CLASSIFICATION OF

DENTAL CARIES
DEFINITION
DENTAL CARIES IS AN IRREVERSIBLE MICROBIAL
DISEASE OF THE CALCIFIED TISSUES OF THE
TEETH, CHARACTERIZED 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
13. MOUNT’S CLASSIFICATION
14. ICDAS SYSTEM
 1.BASED ON ANATOMICAL SITE

OCCLUSAL
SMOOTH
SURFACE
(PIT AND CARIES
FISSURE) (PROXIMAL LINEAR
AND CERVICAL ENAMEL
CARIES) CARIES

ROOT
CARIES
PIT AND FISSURE CARIES
 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.
 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
 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

 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.
 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
 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
 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

 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 well-defined
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
 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
 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:-
 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
 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)
 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)
 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
 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
 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
 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.
 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.
 CAVITATION
 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
5.Based on tissue involvement
1. Initial caries

2. Superficial caries

3. Moderate caries

4. Deep caries

5. Deep complicated caries

Dental caries can be divided into 4 or 5 stages

1. Initial caries: Demineralization without

structural defect. This stage can be reversed
by fluoridation and enhanced mouth hygiene
2. 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

 “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.
 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.
 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

A caries involving only one tooth

Simple surface

Compound A caries involving two surfaces of

tooth

Complex
A caries that involves more than
two surfaces of a tooth
 8. BASED ON CHRONOLOGY

EARLY CHILDHOOD CARIES

ADULT CARIES

ADOLESCENT CARIES
 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
 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 All
teeth including mandibular incisors
(SEVE Causemultitude of factors
RE)
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 in infant and Seen in all ages,
toddler including
Affects primary adoloscennce
dentition Affects primary and
permanent dentition
Mandibular incisors are Mandibular incisors
not involved are
ETIOLOGY also affected
Improper bottle ETIOLOGY
feeding MULTIFACTORIAL

Pacifierdipped in Frequent snacks

Sticky refined CHO
honey/other sweetner Decreased salivary
flow
 TEENAGE CARIES
(ADOLESCENT CARIES)
 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
 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.
11.BLACK’S CLASSIFICATION
Class 1 lesions:
 Lesions that begin in 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 lesions:
 They are found on the proximal surfaces of the bicuspids
and molars.
Class 3 lesions:
 Lesions found on the proximal surfaces of anterior teeth that do
not involve or necessitate the removal of the incisal angle.

Class 4 lesions:

 Lesions found on the proximal surfaces of anterior teeth that

involve the incisal angle.

Class 5 lesions:
 Lesions that are found at the gingival third of the facial and
lingual surfaces of anterior and posterior teeth.

Class 6 (Simon’s modification):

 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
 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.
 Three types of defects due to irradiation
1. Lesion usually encircling the neck of teeth
amputation of crowns may occur
2. Begins as brown to black discolouration of
tooth occlusal surface and incisal edges wear
away
3. Spot depression which spreads from any
surface
MOUNT’S CLASIFICATION
 Site 1: lesi pada pit dan fissure
enamel pada gigi posterior
atau permukaan halus
 Site 2: lesi pada approksimal enamel
yang berhubungan dengan
daerah kontak
 Site 3: Lesi servikal pada mahkota
maupun akar
 Size 0: Lesi pada stadium permulaan dari
demineralisasi  dapat disembuhkan
dan tidak memerlukan perawatan lanjut

 Size 1: terjadi kavitas yang minimal telah

melibatkan dentin  diperlukan
restorasi dan prevensi akumulasi plak

 Size 2: Telah melibatkan dentin, sisa gigi masih

cukup kuat untuk menyangga restorasi
 Size 3: Kavitas yang besar, sisa gigi rapuh,
diperlukan preparasi untuk
mendapatkan resistance

 Size 4: Karies yang sangat besar, kehilangan

struktur yang banyak (cusp, incisal
edge dll)
 Alasan klasifikasi baru
1. Proses karies sudah berjalan pada tingkat
migrasi ion. Secara visual belum terlihat, 
bisa diseteksi dgn alat spt diagnodent 
keadaan ini bisa disembuhkan
2. Sudah ada restorasi adhesive  preparasi tdk
seperti Black
3. Adanya bahan adhesive memungkinkan terjadi
demineralisasi remimeralisasi
 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
 International Caries Detection and
Assessment System (ICDAS II)

 0 = Sehat
 1 = Terlihat perubahan / porous pada Enamel
(terlihat hanya setelah pengeringan udara )
 2 = Perubahan Visual pada Enamel
 3 = Localized Enamel Breakdown (tanpa tanda
-tanda visual klinis adanya keterlibatan
dentin)
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