Classification of carious cavities by car. Dissection of Class V cavities according to Black. Prevention includes

In dental practice, there is a special classification of carious lesions, which was founded by the famous American specialist Green Vardimar Black. Based on this scale, developed by a scientist, dentists classify the degree of development of the disease in a certain class, which serves as the basis for choosing the optimal method of treatment.

The essence of the system

Black's classification of carious lesions is a system for dividing the disease into certain classes, depending on the localization of the destroyed area of hard tissue and the coverage of certain elements of the jaw row.

Despite the fact that this scale was developed more than a hundred years ago and does not include secondary and root caries, its use is widespread in modern dental practice.

Dr. Black identified 5 main classes of caries, to which another degree of development of the disease was later added.

The purpose of creating this classification was to select the optimal method of therapy - the selection of a suitable material for filling and a method for preparing the affected surface.

The topography of Black cavity views is well demonstrated in the following diagram:

1 - Natural fissures and blind fossa

The first class of caries is awarded to pathology, as a result of which fissures, deepening of the chewing surface of the elements of the jaw row and blind fossa of the lateral incisors are affected. In this variant of the disease, incisors, canines and premolars may be affected. In some cases, the changes involve the molars.

Photo # 1. Location of carious cavities I class(view of the tooth after preparation):

1. Large molar tooth. Chewing surface.
2. Cutter. Lingual surface.
3. Large molar tooth. Buccal surface.
4. Large molar tooth. Combination of lesions of the chewing and buccal surfaces.

Treatment

Since in the first class of caries mainly the chewing surface is affected, on which there is a large load, when placing a seal, it is necessary to exclude the possibility of its edges breaking off.

For this, during the preparation of the tooth, the enamel bevel is reduced with the imposition of a dense layer of composite material. Experts prefer to use a cone-shaped bur with a rounded edge of the working surface to form the cavity. - this ensures the creation of a cavity, the shape of which corresponds to the fissures.

To close the cavities of the 1st class, various filling materials are used:

application of a chemically cured composite involves its application parallel to the base of the cavity for shrinkage into the pulpal part;
light-curing material application occurs in oblique layers, which is necessary for shrinkage in the area of the polymerization lamp.

If these methods of applying the composite material are observed, its most tight fit to the treated carious cavity is ensured and the risk of further chipping is eliminated.

2 - Contact surfaces of molars, premolars

Caries of the second class according to Black involves the defeat of the contact surfaces of the teeth located in the same jaw row. Most often, this type of pathology is observed between the chewing teeth - premolars and molars.

The lesion can involve the distal or medial surface, or be located on both sides.

Photo # 2. Location of carious cavities Class II.

1. Contact surface.
2. Combination of lesions of the chewing and contact surfaces.

Treatment

Preparation of teeth to eliminate caries of the 2nd class is most often carried out through their chewing surface and is carried out in five stages:

opening the cavity;
preventive expansion - if necessary;
removal of necrotic tissue;
cavity formation;
finishing of the enamel bevel.

When filling a class 2 carious cavity, it is necessary to pay attention to the need to perform two important tasks - ensuring a tight fit of the composite material and creating a strong contact between the teeth.

For this purpose, specialists use a thin matrix and a slight displacement of the tooth using wooden wedges. For a strong adhesion of the composite to the edges of the carious cavity, a special adhesive is applied.

3 - Lesions of incisors and canines

The third class of caries is the defeat of the contacting surfaces of the canines and incisors. However, according to Dr. Black's classification, the incisal edge and corners of the teeth are not affected.

Photo # 3. Location of carious cavities III class.

1. Contact surface.
2. The combination of lesions of the contact and lingual surfaces.
3. Combination of lesions of contact, labial and lingual surfaces.

Treatment

In addition to restoring the natural shape of a damaged tooth, the dentist is faced with the task of preserving its aesthetic appearance.

For this reason, various composites are used as filling material. Cement compounds, amalgams and cast inlays are practically not used in this case.

Dissection is done like this:

Aesthetic restoration of a tooth involves the preparation of a carious cavity with a lingual approach.

In the process of removing necrotic tissue, the specialist also removes the pigmented areas of dentin.

