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Root Caries: A Significant Dental Problem

People are living longer and keeping their natural teeth more than ever before. The advances in tooth retention, the desire to look one's best, and higher expectations about oral health have raised dental awareness among older adults.

With the significant increase in the older portion of society, with even greater increases expected, more older adults will have more teeth that are susceptible to root caries. Root caries may emerge as one of the most significant dental problems among older adults during the next decade. A recent study conducted by the National Institute for Dental and Craniofacial Research (NIDCR) showed that over half of older adults have decayed or filled root surfaces. The frequency of root caries is strongly age-dependent and will continue to be a major dental problem among the elderly.

Root caries lesions can be caused by new or primary root caries, caries around existing dental fillings or recurrent caries, and abrasion or erosion of the root surfaces. Root caries progress quickly due to the relatively soft nature of the root surface, as well as the risk factors associated with the incidence of root caries.

Risk factors associated with the high prevalence of root caries among older adults include decrease salivary flow or xerostomia, exposure of root surfaces due to periodontal (gum) disease, chronic medical conditions, radiation treatment for head and neck cancer, physical limitations, and diminished manual dexterity due to stroke, arthritis, or Parkinson's disease, cognitive deficits due to mental illness, depression, Alzheimer's disease or dementia, Sjögren's syndrome (an autoimmune disease), diabetes, poor oral hygiene, multiple medication use, and changes in dietary habits. One or more of these risk factors or life changes, which are more common among older adults, can increase root caries in an individual who has not had dental caries for many years.

Root caries can be a challenge for the dentist to treat depending on the size and the type of root caries lesion, the extent and rate of caries activity for that person, the physical and mental condition of the individual, and where the root caries are located in the mouth. Many root lesions have limited accessibility and visibility, are often more complicated by pre-existing extensive dental work, and are difficult to isolate from oral fluids during the restoration process. Also, many people who have widespread root lesions have limited tolerance for dental treatment because of medical conditions, illness, and mental health problems.

By Denise J. Fedele, DMD, MS

Learn About Invisible Fillings for Your Teeth

Technology now offers attractive options for cavity restorations in dental care. Called composites, these new tooth-colored fillings are excellent choices for front teeth and other repairs that might be visible. Composites duplicate the natural appearance of a tooth in restoring decayed teeth or repairing a defect.

What Material Is Used in the Composite?

Composites are made from a mixture of microscopic plastic and ceramic resin particles. Another type of tooth-colored filling is called a resin ionomer, which releases fluoride useful for preventing tooth decay.

Besides Their Cosmetic Value, What Other Benefits Do Composites Provide?

The bonding process used in restoration provides strength to the tooth, making it more structurally sound. It also seals the tooth, decreasing the chance of sensitivity to hot and cold. Some composites made with materials releasing fluoride are ideal for treating root decay, a condition when gums recede, exposing tooth roots to more cavity-causing plaque. These fluoride-releasing materials also are useful for filling decayed baby teeth.

What Is the Process for Treatment?

Following removal of the decayed area, a mild acid solution is used to prepare the tooth's surface for bonding. A bonding agent is then brushed over the surface. Next, several layers of the composite are applied. For a natural appearance, the dentist matches the color of the composite to the tooth.

Then, it is chemically hardened or cured with a special light and finally polished for a natural-looking finishing touch.

How Durable Are Composite Fillings?

In a five-year clinical study, some of the resin materials demonstrated 100% effectiveness for adhesion and retention. Like other types of fillings, they may require periodic replacement. While the material is very durable, they may not perform quite as long as silver fillings or amalgams for their resistance to the rigors of grinding and chewing.

Scheduling regular dental exams is an important part of good oral hygiene. Your dentist will check your invisible fillings each time to ensure their performance.

By Brian J. Gray, DDS, MAGD, FICO