1. G.V.

Black Caries Classification (class I to VI)

Over 100 years ago, Dr. G.V. Black (1836-1915) developed a system to categorize carious lesions
based on the type of tooth affected (anterior or posterior tooth) and the location of the lesion (e.g.
lingual, buccal, occlusal, etc.). The six classes of carious lesions according to G.V. Black are as
follows:1

• Class I: Cavity in pits or fissures on the occlusal surfaces of molars and premolars; facial
and lingual surfaces of molars; lingual surfaces of maxillary incisors (Class I corresponds to
surfaces of a posterior tooth you can clinically see—occlusal/lingual/buccal surfaces.
Therefore, the interproximal surfaces are not classified as Class I)
• Class II: Cavity on proximal surfaces of premolars and molars (Class II corresponds to
surfaces of a posterior tooth you cannot see clinically)
• Class III: Cavity on proximal surfaces of incisors and canines that do not involve the incisal
angle (Class III corresponds to surfaces of an anterior tooth you cannot see clinically)
• Class IV: Cavity on proximal surfaces of incisors or canines that involve the incisal angle
(Class IV lesion is the larger version of Class III that covers the incisal angle)
• Class V: Cavity on the cervical third of the facial or lingual surfaces of any tooth (Think of
the neck of the tooth)
• Class VI: Cavity on incisal edges of anterior teeth and cusp tips of posterior teeth (Class VI
corresponds to the very top surface of a tooth)

Review the example below.

Question: According to G.V. Black classification of carious lesions, sealants are placed on
permanent molars as soon as they erupt to prevent:
1. Class I caries
2. Class II caries
3. Class III caries
4. Class IV caries
5. Class V caries
Enamel sealants are generally applied on deep pits and fissures of the occlusal surfaces of posterior
teeth. Those areas correspond to the area of Class I carious lesions according to G.V. Black
classification (the correct answer choice is 1).

2. Caries Classification According to Their Severity

The appearance of interproximal caries can be classified as incipient, moderate, advanced, or
severe, depending on the amount of enamel and dentin involved in the caries process.2

Tips for memorization: Imagine a line halfway through the thickness of enamel, and a line
halfway through the thickness of dentin. Those lines are the “STOP” points that determine the
severity of the carious lesions.
• Incipient: Lesion that extends less than halfway through the enamel
• Moderate: Lesion that extends more than halfway through enamel but does not involve the
dentino-enamel junction (DEJ)
• Advanced: Lesion that extends to or through the DEJ but does not extend more than half the
distance to the pulp
• Severe: Lesion that extends through enamel, through dentin, and more than half the distance
to the pulp