An important point is the correct selection of the color of the filling material. Due to the different light transmission of the tooth, dentists use a composite of two shades - white and transparent to recreate the natural appearance of the filling. The creation of an imperceptible transition of shades is achieved by overlapping the enamel bevel by 2-3 mm.

4 - Violation of the integrity of the cutting edges

Caries of grade 4 according to Black is also a lesion of the contact surfaces of the canines and incisors, however, unlike the previous type of the disease, the lesion covers the cutting parts of the teeth and their corners.

Photo # 4. Location of carious cavities IVclass.

According to the developer of the classification, this form of the disease may result from the progression of caries or result from mechanical damage to the elements of the jaw row, enamel hypoplasia, etc.

Treatment

The preparation of a class 4 cavity and its closure with a filling material should solve several problems:

elimination of the disease that caused the development of pathology, and prevention of its recurrence in the future;
restoration of the aesthetic appearance of the tooth surface;
ensuring reliable fixation of the filling and preventing its destruction during chewing loads.

To fulfill all of the above requirements, as well as taking into account the area of the affected surface, the dentist chooses one of the following tactics for tooth restoration:

when the incisor or canine is destroyed by less than a third- composite restoration;
with damage to half of the tooth- facing with a composite material, called veneer;
if more than half of the incisor is affected- installation of an artificial crown.

5 - Vestibular surfaces

Caries class 5 is the destruction of the vestibular and lingual surfaces of the teeth in the cervical area. In addition, cavities are often located on the roots of molars. Any elements of the jaw row can be affected by this pathology.

Photo # 5. Carious cavity Vclass.

The reason for the formation of class 5 cavities is not only caries, but also other diseases: erosive processes in hard tissue, enamel hypoplasia, wedge-shaped defect.

The peculiarities of eliminating cavities of this classification group are that the lesions are often located close to the gingival margin or are hidden under it.

For this reason, in some cases, a correction of the edge of the soft tissue is required, after which a temporary filling is applied, which facilitates the further setting of a permanent one.

Treatment

A composite is most often used as a filling material for closing a type 5 cavity. In the case of a superficial lesion of a large area of the tooth surface, it is advisable to use a composite-inomeric composition.

In case of damage to the enamel or the need to restore teeth in the smile zone, light-curing composite materials of suitable shades can be used.

This video shows the preparation and filling process:

6 - Lesions of the cutting edges of the anterior units and tubercles of the molars

Dr. Black identified only 5 classes of caries, which have been used for a long time in dental practice to determine the nature of tooth damage.

However, some time later, the World Health Organization initiated changes to the classification, according to which another class of dental carious lesions was determined.

The sixth grade involves the formation of cavities at the edges of the cutting surfaces of the anterior teeth, as well as the tubercles of the canines and other chewing elements of the jaw rows.

Defects are formed as a result of abrasion of the enamel with further damage to the dentin. Typically, the bottom of such cavities is often darkened by food coloring. Dentin involvement by caries is rare.

Most often, the defeat of the teeth of the 6th class begins with concomitant diseases of the oral cavity: bite defects, pathological abrasion of the enamel, the presence of poorly fitted dentures. Therefore, establishing the cause of the cavity is a key factor in successful treatment.

Treatment

If the therapy does not require a change in the bite height, the cavity is prepared and the composite material is applied. If it is necessary to increase the bite height, specialists carry out orthopedic treatment with an artificial crown covering the tooth.

In some cases, to restore the functionality and aesthetic appearance of the elements of the jaw row, fixation of veneers is required.

In the video, see the preparation and treatment of fifth grade carious cavities.

Dr. Greene Vardiman Black

Dr. Green Vardimar Black is a well-known personality who pioneered the development of dental science in the United States of America. He was born in 1836 in Winchester.

At the age of 17, the young man became interested in medicine, for several years he worked as an assistant dentist D.S. Spira, while gaining theoretical knowledge on this topic.

After completing his education, Green Vardimar Black opened a personal dental office in Jacksonville. In addition to providing services to the public, Dr. Black never stopped studying science and improving.

In 1870, a mechanical drill equipped with a foot drive was invented by a specialist. The composition of the gold amalgam, developed by Dr. Black, is also used in modern dentistry.

