Transcript CLASSIFICATION OF DENTAL CARIES - HMTU

CLASSIFICATION OF
DENTAL CARIES
Dr shabeel pn
DEFINITION
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
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.BLACK’S CLASSIFICATION
12.WHO SYSTEM
1.BASED ON ANATOMICAL SITE
OCCLUSAL
(PIT AND
FISSURE)
SMOOTH
SURFACE
CARIES
(PROXIMAL
AND CERVICAL
CARIES)
LINEAR
ENAMEL
CARIES
ROOT
CARIES
PIT AND FISSURE CARIES
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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.
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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
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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
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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.
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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
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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
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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
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The root surface is refer 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 welldefined 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
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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
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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:
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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
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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)
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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)
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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
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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
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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
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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.
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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.
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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
CAVITATION
5.Based on tissue
involvement
1.
2.
3.
4.
5.
Initial caries
Superficial caries
Moderate caries
Deep caries
Deep complicated caries
Dental caries can be divided into 4
or 5 stages
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Initial caries: Demineralization
without structural defect. This
stage can be reversed by
fluoridation and enhanced mouth
hygiene
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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
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“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.
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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.
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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
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
8. BASED ON CHRONOLOGY
EARLY CHILDHOOD CARIES
ADOLESCENT CARIES
ADULT CARIES
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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
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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
Causecariogenic semisolid food +lack
of oral hygeine
TypeII Unaffected mandibular incisors
(MODE Soon after first tooth erupts
RATE)
Causeinappropriate feeding +lack of
oral hygeine
TypeIII
(SEVE
RE)
All
teeth including mandibular incisors
Causemultitude of factors
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
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
TEENAGE CARIES
(ADOLESCENT CARIES)
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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
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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.
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11.BLACK’S CLASSIFICATION
Class 1 lesions:
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Lesions that begin in the structural defects of
teeth such as pits, fissures and defective
grooves.
Locations include
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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:
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They are found on the proximal surfaces of
the bicuspids and molars.
Class 3 lesions:
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Lesions found on the proximal surfaces of anterior
teeth that do not involve or necessitate the removal
of the incisal angle.
Class 4 lesions:
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Lesions found on the proximal surfaces of anterior
teeth that involve the incisal angle.
Class 5 lesions:
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Lesions that are found at the gingival third of the
facial and lingual surfaces of anterior and posterior
teeth.
Class 6 (Simon’s modification):
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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
RADIATION CARIES
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Radiography is frequently associated with
xerostomia due to decreased salivary
secretion,an increase in viscosity and low PH
This and other causes of decreased salivary
secretion may lead to a rampant form of caries,
including the significance of saliva in preventing
caries.
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1.
2.
3.
Three types of defects due to
irradiation
Lesion usually encircling the neck
of teeth amputation of crowns may
occur
Begins as brown to black
discolouration of tooth .occlusal
surface and incisal edges wear
away
Spot depression which spreads
from any surface
CLASSIFICATIONS
OF CAVITY
PREPARATION
1.BASED ON TREATMENT&RESTORATION
DESIGN(BLACK’S)
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 (Simon’s modification):
restoration involving cuspal tips and incisal edges of
teeth.
2.Other modifications
Charbeneu’s 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.Sturdevant’s classification
Cavity
Feature
Simple cavity
A cavity involving only one
tooth surface
A cavity involving two
surfaces of tooth
Compound
cavity
Complex
cavity
A cavity that involves more
than two surfaces of a tooth
4.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.
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.Baume’s 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
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, 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
3.1
3.2
3.3
3.4
Cervical 3
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