Root Surface Caries Caries can affect any surface of the teeth. The most commonly seen caries are found on the crown of a tooth, above the cement o-enamel junction, it is also possible for caries to form on the root surface, below the cement o-enamel junction. Dental root caries has received a great deal of attention in the past few decades. A variety of different patients are at risk for root surface caries.
Dentists use several methods of treatment. Root surface caries are also called ce mental caries, cervical caries, or caries. (Wilkins) Root surface caries only involves the roots of teeth. The cementum and dentin located just below the crown of the tooth is involved. No involvement of enamel is seen with root surface caries. Bone loss and corresponding gingiva l recession are the first symptoms to be seen in the caries process.
These result in exposed root surfaces, which are more prone to forming caries because caries does not form in the root surface while periodontal fibers are still attached. Clinically, the lesion starts on the root surface. It has been found that root caries spreads in a lateral or circumferential manner, and over time can extend completely around the tooth, undermining the enamel. (Wilkins) In general, root caries have the same etiology as coronal cavities. S.
mutant, Lactobacilli, and sometimes, Actinomyces are involved and are found in high numbers in root caries, but there are two main differences between enamel and root surface caries. (Flaitz) These differences cause the lesion on a root surface to be more destructive than that in enamel. First, because the pH at which demineralization will occur is higher for root cementum (approx. pH 6. 0) than for enamel (approx. pH 5.
0). (Wilkins) Therefore, root cementum has potential for demineralization at an earlier point in time than enamel does. Secondly, once the cementum is demineralize d, the dentin contains dentinal tubules which, if present, are potential methods of entry for the pathogenic microbes as mentioned previously, such as S. mutant, Lactobacilli, and sometimes Actinomyces; whereas, enamel consists of tightly-arranged crystal prisms, which have a much lower chance for bacterial entry. The process of caries formation begins with colonization by acid-producing bacteria plaque. In the next step, Gram-positive bacteria invade the dentinal tubules, which leads to the formation of micro cavities, demineralization of the dentinal tubules, and destruction of the organic material.
This process is enhanced with the presence of gingiva l recession. (Hammel) Clinically, root caries appears as a soft, irregularly shaped lesion, either totally confined to the root surface or also involving the enamel at the cement o-enamel junction. (Flaitz) It is more easily detected on exposed root surfaces. It has been found that 10% to 20% of root caries lesions are found, especially at the inter proximal region. The most common locations also include exposed roots of the mandibular premolar and molar areas. On a dental radiograph, root surface caries appears as a cupped-out or crater-shaped radio lucency just below the cement o-enamel junction.
Early lesions may be difficult to detect on a dental radiograph. (Hassan) Clinical description is very subjective and is based on color, texture, surface smoothness, depth of the lesion, and distinctiveness of its border. Root caries can be classified as active or inactive. Active lesions are leathery or soft, and inactive or arrested lesions are hard upon touch with an explorer. Root caries can vary in color from black or dark brown to yellowish or light brown. (Wilkins) Measures that can be taken to prevent root surface caries are just as one would perform to prevent coronal caries.
Oral hygiene is most important. Brush your teeth at least twice a day, preferably after each meal. Floss your teeth regularly to remove food particles between your teeth that cannot be removed by ordinary brushing. Because you can have small cavities without even knowing, visit your dentist regularly for a check up. Use a fluoride containing toothpaste or mouthwash, and ensure that your drinking water is fluoridated.
One can also use a home fluoride rinse and have fluoride varnishes applied to help prevent root surface caries. Also, make sure to eat nutritious and balanced meals and limit snacking. A number of predisposing factors make an individual more susceptible to root caries. Medications with side effects of Xerostomia, a serious systemic disease, no fluoride supplementation available in the water or toothpaste, malocclusion, a history of previous caries, not maintaining a well balanced diet, an individual with large amount of plaque, poor personal hygiene, tobacco use, or stress are such factors that increase the risk for root caries. Chewing tobacco users are more likely to develop dental caries, particularly on the root surfaces of their teeth, than those who don't use tobacco. Researchers speculate that the high sugar content in chewing tobacco is one reason that it is associated with an increased risk of dental caries on tooth roots and crowns.
(Wilkins) Compared with individuals who have resided in a non fluoridated community, water fluoridation with a history of long term residence in the area, has been shown to reduce root surface decay up to 30%. (Beck) Root caries and root surface decay is increasing as a result of longer retention of teeth and aging of the population. (Hassan) Older adults experience more gum recession than other age groups and these exposed roots are at a high risk for decay. It has been proposed that this increased occurrence of root caries in older patients may be due to the presence of periodontal disease, decreased flow of saliva, poor oral hygiene, or poor health status. However, a study done on a total of 420 Benghazi patients showed that root caries was not limited to only older patients. 56.
3% in age group 56-70 had root caries, 52. 5% in age group 36-45, and 48. 8% in age group 26-35. (Hassan) In 1986, Billings developed a staging classification, called a 'severity index,' of root caries lesions as follows: Grade I (incipient), Grade II (shallow), Grade III (cavitation), and Grade IV (pulp al). (Katz) Katz developed the Root Caries Index (RCI). It was developed report the severity of a person's caries.
Since gingiva l recession is usually present before a root surface lesion can occur, only teeth with gingiva l recession are recorded in this index. The root caries index is: the number of teeth showing gingiva l recession with decay, plus the number of teeth showing gingiva l recession with root lesions filled, divided by the total number of teeth showing gingiva l recession, then multiplied by 100. The higher the score the more severe the caries. The minimum score is 0, and the maximum score is 100. (Katz) Treatment options include: with fluoride rinses or, somewhat more tentatively, with fluoride gels and varnishes or a varnish. Some dentists may restore root caries with amalgam restorations.
Another treatment option used by some dentists to restore root caries is Glass Ion omer Cements. Glass ion omer cements were first introduced in the early 1970 s. They have good adherence to mineralized tooth tissue, which keeps the removal of tooth structure to a minimum. Glass ion omer cements also have the ability to leak and absorb fluoride into the tooth, which decreases the rate of secondary caries. These factors have increased the potential for glass ion omer cements to replace amalgam as a restorative material. (Hammel) Although the most common caries seen are coronal, root surface caries present just as much of a problem.
Once root caries are detected, the bacteria have already begun to demineralize the cementum or dentin and create a great deal of damage. There are several different ways that root caries may appear clinically. A variety of different patients are at risk for root surface caries. Different measures can be taken to prevent root surface caries. Methods of treatment differ among dentists, but there are several choices.