Must-know classifications of

dental caries for the national

dental hygiene boards
03/14/2016
Claire Jeong, BS, MS, RDH, and Delphine Jeong, DMD
Detecting and recording carious lesions is an essential component of the assessment phase in
the dental hygiene process of care. Because of its importance, the National Dental Hygiene
Board examinations require students to be proficient in detecting and classifying dental
caries. So be prepared to be challenged on this topic!
The concepts related to caries may appear in session one (3.5 hours, 200 questions), and the
detection of caries using radiographic or photographic images may appear in session two (4
hours, 150 questions with case studies). This article presents two types of caries
classifications (G.V. Black classifications, and classifications according to the severity of the
lesion) that are most commonly used. Take this chance to fully understand those concepts
and train your eyes to detect caries based on radiographic/photographic images. This
knowledge will increase your chances at scoring higher on the board exams. If you can recite
those classifications as if you are singing your favorite song, you know you are on the right
track!
1. G.V. Black Caries Classification (class I to VI)
Over 100 years ago, Dr. G.V. Black (1836-1915) developed a system to categorize carious
lesions based on the type of tooth affected (anterior or posterior tooth) and the location of the
lesion (e.g. lingual, buccal, occlusal, etc.). The six classes of carious lesions according to
G.V. Black are as follows:1

Class I: Cavity in pits or fissures on the occlusal surfaces of molars and premolars;
facial and lingual surfaces of molars; lingual surfaces of maxillary incisors (Class I
corresponds to surfaces of a posterior tooth you can clinically see
occlusal/lingual/buccal surfaces. Therefore, the interproximal surfaces are not
classified as Class I)
Class II: Cavity on proximal surfaces of premolars and molars (Class II corresponds
to surfaces of a posterior tooth you cannot see clinically)
Class III: Cavity on proximal surfaces of incisors and canines that do not involve the
incisal angle (Class III corresponds to surfaces of an anterior tooth you cannot see
clinically)
Class IV: Cavity on proximal surfaces of incisors or canines that involve the incisal
angle (Class IV lesion is the larger version of Class III that covers the incisal angle)
Class V: Cavity on the cervical third of the facial or lingual surfaces of any tooth
(Think of the neck of the tooth)
Class VI: Cavity on incisal edges of anterior teeth and cusp tips of posterior teeth
(Class VI corresponds to the very top surface of a tooth)
Review the example below.
Question: According to G.V. Black classification of carious lesions, sealants are placed on
permanent molars as soon as they erupt to prevent:

1. Class I caries
2. Class II caries
3. Class III caries
4. Class IV caries
5. Class V caries

Enamel sealants are generally applied on deep pits and fissures of the occlusal surfaces of
posterior teeth. Those areas correspond to the area of Class I carious lesions according to
G.V. Black classification (the correct answer choice is 1).
2. Caries Classification According to Their Severity
The appearance of interproximal caries can be classified as incipient, moderate, advanced, or
severe, depending on the amount of enamel and dentin involved in the caries process.2
Tips for memorization: Imagine a line halfway through the thickness of enamel, and a line
halfway through the thickness of dentin. Those lines are the STOP points that determine
the severity of the carious lesions.

Incipient: Lesion that extends less than halfway through the enamel
Moderate: Lesion that extends more than halfway through enamel but does not
involve the dentino-enamel junction (DEJ)
Advanced: Lesion that extends to or through the DEJ but does not extend more than
half the distance to the pulp
Severe: Lesion that extends through enamel, through dentin, and more than half the
distance to the pulp

Review the example below.

Question: According to the following image, the carious lesion on the distal of the premolar
can be classified as:
 1. Incipient
2. Moderate
3. Advanced
4. Severe

On the radiograph, the dark area protrudes more than half way through the enamel, but does
not touch the DEJ. Therefore, this lesion is a moderate lesion. The lesion on the mesial
surface of the molar on the other hand can be classified as incipient.
Note: You will be asked to be competent in identifying carious lesions from the radiographs
on the case studies in session two. The quality of images may not be very good, but a
magnifier is available for you to use.
Now we have reviewed some major caries classifications, take this opportunity to master
them. These are very important basic concepts that are likely to be emphasized in
the National Dental Hygiene Boards. Use this information to successfully pass the
exams, and also use them to become an exceptional clinician.

Claire Jeong, BS, MS, RDH is the founder of StudentRDH, a review solution for
the National Dental Hygiene Board Exams. She graduated from MCPHS University,
Forsyth School of Dental Hygiene; served as a student delegate for the ADHA; and is a
member of Sigma Phi Alpha, the dental hygiene honor society. Claire has a true passion in
education and has been mentoring students from all around the country for the dental
hygiene board examinations. Claire is licensed in the United States and Canada. She
provides personalized mentorship at StudentRDH and can be reached
at clairej@studentrdh.com.
Dr. Delphine Jeong is the co-founder of StudentRDH, a review solution for the National
Dental Hygiene Board Exams. She received her doctors degree from Boston University
Goldman School of Dental Medicine. Dr. Jeong also has a B.S. from Purdue University. She
has a great passion for community health and cultural literacy. Dr. Jeong is licensed in the
United States and Canada.
References

1. Rashid EG. Operative Dentistry. In: Scheid RC. Woelfels Dental Anatomy. 7th ed.
Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 432-465
2. Interpretation of Dental Caries. In: Iannuci JM, Howerton LJ. St. Louis. MO: Elsevier
Saunders; 2012; 402-411