Black classification of carious cavities: description, degree, class and therapy. Black classes: location of carious cavities, classification and treatment of caries What applies to black immune zones

There are five classes of defects in the hard tissues of the tooth of a carious lesion, differing in localization. This classification was first proposed by the American dentist J. Black. It is guided by the preparation and the choice of filling material. There are V classes:

Class I - cavities are localized in fissures, in blind pits of molars, premolars, incisors and canines. Thus, according to the first class, it can be located on the occlusal, buccal or lingual surface.

Class II - the cavity captures at least two surfaces: the medial or distal and occlusal surfaces of the molars and premolars. Thus, a filling according to the second class can be located, for example, on the medial-occlusal surface (MO) of the premolar or on the medial-occlusal-distal surface (MOD) of the molar.

Class III - cavities are localized on the medial and distal surfaces of the incisors and canines.

Class IV - cavities are localized in the same place as class III cavities, but with a violation of the angle of the crown part of the tooth or its cutting edge

Class V - cavities are localized in the cervical region of all groups of teeth.
Thus, a filling according to the fifth class can be located, for example, on the vestibular surface of the incisor of the upper jaw in the cervical region or on the lingual surface of the molar of the lower jaw in the cervical region.

Basic principles of preparation of hard dental tissues:

A permanent filling cannot be placed directly into a carious cavity. The cavity must first be prepared to ensure the following:

All soft carious dentin has been removed from the cavity, however, in some exceptional cases, the deepest pigmented but hard layer of dentin can be left to avoid accidental opening of the tooth pulp.
Enamel, devoid of underlying dentin, is removed.
The filling will last a long time.
There will be no secondary caries.

O.E.Khidirbegishvili,
dentist.
Georgia, Tbilisi

Upgraded Black classification
Modernized Black's Classification

The frieze that surrounds the top of the Illinois State Office Building is embossed with the names of Abraham Lincoln, Steve Douglas, and other prominent state figures along with the name of Green Wardiman Black. Such an attitude to the scientific activity of Black is explained by the fundamental contribution of the scientist to the development of dental science. Much that Black once proposed has not lost its relevance in our time, however, some developments, such as his classification, should be revised in the spirit of modern requirements.

It must be understood that Black's surgical approach, based on the principle of "expansion for prevention", was designed for the use of inlays, as well as fillings of gold, cement and amalgam, the use of which often involved the removal of not only carious, but also a significant amount of unaffected tooth tissue in first of all to ensure reliable fixation of the seal. It is also important that Black's classification was intended not so much to describe the localization of carious cavities as to standardize the methods of preparation and filling. Proceeding from this, a strictly defined form of the prepared cavity and the appropriate material for filling it had to correspond to a certain class of carious cavity. That is why in those days the classification met the requirements of clinicians, since the preparation technique and the design of the prepared cavity completely coincided with the parameters of the materials used at that time. Curiously, even after the death of the scientist, any filling materials that appeared on the dental market, regardless of their properties and the methods of preparation used, were adapted to his classification, which, in my opinion, is not entirely justified, because as a result of this, the original the principle of building a classification. It is unlikely that the legendary scientist would agree with such tactics.

It should also be noted that this classification also applies to defects in the hard tissues of teeth of non-carious origin, so it would be more correct to call it “Black Classification of Cavities”, excluding the word “carious” from the name. Clinicians, on the other hand, need a separate systematization of the localization of carious cavities, since the etiology, clinic, and tactics of treating carious and non-carious lesions are so different from each other that, I believe, these pathologies should not be considered together.

There are many modifications of the Black classification proposed by various authors, but none of them meets the requirements of clinicians. The only addition in more than a century of practice of its use was the adoption of class VI. However, this innovation turned out to be rather controversial, since many scientists, among whom, for example, Professor Mount, class VI lesions, like class I lesions, are attributed to manifestations of fissure caries. I consider this approach justified, since class VI lesions are rarely diagnosed in the clinic and occur only when there are depressions (fissures, pits, grooves, etc.) on the tops of the tubercles of the lateral and cutting edges of the anterior teeth, otherwise caries in these areas will not will arise, since there are no other conditions for food to get stuck in these, in general, non-cariogenic areas. In addition, the treatment of lesions of classes I and VI, in principle, does not differ from each other, therefore, I believe, there is no need to isolate these lesions in separate classes in vain, but it is more expedient to combine them together in class I.

