Black caries treatment. classification of caries. Classification of carious formations proposed by J. Black

In an effort to systematize knowledge about caries, doctors have come up with several classification systems. The authorship of one of the most common belongs to J. Black. Black's classification of caries in pictures became known at the end of the 19th century. The American dentist managed to collect all the symptoms of the disease known at that time and logically distribute them into groups.

The principle of classification of carious foci

The division of carious foci and cavities into groups is based on their location:

• Class 1 according to Black involves the localization of lesions in the blind pits of the incisors and in the fissures of the molars;
• Class 2 according to Black includes carious lesions located on the lateral surfaces of premolars and molars;
• Class 3 according to Black indicates lesions that appeared on the canines and incisors, but did not violate the integrity of the cutting edge;
• class 4 according to Black includes destruction of the cutting edges and corners on the canines and incisors, resulting from the development of caries;
• Class 5 according to Black suggests the localization of carious cavities in the cervical region.

Initially, there were five categories of caries in the classification system, later, at the insistence of WHO, another group was added to them, known as the 6th class according to Black. It included damage to the cutting areas of the incisors and canines, as well as hard tissues of the molars protruding above the surface of the tooth (bumps).

Features of the treatment of caries of different classes

The meaning of the distribution of different forms of the disease into groups is not only to facilitate the doctor's task in making a diagnosis. Black classes are very important in dentistry, as they are a "guide" to treatment. Depending on the location and severity of damage to the tissues of the tooth, the doctor chooses a method for preparing the cavity, a method for installing filling material.

I class

Incorrectly performed treatment of group I caries can cause the filling to fall out of the cavity of the diseased tooth during chewing, the risk is due to the location of the focus. Therefore, in the treatment of caries, which is included in the 1st group of the Black classification, the dentist uses several techniques to prevent such consequences:

• reduces the bevel of tooth enamel;
• applies the composition parallel to the base of the carious cavity (when working with composites);
• lays light-hardening mixtures at an angle in several layers (to change the direction of shrinkage);
• produces the final reflection of the filling through the side walls of the tooth.

There are many ways to reduce the risk of a filling falling out. For the treatment of first-class dental caries, special algorithms have been developed that take into account the peculiarities of working with different materials. All of them are reflected in the curricula, specialized leaflets for dentists.

II class

This class of caries has its own characteristics. The main task of the dentist in the treatment of teeth affected by the disease of the second group is to prevent the edge of the filling from overhanging, to ensure its tight fit to the bottom of the filled cavity.

The process can be complicated by too wide or too closely spaced teeth, so one of the stages of treatment may be bringing the contact surfaces closer or apart with the help of wooden wedges, holders.

All procedures, including the preparation of the cavity of the tooth and the spreading of the contact surfaces, are performed after adequate anesthesia.

III and IV classes

Features of the preparation of carious cavities of the third and fourth categories according to Black play a less important role; in the treatment of this type of dental caries, a competent selection of filling material comes to the fore. Since the darkened areas of the enamel are in visible places, it is necessary to use a filling of a suitable color.

For this the prepared tooth is filled with a composite of not one, but two shades:

• white or milky to restore dentin;
• almost transparent for the restoration of tooth enamel.

The main difficulty in the treatment of carious cavities on visible contact surfaces is to correctly assess the transparency of the tooth. There are no exact criteria for this, the dentist is forced to rely on his own feelings. Therefore, it would be better if an experienced specialist takes up the treatment of caries IV and III class according to Black.

V class

According to the classification of carious cavities according to Black, the foci of the fifth class are located in the immediate vicinity of the gums. This is the main difficulty in their treatment. If the patient is worried about gingival bleeding and tangible discomfort in the cervical area, the doctor may suspect a deep location of the cavity affected by decay.

In this case, dental care is provided in several stages:

1. Removal of plaque from the surface of a diseased tooth.
2. Determining the shade of the future filling.
3. Anesthesia.
4. Opening the cavity, cleaning the softened tissues.
5. Gingival margin correction.
6. Treatment, placing a filling in a drug-treated cavity.
7. Polishing.

If the clinic adheres to the Black classification, the doctor will be advised to use a composite-ionomer composition. Due to its properties, this material is ideal for filling large cavities.

