This document summarizes the classification and detection of dental caries. It discusses how caries can be classified based on anatomic site (pit and fissure caries, smooth surface caries, root caries), severity (incipient, occult, cavitation), progression (arrested, recurrent, radiation), and chronology (early childhood, teenage, adult). It also describes various methods for detecting caries, including visual and tactile examination, radiography, fiber optic transillumination, fluorescence, electronic resistance measurement, ultrasonics, and dyes.

2. Dental caries is an irreversible microbial
disease of the calcified tissue of the teeth ,
characterized by demineralization of the inorganic
compound and destruction of the organic substance of
the teeth.
The word dental caries is derived from a
latin word rot or decay .

3.  1.Based on anatomic site
 2.Based on severity
 3.Based on progression
 4.Based on chronology
1.Based on anatomic site:
Based on anatomic site dental caries are
classified as followes
A, Pit & fissure caries
B, Smooth surface caries
C, Root caries

4. pit & fissure caries are seen on the
occlusal surface of the tooth and they are also called as
occlusal caries

5. Smooth surface caries are also seen
on the cervical surface of the tooth.

6. Root caries are seen mostly in older
individuals

7. Based on the severity the caries are calcified into three as
A, Incipient caries
B, occult caries
C, Cavitation
A,INCIPIENT CARIES:
These are early carious lesion , best seen on the
smooth surface of the teeth, is visible as a white spot
significantly many such lesions can undergo remineralisation
, such lesions are not an indications for restorative treatment

8. caries attack changes the optical behaviour of the
affected enamel . The result is that the enamel becomes
opaque because of the porous enamel which scatters the
light more than does sound enamel
It can not be diagnosed radio graphically and is
usually missed during routine film surveys
these incipient caries can be diagnosed with the
help of diagnodent

9. These white spot lesions may be confused
initially with white developmental defects of enamel
formation which can be differentiated by their position
,their shape and their symmetry. Also on wetting the
carious lesion disappears while the developmental defect
persists

10. occult caries (or) Hidden caries is used to describe
such lesion, which is not clinically diagnosed but detected
only on radiograph
The prevalence of occult caries has been reported to
range from 0.8% in premolars in 14-14 years to as high as 50%
in 20 years old . These carious lesions are usually seem to be
increasing with age. It is believed that increase fluoride
exposure encourages remineralisation and slows down
progress of caries in the pit & fissure enamel while the
cavitation continues in dentin , and the lesions becomes
masked by relatively intact enamel surface. The hidden
lesions are called FLOURIDE BOMBS (or) FLOURIDE
SYNDROME.

11. Once it reaches the dentinoenamel junction the
caries process has the potential to spread to pulp along
the dentinal tubules and also spread in lateral direction
DIAGNOIS:
It can be detected by the radio graph.

12. Based on progression dental caries are classified as
A, Arrested caries
B, Recurrent caries
C, Radiation caries
A , Arrested caries:
Arrested caries occur with a 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.
.

13. Recurrent caries is that occurring immediately
next to a restoration .It may result in the poor adaption
of restoration , which allows for a marginal leakage, or it
may be due to inadequate extension of the restoration.

14. Radiotherapy is frequently associated with
xerostomia due to decreased salivary secretion . This and
other causes of decreased salivary secretion may lead to
rampant form of caries.

15. Based on chronology caries are classified into
three types
A , Early child hood caries
B ,Teenage caries
C , Adult caries
caries incidence i…e; the number of new
lesions occuring in a year, shows three peaks at the ages
4-8,11-19 and 55-65 years.

16. Early childhood caries would include varients
of two whish are NURSING CARIES; RAMPANT
CARIES.
The difference primarily exists in involvement
of the teeth (mandibular) incisors in case of rampant
caries as opposed to nursing caries.
Linear enamel caries is seen ocuring the to
occur in the region of neonatal line.

17. This is 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.
C , 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.

18. Root caries are classified based
on the extent of the lesion as
Grade-1(initial)
Grade-2(shallow)
Grade-3(cavitation)
Grade-4(pulpal)

19. Surface texture:
Soft , can be penetrated with a
dental explorer.
Pigmentation:
Variable, light tan to brown.
Surface defect:
No surface defect.

20. Surface texture:
Soft , irregular ,rough, can be
penetrated with a dental explorer.
Pigmentation:
variable , tan to dark brown.
Surface defect:
More tan 0.50mm is deep.

21. Surface texture:
soft, can be penetrated by dental
exposure.
Pigmentation:
Variable, light brown to dark brown.
Penetration lesion, cavitation present
greater than 0.50mm in depth no pulpal involvment

22. It is a deeply penetrating lesion with
pulpal or root canal involvement.
Pigmentation:
Variable, brown to dark brown.

