What are Types of Caries?

Incipient Caries Occlusal Caries Smooth Surface Caries Proximal Caries Root Surface Caries Nursing Bottle Caries Rampant Caries Arrested Caries Secondary Caries Radiation Caries

Incipient Caries

Incipient caries refers to the initial lesion on the smooth surfaces of the teeth. It is visible clinically as a “white spot”. Histologically, incipient lesion may have an intact surface layer of enamel. The subsurface layer shows demineralization. In some cases, the lesion can undergo remineralization. White spots on the tooth surface may not always require restorative treatment. On examination, the  white spots of incipient lesions may be confused with developmental defects of enamel formation. Wetting the tooth surface may cause disappearance of the lesion. It has been found that increased fluid exposure encourages remineralization and can also slow down the progression of caries in the pit and fissure enamel, while the cavitation may continue in the dentine. Thus, the lesion is actually  masked by a relatively intact enamel surface. These hidden lesions are called as “fluoride bombs” or “fluoride syndrome”. It has also been found out that occult caries may have its origin as pre-eruptive defects which may be able to identify only by radiographic examination.
Types of Caries

Occlusal Caries

Occlusal caries usually originates in the pits and fissures of the occlusal surface due to the retention of food debris and bacteria. Constant microbial adherence promotes tooth decay. It has been found that the main organisms identified in pit and fissure caries are S. mutans, S. sanguis, Lactobacillus species, and Actinomyces species. Mango in 1960 has classified morphology of the fissures based on the alphabetic pattern. This is given below:
  • V and U type: Self-cleansing and somewhat caries resistant
  • U type: Narrow slit-like opening with a larger base as it extends towards dental enamel junction. It is caries susceptible and can have different branches
  • K type: It is highly susceptible for caries.

Smooth Surface Caries

Smooth surface caries develops on the buccal and lingual smooth surfaces of the teeth. It is not usually seen in areas readily accessible to the toothbrush and the self-cleansing effects of the tongue and buccal mucosa. The major organisms associated with smooth surface caries are S. mutans and S. salivarius.

Proximal Caries

Proximal caries is seen in the interproximal region of the teeth. These lesions are
usually seen between the contact point and the free gingival margin, in an area called the caries susceptible zone which has a vertical dimension of 1–1.5 mm in the radiograph.

Root Surface Caries

Root surface caries is confined to the area of the cementoenamel junction. Lesions are usually shallow and may be dark in color and occurs on the buccal, lingual, and interproximal surfaces. The root surface is highly susceptible for plaque formation as it is difficult to clean the interproximal region. The cementum covering the root surface is relatively thin and provides little resistance to caries occurrence. Root caries lesions have less well-defined margins and is usually U-shaped in cross-section. It progresses more rapidly because of the lack of protective enamel covering. The major organisms associated with root surface caries are A. viscosus, A. naeslundii, S. mutans and S. sanguis. Some of the characteristics of root surface caries are the following:
  • It has a rapid progression
  • It is asymptomatic in the initial stage and when it becomes symptomatic, it may be very advanced
  • It can cause early pulp involvement
  • It is more difficult to restore.

Nursing Bottle Caries

Nursing bottle caries or baby bottle caries is a rampant type of caries that occurs in some children who are permitted to use a nursing bottle filled with carbohydrate-containing liquids when lying down to sleep. The newer terminology for nursing bottle caries is early childhood caries. It is also sometimes referred to as nursing caries, nursing bottle mouth, nursing bottle syndrome, bottle-propping caries, baby bottle mouth, nursing mouth decay, and baby bottle tooth decay. It is also sometimes called maternally derived streptococcus mutant disease.
According to the American Academy of Pediatric Dentistry, early childhood caries (ECC) is the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of 6. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, one or more cavitated, missing (due to caries) or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing or a decayed or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces also constitutes S-ECC.
ReadTooth Wear and Erosion in Dentistry 
The four maxillary incisors are the teeth which are affected most. Sometimes, the maxillary and mandibular first primary molars and the mandibular canines are affected. The mandibular incisors are not usually involved as the tongue gives protection to these teeth.