It is also difficult to agree with the class V interpretation, since it does not pay attention to lesions in the cervical region on the contact surface of the tooth. The fact is that this surface has a characteristic feature that distinguishes it from other surfaces of the tooth. In particular, there are three cariogenic zones on it (contact, cervical and root), directly passing one into another. However, after the removal of an adjacent tooth, the open contact surface ceases to be a cariogenic zone, as a result of which only cervical and root caries can initially occur on it. In addition, if the cervical region is located around the neck of the tooth as a whole, then caries in this area on the approximal surface should also be considered cervical (this is once again evidenced by the allocation of circular caries as a kind of cervical). Based on this, it would be advisable to expand the interpretation of Black's class V - various lesions of the cervical area around the neck of the tooth as a whole.

Most of all, the tactics of combining root and cervical caries into V class causes doubts. Despite the fact that these lesions occur in neighboring cariogenic zones, however, these are completely different pathologies. This is also evidenced by the fact that root caries is not initiated by Str. mutans, а Aktinomyces viscus and its transformation
occurs without a white spot stage. It is also important that WHO classifies lesions of enamel and dentin as coronal caries, and cementum as root. At the same time, there are also combined lesions of these pathologies, which, by the way, became the main reason for Black's joint consideration of cervical and root caries in class V. However, with the advent of new filling materials and treatment methods, it became obvious that it was necessary to strictly differentiate such lesions (see below), therefore, in 1990, the international RCI root index according to Katz was adopted:

crown restorations extending into the root area more than 3 mm below the enamel-cement border should be considered root caries filling;
Restorations ending in the root area above these limits are not considered root fillings.

Thus, a paradoxical situation has arisen when clinicians use the RCI root index to differentiate cervical caries from root caries, while in Black's classification, these lesions, on the contrary, are combined into class V. Therefore, it is necessary to draw appropriate conclusions and correct the situation that has arisen.

The proposed root index makes it possible not only to differentiate these lesions, but also helps to choose treatment tactics, which depend both on the depth and size of the lesion, and the location of the cavity above or below the neck of the tooth. The latter is especially important, since it reflects the ratio of tissues (enamel, dentin and cement) in the carious cavity, which are characterized by a different degree of adhesion of filling materials to them, and hence the quality of the restoration.

To verify this, consider the tactics of treating these lesions, which are offered in their book "Therapeutic Dentistry" (1999) by German scientists E. Helwig and J. Klimek.

If the cavity is located above the neck of the tooth and is limited by enamel and dentin (Fig. 1a), then the choice of filling materials in this case is unlimited, although a composite filling is preferred.

Rice. 1. Formation of cavities in the cervical and root areas of the tooth (according to Hellwig, 1999).

If part of the cavity is located above the neck of the tooth, and the rest is in the root part (Fig. 1b), the filling of such cavities has its own characteristics, since it is necessary to achieve high-quality adhesion simultaneously to enamel, dentin and cement, which is very difficult. That is why the sandwich technique is shown in this case.

When the cavity is located below the neck of the tooth, the treatment tactics are completely different (Fig. 1c), since in this case only glass ionomer materials are indicated for filling the cavity, since other filling agents do not have sufficient adhesion to cement. It is important to note that it is this form of root caries, the boundaries of which do not extend to the neck of the tooth, that has nothing to do with cervical caries.

The considered facts clearly demonstrate how different the clinic and tactics of treatment of cervical and root caries are, therefore, they should be considered separately in the classification. The advantages of such a tactic are especially evident in the diagnosis and treatment of teeth with a clinical neck, because, unlike teeth with an anatomical neck, in which only three cariogenic zones are distinguished, the bare root surface in this case becomes the fourth cariogenic zone, which additionally arose as a result of gingival recession. and located within the boundaries of the clinical crown of the tooth. Unfortunately, these features are not taken into account in the existing classification, since Green Black systematized lesions that occurred only within the anatomical crown of the tooth.

