Root Caries

• Root caries lesion is:

“a soft, irregularly shaped lesion either totally confined to root
surface or
involving the undermining of enamel at cemento-enamel junction,
but clinically indicating that the lesion initiated on the root surface”

• Sometimes termed as “Senile Caries”

• It is a common problem in elderly because gingival recession is

common in this age group

• May occur in younger age group if roots are exposed to oral

environment
Site of lesion

• Root caries occurs in a location adjacent to the crest of the

gingiva where dental plaque accumulates

• They occur predominantly on the

• proximal (mesial and distal) surfaces,
• followed by the facial surface
• In mandible molars appear more susceptible to root caries followed
by premolars, canines and incisors

• In maxilla the order is reversed

Histochemistry,Microbiology
• Demineralization + Denaturation of collagen

• pH necessary for demineralization in cementum and dentin is

6.2-6.7 and for enamel it is 5.4-5.5

• The organisms most commonly associated with root caries are

• Streptococcus mutans (aid in initiation and
progression of caries)
• Lactobacilli
Diagnosis(Clinical)
• Carious lesion may be:
• Active
• Slowly progressing
• Arrested
• Clinicians detect root caries by judging
• Colour (yellow , brown, black)
• Contour (regular, irregular)
 Texture (soft, hard)

• Identify the contributory factors and oral hygiene practices

• Active lesions
• Soft
• Wet
• May be cavitated
• Arrested or slowly progressing lesion
• Hard
• Dry consistency
• Darkly coloured
• ICDAS Codes for the detection and classification
of carious lesions on the root surfaces

One score will be assigned per root surface. The

facial, mesial, distal, and lingual root surfaces of
each tooth should be classified as follows:
• Code E: If the root surface cannot be visualized
directly as a result of gingival recession or by
gentle air-drying, then it is excluded. Surfaces
covered entirely by calculus can be excluded or,
preferably, the calculus can be removed prior to
determining the status of the surface.
.
• Code 0:
The root surface does not exhibit any unusual discoloration
that distinguishes it from the surrounding or adjacent root
areas, nor does it exhibit a surface defect either at the CEJ
or wholly on the root surface. The root surface may have a
natural anatomical contour or the root surface may exhibit
a definite loss of surface continuity or an anatomical
contour that is not consistent with the dental caries
process
• Code 1: There is a clearly demarcated area on
the root surface or at the CEJ that is discolored
(light/dark brown, black) but there is no
cavitation (loss of anatomical contour < 0.5 mm)
present.

• Code 2: There is a clearly demarcated area on

the root surface or at the CEJ that is discolored
(light/dark brown, black) and there is cavitation
(loss of anatomical contour ≥ 0.5 mm) present.
Diagnosis (Radiographic)

Periapical
radiograph
Bitewing
radiograph
Risk Factors for Root caries
• Decrease salivary flow rate / Buffering Capacity

• Medical conditions
• Radiation treatment for head and neck cancer
• Diabetes
• Sjögren's syndrome (an autoimmune disease

• Multiple medication use

• Xerostomia (Anti-inflamatories , antihypertensives, antidepressants,
Antihistamines)
• Cariogenic diet
• Poor oral hygiene
• Exposure of root surfaces due to periodontal disease
• Use of removable partial dentures
• Smoking, alcoholism
• Low educational level
• Physical limitations
• Diminished manual dexterity due to stroke, arthritis, or Parkinson's
disease,

• Cognitive deficits due to mental illness, depression, Alzheimer's

disease or dementia,
• Caries after radiation therapy
Preventive Measures
• Plaque control
(biofilm control)
• Dietary advice
• Topical fluoride
• Gel
• Varnishes
• Fluoride releasing devices
• Solutions
• Dentrifices
• Chewing gums
• Antimicrobials
• 0.12% chlorhexidine mouthwash
• Chlorhexidine varnish
• Evaluate salivary flow rate
• Substituting dietry sugars……
• Xylitol
• Smoothing and polishing the softened root surface may
sometimes assist plaque control and favour lesion arrest
How to deal with Xerostomia?
• Control the underlying disease/cause

• Treat Candidosis
• Preserve Saliary secretion remains
• Sip water
• Avoid drugs causing xerostomia
• Mainatin fluid intake
• Stimulate salivary flow (chewing gum)
• In severe cases (drugs to stimulate salivary flow)
• Pilocarpine
• Cevimeline
• Prevent and treat caries
• Salivary substitutes
• In case of bacterial sialadenitis ..treat aggressiely
• Ophthalmological follow up
• follow up for other complications
• Dry skin
• Lung disease etc
• Salivary gland swelling
• Continued reassurance
Restorative Treatment
• Isolation
• Rubber dam
• Retaction cord
• &/or surgical exposure
• Remove the soft dentin

• Hard and stained dentin should not be removed

• Lesion may be removed with round bur in low-speed

handpiece or with excavators

• It is better to remove soft dentin closer to pulp with hand

instrument
Choice of restorative material
• Resin composite (microfilled/hybrid , flowable)

• Polyacid-modified composite (Compomers)

• Glass ionomer cement (GIC)

• Resin-modified glass ionomer cement (RMGI)

• ?Amalgam?
• ?Direct filling gold?
Restorative Challenges
• Impaired visibility

• Difficult access

• Moisture control

• Pulpal proximity

• Nature of dentinal substrate itself

Case 1 (root caries)
• 80 yr old male
• Initial presentation
• Canine
• Lateral incisor
• Pre op with retraction cord
• Cavity preperations
• Good prognosis
• Post-op image
Resin Composite
Questions?

• How do we deal with the bacteria during caries

management?
• What can we do about “dry mouth”
• Why doesn’t fluoride deal with the caries problem? Do we
just need to use more?