Root CariesRoot CariesDr.Ghada MaghairehDr.Ghada Maghaireh

BDS,MS,ABODBDS,MS,ABOD

Definition of Root CariesDefinition of Root Caries A soft irregular shaped lesion eitherA soft irregular shaped lesion either (1)Totally confined to the root surface or,(1)Totally confined to the root surface or, (2) Involving the undermining of enamel (2) Involving the undermining of enamel

at the cementoenamel junction but at the cementoenamel junction but clinically indicating that the lesion clinically indicating that the lesion initiated on the root surface.initiated on the root surface.

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

Appearance and LocationAppearance and Location New lesions appear as small, well-defined areas of New lesions appear as small, well-defined areas of

a yellowish to light brown color.a yellowish to light brown color. AsAs caries progress, the surface of the lesion has a caries progress, the surface of the lesion has a

leathery consistency that can be easily peeled leathery consistency that can be easily peeled away.away.

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

Initial lesions are more common on facial and Initial lesions are more common on facial and proximal surfaces.proximal surfaces.

In the mandible, molars appear to be most In the mandible, molars appear to be most susceptible to root caries followed by premolars, susceptible to root caries followed by premolars, canines and incisors, while in maxilla the order is canines and incisors, while in maxilla the order is reversed.reversed.

Caries Activity in Root Caries Activity in Root SurfaceSurface

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

ArrestedArrested - Distant from gingiva and not plaque - Distant from gingiva and not plaque

coveredcovered - Hard healthy root surface- Hard healthy root surface

Histochemistry of Root Histochemistry of Root CariesCaries

The caries process on root surface is very The caries process on root surface is very similar to that in coronal caries.similar to that in coronal caries.

Root surface is more susceptible to Root surface is more susceptible to chemical dissolution than enamel surface.chemical dissolution than enamel surface.

The drop in pH necessary for The drop in pH necessary for demineralization in cementum and dentin demineralization in cementum and dentin is 6.2 to 6.7.is 6.2 to 6.7.

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

Microbiology of Root Microbiology of Root CariesCaries

Early studies pointed to Early studies pointed to Actinomyces Actinomyces viscousviscous as a prim suspect. as a prim suspect.

Recent studies emphasized the Recent studies emphasized the importance of importance of Streptococcus mutansStreptococcus mutans and and LactobacillusLactobacillus..

It is likely that root caries is a It is likely that root caries is a continuous, destructive process involving continuous, destructive process involving a succession of bacterial population that a succession of bacterial population that vary depending on the condition of the vary depending on the condition of the substrate and the depth of the lesion.substrate and the depth of the lesion.

Prevalence and IncidencePrevalence and Incidence Population at risk of root caries is older Population at risk of root caries is older

adults.adults. However, younger patients with However, younger patients with

periodontal problems are susceptible to periodontal problems are susceptible to root caries as well.root caries as well.

International surveys have estimated that International surveys have estimated that the diseases affects 60% to 90% of adults.the diseases affects 60% to 90% of adults.

It has been suggested that 1 in 9 root It has been suggested that 1 in 9 root surfaces is at risk of becoming carious.surfaces is at risk of becoming carious.

Studies on caries incidence reported that Studies on caries incidence reported that root caries/root restoration experience root caries/root restoration experience ranging from 19% to 69%.ranging from 19% to 69%.

Risk Factors and Risk Factors and AssessmentAssessment

It is of critical importance to identify It is of critical importance to identify persons at risk early in the root persons at risk early in the root caries process.caries process.

Early detection permits preventive Early detection permits preventive and chemotherapeutic intervention.and chemotherapeutic intervention.

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

Risk Factors for Root Risk Factors for Root CariesCaries

Exposure of root surfacesExposure of root surfaces: patients with attachment : patients with attachment loss, gingival recession, and periodontal pocketing is loss, gingival recession, and periodontal pocketing is at risk of initiation of the disease process.at risk of initiation of the disease process.