In addition, the specialist brought the terminological base to the standard, and also developed a classification of carious cavities and cutting dental instruments.

Dr. Black has compiled several books, which described methods of preparing the tooth surface, touched upon the features of therapeutic dentistry, and also described some pathologies. In addition, Mr. Black has taught dental science at the College of Chicago and served as Dean of Northwestern University School of Dentistry.

What other systems exist

Black's classification is topographic, in dentistry there are several more ways of dividing types of caries into features:

Universal classification ICD 10

ICD 10 is a generally accepted and unified classification of diseases that applies to all human organs, including teeth. It is described in detail about the classification of caries according to this system.

Histological

Assumes sorting by histological features, i.e. the conclusion is made on the basis of what is affected from the tooth tissue: enamel, dentin or cement. The classification includes 3 relevant varieties:

Enamel caries.
Dentin caries
Caries of cement.

According to the clinical course

With the help of diagnostic methods and analysis of patient complaints, the doctor determines the nature of the course of the disease:

Spicy.
Chronic.

By the depth of defeat

The main method that helps to choose an approach to treatment. For example, medium caries lesions of the contact surface of the tooth (type 2 according to Black). There are 4 types:

In the spot stage.
Surface.
Average.
Deep.

In relation to the state of the pulp

A conclusion is made about the involvement of the pulp in the process of tooth decay.

Simple.
Complicated.

By the number of affected teeth

How many teeth are affected by caries at the time of the patient's visit to the dentist.

Single.
Multiple.
Generalized.

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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 variety of the toothbrush. As for electric brushes, they are the preferred option for uninformed people; although you can brush your teeth with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between teeth.

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

The latter include mouthwash, which eliminates unpleasant odors and promotes fresh breath.

With regard to therapeutic and prophylactic, these include rinses that have an anti-plaque / anti-inflammatory / anti-carious effect 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 aid must be selected for each specific person on an individual basis, as well as the toothpaste. And due to the fact that the product is not washed off with water, it only strengthens the effect of the active components of the paste.

Such cleaning is completely safe for dental tissues and less traumatic for 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 processed with an ultrasound scaler (this is the name of a device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from the water droplets, which enter the treatment zone and cool the tool tip). The cell membranes of pathogenic microorganisms are ruptured by these molecules, which causes the microbes to die.

It turns out that cleaning with ultrasound has a complex effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleansing it. And this cannot be said 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 to two months, because, as you know, when carrying a baby, teeth are significantly weakened, 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 anesthetics. The most suitable course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required preparations that strengthen the tooth enamel.

It is quite difficult to treat wisdom teeth due to their anatomical structure. However, trained professionals treat them successfully. Prosthetics of wisdom teeth is recommended in the case when one (or several) adjacent teeth is missing or it needs to be removed (if you also remove a wisdom tooth, then there is simply nothing to chew with). In addition, the removal of a wisdom tooth is undesirable if it is in the right 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, a lot depends on the taste of the person. So, there are completely invisible systems attached to the inside of the teeth (known as lingual), and there are transparent ones. But the most popular are still metal braces with colored metal / elastic ligatures. It's really trendy!

To begin with, this is simply unattractive. If this is not enough for you, we will give the following argument - calculus and plaque on the teeth often provoke bad breath. Isn't that enough for you? In this case, we move on: if 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 are formed, pus constantly flows out of them, and the teeth themselves become mobile ). And this is already a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria increases, which is why there is an increased tooth decay.

The lifespan of the established implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after insertion, while the service life averages 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, you must visit the dentist at least once a year. All these measures will significantly reduce the risk of losing the implant.

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

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

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

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

Class I - cavities are localized in the fissures, in the blind fossa 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 covers at least two surfaces: the medial or distal and occlusal surfaces of molars and premolars. Thus, a Class II filling can be located, for example, on the medial-occlusal surface (MO) of a premolar or on the medial-occlusal-distal surface (MO) of a molar.

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

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

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

Basic principles of preparation of hard dental tissues:

A permanent filling cannot be placed directly into the cavity. First, the cavity must be prepared in order 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 pulp.
The enamel without underlying dentin was removed.
The seal will last for a long time.
There will be no secondary caries.