Classification of dental caries according to other systems

The classification of dental caries according to the J. Black system is not the only one; there are several dozens of other versions in the world. The most common:

• WHO classification of caries;
• by primacy - a disease that arose for the first time, or its recurrence;
• topographic - takes into account the degree of damage to the dental canals;
• by intensity - one tooth affected by caries or several;
• by the presence of complications - only the tooth cavity is affected, or the process has moved into the oral cavity, onto the gums.

Despite the fact that the Black classifier with pictures, including class VI, has become widespread in the countries of the former Soviet Union, dentists call the WHO system the most convenient (image below). It not only reveals the coordinates of oral caries, but also allows you to clarify its types and features (suspended, unspecified, children).

Black classification in pediatric dentistry

The principle of determining the type of disease in children is the same: having established the location of a carious cavity, the doctor can attribute the diseased tooth to one category or another. The only difference in the design of the diagnosis is an additional entry that the bite is milky.

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 targeted action by 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:

1. The stain stage is a slight destruction of the enamel, in which pathogenic bacteria act only on the protective layer of hard tissues.
2. - becomes noticeable during visual inspection, but its depth is not very large and does not reach the dentin.
3. - 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.
4. - 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:

1. When pathology affects only a single element in a row.
2. With multiple lesions in several areas.
3. 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.

Dental caries is one of the most common and well-known human diseases worldwide. It affects the tissue disease of milk and permanent teeth. The development of caries is associated with various reasons, and there are many factors that negatively affect the formation of healthy teeth, their development and condition! Caries causes a lot of worries for both adults and children, being a trigger for inflammatory diseases of tissues inside and outside the tooth.

Distinguish caries according to the degree of activity of the disease, the intensity of the course of the process, the localization of the lesion and the depth of tissue destruction. Classifications of caries are constantly updated with the development of progress, medicine and the allocation of various new forms of the pathological process.

Classification of caries according to the intensity of the lesion

• Caries of one tooth (single lesions).
• Multiple caries (carious disease, when 4-5 teeth in the oral cavity are simultaneously affected, and during their treatment, new foci also appear on several teeth).

Occlusal caries

Damage to the chewing surface of the teeth. Fissures are natural depressions in the form of furrows on occlusal surfaces, so fissure caries can also be attributed here separately.

Interdental caries

Defeat of contact surfaces, approximal caries. Such carious cavities are hidden for a long time, because the destruction develops deep into the center of the tooth. Outside, such a cavity is covered with a “roof” of preserved enamel. Cavities are detected between the teeth either by translucent dark areas of the teeth, or using an X-ray examination.

Cervical caries (cervical)

The neck of the tooth is the area closer to the gum between the crown and the root, hidden in the bone. Such caries often occurs as a result of poor oral hygiene.

Circular caries (ring)

With this form, caries surrounds the tooth around the entire circumference in the form of a belt. It is often determined in children in the form of yellow or dark rings around the necks of the teeth.

Hidden caries

Cavities hidden from the eyes in areas of the tooth that are difficult to access for inspection.

Clinical classification of caries

1. Caries initial(caries in the stain stage). It is characterized by the appearance of spots of different colors on the surface of the teeth. There is no enamel defect, there is no shine of the spots, the spots are stained with dyes during diagnostic tests.
2. Superficial caries. The beginning of the destruction of tooth tissues with the appearance of a small thickness of defects within the enamel. The surface of such areas is rough, stained with dyes. Pain can occur when brushing your teeth or taking sour, sweet.
3. Medium caries. Deeper damage to enamel and dentin tissues. Medium-depth carious cavities appear, in which food debris can linger, causing pain in a person.
4. deep caries. Cavities occupy up to ½ of the surface by area or depth of penetration of the process. In the absence of proper treatment, it quickly passes into complicated forms - pulpitis or periodontitis.

Classification of caries according to the course of the disease

Spicy

The appearance of light carious spots can take only a few weeks.

Chronic

Longer process. When destroyed, the affected tissues have time to be stained with food dyes, plaque and acquire a color from yellow to dark brown.

Acute or blooming caries

It develops in children weakened by various diseases, after the removal of the salivary glands in adults with the appearance of dryness in the oral cavity. Such caries affects many teeth at once, its course is fast, cavities are localized on atypical surfaces, at the same time there are several carious foci on one tooth.

Recurrent (secondary)

Caries occurs repeatedly with poor hygiene, weakening of tooth enamel, damage, and the development of general somatic diseases of the body.

