The document discusses the need to update the traditional Black classification system for dental caries from the early 1900s. It recommends adopting a new caries lesion classification system and separate caries management system that can describe the total caries experience at both population and individual levels. The new systems should recognize caries at different stages, sizes, activities, and locations. It also recommends the new systems be used to communicate with patients and professionals about caries prevention, treatment, and management.

1. International Dental Journal 2013; 63: 4–5
ORIGINAL ARTICLE
doi: 10.1111/idj.12014
FDI policy statement on Classification of caries lesions
of tooth surfaces and caries management systems
Adopted by the FDI General Assembly: 17 September 2011,
Mexico City, Mexico
FDI World Dental Federation
FDI World Dental Federation, Geneva, Switzerland.
INTRODUCTION CURRENT SITUATION
Caries is a major global oral disease and its manage- • Caries is a multifactorial disease, which is largely
ment should be based on our current knowledge of preventable
the disease process; its aetiology, prevention and • The disease process results in loss of mineral ions
control. Health promotion and wellbeing across all from the tooth surface and subsurface, which may
communities are linked to caries control. lead to surface cavitation
• The disease becomes established before cavitation
of the tooth surface
BACKGROUND
• The disease process can be treated and reversed in
The original classification of carious cavities in its earliest stages; early recognition and arrest or
exposed tooth surfaces was proposed by G. V. Black reversal is therefore highly desirable and possible in
in the early 1900s for use in operative procedures1. A most cases, without restoration (‘surgical treat-
century later, this system is still in widespread use by ment’) of the tooth
the majority of dentists. • Failure to intervene early may result in lesion pro-
Over the last 30 years there have been marked gression, leading to irreversible damage to the tooth
improvements in the understanding of the aetio- structure (i.e. cavitation) and an increasing burden
pathology and the nature of caries and the caries to the patient throughout life
process. Dental caries is the localized destruction of • Modifiable and non-modifiable risk factors are
susceptible dental hard tissue by acidic byproducts important contributory factors
from bacterial fermentation of carbohydrates. The • Social determinants of health play an important
caries process is the dynamic sequence of biofilm– role in the risk assessment, prevention, surgical
tooth interactions which can occur over time on and treatment and continuing management of a caries
within a tooth surface. Improvements in understand- lesion.
ing also extend to the role of bacterial transmission • The Black caries classification, as commonly imple-
in young children, the importance of common risk mented, is based on five standardized cavity
factors and the potential impact of caries on general designs, regardless of the stage or size of the lesion
health. • Any revised classification should recognize the site,
Scientists and clinicians now also recognize the need the stage, activity and size of lesions, for both pri-
for a minimal intervention approach to surgical caries mary caries and recurrent caries, associated with
management, including the potential for arrest and both restorations and sealants
remineralisation of early lesions. • Any new classification would ideally be relevant for
At the other end of the disease spectrum there is a deciduous and permanent teeth and take into
need to recognize the consequences of untreated car- account the systemic consequences of untreated
ies, both to the individual and society, as the evidence caries
for the close interrelation between oral health, general • Any new classification should enable decision
health and quality of life is growing. makers to understand the oral health status of the
4 © 2013 FDI World Dental Federation

2. Classification of caries lesions
population, to identify needs and priorities in den- governments about caries, its prevention, control
tal care and reflect the care that has been provided and management
• Any new classification should be designed to give rel- • That the caries classification and caries manage-
evant and high-quality information to clinical prac- ment system should provide a framework for design
tice, for educational purposes and for researchers of appropriate health policy and planning decisions,
• Any new classification should relate to the need for and relevant and cost-effective implementation of
early arrest of lesions and their reversal to the ability caries management planning
to monitor preventive treatment, and to the complex- • That adequate and appropriate surveillance, record
ity of a restoration, if a restoration is required keeping and information technology support
• Caries management and monitoring of the disease systems be developed
progress should take into account local oral factors, • That implementation of existing, continuing and
and the general health status and environment of future research activities to improve the systems
the individual patient. and their delivery be a priority.
THE FDI WORLD DENTAL FEDERATION REFERENCE
RECOMMENDS
1. Black GV. A work on operative dentistry, vol 2. Chicago: The
• The continued development and adoption of a car- Medico-Dental Publ Co, 1908.
ies lesion classification and a separate caries man-
agement system, including risk assessment and Correspondence to:
prevention, that are able to describe and document FDI World Dental Federation,
the total caries (clinical) experience at both a popu- Avenue Louis Casai 84,
lation and an individual level Case Postale 3,
• That this caries classification and caries manage- CH–1216 Geneva,
ment system be used as the basis for communicat- Switzerland.
ing and educating patients, health professions and Email: info@fdiworldental.org
© 2013 FDI World Dental Federation 5