Based on the foregoing, if Black's classification is still subject to modernization, in my opinion, it would be more appropriate to supplement class I (fissure caries) with lesions previously classified as class VI, contact surface lesions (class II, III and IV) remain unchanged, expand the interpretation of class V, and class VI include lesions of the root region (root caries). Such a seemingly minimal modernization would significantly improve the quality of diagnostics and, most importantly, it could easily be adapted to the long-established stereotype of using the five main Black classes. However, despite such an important advantage, some omissions in the proposed version of the classification cannot be ignored.

First of all, the use of three forms of damage to contact surfaces (II, III and IV class) in it at the same time is doubtful. It should be clear that Black was forced to propose such a tactic, because at that time, due to the lack of universal filling materials, lesions of the posterior teeth (Class II) were filled with amalgam, and the anterior ones (Class III and IV) were filled with more suitable cosmetic materials or covered artificial crown. With the advent of universal filling materials on the market, which could restore almost any lesions, it is necessary to abandon the allocation of three forms of contact caries and consider these lesions as a whole (lesions of contact surfaces). In this case, the number of classes in the classification will be reduced to four: class I - fissure, class II - contact, class III - cervical and class IV - root caries. Thus, the localization of the cavities completely coincides with the topography of the cariogenic zones in which they arose (hence the name of the classes), therefore, the chosen tactics for constructing the classification is, in general, correct. However, despite this, certain diagnostic problems still arise when using it in the clinic. The fact is that the classes of carious cavities discussed above cannot cover the entire variety of variants of lesions of hard dental tissues encountered in the clinic, therefore, clinicians often encounter diagnostic problems, the cause of which is the lack of differentiation of cavities into single-surface and multi-surface cavities in the classification.

At the initial stages of the development of the carious process, the defeat of cariogenic zones occurs on one isolated surface of the tooth ( single surface cavities). With the spread of the carious process to adjacent surfaces, a combined cavity is formed, extending simultaneously to several surfaces of the tooth - multisurface cavities(Fig. 2).

Rice. 2. Single-surface and multi-surface cavities.

Diagnosis of single-surface cavities does not cause difficulties, since their localization, as a rule, coincides with the localization of cariogenic zones. Problems arise when several cariogenic zones are completely destroyed and the lesion spreads to adjacent tooth surfaces, turning into a multi-surface cavity, in which one or more tooth surfaces are partially or completely missing. In this case, information about the localization of cariogenic zones loses its significance due to their complete destruction, and the combination of involved surfaces can be countless, so another suitable diagnostic principle should be used, focusing on the localization of each affected surface separately.

The differentiation of cavities into single-surface and multi-surface ones is justified not only by diagnostic problems, but also by the peculiarities of preparation and the choice of filling materials for restoring these cavities. Quite often, when preparing multi-surface cavities, the main and additional sites are distinguished to eliminate the overturning action of masticatory forces. When preparing single-surface cavities, this tactic is not used, since the isolated surface ensures the stability of the seal and excludes tipping under the action of masticatory forces. In addition, not all materials suitable for filling single-surface cavities can be used in the treatment of multi-surface ones. For example, Professor Mount advises using glass ionomer cements as a standalone material only for single-surface cavities with minimal occlusal loading.

Thus, when diagnosing a carious cavity, attention should be paid not only to localization, but also to its belonging to single-surface or multi-surface types of lesions. This differentiation of the cavities is of the utmost importance, because without this distinction there will always be diagnostic problems in the clinic. A good example is Black's classification, in which there is no strict differentiation of cavities into single-surface and multi-surface cavities. For example, unlike class I, class II lesions include both single-surface and multi-surface lesions of the masticatory and contact surfaces. At the same time, the interpretation of multisurface lesions does not always make it possible to unambiguously diagnose them; therefore, cavities that do not fit into the framework of Black's classification are classified by some authors as atypical cavities. Such cavities, of course, could include the fourth premolar (Fig. 2), in which most of the chewing and contact surfaces are destroyed (according to Black's classification, this is class II). At the same time, the question arises: is it logical to call a cavity atypical just because it does not fit into the framework of the proposed classification? There are many more similar examples related to diagnostic problems, so it is time to evaluate the classes of carious cavities in more detail.