International classification of the disease according to WHO

• Enamel caries
• Dentin caries
• caries cement
• Suspended (In this form, under the influence of intensive hygienic and preventive procedures, the rate of development of caries slows down).
• Odontoclasia (A state of resorption of the roots of milk teeth).
• Another.
• Unspecified.

According to the development of the process, the following forms of the disease are distinguished:

A) Simple caries (uncomplicated).

C) Complicated caries (Accompanied by inflammation of the tissues of the tooth with the development of pulpitis or periodontitis).

1 class

Caries in natural depressions, pits, fissures on the chewing, buccal or palatal surfaces of molars and premolars.

Grade 2

Caries of contact surfaces of molars and premolars.

3rd grade

Caries of the contact surfaces of the incisors and canines without disturbing the cutting edge of the teeth.

4th grade

Carious cavities on the contact surfaces of incisors and canines with a violation of the integrity of the cutting edge.

5th grade

Carious cavities in the region of the necks of all teeth.

Classification depending on the affected part of the tooth

• tooth crown caries;
• cervical caries (develops in the area of ​​the necks of the teeth near the edge of the gums, on the buccal or labial surface);
• caries of the root of the tooth (the carious cavity extends deep under the gum, affecting the root, which is not naked and invisible during examination);
• radical caries (develops on the lingual, buccal or contact surfaces along the exposed roots of the teeth).

Classification of caries according to the sequence of occurrence

• primary caries - develops on the tooth for the first time;
• secondary caries - a new caries occurs on previously treated teeth, next to or around fillings;
• relapse - caries under the filling. As a rule, such caries is invisible during a routine examination. The affected tooth changes in color, darkens.

Pakhomov classification

G. M. Pakhomov identified 5 groups of initial caries (stain stages):

• white;
• gray;
• light brown;
• brown;
• black.

There is also the concept of "bottle" caries. "Bottle" caries develops in children who are often fed from a bottle, especially at bedtime or at night, as well as in babies who are breastfed for a long time (night feedings play a special role).

Often parents give their children sweet water, compotes, juices, sweet kefir or milk to drink at night. First, the front upper teeth are affected from the side of the sky, therefore, with such a hidden localization, the process is invisible for a long time. Such caries develops with prolonged contact of carbohydrates with the surface of the teeth. In addition, much less saliva is secreted at night than during the day, as a result, it does not provide a natural cleansing of the surfaces of the teeth.

Determining the intensity of caries

Classification of the disease in children depending on the index of caries activity (intensity) proposed by T. F. Vinogradova:

• compensated caries;
• subcompensated caries;
• decompensated caries.

The caries activity index (intensity index) is defined as the sum of carious (K), filled (P) and teeth removed due to complicated caries (U) in one person. The KPU-index in children includes an examination of milk teeth (c-carious, p-filled teeth), i.e. KPU + kp in a mixed dentition, when there are both temporary teeth and permanent teeth in the oral cavity.

The KPU caries activity index can be very low (0.2-1.5 for adults and 0-1.1 for children), low (1.6-6.2 and 1.2-2.6 respectively), medium (6.3-12.7 for adults and 2.7-4.4 for children), high (12.8-16.2 and 4.5-6.5) or very high - for an adult it is 16.3 and above, and for a child - 6.6 and above.

Dental caries, regardless of classification, is a problem for many people. Dentistry has never been fun for anyone. Rather, it is a forced necessity. But a necessary and responsible procedure that will allow you to maintain health in the oral cavity for a long time.

Classification by localization

The American scientist Black proposed a classification of carious cavities according to localization:

1 option

Classes of dental caries according to Black:
Class I - cavities in the area of ​​fissures and natural depressions.
Class II - cavities on the contact surfaces of molars and premolars.
Class III - cavities on the contact surfaces of incisors and canines without breaking the cutting edge.
Class IV - cavities on the contact surfaces of incisors and canines with a violation of the cutting edge and corners of the crown.
Class V - cavities on the labial, buccal, lingual surfaces located in the gingival part of the tooth crown.
Class VI - cavities located on the tops of the tubercles of molars and premolars, as well as on the cutting edges of incisors and canines.

Option 2

Classification of caries according to the location of the carious cavity (according to Black):

Class I - caries in the area of ​​fissures (natural furrows);

Class II - caries of the contact surfaces of large and small molars;

Class III - caries of the contact surfaces of the incisors and canines while maintaining the cutting edges;

Class IV - caries of the contact surfaces of the incisors and canines in violation of the cutting edges;

Class V - cervical caries.

