REVIEW ARTICLE Roots Caries A problem of growing age Vikram Bansal’, Ramandeep Kaurschi’, Veeresha’, Adarsh Kumar’, Shelly Bansal, Sogi DR, VIKRAM BANSAL? Assistant Professor DR. RAMANDEEP KAUR SOH ‘Acsitant Professor DR. KLLVEERESHA Professor DR. ADARSH KUMAR Assistant Professor DR. SHELLY BANSAL ‘Senor Dental Surgeon DR.G.MsOGt Professor “Department of Preventive & Community Dertstry MAM. Colege of Dental Sciences & Research Mulana (Ambala), Haryana, India “Department of Preventive & Community Dentis'y PGI Government Dental College, Rohtak, Haryana, India “Bansal Dental lini, Ambala City, Haryana, India For correspondence: Dr. Vikram Bansal, e Lecturer, Dept of Preventive & Community Dentistry, MM.Colege of Dental Sciences & Research, ‘Muliana, Ambala, Haryena, Contact No. 03896738139; vikrambansal2001@gmaicom Root cares is now considered a major dental public heath problem forthe {ehavour, rormaly cartant this tssocation prodecesagrester effect among ‘ler people. the olcer a person is tre onger nese nas beer exposes to risk ‘actors and he greaterseir outcomes have been. The aetiology of oot crise ‘muttfactoriaof whieh merobiologeal factor pays acrtical ole. The elder are \sualy more vulnerable to rot cris because of several medical conditions. Many oder patienes use medestions thatreduce salary fow and caute them to have ry mouth. Root caries can beclagnosedby a dentist during regular dental ‘examination. Teatmere of root caries generally requires the placement of a rezorston of crown. A number of tudies Mave been conducted on the prevalence and fartors assodated with root caries, yet cur knowledge ofthis ‘seas in the face ofan increasing proportion of the population at sk, should rove the stimulus for Turtherresearen ana development related to the ‘ecogritionetioiagy, treatment and preveation of rot cares. Key words: “oot cries cry mouth, eldey, dental ales, oa hygiene. anstract Root caries is now consitered a major dental pubic health problem for the midele aged and elcerly Root caries is relates to asubject’s dental health behaviour, normally constant, this assaciaton produces a greater effect among oder people. The older a person is, the onger he/she has been exposed to rk attors, and he greater thelr outsomes have been. The aetiology of root caries ‘s multifactorial of which ‘microbiclogica! factor pays acritcal ole. The eleerly are usually more Vulnerable to root carles because of several medical conditions. Mary older patients use mecications that reduce salivary flow and cause them to have dry mouth. Root caries can be diagnosed by @ dentist during regular dental examiration. Treatment of root cares generally requires the placement ofa restoration ar crown. A numberof studies have been conducted on the prevalence and Factors ateociated with root cares, yet our knowledge of this disease process remain limited. The fact that too Wel is known about this disease in the face of an Increasing proportion of the population at risk, should provide the stimulus for further research and development related to the recognition, etiology, treatment and prevention ofrootearier. Key words: root caries, dry mouth, elderly, dental caries, oral hygiene. INTRODUCTION Root surface caries has affected mankind for centuries but litte Root carieclesions were definedas sft, progressive, destructive lesions, ether totaly confined to the reot surface or involving undermining of enamel at the cemento-enamel junction but clinically indicating the lesion nitiazed on theroot surface (Katz, 1980) Root caries is now been censidered as a major dental public problem forthe elderly. There ate thrae main interrelated arguments supporting this satement. Firstly ifeexpectancies a bath birth andage 65 have been increasing markedly in industriaised societies. Secondly, there sample evidence showing that periodontal dieaseincreases with age due tots cumulative nature, Thus most old adults may have some tingivel recession and elveoler bone loss, which shall predispose the person to suffer from root cares, The final argument states that the ‘aserved improvementin oral healthis causing:he elderly to experience 2 higher retention of teeth, sthich implies an increased mimber of exposed root surfaces susceptible tocaris.’The dental health status of the elderly s improving due tothe provisicn of specialist centaicare, the \wider availabilty of dentalhealth education, growing dental awareness and the widespread use of flucride-containing toothpastes. Therefore the number of elderly retaining some or most of their ratural teeth is significantly greater than only afew years ago and will continue to grow inthe coming decades" While root caress related to a subject's dental health behaviour, normally constant from year to year, this associction produces greater effect JIADS VOL-2 ssue2 Apil- June, 2023 143]Roots Caries A Problem of Growing Age Vikram Bansal, Rarvandeep Kaursohi Veeresha Adarsh Kuma, Shelly