Classification of Dental Caries

(Lecture Outline)
Dr.Ghada Maghaireh

There is currently no universally accepted classification of the disease.

On the basis of clinical features and patterns, dental caries may be classified
in many ways:

1. Morphology (Location of the Lesion).

2. Prior condition of the tooth.
3. Dynamics (Rate of destruction of the lesion).
4. Extent of the lesion.
5. Chronology (age).

Classification Based on Morphology (Location of the Lesion):

I. Crown caries
A. Occlusal caries.
B. Smooth surface caries

II. Root Caries

Crown Caries
A. Occlusal caries:
Occurs in pits and fissures of occlusal surface.
It also includes buccal pits of molars, and lingual surface of maxillary anterior
teeth.
Occlusal caries usually appears earlier in life before smooth surface caries.

B. Smooth surface caries:

Occurs in the smooth surfaces of the teeth. These includes:
Interproximal surface caries occurs at mesial or distal contact points.
Cervical or gingival surface caries occurs on buccal or lingual surfaces near the
DEJ.

Root Caries
It is the caries that is initiated at the root portion of the tooth.
This type of caries is predominantly found in teeth of older age group with
significant gingival recession leading to exposed root surfaces.
The bacterial flora causing the root caries may be different from the flora
that initiates enamel caries.
 Classification Based on Prior condition of the Tooth
Primary (initial) Caries:
Caries: The process attacks the tooth surface for the first
time, regardless of progression or extent.

Secondary (Recurrent ) caries: The process attacks the tooth at the margin
or margins of an existing restoration, regardless of extension or progression.

Classification Based on Severity and Rate of Caries Progression

Dental caries may be classified according to the severity and rapidity of
attack:

I. Acute Caries (Rampant

( caries).
II. Chronic Caries.
III. Active Caries.
IV. Arrested Caries.

Acute Caries (Rampant caries)

It is characterized by sudden, rapid, and almost uncontrollable destruction of
teeth.
Rampant caries also involves surfaces of teeth that are relatively caries free
(proximal and cervical surfaces of anterior teeth including mandibular
incisors).
Rampant caries is most often observed in the primary teeth of young children
and permanent teeth of teenagers, 11-19 years.

Chronic Caries
Much lower progression of the lesion.
The average lesion size is smaller than in acute caries.
The involved tooth structure is usually stained a darker color.

Active caries: Describe lesion that progressively destroys more tooth structure.

Classification Based on Extent of the lesion

Incipient caries: The lesion is confined to enamel and does not penetrate the
DEJ. The early carious lesion on visible smooth surfaces of teeth is clinically
manifested as a white, opaque region. An important feature of the early
lesion is the apparently intact surface layer overlying subsurface of
demineralization.

Advanced caries: The lesion penetrates the DEJ and creates a lesion that
usually requires restoration.
 (Classification based on Chronology (age
Infancy caries
Adolescent caries

Infancy caries
In children with infancy caries, there is a unique distribution of dental decay.
The four maxillary anterior incisors are affected first; these teeth are
anatomically positioned in the mouth that is frequently bathed by a feeding
formula.
Infancy caries is most often seen in children with unusual dietary history such
as addition of syrup, honey or sucrose to the formula or the use of pacifier
dipped in honey or other sweeteners.
It has been reported that prolonged and unrestricted night-time breast-feeding
can result in increased caries rate.
The stagnation of milk about the neck of anterior teeth and the fermentation of
disaccharide lactose contribute to carious process.

Adolescent Caries
There are two chronological periods when acute, rapidly progressed caries is
commonly observed. Acute exacerbation in caries rate is usually seen at 4-
8 years of age and at 11-18 years of age. The acute attack in the period of
11-18 years of age usually characterized as adolescent caries. The
characteristic features of this type of caries are:
Lesions are in teeth and surfaces that are relatively immune to caries.
Lesions had relatively small opening in enamel with extensive undermining.
There is rapid penetration of enamel and extensive involvement of dentin.