Therapeutic dentistry department Dental caries. Classification. Morphological changes of hard tissues of teeth on the different stages of caries from data of radial, electronic and polarization microscopy. Clinic, diagnostics and differential diagnostics of caries. The use of physical methods for diagnostics of caries.

Histopathology of caries

Carious lesion Dentin reaction to caries

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

PIT AND FISSURE CARIES Highest prevalance of all caries bacteria rapidly colonize the pits and fissures of the newly erupted teeth 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 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 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. Numerous gram positive cocci, especially dominated by s.sanguis are found in the newly erupted teeth.

MORPHOLOGY OF FISSURES NANGO (1960):Based on the alphabetical description of shape– 4 types 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 V&U type: self cleansing and somewhat caries resistant

Entry site may appear much smaller than actual lesion, making clinical diagnosis difficult. 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. 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. 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

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. 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. Lesion have a broad area of origin and a conical, or pointed extension towards DEJ. V shape with apex directed towards DEJ. V shape with apex directed towards DEJ. After caries penetrate the DEJ softening of dentin spread rapidly and pulpally After caries penetrate the DEJ softening of dentin spread rapidly and pulpally

2.BASED ON PROGRESSION 2.BASED ON PROGRESSION ACUTE CARIES CHRONIC CARIES ARRESTED CARIES

ACUTE CARIES ACUTE CARIES Acute caries is a rapid process involving a large number of teeth. 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 (soft) consistency makes the excavation difficult. These lesions are lighter colored than the other types, being light brown or grey, and their caseous (soft) consistency makes the excavation difficult. Pulp exposures and sensitive teeth are often observed in patients with acute caries. 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 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 CHRONIC CARIES These lesions are usually of long-standing involvement, affect a fewer number of teeth, and are smaller than acute 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 Pain is not a common feature because of protection afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery. 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. 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. The lesions range in depth and include those that have just penetrated the enamel.

ARRESTED CARIES :- ARRESTED CARIES :- Caries which becomes stationary or static and does not show any tendency for further progression Caries which becomes stationary or static and does not show any tendency for further progression Both deciduous and permanent affected Both deciduous and permanent affected With the shift in the oral conditions, even advanced lesions may become arrested. 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’] 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 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 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 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) PRIMARY CARIES(INITIAL) A primary caries is one in which the lesion constitutes the initial attack on the tooth surface. 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. 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) SECONDARY CARIES (RECURRENT) This type of caries is observed around the edges and under restorations. 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. 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. 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. 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 OCCULT CARIES CAVITATION

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]. 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].

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. 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. Thus some amount of sensitivity may be associated with this type of lesion. This may be generally accompanied by cavitation This may be generally accompanied by cavitation

5.Based on tissue involvement 1. Initial caries 4. Deep caries 2. Superficial caries 3. Moderate caries

Dental caries can be divided into 4 or 5 stages Initial caries: Demineralization without structural defect. This stage can be reversed by fluoridation and enhanced mouth hygiene 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. Caries has affected the enamel layer, but has not yet penetrated the dentin. 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

7.BASED ON NUMBER OF TOOTH SURFACE INVOLVED SimpleCompoundComplex A caries involving only one tooth surface A caries involving two surfaces of tooth A caries that involves more than two surfaces of a tooth

8. BASED ON CHRONOLOGY EARLY CHILDHOOD CARIES ADOLESCENT CARIES ADULT CARIES

EARLY CHILDHOOD CARIES Early childhood caries would include, two variants: Nursing caries and rampant 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. 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 Type I (MILD ) Involves molars and incisors Seen in 2-5 years Cause  cariogenic semisolid food +lack of oral hygeine Type II (MODE RATE) Unaffected mandibular incisors Soon after first tooth erupts Cause  inappropriate feeding +lack of oral hygeine Type III (SEVE RE) All teeth including mandibular incisors Cause  multitude of factors

NURSING CARIES Seen in infant and toddler Affects primary dentition Mandibular incisors are not involved ETIOLOGY Improper bottle feeding Pacifier dipped in honey/other sweetner RAMPANT CARIES Seen in all ages, including adoloscennce Affects primary and permanent dentition Mandibular incisors are also affected ETIOLOGY MULTIFACTORIAL Frequent snacks Sticky refined CHO Decreased salivary flow Genetic background

TEENAGE CARIES (ADOLESCENT CARIES ) TEENAGE CARIES (ADOLESCENT CARIES ) This type of caries is a variant of rampant caries where the teeth generally considered immune to decay are involved. 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 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 The presence of a large pulp chamber adds to the woes, causing early pulp involvement

ADULT CARIES ADULT CARIES With the recession of the gingiva and sometimes decreased salivary function due to atrophy, at the age of years, the third peak of caries is observed. With the recession of the gingiva and sometimes decreased salivary function due to atrophy, at the age of years, the third peak of caries is observed. Root caries and cervical caries are more commonly found in this group. Root caries and cervical caries are more commonly found in this group. Sometime they are also associated with a partial denture clasp. Sometime they are also associated with a partial denture clasp.

11.BLACK’S CLASSIFICATION

RADIATION CARIES Radiography is frequently associated with xerostomia due to decreased salivary secretion,an increase in viscosity and low P H This and other causes of decreased salivary secretion may lead to a rampant form of caries, including the significance of saliva in preventing caries.