Bansal, Sog! among older people, The older a persons, the longer he/shehas been exposed to risk factors, and the greater thelr outcome has been. For example, the use of sur in coffee or tea, combined with irregular check-ups, doubled the risk of root caries for the oldest subjects compared with middle-aged subjects.” Globally, proportion of the population over 65 years of age who are ddentates is increasing. The prevelence of root caries lesions was reported by various stucles as ranging from 35% to 67% ""*” Helver (190) reported the prevalence of 88.4% in people aged 55 years and above". Imazato $ (1990) reported that 39% ofthe subjects had one or more decayedroots, \Within a person (ie, within a mouth) thereisa characteristic pattern of root caries attack which is infuenced by several factors including the number and type of natural teth remaining and the propensity ofthe rootsurfoces of those teeth to exhibit gingival recession. Old age people Usually have several teeth missing which limits the study of the pattern lof root cares in person but many ofthe teeth which are missing may actually be those most susceptible to root caries. Indeed, they may be ‘missing as consequence of root cares, even though most tooth loss in aduts hat traditionally boon attributed to advanced periodontal disease. Katz etal hve shown that, ike enamel caries, root caries tends +o primanly afect mandibular molars with a decreasing suscepticlty for premolars and incisors. In the maxillary arch theanterior teeth have higher root cares rates than the mandibular teeth. Although the rate of ingival recession was similar for exch toath tyne, the widely variable Toot caries rates suggest that specific intra-oral factors, as yet Undefined, may determine the pattern of root caries attack Considerable controversy has arisen regarding the tooth root surfaces, most frequently affected by caries. The evidence suggests that either facial or interproximal surfaces are primarily affected followed by lingual surfaces.” ISKFACTORS” Risk factors associated with the high prevalence of root caries among older adults incluce: Decrease salivary flow or xerastomia, Exposure of root surfaces due to periodontal (gingval) disease, Chronic medical conditions, Radiationtreatmentfor head and neck cancer, Physeallimitations, Diminished manual dexterity due to stroke, arthritis or Parkinson's disease, Cognitive deficits due to mental ilitess, depression, Alzheimer's disease or dementia, Sdgren's syndrome (an autommunedsease), Diabetes, Poororal hygiene, Multiple medicationuse, Chargesindlietary habits. Previous root caries experience, either in the form of filed surfaces or decayed untreated lesions is also a potent risk factor for he development of new lesions. Removable partial dentures are important indeperdent risk ingieatortorrostesries." ‘The aetilogy of root caries is mulkfactoral of which microbiological {actor plays a critical role. The microbiological nature ofthe associated plague bio-film is different from that assocated with crown caries (supragingival plaque) even though plaque assaciated with root caresis, ‘echnical stilla supragingivalplaque. The microbiology ofthis bio film dentine been sented and addressed, Whilethereis ample evidence to impy a strong asscciaion between mutans group of streptococci and coronal caries, simlar data on microbiological agents in roct cares is poorly urderstood.” “The bacterial fore of root caries was more diverse than areviously reported, an¢ found that the previously mentioned species (vz ‘etisomces uscosis /naeslundliand Lactobsili played essot aol. Aerobic Grammpostive cocci (Staphylococcus spp. and Streptococcus spp) as wll as anaerobic ones (eptostreptococcs sp.) ard Candida albicans were reparted by one study to occur most frequerty in root caries lesion in middle-aged and oder adults. . More recently, culture independent studies have focusec either on singe species suchas 5. ‘mutans and Actinemyees naeslurdit 0: on the analysis of microbial derived organc acids. Several other studies have ivestigated advanced dlertinal lesions from coronal caries with molecultr methods, bt they were not designed to study oot cates inparteulae Overall, the present Lngerstanaing of the merotora of root cares 's mites compared to other infectious orl diseases.” ‘he clinzal investigators who studied root caries provided! chnieal descriptions ofthe signs and symptoms of roc eaves lesions. The mast commony used clinical signs to describe root caries utileed visual (colour, contour, surface cavitation) and tactile (surface texcure) specifications. There are no reported clinical symptoms of rot caries although pain may be present in advanced lesions Ths maybe one of the reasens way the middle aged and oder adults have advanced root caries lesions but donot reportforthertreatment. MANAGEMENT OFROOTCCARIES Prevention of occurrence of aot caries may be dificult because root caries often