• I class- cavities in the area of ​​fissures and natural depressions of the teeth.
• II class- cavities located on the contact surfaces of small and large molars.
• III class- cavities located on the contact surfaces of incisors and canines without involving the cutting edge.
• IV class- cavities located on the contact surfaces of incisors and canines with the involvement of the cutting edge and corners.
• V class- cavities in the area of ​​the necks of all groups of teeth.
• Later it was also singled out VI class- cavities of atypical localization: cutting edges of the frontal and mounds of chewing teeth.

Detection and recording of carious lesions is an important component of the evaluation step in the oral hygiene process. Because of its importance, all dentists should be able to detect caries and classify it.

More than 100 years ago, Dr. Black developed a classification of carious cavities based on the location of the affected tooth (anterior or posterior teeth) and the location of the hard tissue defect on the tooth itself. The system was described a long time ago, in the current realities it is considered incomplete, since it does not cover root and secondary caries. However, it is still widely used in dental practice. Black's classification of caries includes 5 classes! Over the years, many have tried to modify the classification and still managed to “shove” the “6th grade according to Black” into the masses:

Carious cavities are located in the pits and furrows on:

• occlusal surfaces of molars and premolars
• occlusal-buccal and lingual surfaces of molars
• lingual surface of the anterior teeth (incisors and canines)

Black class 1 cavity in the molar

2nd class according to Black

Class 2 cavities according to Black are simultaneous lesions of at least two surfaces. Carious cavities are located on the proximal (medial or distal) surface with access to the occlusal surface of the molars and premolars.

Class 2 cavities according to Black- damage to two surfaces of molars or premolars

3rd grade according to Black

The cavities are placed on the proximal surfaces of the anterior teeth (incisors or canines), without violating the angle of the crown of the tooth.

Class 3 black cavities on incisors and canines

4th grade according to Black

The carious cavity of the 4th class according to Black provides for the involvement in the process of all proximal surfaces on the anterior group of teeth, with an additional lesion of the cutting edge.

Black class 4 cavity - lesions on the anterior inter-proximal surface of the tooth, including the incisal angle

5th grade according to Black

Cavities are located in the cervical regions of absolutely all groups of teeth.

Carious lesions on the gingival third of the crown of the lingual or vestibular surfaces of the tooth.

6th grade according to Black

Grade 6 was never actually described by Black, it was invented later by other scientists. Grade 6 - these are cavities on the cutting edges of the anterior teeth and the tops of the tubercles of the molars and premolars. This class in the diagnosis is used very rarely!

Black class 6 cavity - a carious lesion at the top of the cusps of the posterior teeth

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Dr. Greene Vardiman Black

Greene Vardiman Black (1836-1915) is widely regarded as one of the founders of modern dentistry in the United States. Also known as the father of surgical dentistry. Born near Illinois on August 3, 1836. Parents William and Mary Black. He spent his childhood on a farm and quickly developed an interest in the natural world. At the age of 17, he began to study medicine, with the help of his older brother. In 1857 he met Dr. J.C. Speer, who began to teach him practical dentistry.

After the Civil War, in which he served as a scout, he moved to Jacksonville, Illinois. It was here that he began an active career in the emerging field of dentistry. He researched many important topics, including the causes of fluorosis and the development of caries.

In addition to developing a standard for cavity preparation, Black also experimented with different amalgam mixtures. After several years of experimentation, he published his balanced amalgam formula in 1895. This formula quickly became the gold standard for the next 70 years!

Black was the second dean of Northwestern University of Dentistry, where his portrait hung until the school closed in 2001. A statue of him can be found in Chicago's Lincoln Park. He was also inducted into the Pierre Fauchard International Dental Hall of Fame on February 25, 1995.

Carious damage is the process of demineralization of the tissue structures of the tooth, which leads to the formation of pathological cavities. Little is known to patients, but caries has several classifications, one of the main ones is according to Black. However, for a complete understanding of the pathology, all types of carious lesions according to various classifications should be mentioned.

Black's classification of caries

Classification of caries according to the depth of the lesion

It is determined that this classification is quite common in terms of ease of use in dental practice. Most often used by dentists in the CIS countries.

Attention! Complicated carious lesions of the teeth are accompanied by periodontitis and pulpitis, and therefore require long-term treatment.