24. Dental caries in our country is consistently
increasing in prevalence and severity especially in
children.
Today according to a number of
investigators, 70-80% are suffering from this disease.
The average number of decayed, filling and missing at
the age of 15-16 years is about 4 in rural and 5 in urban
areas.
They examined 750 subjects from lahore in
the age group of 5-18 years and reported that the caries
prevalence was 94%.

25. In southern states, an incline in dental
caries was noted in both primary and permanent
dentition .A declining trend was noted at manipal again
probably due to well organized school health programs.

26. ETIOLOGY OF DENTAL CARIES:
EARLY THEORIES :
THE LEGANG OF THE WORM:
Several early references to the decay process
include the LEGAND OF THE WORM where the
marshes created the worm .This theory also found
acceptance in INDIA.
There are two types of theories which are
EXOGENOUS THEORIES
ENDOGENOUS THEORIES

27. ENDOGENOUS THEORIES:
Endogenous theories are of two types which are
said as HUMORAL THEORY
VITAL THEORY
EXOGENOUS THEORIES:
They are of five types in theories
CHEMICAL THEORY
PARASITIC THEORY
MILLER’S THEORY
PROTEOLYTIC THEORY
PROTEOLYSIS THEORY

28. Sulfatase theory
Complexing and phosphorylation theory
Burch and jackson theory

29. Caries is preceived to be a prolonged
imbalance in the oral cavity such that factors favouring
demineralization over whelm factors that favour
remineralisation.
DEMINERALIZATION:
The mineral content of tooth surface is
hydroxyapatite (ca(po4)6(OH)2) which is in equilibrium
and neutral environment saturated with calcium and
phosphate.It is reactive to hydrogen ions at the critical PH of
5.5 and below. Hydrogen ions reacts with the phosphate
group in the aqueous environment immedietly by addition
of hydrogen ions being buffered at the ssamee time.

30. REMINERALIZATION:
The demineralization can be reversed if
the PH is neutral and there are sufficient calcium and
phosphate ions in the immediate environment . Either
apatite dissolution can reach neutrality by buffering or
the calcium and phosphate ions in saliva can inhibit the
process of dissolution through the common ion effect
.This enables rebulding of partly dissolved apatite
crystals and is tearmed remineralization.

33. In simple terms the caries process can be explained as
Cariogenic bacterial + Suitable local - Organic
plaque substrate Acid
Organic acid +Tooth mineral – loss of enamel
Demineralized tooth +Bacterial – Cavitation
(dentin) proteolytic
enzymes

34. 1.THE TOOTH : The three aspects of the tooth to be
considered are Composition of the tooth caries ;
Morphologic characteristics of caries ; position of
the caries.
2.ESSNTIALITY OF ORAL BACTERIA : A sterile oral
cavity of the newly born child with in a few hours
of birth starts getting invaded by a good number of
bacteria notably the species streptococcus , neisseria
, actinomyces , veillenella , and lacto baacilli.

35. 3.ESSENTIALLY OF ORAL SUBSTRATE : Essential
cariogenic factors regarding the diet:
The frequency of consumption of sugar containing
food is directly proportional to the caries experience.
The frequency investigations of sucrose even with a
relatively low concentration of 1.25% will cause a drop
in PH to between 4 and 5.
Retentive , sticky , sweet foods with a little detergent
or self cleaning properties may be potentially highly
cariogenic.
Monosaccharides and disaccharides are more
harmful as they are easily fermentable than
polysaccharides.

36. 4. ENVIRONMENT: The integrity of the enamel
environment is totally dependent on composition
and chemical behaviour of the surrounding fluids
, consisting of saliva and plaque fluid.
SALIVA: Under normal physiological conditions the
saliva is supersaturated in term of calcium and
phosphorus with respect to the enamel surface . This
prevents the hydroxyapatite form dissolving in the oral
environment as long as the oral environment is
maintained.

37. A PH drop , initially is countered by the buffering
action of the saliva.
The critical PH at which demineralization is about
5.2-5.5 depending on calcium and phosphate
concentrations of the mixed saliva.
The calcium and phosphate in saliva exist in two
forms ultra filterable has potential to come out of the
solution and thus it may precipitate.
Important mechanisms of salivary factors related to
dental caries are given.

38. PLAQUE : More important in the carious process is the
plaque tooth interface.
The mechanism of carbohydrate degradation to
form acids in the oral cavity by bacterial action occurs
through enzymatic break down of sugar.
Factor in plaque that may be responsible for the
initiation of caries are
A . The ability of the plaque to buffer pH changes caused by
a carbohydrate exposure.
B . The quantitative and qualitative changes in the plaque
microflora . Thus the presence of strept. mutants in higher
levels as compared to more being micro organisms will
determine the pre disposition to caries.

