Black caries classification,dental abrasion, dental abfraction, dental trauma, enamel infraction and fracture, dental root fracture,

1. DENTAL CARIES 2

2. CLASSIFICATION
Caries can be classified by location, etiology, rate of progression, and affected hard tissues.
These forms of classification can be used to characterize a particular case of tooth decay in order
to more accurately represent the condition to others and also indicate the severity of tooth
destruction.
In some instances, caries is described in other ways that might indicate the cause.

3. G.V. BLACK CARIES CLASSIFICATION
(CLASS I TO VI)
The G. V. Black classification is as follows:
Class I – occlusal surfaces of posterior teeth, buccal or lingual pits on molars, lingual pit near cingulum of maxillary incisors
Class II – proximal surfaces of posterior teeth
Class III – interproximal surfaces of anterior teeth without incisal edge involvement
Class IV – interproximal surfaces of anterior teeth with incisal edge involvement
Class V – cervical third of facial or lingual surface of tooth
Class VI – incisal or occlusal edge is worn away due to attrition

4. 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)

5. CLASS II
Cavity on proximal surfaces of premolars and molars (Class II
corresponds to surfaces of a posterior tooth you cannot see
clinically)

6. 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)

7. 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)

8. CLASS V
Cavity on the cervical third of the facial or lingual
surfaces of any tooth (Think of the neck of the tooth).

9. 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)

10. DIVISION ACCORDING TO SURFACE
ORIGINATED:
Primary DC; originates on intact tooth surface.
Secondary DC; originates next to filling.
Recidivans DC; originates under filling (due to incorrect treatment).

11. DIVISION ACCORDING TO SPEED OF
COURSE
Acute DC; caries lesion has yellow colour, spread quickly.
Chronic DC; caries has dark colour, slow course.
Stopped DC; caries have dark pigmentation, only in enamel, hard.

14. DIVISION ACCORDING TO RELATION TO
VITALITY OF DENTAL PULP:
Caries superficialis: reaches into enamel & close to dentin, is separated from dental pulp by thick layer
of dentin.
Caries media: carious lesion is located into dentin.
Caries pulpae: deep carious lesion is located near dental pulp.
Caries ad pulpae penetrans: carious lesion penetrate into dental pulp.

15. DIVISION ACCORDING TO CHARACTER OF
COURSE OF DC IN DENTIN.
Dental caries undermine; in enamel as small carious lesion, but in dentin spreads
in large area.
Dental caries penetrative: direction of caries is from carious lesion straightly from
enamel through to dental pulp.

16. NON CARIOUS TOOTH DEFECTS
Erosion:This is the loss of tooth substance by a non-bacterial chemical process.
Abrasion:Dental abrasion is the pathological wearing away of teth due to abnormal processes,
habits or abrasive substance.
Abfraction:This is the pathologic loss of tooth substance due to biomechanical loading forces that
result in flexure and ultimate fatigue of enamel and dentin at a location away from loading.

17. NON CARIOUS TOOTH DEFECTS

18. DENTAL ATTRITION
Attrition is a normal process that occurs in every person, wherein, the opposing teeth rub against each other while chewing. In a long term this leads to gradual
wearing down of the occlusal surface of the teeth. However, some people exhibit an accelerated rate of wear which is often attributed to bruxing.
Clenching and grinding bring the opposing teeth in contact with a greater than normal force and for a longer period of time.
It is typical for attrition that no outside or foreign object is involved.
The effect is visible only on the biting surfaces of the back teeth and incisal edges of the front teeth which generally become flat over time.

19. DENTAL ATTRICTION

20. BRUXISM
• Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity;
i.e., it is unrelated to normal function such as eating or talking.
• Bruxism is the involuntary gnashing, grinding, or clenching of teeth. It is usually an
unconscious activity, whether the individual is awake or asleep; often associated with
fatigue, anxiety, emotional stress, or fear and frequently triggered by occlusal
This usually results in abnormal wear patterns on the teeth, periodontal breakdown, and
joint or neuromuscular problems.
• Bruxism can be subdivided into two types based upon when the parafunctional activity
occurs – during sleep ("sleep bruxism"), or while awake ("awake bruxism").
• Occlusal splints (also termed dental guards) are commonly prescribed, mainly by dentists
and dental specialists, as a treatment for bruxism.