Rampant Caries

Rampant caries is defined as wide-spread, rapidly burrowing type of lesion of sudden onset, which may involve teeth not frequently affected by ordinary caries and resulting in the early involvement of the pulp. Massler defined it as suddenly appearing, wide-spread, rapidly burrowing type of caries, resulting in early involvement of pulp and affecting those teeth usually regarded as immune to ordinary decay.
Winter defined it as an acute onset of carious lesion involving many or all erupted teeth rapidly destroying coronal tissue often on surface immune to decay and leading to early involvement of pulp. Primary and permanent teeth may be affected by rampant caries. It can affect both children and adults. Most prevalent age group is 4–8 years and 11–19 years. Based on its occurrence, it can be classified as occurring in:
  • Infants
  • Young children
  • Teenagers
  • Adults of all age group.
Rampant caries is mainly caused by the consumption of liquids and food substances containing non-milk extrinsic sugars. In between snacking of cariogenic food and high sucrose content in the diet can also predispose to rampant caries. Apart from the already mentioned factors, xerostomia may also contribute in rampant caries. Common sites of occurrence of rampant caries are the proximal surface of mandibular anterior teeth and root surface (cervical areas) and also the labial surface of maxillary anterior teeth.
According to Davies, there are certain criteria for classifying caries to the category of rampant caries. These criteria are given below:
  • Lesions are more than 10 in number
  • High caries experience for the age of the child

Arrested Caries

Arrested caries refers to a carious lesion which is not likely to progress further. Clinically, the lesion appears as blackish or brownish in color. The lesion is not soft on probing and there may not be a ‘catch’. The caries does not progress further from where the decay process has stopped. It can occur in the enamel and dentine. Arrested caries usually results when the oral environment has changed from conditions predisposing to caries to conditions that tend to slow down the process.
Arrested caries results when the dentinal tubules contain increased amount of mineral salts. If bacterial acid production is decreased and pH increases, salts precipitate into large crystals of tricalcium phosphate which temporarily block the tubule. If further bacterial activity is suppressed, the odontoblasts secrete collagen and calcium salts. There will be formation of crystals of hydroxyapatite that block the tubule more effectively. Arrested caries involving dentine shows a marked brown pigmentation and induration of the lesion. It is called “eburnation of dentine”
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Arrested caries may appear as a white spotted lesion or it appears yellowish when the dentine is affected. The white spotted lesion has shiny surface. Sometimes it may also be brownish. It is more resistant to attack by acid than sound enamel. Sometimes, it is also considered as a “scar tissue”. Arrested caries in the dentine is usually discolored (yellowish, brownish, or blackish). It is hard or leather consistency because of the presence of tertiary and sclerotic dentine. Rest of dentine appears polished. Clinically, caries can be arrested by improved plaque control with fluoride toothpastes or by altering the diet (avoiding highly caries-inducing diet). Fluoride increases the resistance of hydroxyapatite in the enamel and dentine to dissolution by the acid content of the plaque.

Secondary Caries

Secondary caries refers to caries occurring adjacent to a restoration, either around the restoration or beneath the restoration. In many cases, secondary caries results due to failure of removal of the entire carious lesion during previous restoration or due to microleakage. It can also occur due to poor adaptation of a restoration to the tooth structure, which in turn favoring microleakage. The common locations of secondary caries are the rough or overhanging margins of restorations. Some of the common symptoms associated with secondary caries are the following:
  • Sensitivity to thermal changes

Radiation Caries

It is a rampant form of dental caries seen following irradiation to the teeth and salivary glands. Radiotherapy leads to xerostomia, acidic pH of the saliva and lack of buffering capacity of the saliva. Apart from these, the viscosity of saliva also increases. There can also be change in the bacterial flora following radiotherapy. The dietary modifications after radiotherapy may also predispose to the development of radiation caries. Painful and inflamed oral mucosa can also lead to poor oral hygiene favoring the development of carious lesions. Radiation caries occurs regardless of any previous history of dental caries. It is a rapid form of caries with frank lesions especially developing in the cervical region. Progression of caries from both the mesial and distal side can lead to constriction and amputation of the crowns of teeth. Clinically, three types of radiation caries have been identified. These are the following:
  • Some lesions involving the dentin and cementum in the cervical region
  • Superficial lesions involving buccal, occlusal, incisal, and palatal surfaces
  • Lesions appearing as generalized dark pigmentations.
Meticulous oral hygiene practice and prophylactic fluoride application can greatly reduce the incidence of radiation caries.

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Dr Lobby | DrLobby.com: What are Types of Caries?
What are Types of Caries?
Incipient Caries Occlusal Caries Smooth Surface Caries Proximal Caries Root Surface Caries Nursing Bottle Caries Rampant Caries Arrested Caries Secondary Caries Radiation Caries
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