Let's touch on the topic of classification of caries according to Black with a clear demonstration of 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.

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

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

To date, it is not difficult to eliminate caries and completely restore the decayed 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 cavities, to restore the functionality of the row and maintain a healthy smile.

Black caries classes have existed since 1896 and were developed by the American dentist to simplify their work. For a long period, it was the main classification used all over 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 this was partly successful.

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

1 class

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

2nd grade

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 area, several adjacent teeth are affected at once.

Grade 3

The problem is focused 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 is preserved.

In addition to the anterior surface, the lateral and incisal edges of the incisors are also affected. The disease becomes more complex and leads to the rapid destruction of the whole tooth.

Grade 5

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

6th grade

Was not described by Black, but became part of this scheme thanks to the works of other scientists and doctors. It is determined in cases of carious lesions of only the incisal edge of any tooth (incisor, molar or premolar).

Other classification systems

European doctors and our domestic doctors give preference to other diagnostic criteria, as they consider them more convenient and easy to use. Let us list the main ones that help to determine the right part of the tooth for processing, the complexity and methods of treatment.

By the depth of defeat

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

Stain stage - slight destruction of enamel, in which pathogenic bacteria affect only the protective layer of hard tissues.
- becomes noticeable on visual inspection, but its depth is not very great and does not reach dentin.
- this is already a deep enough tissue damage, in which their structure is disrupted. 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 close enough to the dental nerve and, if untreated, will lead to severe pain and the development of other concomitant diseases.

If you leave this process unattended, then in addition to caries and possible tooth extraction, you can also face 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 at the stage of suspended pathology of the dental element.

Downstream of the process

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 not superfluous for a doctor to determine the intensity of the disease:

When the 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 the damage to neighboring organs, tissues and systems;
with complications - if a person consults a 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.

According to the sequence of appearance

To select adequate treatment 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 such varieties of it:

primary - when pathogenic bacteria appeared for the first time in a certain dental 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 decay occurs.

Of course, these are not all currently available classifications of carious lesions. But for the doctor, the most important thing is to make the correct diagnosis, assess the state 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 a 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, destructive processes will end with periodontitis and other gum diseases.

The detection and recording of carious lesions is an important component of the assessment phase in the oral hygiene process. Because of its importance, all dentists must be able to detect and classify tooth decay.

More than 100 years ago, Dr. Black developed a classification of cavities based on the location of the affected tooth (front or back teeth) and the location of the hard tissue defect on the tooth itself. The system has been described for a long time, in 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 caries classification includes 5 classes! Over the years, many have tried to modify the classification and still managed to "push" Black Grade 6 into the masses:

Carious cavities are located in pits and grooves on:

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

Black class 1 cavity in the molar

Grade 2 according to Black

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

Black class 2 cavities- affection of two surfaces of molars or premolars

Grade 3 Black

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

Black class 3 cavities on incisors and canines

Grade 4 Black

A carious cavity of grade 4 according to Black provides for the involvement of all proximal surfaces on the anterior group of teeth in the process, with an additional lesion of the incisal edge.

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

Grade 5 Black

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

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

Grade 6 Black

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

Black class 6 cavity - carious lesion at the apex of the masticatory teeth

Table of contents [Show]

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 dental surgery. 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 teaching him practical dentistry.

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

In addition to developing a standard for cavity preparation, Black also experimented with various amalgam mixtures. After 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. His statue 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 lesion 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 being Black. However, for a complete understanding of the pathology, it is necessary to mention all types of carious lesions according to various classifications.

Black caries classification

Classification of caries by the depth of the lesion

It was determined that this classification is quite widespread to the extent of ease of use in dental practice. Most often used by dentists in the CIS countries.

Spot stage		The development of pathology begins with an insignificant focus of demineralization. Thus, the enamel is subject to minor damage.
Superficial caries		Damage can be seen on visual inspection, but the depth of the pathological cavity does not reach the level of dentin
Secondary carious lesion		It is considered a deeper damage, since it violates the integral structure of not only the enamel layer, but also dentin. However, caries can be painlessly eliminated, since the pulp remains unaffected.
Deep caries		This type of pathological carious lesion practically does not differ from middle caries, however, the pulp is protected by a very thin layer of dentin. In the future, in the absence of treatment, the pathology may be complicated by ailments - cyst, pulpitis and others.