Given the importance of differentiating cavities into single-surface and multi-surface, it is advisable to classify the localization of carious lesions according to this principle as follows:

Single surface cavities
1. Fissure caries
2. Contact caries
3. Cervical caries
4. Root caries

Multi-surface cavities
1 class
Grade 2

The interpretation of classes 1 and 2 of multisurface cavities deserves attention:

1 class- multi-surface carious cavities without the involvement of the chewing or cutting surface;

Grade 2

The proposed tactics for differentiating multisurface cavities makes it possible to take into account the two main types of combined lesions encountered in the clinic, while the letter designation of tooth surfaces according to accepted FDI standards will allow a more detailed assessment of the variety of involved surfaces. The latter will make it possible to individually take into account each affected tooth surface separately, which is very important, since the same cavity, but on different surfaces of the teeth, requires a differentiated approach to diagnosis and treatment. Considering the above, shown in Fig. 2 fourth premolar will correspond to class 2 multisurface cavities. Belonging to this class is fixed on the basis of damage to the chewing surface, which, like the cutting surface, is the main diagnostic guide for differentiating multi-surface lesions, since the integrity of the latter largely determines the implementation of the main functions of the tooth (biting off and chewing food). In other cases, when the chewing or cutting surface is not damaged, but various combinations of lesions of the contact, buccal and lingual surfaces are observed, class 1 multi-surface lesions are diagnosed. There are many different options for differentiating cavities into single-surface and multi-surface ones, among which the classification of B. R. Vainshtein and Sh. I. Gorodetsky, as well as Ya. O. Gutner and R. A. Revidtseva should be noted.

The classification discussed above can be used separately in the clinic, however, if we radically modernize Black's classification according to the proposed principle, then it will look like this:

I class- lesions of fissures and grooves (on the chewing surface and the tops of the masticatory tubercles of molars and premolars, on the lingual and buccal surfaces of molars within 2/3, palatine surfaces and the cutting edge of the front teeth).

II class- damage to contact surfaces.

III class- various lesions of the cervical region around the neck of the tooth as a whole.

IV class- damage to the root area.

V class- multi-surface carious cavities without the involvement of the chewing or cutting surface.

VI class- multi-surface carious cavities involving the chewing or cutting surface.

In this version of the classification, the diagnosis of lesions does not cause difficulties, since they are divided into single-surface (I, II, III and IV classes) and multi-surface (V and VI classes). The interpretation of the latter excludes the possibility of considering some cavities as atypical. Class II lesions are fully consistent with the tactics of using modern restorative materials. Significantly expanded and became more informative interpretation of class I and III lesions. I believe it would also be advisable to supplement class I with carious lesions that occur in the region of the tubercles of Carabelli (more precisely, in the groove located between this tubercle and the lingual surface of the tooth).

However, despite the listed advantages, it is not entirely justified to use this classification without taking into account other important characteristics of the carious process. The fact is that the classification does not take into account the increase in the size of the cavity, as a result of which it allows you to determine only fundamental approaches depending on the localization of the carious cavity. In clinical practice, it is advisable to consider various classes of carious cavities depending on the increase in the size of the lesions, which will enable clinicians to understand the increasing complexity of the restoration. In this regard, Mount's classification of cavity localization deserves attention, in which all cavities are considered depending on the increase in four sizes of the lesion. I would also like to note the tactics of Professor A. V. Borisenko, who proposes to additionally take into account the nature of the course of the carious process.

Of course, it is desirable to take into account such characteristics in the diagnosis, so the proposed classification should be supplemented with them, but I have my own thoughts on this matter. It is necessary to understand that there are other, by no means unimportant indicators of the course of the carious process, which must also be taken into account when diagnosing caries. In addition, it is almost impossible to qualitatively diagnose such a complex and diverse process as caries using only the data of one classification, therefore it is necessary to adopt a new method for diagnosing carious cavities, which will unify the most important characteristics of the carious process in one diagnosis. In this regard, in order not to complicate the individual classifications of caries, it is necessary to use complex diagnosis of caries, reflecting the most important characteristics of the carious process (i.e., a comprehensive diagnosis will reflect not only the size of the lesion, but also indicators of various classifications). These issues are discussed in more detail in my article "Modern methods for diagnosing carious cavities."

The proposed modifications of the Black classification are convenient for use in the clinic and will undoubtedly improve the quality of diagnostics, so it is necessary to choose the appropriate option for use in the clinic. Dear colleagues! Black defined the paradigm by setting clear parameters in operative caries, however, this does not mean that these parameters must remain unchanged forever and no new paradigm can be adopted.