21. DENTAL EROSION
What is dental erosion?
Erosion is the loss of tooth enamel caused by acid attack. Enamel is the hard, protective coating of the tooth, which protects
the sensitive dentine underneath. When the enamel is worn away, the dentine underneath is exposed, which may lead to pain
and sensitivity.
How do I know I have dental erosion?
Erosion usually shows up as hollows in the teeth and a general wearing away of the tooth surface and biting edges. This can
expose the dentine underneath, which is a darker, yellower colour than the enamel. Because the dentine is sensitive, your teeth
can also be more sensitive to heat and cold, or acidic foods and drinks.
What causes dental erosion?
Every time you eat or drink anything acidic, the enamel on your teeth becomes softer for a short while, and loses some of its
mineral content. Your saliva will slowly cancel out this acidity in your mouth and get it back to its natural balance. However, if
this acid attack happens too often, your mouth does not have a chance to repair itself and tiny bits of enamel can be brushed
away. Over time, you start to lose the surface of your teeth.

22. DENTAL EROSION

23. DENTAL ABRASION
Abrasion is the non-carious, mechanical wears of tooth from interaction with objects other than tooth-tooth contact.
It most commonly affects the premolars and canines, usually along the cervical margins.
Abrasion frequently presents at the cemento-enamel junction and can be caused by many contributing factors, all with the ability to affect the tooth surface in varying degrees.
The appearance may vary depending on the cause of abrasion, however most commonly presents in a V-shaped caused by excessive lateral pressure whilst tooth-brushing. The surface is shiny
than carious, and sometimes the ridge is deep enough to see the pulp chamber within the tooth itself.
With the presence of non-carious cervical loss due to abrasion, this may lead to consequences and symptoms such as increased tooth sensitivity to hot and cold, increased plaque trapping which
result in caries and periodontal disease, difficulty of dental appliances such as retainer and denture in engaging the tooth, and also it may be aesthetically unpleasant to some people.

24. DENTAL ABRASION

25. DENTAL ABRASION- CAUSE
Cause of abrasion may arise from interaction of teeth with other objects such as toothbrushes, toothpicks, floss, and ill-fitting dental appliance like retainers and
dentures. Apart from that, people with habits such as nail biting, chewing tobacco, lip or tongue piercing are subjected to higher risks of abrasion.
Abrasion can also occur from the type of dentifrice being utilized as some have more abrasive qualities such as whitening toothpastes. The aetiology of dental
abrasion can be due to a single stimuli or, as in most cases, multi-factorial. The most common cause of dental abrasion, is the combination of mechanical and
chemical wear.
Tooth brushing is the most common cause of dental abrasion, which is found to develop along the gingival margin, due to vigorous brushing in this area. The type of
toothbrush, the technique used and the force applied when brushing can influence the occurrence and severity of resulting abrasion. Further, brushing for extended
periods of time in some cases, when co
Different toothbrush types are more inclined to cause abrasion, such as those with medium or hard bristles. The bristles combined with forceful brushing techniques
applied can roughen the tooth surface and cause abrasion as well as aggravating the gums. Combined with medium/hard bristled toothbrushes can cause abrasive
lesions.
Types of toothpastes can also damage enamel and dentine due to the abrasive properties. Specific ingredients are used in toothpaste to target removal of the bio-
film and extrinsic staining however in some cases can contribute to the pastes being abrasive.
Another factor that can contribute to abrasion is alteration of pH levels in the saliva. This can be sugary/ acidic foods and liquids. The reasoning behind this is that an
increase in acidity of saliva can induce demineralization and therefore compromising the tooth structure to abrasive factors such as tooth brushing or normal wear
from mastication.