Types of caries

International classification

This type of qualification is defined as histological. Caries is classified depending on the level of damage to the dental structure:

• violation of the integrity of the enamel;
• dentin damage;
• cement damage;
• suspended pathology of dental elements.

The founder of American dentistry in 1896 established a classification of pathological cavities, which is defined by five main classes. The discovery of this system was more than a hundred years ago, therefore it is considered not a complete classifier, since carious lesions of the root system and a secondary nature are not taken into account. Despite this, dentists widely use the Black carious classifier. Over time, the classification system was modernized and an additional class was added.

Classification of carious cavities

1 class

Furrows on the following surfaces of the dental element (molars, premolars, frontal teeth) suffer from carious lesions:

• occlusal;
• occlusal-alkaline;
• lingual

1st class according to Black

Description of the first class of carious cavities according to Black

Grade 2

This class is characterized by damage to several surfaces at once. That is, the location of the pathological lesion is the approximal surface with the transition to premolars and molars.

2nd class according to Black

Description of the second class of carious cavities according to Black

3rd grade

Pathology is located directly on the anterior dental elements. Most often, caries is diagnosed on canines and incisors (namely, on the proximal surfaces). In this case, there is no violation of the angle of the crown tooth.

3rd grade according to Black

Description of the third class of carious cavities according to Black

4th grade

The diagnosed process becomes more serious, as the proximal surfaces are involved in the process. Anterior dental elements are at risk.

4th grade according to Black

Description of the fourth class of carious cavities according to Black

5th grade

Carious pathology threatens the cervical region of the tooth. In this case, a carious lesion can be placed absolutely on any dental element.

5th grade according to Black

Description of the fifth class of carious cavities according to Black

6th grade

The classifier of the sixth class includes carious lesions of the cutting edge area of ​​only the anterior dental elements. The tubercles of premolars and molars also belong to this class. At the same time, the sixth grade is almost never used when making a diagnosis.

6th grade according to Black

Attention! The sixth grade was not approved by Dr. Black. It was invented much later by other specialists for the convenience of the classifier.

For the convenience of classifying carious cavities, several different systems have been defined. Thus, according to the development of the pathological process, the following are distinguished:

1. A simple carious lesion (caries proceeds without complications and is not characterized by an inflammatory process of soft tissues).
2. Complicated carious lesion (due to the rapid development of pathology, an inflammatory process is observed in the pulp area, as well as the tissue structure near the dental element). Most often, the complication manifests itself in the form of periodontitis or pulpitis.

Classification of carious cavities according to Black

Particular attention should be paid to the unspoken type of carious lesion that develops in young children. If parents teach the baby to eat at night, and later to sweet drinks and sweet juices, then we should expect the development of carious cavities. The danger of children's caries lies in the fact that if the inner part of the incisors is damaged, the pathology is not noticeable for a long time. The rapid development of caries in this case is explained by the deposition of carbohydrates of various sweets on the milk dental elements. Moreover, an increase in the viscosity of saliva due to constant contact with the nipple, become concomitant factors for the development of caries.

Three types are defined:

1. Quick.
2. Slow.
3. stabilized.

Also, when diagnosing carious cavities, the fact of the intensity of the lesion is taken into account:

1. Caries can appear as a single element.
2. These are multiple lesions on several teeth at once.
3. Defined as a systemic lesion.

It is very important to consider the moment when caries began to appear:

• primary phenomenon (the tooth is exposed to caries for the first time);
• a secondary phenomenon (a tooth that was previously sealed is exposed to a carious lesion, mainly caries occurs around the filling);
• recurrent manifestation (when the dental element was not sufficiently treated, caries can develop under the filling on the dental tissues).

There are a large number of systems classifying caries, almost all of them are repeated. Therefore, for an accurate diagnosis, it is very important for a specialist to correctly determine the depth of the cavity, the nature of the course and the main reason for the formation of carious pathology. Indeed, the effectiveness of treatment and the absence of recurrent carious lesions will depend on the reliability of the diagnosis in the future.

An example of a second class caries treatment process:

Today we will talk about the well-known classification of caries according to Black in dentistry.

This scientist devoted a lot of time to researching this disease and, as a result, systematized the knowledge gained and invented his own gradation of this disease, which became popular among practitioners.

The most fundamental is the classification of carious cavities, which Black came up with in 1896. He singled out 6 classes of damage to the teeth by this disease. The purpose of introducing this classification was to standardize the methods of preparation and filling of carious cavities. The filling technique directly depended on the type of caries localization.

