Classification of Caries

1. Based on Anatomical Site

Occlusal (Pit and Fissure) located on the pit and fissure
Smooth Surface Caries usually located on the proximal contact
Linear enamel caries (odontoclasia) occur in the neo natal line of the maxillary anterior teeth (caused by
metabolic defect such as hypocalcemia) leading to gross destruction of the labial surface of the teeth.
Root surface caries occurs in the proximal root surface, particularly near the cervical line
2. Based on Progression
Accute Caries: rapid process involving a large number of teeth. These lessions are ligher coloured.
Chronic Caries: long standing involvement, affect a few number of teeth.
Arrested Caries: Caries that doesnt show any tendency for further progression. Arrested caries involving dentin
shows a marked brown pigmentation and induration of the lesion [eburnation dentin]
3. Based on Virginity of Lesion
Primary Caries (Initial): the lesion form the initial attack on the tooth surface. The designation of primary is
based on the initial location of the lesion rather than the extent of damage.
Secondary Caries (Reccurent): observed around the edges and under restorations. The common locations are the
rough or overhanging margin and fracture place in all locations of the mouth. It may be result from poor
adaption of a restoration leading to marginal leakage.
4. Based on Extent of Caries
Incipient Caries: The early caries lesion, best seen on the smooth surface of teeth, is visible as a white spot.
Occult Caries: Not associated with microorganisms. Increase with increasing age. 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 fluoride bombs or fluoride syndrome.
5. Based on Tissues Involvement
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. Has not penetrated
dentin.
Moderate Caries (Caries Media): Dentin caries. Extensive structural defects.
Deep Caries (Caries Profunda): Deep structural defect. Caries has penetrated up to the dentin layers of the tooth
close to the pulp.
Deep Complicated Caries (Caries Profunda Complicata): Caries has led to the opening of the pulp cavity (pulpa
aperta or open pulp)
6. Based on number of tooth surface involved
Simple: caries involving one tooth surface
Compound: caries involving two tooth surfaces
Complex: caries involving more than two surfaces
7. Based on Chronology
Early Childhood Caries: include two variants, the nursing caries and the rampant caries. The difference exist in
involvement of the primary mandibular incisors in the carious process in rampant caries as opposed to the
nursing caries.
Classification of early childhood caries
1) Type I (Mild): involves molar and incisors, seen in 2-5 years, cause cariogenic semisolid food and lack of
oral hygiene.
2) Type II (Moderate): unaffected mandibular incisors, soon after first teeth erupts, cause inappropriate
feeding and lack of oral hygiene.
3) Type III (Severe): all of the teeth. Cause multitude factors
Nursing Caries
Seen in infant and toddler

Rampant Caries
Seen in all ages including adolescence

Affects primary dentition

Mandibular incisors not involved

Affect primary and permanent dentition

Mandibular incisors also affected
Etiology
Improper bottle feeding, pacifier dipped in sweetener Multifactorial: frequent snacks, decreased salivary
flow
Teenage Caries
Adult Caries

Classifications of Caries Lesions (G.J. Mount; 2005)

Caries lessions occur in only 3 sites on the crown or root of the tooth, that is, in those areas subject to the accumulation of
plaque. Therefore, the first parameters for the classification are these sites:

Site 1 pits, fissures and enamel defects on the occlusal surface of a posterior tooth or any simple enamel defect
on an otherwise smooth surface of any tooth.
Site 2 - approximal enamel in relation to areas in contact with adjacent teeth
Site 3 - the cervical one third of the crown or, following gingival recession, the exposed root

However, as caries can be a progressive disease, it is possible then to divine five separate sizes as the lesion progresses:

Size 0 - the earliest lesion that can be identified as the initial stages of demineralisation. This needs to be recorded
but will be treated by eliminating the cause ( non-invasive treatment) and should therefore not require further
treatment,
Size 1 - minimal surface cavitation with involvement of dentine just beyond treatment by remineralisation alone.
Some form of restoration is required to restore the smooth surface and prevent further plaque accumulation,
Size 2 - moderate involvement of dentine. Following cavity preparation, remaining enamel is sound, well
supported by dentine, and not likely to fail under normal occlusal load. The remaining tooth is sufficiently strong to
support the restoration,
Size 3 - the lesion is enlarged beyond moderate. Remaining tooth structure is weakened to the extent that cusps or
incisal edges are split, or are likely to fail if left exposed to occlusal load. The cavity needs to be further enlarged so
that the restoration can be designed to provide support to the remaining tooth structure,
Size 4 - extensive caries or bulk loss of tooth structure e.g. loss of a complete cusp or incisal edge, has already
occurred.

And it is also divided into 5 classes:

1. Class 1 lesions:
Lesions that begin in the structural defects of teeth such as pits, fissures and defective grooves.
Locations include:
o Occlusal surface of molars and premolars.
o Occlusal two thirds of buccal and lingual surfaces of molars and premolars.
o Lingual surfaces of anterior tooth.
2. Class 2 lesions:
Founded on the proximal surfaces of the posterior teeth.
3. Class 3 lessions:
Lessions occuring between anterior teeth only
4. Class 4 lessions:
Extension of a class 3 lession involving the incisal corner or incisal edge of an anterior tooth
5. Class 5 lessions:
Lesions that are found at the gingival third of the facial and lingual surfaces of anterior and posterior teeth.