooves can be both fissure like and groove like. B. **Root caries :** Root Caries is a type of Dental caries which is seen apical to the cement enamel junction (CEJ), this type of lesions have a distinct outline in contrast to the sound tooth structure or the non carious portion of the tooth. **Root Caries Classification based on Extent of Lesion:** Grade 1 or Initial Root Caries: Light Brown to Tan in color on visual inspection, No surface defect seen Surface Texture is Soft and the surface of Caries can be disrupted with the pointed tip of Dental Explorer. Grade 2 or Shallow Root Caries: Dark Brown to variable Tan in Color, Surface defect is seen which can be less than 0.5 mm in depth, Surface texture is Soft, irregular, rough which can be penetrated with the pointed tip of Dental Explorer. Grade 3 or Cavitation Root Caries: Light Brown to Dark Brown in color which is variable, Surface texture is similar to Grade 1 which is soft and penetrated with a dental explorer, The lesion is penetrating and cavitation is more than 0.5mm without pulpal involvement. Grade 4 or Pulpal Root Caries: It is similar in color to Grade 3 type root caries which is Dark Brown, The Surface of Lesion is cavitated and the lesion has pulpal involvement extending upto the Root canal. **Grade** **Description** **Clinical** ------------- ---------------------------------------------------------------------------------- ----------------------- **Grade 1** (initial root caries) Incipient; no surface defect; need remineralizing therapy. **Grade 2** Shallow; surface defect \0.5mm; need filling. **Grade 4** Pulpal carious pulp exposure; need RCT + filling.  1. **Classification according to progression : acute and chronic.** **1.Acute caries** are 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 neutralization. Rampant caries has been defined by Massler as a ―suddenly appearing, widespread, rapidly burrowing type of caries, resulting in early involvement of the pulp and affecting those teeth usually regarded as immune to ordinary decay. There is no evidence that the mechanism of the decay process is different in rampant caries or that it occurs only in teeth that are malformed or inferior in composition. On the contrary, rampant caries can occur suddenly in teeth that were previously sound for many years. The sudden onset of the disease suggests that an overwhelming imbalance of the oral environment has occurred, and some factors in the caries process seem to accelerate it so that it becomes uncontrollable; it is then referred to as rampant caries. Young teenagers seem to be particularly susceptible to rampant caries, although it has been observed in both children and adults of all ages.clinical feature: Seen in primary and permanent dentition.(1) In primary teeth features are related to order of tooth eruption. Initial lesions appear on labial surface of maxillary incisors near the gingival margin as a white area/ pitting on enamel surface. (2)In permanent teeth Related to the eruption of teeth. Buccal and lingual surface of premolar and molar are involved. Proximal and labial surface of maxillary incisors and proximal surface of mandibular incisors are involved. B. **Nursing Bottle Caries:-** Nursing caries is a specific form of rampant decay of the primary teeth of infants. The distinguishing features of rampant caries are: (1) many teeth are involved; (2) lesion development is rapid; and (3) carious lesions occur on surfaces generally considered to be at low risk to decay, such as proximal surfaces of mandibular anterior teeth, facial surfaces of maxillary anterior teeth, and lingual surfaces of posterior teeth. A key feature of nursing caries is the usual absence of decay of the mandibular incisors, thus differentiating this condition from classical rampant caries Clinical Appearance: The intraoral decay pattern of nursing caries is characteristic and pathognomonic of the condition. The 4 maxillary incisors are most affected, while the 4 mandibular incisors usually remain sound. The other primary teeth, the canines, first molars, and second molars may exhibit involvement depending upon how long the carious process remains active, but the extensiveness of the lesions usually is not as severe as those of the maxillary incisors. Initially, the maxillary incisors develop a band of dull white demineralization along the gum line that goes undetected by the parents. As the condition progresses, the white lesions develop into cavities that girdle the necks of the teeth in a brown or black collar. In advanced cases, the crowns of the 4 maxillary incisors may be destroyed completely leaving decayed brownish-black root stumps. Conversely, the 4 mandibular incisors remain unaffected. **2.Chronic caries** 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 tertiary 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. A. **Arrested caries** B. 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. 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. 2. **According to the onset, Primary Caries:** Primary caries is used to differentiate lesions on natural, intact tooth surfaces from those that develop adjacent to a filling. It is widely accepted that primary caries lesions, as soon as the overlying plaque is removed, do not progress further. Once the dentist has detected caries and excluded other diseases in a differential diagnostic process, he/she assesses the caries severity and activity. To document the findings, the dentist generally communicates to the assistant the related tooth, the affected surface, the disease and, in the case of caries, the activity and stage (such as the ICDAS caries code). The assistant enters the code for the caries stage in the corresponding field and marks the relevant surface in the tooth diagram with the corresponding color. A. **White spot lesion :** The first sign of Dental Caries is an area of Decalcification, less translucency of the affected area which appears, resembles a chalky white surface. This white spot is seen when the enamel is thorough lydried. No cavitation is evident (but the surface may be rougher than normal enamel as assessed by a dental probe). The white spot is normally seen in the gingival area of the buccal and labial surfaces of the clinical crown. Proximal surfaces care must be exercised to distinguish a carious white spot from a non-carious white spot (Enamel hypoplasia) 2. **Secondary , Recurrent caries :** The term "recurrent caries" denotes caries at the margin of restorations. Recurrent carious lesions are most often located on the gingival margins of Class II through V restorations. Recurrent caries is rarely diagnosed on Class I restorations. It is important to differentiate recurrent carious lesions from stained margins on resin - based composite restorations. The term "secondary caries" is used more commonly than "recurrent caries" for caries that has developed adjacent to margins of restorations. The percentage of restorations in adults that were replaced because of the clinical diagnosis