Inadequate oral hygieneInadequate oral hygiene.. Cariogenic dietCariogenic diet.. Diminished salivary flow and/or buffering capacityDiminished salivary flow and/or buffering capacity: :

as result of radiation therapy, immunosuppressive as result of radiation therapy, immunosuppressive therapy, autoimmune diseases, HIV infection and a therapy, autoimmune diseases, HIV infection and a number of commonly prescribed medications.number of commonly prescribed medications.

Previous caries/restorationsPrevious caries/restorations: Individuals who have : Individuals who have coronal caries are 2 to 3.5 times more likely to coronal caries are 2 to 3.5 times more likely to develop root caries.develop root caries.

Lack of access and/or interest in dental services.Lack of access and/or interest in dental services.

Risk Factors for Root Risk Factors for Root CariesCaries

Removable prosthesisRemovable prosthesis: retention of food : retention of food debris and gingival recession.debris and gingival recession.

Advanced ageAdvanced age: the effect of all these risk : the effect of all these risk factors may be magnified with aging factors may be magnified with aging related to health problems and treatments.related to health problems and treatments.

Eight or more missing teethEight or more missing teeth.. GenderGender: Root caries is generally more : Root caries is generally more

prevalent among males than females.prevalent among males than females. SmokingSmoking, , alcoholismalcoholism and and drug usedrug use.. Possible ethnicityPossible ethnicity::Asian and blacks exhibit Asian and blacks exhibit

a higher incidence of root caries.a higher incidence of root caries.

Diagnosis of Root CariesDiagnosis of Root Caries The first step in diagnosis of root The first step in diagnosis of root

caries is early identification of caries is early identification of contributory factors and oral contributory factors and oral hygiene factors.hygiene factors.

Dental prophylaxis should be done Dental prophylaxis should be done prior to examination to remove prior to examination to remove plaque and debris that might limit plaque and debris that might limit the visibility of root surface.the visibility of root surface.

Preventive and Preventive and Chemotherapeutic StrategiesChemotherapeutic Strategies

Preventing or arresting root caries Preventing or arresting root caries through:through:

1. Plaque removal1. Plaque removal 2. Diet modification2. Diet modification 3. Topical fluoride application3. Topical fluoride application

Plaque RemovalPlaque Removal Plaque control alone has been shown to Plaque control alone has been shown to

play an important role in arresting root play an important role in arresting root caries.caries.

Plaque thickness and acidogenic Plaque thickness and acidogenic response to sucrose exposure are response to sucrose exposure are significantly reduced when lesion significantly reduced when lesion become inactive.become inactive.

Chlorhexidine can be used to treat root Chlorhexidine can be used to treat root caries by eliminating cariogenic bacteria.caries by eliminating cariogenic bacteria.

Topical FluorideTopical Fluoride Fluoride is accepted as an Fluoride is accepted as an

appropriate chemotherapeutic agent appropriate chemotherapeutic agent in the management of root caries.in the management of root caries.

Prevention or arrest of root caries has Prevention or arrest of root caries has been demonstrated using fluoridated been demonstrated using fluoridated water, fluoride gels, fluoride water, fluoride gels, fluoride mouthrinses, fluoride dentifrices, mouthrinses, fluoride dentifrices, fluoride varnishes, fluoride chewing fluoride varnishes, fluoride chewing gum and fluoride releasing devices.gum and fluoride releasing devices.

Restorative TreatmentRestorative Treatment Amalgam Vs tooth colored restorations Amalgam Vs tooth colored restorations

(composite and glass inomer cement)(composite and glass inomer cement) Glass-inomer cement is the material of Glass-inomer cement is the material of

choice for most root caries lesions.choice for most root caries lesions. The material offer adhesive bonding to The material offer adhesive bonding to

tooth structure and long-term fluoride tooth structure and long-term fluoride release.release.

ReferencesReferences HandoutHandout