Literature:
1. Black G V. A work on operative dentistry; The technical procedures in filling teeth. Medico-Dential Publishing Company. Chicago, 1917.
2. Mount G J, Hume W R. Preservation and restoration of tooth structure. London. Mosby, 1998.
3. Roulet J F, Degrange M. Adhesion: the silent revolution in dentistry. Quintessence Publishing Company, Paris, 2000.
4. Wilson A D, McLean J W. Glass-ionomer cement. Quintessence: London, 1998.
5. Mount G J. Letter to the Editor. Quint. Int. 2000; p. 31:375.
6. Sturdevant C. M. The Art and the Science of Operative Dentistry. - 1995. - Mosby. – New-York. – P. 289 – 324.

FAQ

First of all, one that does not hurt the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or type of toothbrush. As for electric brushes, for uninformed people they are the preferred option; although you can brush your teeth with a simple (manual) brush. In addition, a toothbrush alone is often not enough - flosses (special dental floss) should be used to clean between the teeth.

Rinses are additional hygiene products that effectively clean the entire oral cavity from harmful bacteria. All these funds can be divided into two large groups - therapeutic and prophylactic and hygienic.

The latter include rinses that eliminate unpleasant odors and promote fresh breath.

As for therapeutic and prophylactic, these include rinses that have anti-plaque / anti-inflammatory / anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence in the composition of various kinds of biologically active components. Therefore, the rinse must be selected for each individual on an individual basis, as well as toothpaste. And in view of the fact that the product is not washed off with water, it only consolidates the effect of the active components of the paste.

Such cleaning is completely safe for dental tissues and less injures the soft tissues of the oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment zone and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are torn by these molecules, causing the microbes to die.

It turns out that ultrasonic cleaning has a complex effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleaning it. And you can't say the same about mechanical cleaning. Moreover, ultrasonic cleaning is more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your position. Moreover, a pregnant woman is recommended to visit a dentist every one or two months, because, as you know, when carrying a baby, the teeth are significantly weakened, they suffer from a deficiency of phosphorus and calcium, and therefore the risk of caries or even tooth loss increases significantly. For the treatment of pregnant women, it is necessary to use harmless anesthesia. The most suitable course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required preparations that strengthen tooth enamel.

Treating wisdom teeth is quite difficult due to their anatomical structure. However, qualified specialists successfully treat them. Prosthetics of wisdom teeth is recommended when one (or several) neighboring teeth are missing or need to be removed (if you also remove a wisdom tooth, then there will simply be nothing to chew on). In addition, the removal of a wisdom tooth is undesirable if it is located in the correct place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor-quality treatment can lead to the most serious complications.

Here, of course, much depends on the taste of the person. So, there are absolutely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal braces with colored metal / elastic ligatures. It's really trendy!

Let's start with the fact that it's just unattractive. If this is not enough for you, we give the following argument - the stone and plaque on the teeth often provoke bad breath. And that's not enough for you? In this case, we move on: if the tartar “grows”, this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets form, pus constantly flows out of them, and the teeth themselves become mobile). ). And this is a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria at the same time increases, due to which there is an increased cariousness of the teeth.

The service life of an accustomed implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Tellingly, this period will depend both on the design of the product and on how carefully the patient takes care of it. That is why it is imperative to use an irrigator during cleaning. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.

Removal of a tooth cyst can be performed by a therapeutic or surgical method. In the second case, we are talking about the extraction of a tooth with further cleaning of the gums. In addition, there are those modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complicated operation, which consists in removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (part) is restored with a crown.

As for the therapeutic treatment, it consists in cleaning the cyst through the root canal. It is also a difficult option, especially not always effective. Which method to choose? This will be decided by the doctor together with the patient.

In the first case, professional systems based on carbamide peroxide or hydrogen peroxide are used to change the color of teeth. Obviously, it is better to give preference to professional bleaching.

Class I - cavities are localized in fissures, in blind pits of molars, premolars, incisors and canines. Thus, a first class filling can be located on the occlusal, buccal or lingual surface.

Class III - cavities are localized on the medial and distal surfaces of incisors and canines.