of recurrent caries was about 50 percent, with a range of 45 to 55 percent. The percentage was somewhat more for amalgam than for resin-based composite restorations, and it was somewhat less for restorations in primary teeth because of the relatively high percentage of bulk fractures of restorations in these teeth and their short life spans. Recurrent caries and discoloration of resin-based composite restorations combined represent a higher percentage of replacements than do recurrent caries for amalgam restorations alone. The restorations replaced as a result of the diagnosis of recurrent caries is much higher in general dental practice than in controlled clinical trials in which recurrent caries represents 2 to 3 percent of the failures. **G.V. Black Classification of Dental Caries** The G.V. Black classification of dental caries lesions is the most influential dental caries classification system. This system is based on the anatomical site of the lesion and initially divided carious lesions into 5 classes; a sixth class was later added. The Class I caries affects the occlusal surface, buccal surface and lingual surface of molar and premolar teeth. The class II caries affects the near or the far surface of molar and premolar. The class III caries affects the proximal surface of incisor and canine teeth. The class IV caries affects the angle of canine and incisor teeth. The class V caries affects the one-third of anterior and posterior teeth. The class VI caries affects the tip of molar and premolar teeth. **Table 1. G.V. Black Classification of Dental Caries.**  **Mount-Hume Classification System** More than 100 years later, Mount and Hume published a caries classification system following the current and more conservative approach to caries. The Mount-Hume classification system incorporated the advent of fluoride and adhesive restorative materials, the use of which modified the old principles of cavity design. Mount and Hume classified caries based on their site and size. The size classification was updated in 2006 to include Size 0, referring to non-cavitated lesions, and modify the definition of Size 1. **Table Mount-Hume Site Classification of Caries.** **Table Mount-Hume Site Classification of Caries** **The American Dental Association Caries Classification System** The ADA CCS scores each surface of the dentition based on the following: tooth surface, presence or absence of a caries lesion, anatomic site of origin, severity of the change, and estimation of lesion activity. Clinical application of the ADA CCS relies upon examinations conducted on a clean tooth with compressed air, adequate lighting, and the use of a rounded explorer or ball-end probe. Indicated radiographs also should be available. **Sound surface.** In the healthy state, the surface is sound, and there is no clinically detectable lesion. The dental tissue appears normal in color, translucency, and glossiness, or the tooth has an adequate restoration or sealant with no sign of a caries lesion. **Initial caries lesion**. These are the earliest detectable lesions compatible with net mineral loss. They are limited to the enamel or cementum or very outermost layer of dentin on the root surface and, in the mildest forms, are detectable only after drying. The clinical presentation includes change in color to white or brown (for example, "cervical demineralization" along the gingival area), or well defined areas (for example, "white spot lesions" on smooth surfaces). In pits and fissures, there is a clear change in color to brown but no sign of significant demineralization in the dentin (that is, no underlying dark gray shadow). These initial lesions are considered noncavitated and, with remineralization, are reversible. Most of these lesions would be classified as "sound" in epidemiologic studies. **Moderate caries lesion**. Moderate mineral loss results in a deeper demineralization with some possibility of enamel surface microcavitation, early shallow cavitation, and/or dentin shadowing visible through the enamel, which indicates the likelihood of dentin involvement (for example, micro cavitation with visible dentin staining). These lesions display visible signs of enamel loss in pits and fissures, on smooth surfaces, or visible signs of cementum/dentin loss on the root surface. Although the pits and fissures may appear intact (yet brown), dentin involvement (demineralization) may often be detected by the appearance of a dark gray shadow or translucency visible through the enamel. Dentinal involvement of moderate lesions in approximal areas may be detected in a similar manner by examining the marginal ridges over the suspected lesion site, which may have gray discoloration or appear translucent. If the suspected site of an approximal lesion cannot be directly inspected, which is often the case, the presence and extent of lesion cavitation cannot be assessed without the use of radiographs tooth separation or both, in combination with an assessment of lesion activity, where possible. **Advanced caries lesion.** Advanced caries lesions have full cavitation through the enamel, and the dentin is clinically exposed. In the ADA CCS, any clearly visible cavitated lesion showing dentin on any surface of the tooth is classified as "advanced." In epidemiologic studies, these lesions are classified as "decayed." **\ ** **International Caries Detection and Assessment System\ (ICDAS) Classification System :** The International Caries Detection and Assessment System(ICDAS) is a scoring system for clinical detection and assessment of dental caries lesion. Its aim is to obtain quality infor mation for an appropriate diagnosis, prognosis of caries, and clinical management. Based on the measurement of surface characteristic of the lesion, mainly by visual analysis, the potential histological depth and activity of the lesion is considered, helping the decision-making process about the most recommended treatment. The system has two criteria, which are the detection and the activity of the lesions. The original ICDAS was created in 2003, but several improvements were performed, and the second version became available in 2005, named ICDAS II. The system has two categories, which are coronal primary caries and root caries. For the coronal caries, the lesion is identified by two digits: the first is related to the level of previous dental treatments performed on the tooth and receives codes ranging from 0 to 9 , and the second digit is used to identify the lesion extension and receives codes ranging from 0 to 6, However, the detailed description of the lesion extension is done separately, based on the place where the lesion is located and the presence of previous restorations  **\ ** **\ ** **Correlation of Histology with Clinical Severity of Caries :-** The correlation between histology, and clinical appearance of caries much depends on the circumstances. These include the development of the actual caries lesion, lesion site, and how well clinical observation can be performed.