26. DENTAL ABFRACTION
Abfraction is a form of non-carious tooth tissue loss that occurs along the gingival margin. In other words, abfraction is a mechanical loss
of tooth structure that is not caused by tooth decay, located along the gum line.
Abnormal load created by bruxing is the main causative factor. But this is unlike attrition which is also attributed to bruxing, where direct friction or
rubbing leads to loss of tooth structure at the occlusal level.
The main impact of the loading in abfraction is at a different location from the point of contact. Here, the pressure causes tooth flexure which in
leads to flaking of the enamel at the neck of the tooth instead of the biting surface.
It is normally observed at the buccal side of the teeth near the gum line, where the enamel is at its weakest. Though this is also a mechanical
no external object is involved like abrasion. Abfraction lesions are V-shaped while the abrasion and attrition lesions are flat.

27. DENTAL ABFRACTION

28. DENTAL TRAUMA
• Dental trauma refers to trauma (injury) to the teeth
and/or periodontium (gums, periodontal ligament, alveolar bone), and nearby soft
tissues such as the lips, tongue, etc. The study of dental trauma is called dental
traumatology.
Dental injuries include:
• Enamel infraction
• Enamel fracture
• Enamel-dentine fracture
• Enamel-dentine fracture involving pulp exposure
• Root fracture of tooth

29. ENAMEL INFRACTION AND FRACTURE
Enamel infractions are microcracks seen within the dental enamel of a tooth. They are commonly the result of dental trauma to the brittle
enamel, which remains adherent to the underlying dentine. They can be seen more clearly when transillumination is used.
An enamel fracture, or chip, is a complete fracture of the tooth enamel without the involvement of the dentine and pulp. A fracture occurs when
a tooth contacts a hard object with enough force to break a section of enamel. Chips form with minimal plastic deformation since enamel is
but brittle. A fracture typically occurs as an irregular break on the occlusal edge of the enamel, and is therefore different to other forms of tooth
wear that leave smooth surfaces. Pulp sensibility testing is recommended to confirm pulpal health. Treatment depends on the size of the
If a tooth fragment is still available, it can be bonded to the tooth. For small or minor fractures, it can be smoothed to remove rough margins
edges. For a larger or major fractures, dental composite resin can be used to mask the defective enamel for aesthetic purpose. In archaeological
samples enamel fractures can give insight into the diet and behaviour of past populations.

30. ENAMEL-DENTINE FRACTURE AND
ENAMEL-DENTINE FRACTURE INVOLVING
PULP EXPOSURE
Enamel-dentine fracture is a complete fracture of the tooth enamel and dentine without the exposure of the pulp. Pulp sensibility testing is
recommended to confirm pulpal health.
Treatment depends on how close the fracture is in relation to the pulp. If a tooth fragment is available, it can be bonded to the tooth. Otherwise,
provisional treatment can be done, which the exposed dentine can be covered using glass ionomer cement or a more permanent treatment
restoration using dental composite resin or other accepted restorative dental materials.
If the exposed dentine is within 0.5mm of the pulp, clinically a pink appearance can be seen. This shows close proximity to the pulp. In this case,
calcium hydroxide is used to place at the base and then covered with a material such as ionomer.

31. ROOT FRACTURE OF TOOTH
Root fracture of the tooth is a dentine cementum fracture involving the pulp.
Traumatic root fracture occurs most often in the middle third of the roots of fully erupted and fully formed teeth. However, root
treated teeth are more susceptible to root fracture, as this involves removing root dentine, thereby weakening the tooth.
Objectives of the treatment is to reposition the coronal fragments to allow revascularisation of the tooth, therefore maintaining
aesthetics and functional integrity.

33. SOURCES:
• https://en.wikipedia.org/wiki/Tooth_decay#Classification
• https://www.dentistryiq.com/dental-hygiene/student-hygiene/article/16352162/mustknow-
classifications-of-dental-caries-for-the-national-dental-hygiene-boards
• https://www.dentalhealth.ie/dentalhealth/causes/dentalcaries.html
• https://www.who.int/news-room/fact-sheets/detail/sugars-and-dental-caries
• https://en.wikipedia.org/wiki/Greene_Vardiman_Black
• https://www.dentalhealth.org/dental-erosion
• https://dentagama.com/news/what-is-the-difference-between-dental-attrition-abfraction-
erosion-and-abrasion
• https://en.wikipedia.org/wiki/Bruxism#Causes

34. THANK YOU!