DENTAL CARIES (Classification And Theories) DNT 353 DENTAL CARIES (Classification And Theories) Dr. Shahzadi Tayyaba Hashmi

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 VI CLASSIFICATION BASED ON VIRGINITY OF LESIONS: Primary caries (initial) Secondary caries (recurrent )

CLASSIFICATION CLASSIFICATION BASED ON NUMBER OF TOOTH SURFACE INVOLVED: Simple Compound Complex EARLY 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 IN LOWER PREMOLARS ROOT CARIES ROOT CARIES DIFFICULT TO DETECT CLINICALLY, BECAUSE THEY ARE FREQUENTLY HIDDEN BY GINGIVA ROOT CARIES AS A RESULT OF AGING

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 CLASSIFICATION 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 II CLASS I CLASS III

CLASS IV CLASS V CLASS VI

BLACK’S CLASSIFICATION CASS III CLASS V CLASS II CLASS I

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, Acidogenic theory (miller’s theory) Proteolytic theory 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 microorganisms And, 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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