arises in older peorle who are otherwise aso having problems in maintaining good levels of oral kygiere. In addition, older people ae frequently taking medication which deoresses salivary flow and this xerostomia makes dental caries more likely to occur Tranquilizer, antidepressants, anthypertensives and duretis allhave 2 xerostomic effect. The feelng of a dry mouth may te alleviated by sucing sweets or taking frequent crinks, mary of which are cariogenic, Finally retiverent, bereevement,eillness mey result in dietary changes which may favour caries.” Maintenance or improvement of oral hygiene is the fist step towards prevention. Specific measures like use of powered toothbrushes and chemical plaque contrel measures may be advocated. Addition of fluorides to dally use oral hygiene aids like toothpastes and ure of chlorhexidine gluconate have also sown promising results” ° Primordial prevention of oat caresliesin the prevention of gngival and periodontal disease Older subjects should undergo regular screening for root caries as there reno oraimost negligible symptome which shall create environment for carious lesions to go unnoticed and hence jeopardze the oral heath of the individual Root surfaces being softer, use of force while probing should be avoided or at least minimized. Antiseptics, and/or remineralizing products with calcum phosphopeptide-amorphous calium Phosphate (CPF-ACP) also show a ray of hope in the management of root caries. Regimens to stimulate salivary flow, such as chewing gum with or without the inclusion of active ingredients (eg., chlorhexidine, xyitol, CPP-ACP), sucting sugarless candies, sucking buffered civi/fruitacd tablets, using systemic cholinergic medications (e.g. pilocarpine/ cimeviine, with monitoring of adverse effects) prescribing saliva substitutes, such as Bels, sprays and liquids, with placement around dertures as well as on teethand JIADS VOL-2 Issue 2 April-June, 2013 144)Roots Caries A Problem of Growing Age Vikram Bansal, Rarnandeep Kaursohi Veeresha, Adarsh Kuma, Shelly Bansal, og! Coral soft tissues are among those possible ways which can alleviate xerostomia and hence preventroot cries. 'A maturation’ effect may occur once a root surface hasbeen exposed to the oral environment for @ period of time rendering the root less suscentible to caries, This would be secondary to the effects of preventive measures i, if root lesions 6o not occur within a period of time after the root is exposed to the oral ervironment,it may never From a public health viewpoint, it is of major importance to know whether root caries i 2 disease entity basicaly diferent from coronal caries. Hence the caries process isessentally the same on coronaland root surfaces, ft should be expected to respond to the same preventive measutesin a similar wayregardlessto itstopograpry onthe tooth. * ‘Treatmert strategies for root cariesrely onthe clinical examinationand ‘re determined by the size, type, extent & location of the lesion, ‘2estheticrequirements as wellas the physical & mental condition ofthe patient. The cinical success rate depends on the degree of recession andthedefect.” Grafting of gingiva recessions s indicated when theres lack ofattached ‘ingva ard when gingival recezsionis aeztheteally objectionable. So, it ‘can be used as measure for primordial prevention af root caries. Even the presence of cervical cares at the site has been found as not ‘compromisingthe treatment outcome.” Resin-modified glass ionomer cement and resin composite materials appear te bo better choices in a long-term sconatio because of their lower solubility when compared with conventional lass ionomers.” ‘Ozone therapy can be considered as an alternative management strategy for root cares. Use of 10% sodium hypochlorite (oxidant) on demineralized root dentine lesions has been shown to improve their potential to remineralise since sodium hypochlorte is a non-specific proteolytic agent. Studies have shown that when root dentine samples ‘were treated with sodium hypochiorite, the permeabilty of fluoride ions increased, Rermoval of organic materials from dentine lesions was ‘anacceptable approach to enhanceremineralsation.*"""""""** ‘The management of raot caries In eldecy subjects is compounded by several factors, Various preventive as well as treatment strategies, as mertioned, are available to manage root caries. Their use in such a tender age as of elderly srequiredto be rational andapplied wth care. SUMMARY In summary, current literature suggests that people are living longer, retaining their teeth for greater time and having more root surfaces, ‘exposed, thus inereasing the risk of root caries. fh addressing these _arguments, however, some researchers have argued thatthe decrease in mortality and likewise increase in tooth retention were due to improvements in the social environment and positive oral health behaviours. 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