The discovery of this system was more than a hundred years ago, therefore it is considered not a complete classifier, since carious lesions of the root system and a secondary nature are not taken into account.

Despite this, the Black classification of caries is still widely used by dentists. After a while, the ranking system for the defeat of this disease was modernized, and an additional 6th class was added to its 5 elements. Let's take a closer look at each class separately!

Molars, premolars and anterior teeth suffer from this type of lesion.

This anatomical classification of caries applies to the occlusal, occlusal-alkaline and lingual surfaces of tooth enamel.

Caries is placed on natural fissures.

Thus, seals must be installed in the above places.

This species can affect several places of the tooth at once in different planes.

The location of the pathological lesion is the proximal surface with the transition to premolars and molars.

At contact points on different sides of the tooth, foci of caries may occur. At a minimum, the medial and distal parts of the tooth may be affected.

Thus, a filling according to the second class can be located on the medial-occlusal surface of the premolar or on the medial-occlusal-distal surface of the molar.

Most often, this type of location occurs on incisors and canines, less often on other types of teeth, but always on their front part.

In this case, there is no violation of the angle of the crown tooth. The integrity of the upper edge of the incisors with such caries is not damaged. Both on the medial and on the distal side of the tooth, this pathology can manifest itself.

In this class, caries damages the proximal surfaces, especially the anterior teeth. This type of carious localization is characterized by a violation of the angle of the crown part of the tooth or its cutting edge.

With this type of lesion, the cervical part of any tooth suffers. Both the vestibular and lingual parts of all types of teeth can accommodate this type of pathology.

The defeat of only the anterior edges of the dental elements by caries distinguishes this subspecies from the rest. It is localized on premolars and molars.

The Black classification of caries is considered one of the most popular among practicing dentists. It simplifies the diagnosis and selection of the necessary methods of filling the affected area.

In this direction, there are 3 varieties of the dynamics of the course of this disease: fast, slow and stabilized.

Also, this pathogenic process can be considered by the vastness of its localization: caries manifests itself on one tooth, on several elements, or is systemic in nature and affects most of the different teeth in the upper and lower rows.

As in the previous gradation, experts distinguish 3 types of carious lesions.

The first includes caries, which arose on the tooth for the first time.

To the second - a repeated lesion of an already early sealed tooth.

In the vast majority of cases, this disease spreads around or under the filling.

The third is the so-called recurrent caries lesion. It occurs due to insufficient treatment of this area or a poorly installed filling.

Secondary caries are all new carious lesions that develop next to a filling in a previously treated tooth. Secondary caries has all the histological characteristics of a carious lesion.

The reason for its occurrence is a violation of the marginal fit between the filling and the hard tissues of the tooth, microorganisms from the oral cavity penetrate into the resulting gap and optimal conditions are created for the formation of a carious defect along the edge of the filling in the enamel or dentin.

Recurrent caries is the resumption or progression of the pathological process in the event that the carious lesion was not completely removed during the previous treatment. Recurrence of caries is more often found under the filling during X-ray examination or along the edge of the filling.

There are a large number of systems classifying caries, almost all of them are repeated. Therefore, for an accurate diagnosis, it is very important for a specialist to correctly determine the depth of the cavity, the nature of the course and the main reason for the formation of carious pathology.

The effectiveness of treatment and the absence of recurrent processes in the future will depend on the reliability of the diagnosis in the future.

In many countries, this classification is the most widely used.

It takes into account the depth of the lesion, which is very convenient for the practice of the dentist. There are 4 stages in the development of this disease:

1. The appearance of a carious spot. The focus of demineralization of the tooth element. The process of this harmful phenomenon can last both slowly and quickly, depending on the individual characteristics of the patient's body.
2. Superficial caries is characterized by local damage to the enamel on the tooth.
3. Caries of moderate severity manifests itself in damage to the surface layer of dentin.
4. Deep caries clings to the pulpal dentin and affects the tooth up to the nerve endings.

Let's take a closer look at the features of the course of the chronic and acute forms of this disease.

The acute form of caries is characterized by the rapid development of destructive changes in the hard tissues of the tooth, the rapid transition of uncomplicated caries into a deep one.

Affected tissues are soft, poorly pigmented (light yellow, grayish-white), moist, easily removed by an excavator.

Chronic caries is characterized as a slowly ongoing process (several years).