Attention! Complicated carious lesions of the teeth are accompanied by periodontitis and pulpitis, therefore, requires 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;
damage to dentin;
damage to the cement;
paused pathology of dental elements.

The founder of American dentistry in 1896 established a classification of pathological cavities, which was 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 of a secondary nature are not taken into account. Despite this, dentists widely use the Black caries classifier. Over time, the classification system was modernized and an additional class was added.

Classification of carious cavities

1 class

The grooves on the following surfaces of the dental element (molars, premolars, anterior teeth) suffer from carious lesions:

occlusive;
occlusive-alkaline;
lingual

Black grade 1

Description of the first class of cavities according to Black

2nd grade

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

Grade 2 according to Black

Description of the second class of carious cavities according to Black

Grade 3

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

Grade 3 Black

Description of the third class of carious cavities according to Black

4th grade

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

Grade 4 Black

Description of the fourth class of carious cavities according to Black

Grade 5

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

Grade 5 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 area of the incisal edges of only the anterior dental elements. Also, this class includes the tubercles of the premolars and molars. At the same time, the sixth grade is practically never used when making a diagnosis.

Grade 6 Black

Attention! 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:

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

Black classification of cavities

Particular attention should be paid to the unspoken type of carious lesion that develops in young children. If the parents teach the baby to eat at night, and in the future to sweet drinks and sweet juices, then the development of carious cavities should be expected. 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:

Quick.
Slow.
Stabilized.

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

Caries can appear as a single element.
These are multiple lesions on several teeth at once.
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 carious lesions for the first time);
a secondary phenomenon (a tooth that was previously sealed is exposed to carious damage, mainly caries occurs around the filling);
recurrent manifestation (when the dental element has not been adequately treated, caries may develop under the filling on the dental tissues).

There are a large number of caries classification systems, 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 Black classification of caries, known 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 practicing doctors.

The most fundamental is the classification of carious cavities, which Black invented in 1896. He identified 6 classes of tooth damage with this ailment. The purpose of the introduction of 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 of 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 of the lesion with this ailment was modernized, and an additional 6th grade 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, occlusive-alkaline and lingual surfaces of the tooth enamel.

Caries is placed on natural fissures.

Therefore, the seals must be installed in the above locations.

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

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

At the contact points on different sides of the tooth, foci of caries can occur. At the very least, the medial and distal part of the tooth may be affected.

Thus, the second class filling 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 takes place on the incisors and canines, less often on other types of teeth, but always on their front.

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

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 coronal part of the tooth or its incisal edge.

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

The defeat by caries only of the anterior edges in the dental elements 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 types of dynamics of the course of this ailment: 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 row.

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.

The second is a repeated defeat of an already filled tooth.

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

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

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

Recurrent caries is the resumption or progression of the pathological process if 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.

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 has become the most widespread.

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

The appearance of a carious spot. The focus of demineralization of the dental element. The process of this harmful phenomenon can last either slowly or quickly, depending on the individual characteristics of the patient's body.
Superficial caries is characterized by local damage to the enamel on the tooth.
Caries of moderate severity is manifested in damage to the surface layer of dentin.
Deep caries clings to the peri-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 ailment.

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 to deep.

The affected tissues are soft, slightly pigmented (light yellow, grayish-white), moist, easily removed with an excavator.

Chronic caries is characterized as a slow-moving process (several years).

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

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

dentin caries;
enamel of teeth;
cement;
unspecified caries;
odontoclasia;
suspended caries.

There are 3 types of caries in this category: compensatory, subcompensatory and decompensatory.

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

In this case, the lesions of the surface of the teeth are insignificant and do not cause unpleasant sensations in the patient.

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

Subcompensatory caries is characterized by an average rate of flow, 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 everyday life of the patient.

Because of this, the disease is often referred to as 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 Black classification of caries.

For 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 can 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 a hermetically sealed constructive material that can restore the tooth structure 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 Black classification of caries.