Class IV - cavities are localized in the same place as class III cavities, but with a violation of the angle of the crown part of the tooth or its cutting edge

Class V - cavities are localized in the cervical region of all groups of teeth.

Thus, a filling according to the fifth class can be located, for example, on the vestibular surface of the incisor of the upper jaw in the cervical region or on the lingual surface of the molar of the lower jaw in the cervical region.

Basic principles of preparation of hard dental tissues:

No affected tissue should remain on the walls of the cavity. Carious dentin and infected tissue are removed with an excavator or a large ball bur in a low speed handpiece.

Enamel devoid of underlying dentin is excised with a high-speed handpiece.

Then, with the help of a turbine and mechanical handpiece and burs of various configurations, a cavity is formed, taking into account the retention of the filling and the resistance of the tooth tissues.

preparation- impact on hard tissues of the tooth in order to remove pathologically altered tissues and create a cavity shape that provides convenient and technological filling, preservation of the strength characteristics of the tooth, as well as strength, reliable fixation, aesthetics and medical effectiveness of the filling.

Currently, there are various methods of preparation of hard tissues of the tooth:

Mechanical - using burs and hand tools. This method is currently the most common and popular, so in the future we will consider the preparation of cavities using burs and hand tools;

Chemical-mechanical - the use of systems that destroy tissues affected by the carious process, which are then removed with hand tools. An example of a system for chemomechanical cavity preparation is Carisolv. Gel "Carisolv" is made on the basis of 0.95% sodium hypochlorite and a mixture of amino acids (leucine, lysine, glutamic acid). The gel is introduced into the carious cavity, then the cavity is cleaned with special hand tools and sealed (Fig. 76)

The kinetic or air-abrasive method implements the method of sandblasting hard surfaces in dentistry. This method consists in the directed supply of an aerosol jet containing water and an abrasive agent to the prepared tooth tissues through special tips (Fig. 77, 78). The active component of the aerosol used for the preparation of hard tissues of the tooth is an abrasive powder consisting of aluminum oxide particles of increased abrasiveness.

The air-abrasive method of preparation is used to treat fissures before sealing, to eliminate deep pigmentation of the enamel, when preparing small carious cavities and to prepare adhesive surfaces for applying the adhesive composite system. Air-abrasive processing makes it possible to achieve minimal tissue excision, which is impossible to do even with the smallest bur. In addition, the abrasive action of the aerosol creates a rough surface free from contaminants with a maximum contact area, which, therefore, does not require additional chemical etching (Barrer G.M. et al., 2004); ultrasonic - the use of ultrasonic tips and special nozzles for them with a diamond coating of the working part. The tip of the nozzle during operation makes microscopic vibrating movements along an oval trajectory, processing the walls of the cavity (Fig. 79);

laser - the use of special lasers designed to treat carious cavities and hard tissues of the tooth (Fig. 80)

Let's touch on the topic of the classification of caries according to Black with a visual demonstration of the destructive processes in detail in the pictures. And although it was created more than a hundred years ago, many dentists still use it today to clarify the diagnosis and determine therapeutic measures to eliminate the disease.

Damage to teeth by caries is a process of destruction of the structure of hard tissue, its demineralization, which results in the formation of free cavities. And if pathogenic bacteria are not eliminated in time, this will lead to complete loss of the tooth and other unpleasant consequences.

Since caries is considered the most common dental disease, and its treatment requires the targeted actions of a doctor, it is not surprising that dentists have long been trying to simplify the process of diagnosing a disease. This is necessary to determine what actions should be taken for successful treatment.

To date, it is not difficult to eliminate caries and completely restore the destroyed part of the tooth. And the sooner you see a doctor, the easier it is to completely get rid of the problem with the least use of tools and auxiliary medicines. It is possible even with significant carious cavities to restore the functionality of the row and maintain a healthy smile.

Black caries classes have existed since 1896 and were developed by an American dentist to simplify his work. For a long period, it was the main classification used around the world, but some doctors tried to develop and supplement it for a more complete picture, since it does not cover absolutely all clinical cases. And it succeeded in part.

So, in the classical system created by Dr. Black, there were only five classes of caries distribution. And for a hundred years, scientists were able to add only one - the sixth, which is still used quite rarely. Let's describe them in more detail.

