1. A learning program on the nature and management of dental caries

2. A learning program about a new classification of carious lesions

Welcome to the site where you can learn about the new classification of carious lesions by site and size. If you already know about the system and just want advice on procedures and materials for restoring a particular type of lesion, click here to go directly to the GUIDANCE GRID The classification is simple and logical. It gives the dentist direct guidance about which procedures and materials to use to restore the lesion. It is also a precise tool for recording disease severity.

The classification is described in print form in two sources:

1. in the journal article
   Mount, G.J. and Hume, W.R. (1997) A revised classification of carious lesions by site and size. Quintessence International 28:301-303.
2. in the textbook
   The Preservation and Restoration of Tooth Structure. G.J. Mount and W.R. Hume, Editors, Mosby, London (1998).

1. A general guide to the learning program
2. A narrative learning program
3. A learning by discovery program
4. The guidance grid for the classification We suggest that you click here to start the learning program (go to section B2) and then choose whether learning by narrative or learning by discovery is best for you.
   

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   General Guide to the Learning Programs

   As you will see, this system of classification is primarily related to future restoration. This is not a system related to caries treatment - caries treatment involves the assessment of risk and activity state, then changing the local biochemistry to cure the disease process, with follow-up monitoring of caries activity state. If you want to find out more about the nature of caries and its diagnosis and treatment at the molecular level, then visit http://www.dent.ucla.edu/ce/caries.treatment Once the disease is cured then restoration of irreversible lesions can be considered - and this system of classification helps in that phase of care. Some lesions (those that are reversible by chemical means, or those that are not active - 'are 'arrested') do not need to be restored. We offer two ways to learn about the system - narrative and discovery.

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   Narrative learning program for caries classification

   The classification is by SITE and SIZE.

   To describe a lesion two numbers are used:
   • site 1, 2 or 3
   • size 1, 2, 3 or 4

   So a lesion is described as, say, a 2.3 - which means site 2, size 3.

   When we add the tooth number to that, we know exactly what we have - say, a 2.3 on tooth #12.

   So what are the three SITES ?
   • SITE 1 - Pit and fissure
   • SITE 2 - Approximal surface.
   • SITE 3 - Cervical area.
   What are the four SIZES ?
   • SIZE 1 - minimal dentinal spread - just beyond what can be remineralized.
   • SIZE 2 - moderate involvement of dentine.
   • SIZE 3 - enlarged, with weakened cusps or incisal edges which need protection from occlusal load.
   • SIZE 4 - extensive loss of tooth structure.

   When you put the two numbers together and you describe the lesion - say, a 2.3 means site 2 (approximal) size 3 (enlarged). A 1.2 means site 1 (pit and fissure) size 2 (moderate) When we add the tooth number to that, we know exactly what we have - say, a 2.3 (approximal, enlarged) on tooth #12.

   A note on Size 0 - this can be used for lesions that are not to be restored - lesions that are reversible or arrested.

   Now visit the Guidance Grid for examples and how to treat them.

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   Discovery learning program for caries classification

   Let's imagine that you've just found a carious lesion, by visual or radiographic examination. You want to classify it accurately for your records - and you want some clues from the classification about how you should restore it.

   Where did the lesion begin?
   • Pit and fissure? then it's a SITE 1
     
   • Approximal surface? then it's a SITE 2
     
   • Cervical area? then it's a SITE 3.
     
   How big is it?
   
   • small and early enough to be remineralized, or the lesion has been remineralized and there is just residual stain? then it's a SIZE 0. 'Zero' means no restoration necessary.
   • minimal dentinal spread - just beyond what can be remineralized? then it's a SIZE 1
   • moderate involvement of dentine? then it's a SIZE 2
   • enlarged, with weakened cusps or incisal edges? then it's a SIZE 3
   • extensive loss of tooth structure? then it's a SIZE 4

   Put the two numbers together and you describe the lesion - say, a 2.3 means site 2 (approximal) size 3 (enlarged). 1.2 means site 1 (pit and fissure) size 2 (moderate) When we add the tooth number to that, we know exactly what we have - say, a 2.3 (approximal, enlarged) on tooth #12.

   Now visit the Guidance Grid for examples and how to treat them.

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   Would you like to take this course for Continuing Education credit? Yes

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