Root Caries

Dr.Ghada Maghaireh BDS,MS,ABOD

Definition of Root Caries

A soft irregular shaped lesion either

(1)Totally confined to the root surface or,

(2) Involving the undermining of enamel at the cementoenamel junction but clinically indicating that the lesion initiated on the root surface.

Root caries can be initiated only if the root surface is exposed to the oral environment.

Appearance and Location

New lesions appear as small, well-defined areas of a yellowish to light brown color. As caries progress, the surface of the lesion has a leathery consistency that can be easily peeled away.

Advanced lesion appear darker brown to black and may be hard.

Initial lesions are more common on facial and proximal surfaces. In the mandible, molars appear to be most susceptible to root caries followed by premolars, canines and incisors, while in maxilla the order is reversed.

Caries Activity in Root Surface

Active - Close to gingiva and plaque covered - Soft or leathery

Arrested - Distant from gingiva and not plaque covered - Hard healthy root surface

Histochemistry of Root Caries

The caries process on root surface is very similar to that in coronal caries. Root surface is more susceptible to chemical dissolution than enamel surface. The drop in pH necessary for demineralization in cementum and dentin is 6.2 to 6.7.

Given the proper environment, both the initiation and progression of root surface caries will occur more rapidly in dentin than on enamel surface.

Microbiology of Root Caries

Early studies pointed to Actinomyces viscous as a prim suspect.

Recent studies emphasized the importance of Streptococcus mutans and Lactobacillus. It is likely that root caries is a continuous, destructive process involving a succession of bacterial population that vary depending on the condition of the substrate and the depth of the lesion.

Prevalence and Incidence

Population at risk of root caries is older adults. However, younger patients with periodontal problems are susceptible to root caries as well. International surveys have estimated that the diseases affects 60% to 90% of adults. It has been suggested that 1 in 9 root surfaces is at risk of becoming carious. Studies on caries incidence reported that root caries/root restoration experience ranging from 19% to 69%.

Risk Factors and Assessment

It is of critical importance to identify persons at risk early in the root caries process. Early detection permits preventive chemotherapeutic intervention. and

Root caries is generally more prevalent among males than females.

Risk Factors for Root Caries

Exposure of root surfaces: patients with attachment loss, gingival recession, and periodontal pocketing is at risk of initiation of the disease process. Inadequate oral hygiene. Cariogenic diet. Diminished salivary flow and/or buffering capacity: as result of radiation therapy, immunosuppressive therapy, autoimmune diseases, HIV infection and a number of commonly prescribed medications. Previous caries/restorations: Individuals who have coronal caries are 2 to 3.5 times more likely to develop root caries. Lack of access and/or interest in dental services.

Risk Factors for Root Caries

Removable prosthesis: retention of food debris and gingival recession. Advanced age: the effect of all these risk factors may be magnified with aging related to health problems and treatments.

Eight or more missing teeth.

Gender: Root caries is generally more prevalent among males than females.

Smoking, alcoholism and drug use.

Possible ethnicity:Asian and blacks exhibit a higher incidence of root caries.

Diagnosis of Root Caries

The first step in diagnosis of root caries is early identification of contributory factors and oral hygiene factors. Dental prophylaxis should be done prior to examination to remove plaque and debris that might limit the visibility of root surface.

Preventive and Chemotherapeutic Strategies

Preventing or arresting root caries through: 1. Plaque removal 2. Diet modification 3. Topical fluoride application

Plaque Removal

Plaque control alone has been shown to play an important role in arresting root caries. Plaque thickness and acidogenic response to sucrose exposure are significantly reduced when lesion become inactive. Chlorhexidine can be used to treat root caries by eliminating cariogenic bacteria.

Topical Fluoride

Fluoride is accepted as an appropriate chemotherapeutic agent in the management of root caries. Prevention or arrest of root caries has been demonstrated using fluoridated water, fluoride gels, fluoride mouthrinses, fluoride dentifrices, fluoride varnishes, fluoride chewing gum and fluoride releasing devices.

Restorative Treatment

Amalgam Vs tooth colored restorations (composite and glass inomer cement) Glass-inomer cement is the material of choice for most root caries lesions. The material offer adhesive bonding to tooth structure and long-term fluoride release.

References

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