39. OTHER FACTORS CAUSING CARIES:
HERIDITY: The racial tendency for high caries or low caries
incidence appears to follow hereditary patterns. A high DFM
father and a high DFM mother are seen to produce an
offspring with a high DFM rate.
SYSTEMIC CONDITIONS: Xerostomia caused due to a
variety of factors such as die to drugs ,irradiation of the
glands and diabetes mellitus can cause an increase in the
incidence of dental caries .
Chronic administration of syrups sweetened with
sucrose in children , leads to an increased incidence of
caries in their deciduous as well as permanent dentition .

41. HIGH RISK
CHILD
Social history:
low socioeconomic
status. High caries in
siblings poor dental
awareness .
Motivation level low
LOW RISK
CHILD
Social history:
Middle class/Upper
class .low caries in
siblings conscious of
dental health .
Motivation level high

42. Medical history:
Handicapped .
Medical conditions
Predisposing to
Xerostomia .
Long term cariogenic
Medicines.
Traumatic delivary.
Medical history:
No medical problem.
Handicapped (OR)
salivary deficiency with
normal birth.

43. Dietary health:
Frequent sugar intake
Refined carbohydrate
intake.
Pacifier habits / prolonged
breastfeeding
Dietary health :
Sugar in take in limits .
Refined carbohydrate
intake is less.
No pacifier habits.

44. Fluoride :
Fluoride deficient.
No fluoride supplement
tooth paste.
Oral hygiene:
Poor oral hygiene with
plaque accumulation.
Saliva:
Low buffering capacity
Fluoride :
Optimum water
fluoride level .fluoride
supplement tooth paste.
Oral hygiene:
Faire oral hygiene.
Saliva:
High buffering capacity.

45. Caries susceptibility and activity:
Caries susceptibility refers to the number of new lesions
that may develop in an individual over a period of time while
caries activity suggests the number of lesions that an
individual has at the time of recording.
Primary teeth:
Second molar, First molar, Canine, lateral , central.
Permanent teeth :
First molar ,second molar, upper first & second bicuspid
,lower first & second bicuspid , upper & lower centrals &
laterals , upper & lower cuspids.
Surface of primary tooth:
occlusal, molar interproximal areas ,incisors.

46. CARIES ACTIVITY TEST:
Test based on the estimation of the microorganisms
number have been developed and these have been
related to the caries activity . These tests aid the
clinician in educating the patients regarding his (or)
her caries activity and there by help in motivating them
in good oral hygiene practice.

47. Traditionally caries has been diagnosed by
the means of visual examination , tactile sensations and
by use of radio graph .
Though the methods used for research
purpose i..e; in vitro can some times be applied
clinically as well as , the quantification of the
demineralization requries a histological section of the
tooth and thus may not be viable clinically.

48. There are two methods of caries detection
1. Visual examination
2. Tactile examination
1. Visual examination: The visual examination of the
caries encompasses the use of criteria such as detection
of white spot discolouration and frank cavitation .
Visual examination on it’s own and with out aids can be
quite un reliable.

49. 2. Tactile examination:
The explorer and floss to certain extent have
been used for the tactile examination of the tooth .
The explorers can be different varieties such as
A. Right angle probe[no.6]
B. Back action probe[no.17]
C. Shepherds crook[no.23]
D. Cow horn with curved end[no.2]

50. CONVENTIONAL RADIOGRAPH:
Though conventional radiographs are most
frequently used for the detection of caries, they are
associated with draw backs that it presents a 2-D image
of an object , may cause over lapping of the teeth due to
faulty angulation more so with the use of bisecting
technique and may also miss the initial lesion

51. FIBER OPTIC TRANSILLUMINTION:
The principle of transillumination is that there
is a different index of light transmission for decayed and
sound tooth.
FLUORESCENCE:
The use of fluorescence for the detection of
caries dates back 1929, when benedict observed the normal
teeth fluorescence under ultra violet illumination and
suggested that this fluorescence might be useful for
dermination of caries when monochromatic light is used at
350,410 and 530nm on carious and non-carious teeth.

52. ELECTRONIC RESISTANCE MEASSURMENT:
The low conductance of tooth is primarily
caused by the enamel . At locations where the poor
volume of the enamel is larger. Recently ,site specific
and surface specific measurements have been found to
be useful in detection of caries in the pre cavitation
stage as well.
ULTRASONICS:
Ultrasonics is the use of sound waves for
detection and this offers considerable potential as
diagnostic instruments

53. DYES:
Various dyes have been used in the detection of
enamel caries and dental caries .though the use of dyes
for the detection of carious dentin is used in the
removal of the same concern has been expressed that
the use of dyes is associated with the use of dyes is
associated with excessive removal of the dentin.

54. THANK YOU
B.YAMINI