The spread of the carious process (cavities) is mainly in the planar direction. The altered tissues are hard, pigmented, brown or dark brown in color.

According to this ranking of the affected areas, there are:

• dentine caries;
• tooth enamel;
• cement;
• unspecified caries;
• odontoclasia;
• stopped caries.

There are 3 types of caries in this category: compensation, sub-compensation and decompensation.

Compensatory caries is characterized by a slow current or non-progressive process.

Damage to the surface of the teeth is minor and does not cause discomfort to the patient.

With regular and systematic hygiene procedures, as well as special preventive measures, it is possible to stop the development of the disease at its initial stages.

Subcompensation caries is characterized by an average flow rate at which it can go unnoticed and not cause concern to the patient at all.

Decompensation caries is expressed by the intensive development and dynamics of the course, accompanied by such acute pain that it affects both the ability to work and the daily life of the patient.

Because of this, the disease is often called acute caries. It requires immediate medical procedures, because otherwise the process can spread to third-party teeth, followed by the addition of pulpitis and periodontitis.

To carry out all the necessary therapeutic manipulations, many specialists rely in their work on the classification of caries according to Black.

With any of the above types of tooth damage from caries, it is necessary to carry out a full preparation and filling.

The durability of your tooth (or several) depends on the quality of these manipulations.

Experienced dentists may leave deep pigmented elements during the removal of soft carious dentin, in order to avoid damage to the tooth pulp. After carrying out these works, no affected tissues should remain on the walls of the cavity.

At all stages of preparation and filling, the dentist sets the main goal - to destroy the carious areas of the affected tooth, disinfect the remaining parts and apply hermetically constructive material that can restore the structure of the tooth and help it fully perform its functions in the future.

There are several classifications of caries, which take into account various factors of its manifestation in their hierarchy.

The most common is the classification of caries according to Black.

It indicates the localization of the affected areas with this disease, which is very helpful for dentists in determining the method of filling this area.

Modern dentists distinguish 6 classes of damage on this scale.

There are also classifications according to the activity of the manifestation of caries, according to the severity and severity of the ongoing processes, according to the scale of distribution, according to the sequence of occurrence of foci, etc.

In any case, no matter what reason affects the occurrence of caries, it is best to urgently contact an experienced specialist in its localization and removal. A neglected disease can develop into pulpitis or periodontitis.

These diseases are extremely difficult to treat and can cause a large number of complications that are dangerous for the full functioning of not only the oral cavity, but the whole organism. The foci of inflammatory processes can spread from the teeth to the jaw bones, nerves, and even the soft tissues of the gums.

With an untimely visit to the dentist, people, at least, may eventually lose a tooth affected by caries. We should also not forget about preventive measures to maintain the oral cavity in a healthy state.

Thorough cleaning of teeth, rinsing them with a special antibacterial solution, regular scheduled check-ups at the dentist, eating foods rich in fluorine and calcium can significantly prolong the full functioning of your teeth and make them healthy and beautiful.

At the first appearance of light or dark spots on the teeth, immediately seek help from a dentist.

I hope you learned something new and interesting on this topic and were able to find answers to your questions! Check out other articles on our blog, there is a lot of information there.

Have a nice day and take care!

Dental caries is a pathological process of progressive subsurface demineralization of enamel with the formation of a cavity defect in the future, which occurs after teething under the influence of acids produced by microorganisms that are part of dental plaque.

Dental caries is considered one of the most common diseases. In many countries, the prevalence of caries is 95-98%. The incidence is on the rise worldwide, especially in children.

susceptibility to caries

For the development of caries, various conditions are necessary, in the presence of which the predisposition to this disease increases.

General factors:

• Cariogenic diet with a predominance of carbohydrate foods (cookies, sweets, carbonated drinks);
• Changes in the somatic health of the patient (frequent illnesses with common respiratory diseases, influenza, etc.);
• Extreme stress on the body (radioactive radiation);
• Unfavorable heredity.

Local factors:

• Poor oral hygiene (presence of soft plaque and mineralized dental deposits);
• Violation of the qualitative and quantitative composition of saliva (high viscosity, lack of calcium ions);
• Violation of the resistance of mineralized tooth tissues (due to superficial changes in the structure);
• Changes in the biochemical composition of enamel, dentin and cement;
• Pathological changes in the pulp apparatus of the tooth;
• Violations in the formation of the dental system.