She indicates the localization of the affected areas with this ailment, which greatly helps 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, whatever the reason may have influenced the occurrence of caries, it is best to urgently contact an experienced specialist in its localization and removal. A neglected ailment 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 also the entire body. The foci of inflammation can spread from the teeth to the jaw bones, nerves and even the soft tissues of the gums.

In case of untimely access to the dentist, people, at least, can eventually lose a tooth affected by caries. You should also not forget about preventive measures to maintain a healthy oral cavity.

Thorough brushing of your teeth, rinsing them with a special antibacterial solution, regular scheduled examinations at the dentist, eating foods rich in fluoride 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 - urgently 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 materials in our blog, there is a lot of informative.

Have a nice day and take care of yourself!

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 the eruption of teeth 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 around the world is on the rise, especially in children.

Caries predisposition

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

Common factors:

Cariogenic diet with a predominance of carbohydrate foods (cookies, sweets, carbonated drinks);
Changes in the patient's somatic health (frequent illnesses with general respiratory diseases, FLU, etc.);
Extreme loads on the body (radioactive radiation);
Unfavorable heredity.

Local factors:

Poor oral hygiene (presence of soft plaque and mineralized dental plaque);
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;
Disturbances in the formation of the dentoalveolar system.

The development of caries occurs in several stages:

Caries in the spot stage(elementary). It is asymptomatic, the affected area of the tooth loses its shine, becomes dull, and a chalky spot is formed. The spot may be pigmented (yellowish in color). Usually, white spots appear on the teeth of a child or adult. Probing is painless.
Superficial caries. It is asymptomatic, sometimes painful sensations from sweet, sour, salty, less often from mechanical stimuli. A rough defect with a depth of 1 mm is determined on the tooth, a color change to light brown is possible. Probing is painless.
Medium caries. Complaints of short-term sharp pain from food entering the tooth, cold and hot, the pain disappears immediately after the stimulus stops acting. The carious cavity in the tooth is small or medium in size, up to 1.5-2 mm deep. Probing is painful along the dentin-enamel junction.
Deep caries. Complaints about painful sensations from all types of irritants, from cold, hot, from food entering the carious cavity. Deep carious cavity filled with softened, necrotic dentin and food debris. Probing along the dentine-enamel border and the bottom of the carious cavity is painful, there is no communication with the dental 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 the Black classification?

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

Black caries classification:

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.
2nd grade- cavities on the medial and distal surfaces of premolars and molars, limited by the tooth tissues on three sides.
Grade 3- cavities on the medial and distal surfaces of the anterior group of teeth with no destruction of the incisal edge.
4th grade- cavities on the medial and distal surfaces of the anterior group of teeth with a violation of the cutting edge.
Grade 5- cavities in the neck of all groups of teeth.
6th grade- cavities on immune zones (cusps of teeth, enamel ridges)

To reduce the risk of tooth decay, prevention and treatment are required.

Standard treatments include:

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

Filling the teeth restores their 5 main functions: speech, chewing, aesthetics, maintaining the soft tissues of the face, creating an occlusal plane.

Methods for processing hard tooth tissues:

Mechanical- with rotary burs and hand tools).
Chemical-mechanical- the use of chemicals to soften non-viable tooth tissues with their subsequent removal.
Pneumokinetic- the effect of a 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 too badly damaged and there is no way to restore it with filling materials, then it is necessary to apply orthopedic treatment (artificial crowns, inlays on the tooth under the crown).

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

Prevention includes:

Regular visits to the dentist at least once every six months.
Carrying out professional hygiene of the oral cavity.
Brushing your teeth at least 2 times a day.
The use of additional hygiene products (gum rinses, dental floss, toothpicks, irrigators).
Mouthwash with remineralizing and fluoride preparations.
If the fluoride content in the water is insufficient, it is necessary to make up for the fluoride deficiencies by drinking fluoridated milk.
The use of fluoride gels for the prevention of caries.
Dentists deliver hygiene lessons in schools and preschool institutions with demonstrations of dental cleaning techniques on models.
Lectures on oral care, risk factors for dental diseases and their prevention.
Drug therapy (fluoride tablets).

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