1 class

It is characterized by processes of demineralization in the area of fissures, blind fossae and furrows between tubercles. The occlusal, lingual and occlusal-buccal areas of the tooth are affected. In this case, both molars and premolars, as well as frontal incisors, can suffer.

Grade 2

Several enamel surfaces are exposed to carious destruction at once. Moreover, pathological processes affect the proximal areas and spread more often along the lateral chewing units. Due to the disease in the contact zone, several adjacent teeth are affected at once.

3rd grade

The problem is concentrated on the anterior elements - incisors and canines, affecting the proximal surfaces. But in this case, the cutting edge of the tooth does not change, its integrity and functionality are preserved.

In addition to the anterior surface, the lateral as well as the cutting edge of the incisors are also affected. The disease becomes more complicated and leads to the rapid destruction of the whole tooth.

5th grade

It is called cervical caries and is characterized by damage to the corresponding section of the unit. The demineralizing process affects the root region, which is quite difficult to treat. All elements of the dentition can be exposed to such a disease.

6th grade

It was not described by Black, but became part of this scheme through the work of other scientists and doctors. It is determined in cases of carious lesions of only the cutting edge of any tooth (incisor, molar or premolar).

Other classification systems

European doctors and our domestic ones prefer other diagnostic criteria, as they consider them more convenient and easy to use. We list the main ones that help determine the desired area of the tooth for processing, the complexity and methods of treatment.

Depth of damage

In this system, the following stages of carious disease are distinguished:

The stain stage is a slight destruction of the enamel, in which pathogenic bacteria act only on the protective layer of hard tissues.
- becomes noticeable during visual inspection, but its depth is not very large and does not reach the dentin.
- this is already a rather deep tissue lesion, in which their structure is disturbed. Dentin and enamel are affected, but the pathology does not cause painful sensations, since it is far from the pulp.
- a more serious lesion, in which there is still no pulpitis and other complications, but pathogenic bacteria are already quite close to the dental nerve and, if left untreated, will lead to severe pain and the development of other concomitant diseases.

If you leave this process without attention, then in addition to caries and possible tooth extraction, you may also encounter the need to treat pulpitis, periodontitis and other pathologies.

For an even more simplified diagnostic scheme, caries can be defined as a process of demineralization of hard tissues at the level of:

enamels;
dentin;
cement;
or in the stage of suspended pathology of the dental element.

Downstream

Depending on the rate of occurrence of destructive phenomena, we can talk about:

fast carious process;
slow;
or stabilized, when after the treatment it was possible to stop the spread of bacteria.

It is useful for the doctor to determine the intensity of the disease:

When pathology affects only a single element in a row.
With multiple lesions in several areas.
Or systemic caries that has spread to all surfaces of hard tissues in the mouth.

The development of the pathological process can take place in the following forms:

simple - when caries can be detected and treated even before damage to neighboring organs, tissues and systems;
with complications - if a person went to the doctor too late and in addition to carious cavities in the teeth, other inflammatory or infectious processes in soft tissues, pulpitis, etc. are also found.

Video: preparation of carious cavities according to Black.

By order of appearance

To select adequate therapeutic measures, it is important for a specialist to find out the cause of caries formation, as well as other features. In this case, they talk about its varieties:

primary - when pathogenic bacteria appeared for the first time in a certain tooth area;
secondary - even after filling, the disease continues to spread through hard tissues, more often it forms directly around the artificial material;
manifestations of relapse - with insufficient quality treatment, further tooth destruction occurs.

Of course, these are not all classifications of carious lesions available today. But for the doctor, the most important thing is to make the correct diagnosis, assess the condition of the patient's hard and soft tissues, the intensity of the lesion, and also choose the appropriate way to eliminate pathogenic microorganisms from all surfaces.

Only with adequate treatment and targeted actions of a specialist can we talk about the complete elimination of the problem. After all, if you leave at least a small untreated area, then this will lead to the development of pathology and deterioration of the condition of the tooth, and in the future, its loss.

In advanced cases, the disease leads to other unpleasant consequences. So, if bacteria affect the nerve, then the complication of caries will be called pulpitis. And when the infection spreads to soft tissues, the destructive processes will end with periodontitis and other gum diseases.