The development of caries occurs in several stages:

1. Caries in the stain stage(elementary). It is asymptomatic, the affected area of ​​the tooth loses its luster, becomes dull, a chalky spot forms. The spot may be pigmented (have a yellowish color). Usually there are white spots on the teeth of a child or an adult. Probing is painless.
2. superficial caries. It is asymptomatic, sometimes pain from sweet, sour, salty, less often from mechanical stimuli. A rough defect up to 1 mm deep is determined on the tooth, a color change to light brown is possible. Probing is painless.
3. Medium caries. Complaints of short-term sharp pain from getting food into the tooth, cold and hot, the pain disappears immediately after the cessation of the stimulus. A carious cavity in a tooth of small or medium size, up to 1.5-2 mm deep. Probing is painful along the dentin-enamel junction.
4. deep caries. Complaints about pain from all kinds of irritants, from cold, hot, from getting food into the carious cavity. A deep carious cavity filled with softened, necrotic dentin and food debris. Probing along the dentin-enamel border and the bottom of the carious cavity is painful, there is no communication with the tooth pulp.

Last time we covered the topic of ICD 10 dentistry - an international classification of dentistry that divides caries into categories.

What are the features of Black's classification?

In 1891 A. Black, based on the patterns of distribution and typical localization, systematized all the cavities, dividing them into 6 classes. The proposed classification is convenient for choosing tactics for treating a tooth, depending on the location of the defect. The purpose of this classification is to standardize the methods of filling and preparation of various carious cavities.

Black's classification of caries:

• 1 class- carious cavities located in the area of ​​fissures and natural depressions of the chewing group of teeth and in the area of ​​​​the blind fossa of the lateral incisor.
• Grade 2- cavities on the medial and distal surfaces of premolars and molars, limited by tooth tissues on three sides.
• 3rd grade- cavities on the medial and distal surfaces of the anterior group of teeth with no destruction of the cutting edge.
• 4th grade- cavities on the medial and distal surfaces of the anterior group of teeth with a violation of the cutting edge.
• 5th grade- cavities in the neck of all groups of teeth.
• 6th grade– cavities on immune zones (tooth bumps, enamel ridges)

To reduce the risk of developing caries, its prevention and treatment is required.

The standard treatment includes:

• Examination, questioning, diagnosis, treatment plan.
• Anesthesia.
• Opening of the carious cavity (removal of the overhanging edges of the enamel, which do not have a base of dentin).
• Cavity expansion (improved visibility).
• Necrectomy (removal of softened dentin).
• Cavity formation (creation of the necessary conditions for filling).
• Finishing the edges of the enamel (creating a better fit of the filling to the tooth).
• Sealing (using composite materials and cements).

Tooth filling restores their 5 main functions: speech, chewing, aesthetics, maintenance of facial soft tissues, creation of an occlusal plane.

Methods for processing hard tissues of the tooth:

• Mechanical- with the help of rotary burs and hand tools).
• Chemical-mechanical- the use of chemicals to soften non-viable tooth tissues with their subsequent removal.
• Pneumokinetic- the impact of the directed supply of an abrasive substance in the form of an aerosol under pressure.
• Acoustic- ultrasonic.
• Laser preparation. It is based on microexplosions of water, which is part of the hard tissues of the tooth under the action of laser irradiation.

If the tooth is destroyed too much and there is no way to restore it with filling materials, then it is necessary to apply orthopedic treatment (artificial crowns, tabs on the tooth under the crown).

The search for effective methods of caries prevention is one of the main areas of modern dentistry. Prevention of caries consists of a set of measures and its effectiveness depends on the interaction of dentists and dental hygienists with the population.

Prevention includes:

1. Regular visits to the dentist at least once every six months.
2. Carrying out professional oral hygiene.
3. Brushing your teeth at least 2 times a day.
4. The use of additional hygiene products (gum rinses, dental floss, toothpicks, irrigators).
5. Rinsing the mouth with remineralizing and fluoride preparations.
6. If the fluoride content in the water is insufficient, it is necessary to make up for the lack of fluoride by drinking fluoridated milk.
7. The use of fluoride-containing gels for the prevention of caries.
8. Conducting hygiene lessons by dentists in schools and preschool institutions with demonstrations of methods of brushing teeth on models.
9. Conducting lectures on oral care, risk factors for dental diseases and their prevention.
10. Drug therapy (fluoride tablets).

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