Classification and

Etiology of Caries

What causes caries?

Host
Resistance

What causes caries?

Bacterial
Plaque

What causes caries?

Diet
(sugars)

What causes caries?

Time

Bacterial
plaque

Host
resistance

Diet

Time

Bacteria implicated in
caries infection

Mutans streptococcus
Primary initiator

Lactobacillus
Responsible for progression

What Mutans streptococcus

looks like

Progression of caries
Acids from bacterial plaquedemineralization

Bacterial invasion

Demineralization proceeds to
cavitation (in enamel)

Demineralization proceeds to root
softening (cementum/dentin)

Classification of carious lesions and

tooth preparations

Systemic groupings first described by

G.V. Black, the father of operative
dentistry
Classification according to locations in
permanent teeth

Classifies according to number of

surfaces prepared
Classifies by location tooth preparation
surfaces

Blacks classification
Class 1 (I)

Class 2 (II)

Class 3 (III)

Class 4 (IV)

Class 5 (V)
According to Schlutz

Class 6 (VI)

Number of surfaces prepared

Simple- involving one surface of a
tooth

Compound- involving two surfaces
of a tooth

Complex- involving three of more
surfaces of a tooth

Location of tooth preparation

EXAMPLES

O- occlusal

MO- mesio-occlusal

DO- disto-occlusal

MOD- mesio-occlusodistal

F- facial

DL- disto-lingual

MID- mesioincisodistal

DF- distofacial

Class I: pit and fissure caries to

include posterior occlusal surfaces,
facial and lingual surfaces; buccal
pits of molars; lingual pits of anterior
teeth

Class I: pit and fissure caries to

include posterior occlusal surfaces,
facial and lingual surfaces; buccal
pits of molars; lingual pits of anterior
teeth
Progression of
caries are two
cones base to
base

Pit or fissure

DEJ

CLASS IIOCCLUSAL PIT AND FISSURE

CLASS IIOCCLUSAL PIT AND FISSURE

Caries Lesion Continuum

< thickness
Radiographic
evidence
Sound
Tooth
No caries

Definite dentinal
caries
(radiographically);
Enamel surface intact
RESTORATION
INDICATED

Definite enamel caries

(radiographically);
Slight enamel
Histological
Dentin affected
Surface cavitation
evidence
histologically;
of caries
Enamel surface intact
demineralization
remineralization
Adapted from Suddick et al, Caries activity estimates and implications:
insights into risk vs activity. J Dent Educ 61:876-884, 1997)

Caries Management Paradigm

classifying lesions by appropriate care
Lesions into pulp

Clinically detectable
Lesions into dentin

Preventive and
Operative care

Progressive/cavitated
Stable/non-cavitated

(open and closed)

Clinically detectable
cavities limited to enamel

Preventive
care advised

Clinically detectable enamel lesions

With intact surfaces
Lesions detectable with additional
Diagnostic aids (transillumination and radiographs)
Sub-clinical initial lesions in a dynamic
State of progression/regression

No active
caries

Caries extension = preparation

Caries diagnosed extension into
pits and fissures = preparation
composite resin or amalgam

Caries removal

Occlusal caries

Extension to avoid unsupported

enamel and caries removal

Caries extension = preparation

Diagnosed expected caries extension
bitewing x-ray + pits and fissures = preparation

Radiographic
diagnosis

Clinical appearance
And diagnosis

Caries extension = preparation

Diagnosed expected caries extension
bitewing x-ray + pits and fissures = preparation

Radiographic
diagnosis

Clinical appearance
And diagnosis

Class I
lingual or buccal pit

Class II: smooth surface caries on

the proximal surfaces of posterior
teeth

Progression of
caries are two
cones tip to
base

Class II: smooth surface caries on the

proximal surfaces of posterior teeth
DEJ
Progression of
caries are two
cones tip to
base

Enamel

Smooth surface

CLASS IIIIinterproximal caries

CLASS IIIIinterproximal caries; occlusal no

caries not caries susceptible

Class II
amalgam

Radiographic appearance of
Class II caries

Radiographic appearance of
Class II amalgam restorations and caries

Class II
caries

Well contoured and carved Class II amalgam gingival margin

Radiographic appearance of
Class II amalgam restorations

Do you see any problems?

Radiographic appearance of
Class II amalgam restorations
Did you
See the
Class II
caries

Amalgam restorations with overhangs.

Radiographic appearance of
Class II caries-note the
Caries on the primary molars

Erupting
Permanent
1st premolar

Class III: smooth surface caries on the

proximal surfaces of anterior teeth

Progression of
caries are two
cones tip to
base

Class III: smooth surface caries on the

proximal surfaces of anterior teeth
DEJ
Progression of
caries are two
cones tip to
base

Enamel

Smooth surface

CLASS IIIIII- Proximal caries

Radiographic appearance
of lesion

Visible, invasive to <1/2
thickness of enamel

Definite enamel caries
(radiographically); dentin
affected histologically;
enamel surface intact

Definite dentinal caries;
enamel surface intact

Dentinal caries with
enamel cavitation

radiograph
demonstrates
Class III lesion
on mesial surface of
Maxillary lateral incisor.

CLASS IIIIII- Proximal caries

Clinical appearance

Discolored with no cavitation;
depth within the enamel as
seen through light
transillumination

Non-cavitated but visible with
transillumination as being
through enamel into the
dentin

Clinically cavitated verified
with explorer

Transillumination
demonstrates
Class III lesion
on mesial surface of
Mandibular incisor.

Class III
caries or defective restoration

Class IV: lesions on the

proximal surface of anterior
teeth that include the incisal
edge
Usually due
to traumatic
fracture

Class IV: lesions on the

proximal surface of anterior
teeth that include the incisal
edge

Class IV
incisal edge with proximal surface

Class IV
caries or defective restorations

Traumatic fracture with

pulpal exposure

Class IV restoration and

its relationship to occlusion
Whenever restoring Class IV fractures, occlusal
considerations will provide important information
regarding tooth preparation before restoration.

This restoration has fractured two previous times

over a period of 4 months. Note the edge to edge
occlusion that must be changed to expect a more
durable long lasting restoration.

Class V caries: smooth surface caries on

the facial or lingual surfaces of both
anterior and posterior teeth at the
gingival third; may involve cementum or
dentin as well as enamel surfaces

Progression of
caries are two
cones tip to
base

Class V caries: smooth surface caries on

the facial or lingual surfaces of both
anterior and posterior teeth at the
gingival third; may involve cementum or
dentin as well as enamel surfaces
DEJ
Progression of
caries are two
cones tip to
base

Enamel

Smooth surface
Facial or lingual

Root Surface Caries Morphology

Carious lesion is a softening of the root

surface that progresses following the
paths of the dentinal tubules

Root surface demineralization

with softening

Class V also describes nonnoncarious smooth surface loss of

tooth substance lesions on
facial and lingual surfaces

Non--carious Class V lesions

Non

Erosion

Abrasion

Abfraction

Root surface demineralization

with softening
Erosive lesion
becomes carious

Restorative intervention
Class V caries, nonnon-esthetic zone

Class V caries

Diagnosis

Calculus, teeth
must be cleaned for
definitive diagnosis

Class VI: lesions are pit or wear

defects on the incisal edges of
anterior teeth or cusp tips of
posterior teeth;
lesions can be caries but dont
have to be

Class VI: lesions are pit or wear

defects on the incisal edges of
anterior teeth or cusp tips of
posterior teeth;
lesions can be caries but dont
have to be

Class VI: Wear

Class VI: Caries

Review

Class

1

Class 2

Class 3

Class 4

Class 5

Class 6