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PubMed1989

[Clinical aspects of root surface caries].

The present epidemiologic data indicate that root caries increases with age. Since the number of people in old age categories of population is increasing, root caries may be expected to become more and more common. This prediction is supported also by the anticipated increase in tooth longevity due to the declining caries prevalence in children and adolescents. Thus root caries is likely to become one of the problems in dentistry. Our present knowledge of root caries is insufficient and more research is needed into every aspect of the disease.

Adolescent↗
PubMed1996

Aging and medically compromised periodontal prosthodontic patients--salvaging abutment teeth undermined by root surface caries.

Aging and medically compromised patients are retaining their teeth longer. With the prolonged use of medications that produce xerostomia, these patients become more caries susceptible. Root surface caries, which undermines abutment crowns, results in loss of abutments because it is difficult to detect incipient lesions and make appropriate repairs before a significant amount of coronal dentin is lost. With the absence of a significant amount of coronal dentin, routine preparation and impression techniques can result in failure and frustration. For many such patients crown lengthening is the treatment of choice. It provides the restorative dentist convenient access and visibility. However, surgery may be contraindicated because of unfavorable anatomy. It may also be refused by the patient, often upon the advice of a physician. This article provides predictable alternatives for routine preparation and impression techniques. Documentation substantiates the long-term efficacy of these alternatives.

Aged↗
PubMed1990

Association of selected bacteria with the lesions of root surface caries.

Plaque from the root surfaces of 165 subjects (mean age 65.5 years, 22-26 teeth/subject) was analysed for specific bacteria. Five subject groups were defined: A (DMFS 16.4), B (DMFS 55.9), C1 (DMFS 55.6), C2 (DMFS 57.0) and C3 (DMFS 48.1). Groups C1 and C2 had unrestored root surface lesions; Group A, B and C3 were free of unrestored root caries and differed in their coronal caries experience. Streptococcus mutans was isolated more frequently from the root lesions in Groups C1 and C2 than from intact root surfaces in Group A. Streptococcus oralis, Streptococcus mitis 1 and Streptococcus sanguis were isolated more frequently from Group A. The percentage contribution that S. mutans made to plaque from lesions in Groups C1 and C2 was higher than that from plaque in Group A and Actinomyces viscosus serovar 2 contributed more to plaque in Group C1 than in samples from Group A. The percentage counts of Lactobacillus in plaque from lesions in Groups C1 and C2 were higher than those from intact roots in Groups A, B, and C3. Subjects were also grouped on the presence of Lactobacillus and S. mutans in plaque samples. Samples with both organisms (n = 17) showed significantly higher isolation frequencies of specific strains of S. mitis 1 and also A. viscosus serovar 2 compared with samples of plaque containing S. mutans or Lactobacillus. Actinomyces naeslundii serovar 1 was not isolated from samples containing both S. mutans and Lactobacillus. The results confirm an association of S. mutans and Lactobacillus with root surface lesions and suggest a relationship between lesions and A. viscosus serovar 2.

Actinomyces↗
PubMed1982

Changes in the prevalence of dental disease. Bureau of Economic and Behavioral Research, Council on Dental Health and Health Planning.

The literature currently available indicate that there have been substantial improvements in at least four areas of dental diseases: dental caries, root surface caries, edentulousness, and periodontal disease. Oral cancer appears to have remained stable. The literature on craniofacial anomalies, malocclusions, and traumatic injuries is such that similar statements cannot be made. Although decreases have been observed in caries, root surface caries, edentulousness, and periodontal disease, the improvements have occurred largely within the white population. Caries, for example, has been significantly reduced because of water fluoridation, fluoride dentifrices, and perhaps some changes in dietary patterns. Nevertheless, the disease continues to increase with age, although the cumulative effect of fluorides lowers the overall magnitude. The sheer numbers will still be substantial. For a variety of reasons, dental disease still remains substantially high in the nonwhite population, and will require concerted intervention if it is to be reduced.

Adolescent↗
PubMed1993

The epidemiology of root surface caries: North American studies.

After some problems resulting from the lack of standardized methods in the conduct of root caries studies and the lack of standardized reports of findings are reviewed, the prevalence and incidence of root surface caries in North America are reviewed through a combination of epidemiologic studies and large clinical trials. As part of this review, the available evidence on the relationship between root caries and missing teeth is presented. These data lead to the conclusion that the prevalence and, to some extent, the incidence of root caries are underestimated in adults with missing teeth. This review resulted in a number of observations regarding the status of root caries as an oral health problem. First, there is little evidence that would allow conclusions regarding the secular increase or decrease in the prevalence or incidence of root caries to be drawn. Other observations gleaned include the remarkably similar prevalence and incidence rates obtained from the studies reviewed, positive associations between root caries and age, negative associations between the prevalence and incidence of root caries and consumption of water containing fluoride, indications that root caries is a problem in adults with incidence rates that approach caries rates in children, and associations between the prevalence and incidence of root caries and a wide variety of oral, behavioral, and medical conditions. The final observation is the need for the acceptance of conventions for the definition of root caries as well as the reporting of findings in order for more firm conclusions to be drawn from future studies.

Adult↗
PubMed1998

Root-surface caries in rats and humans: inhibition by a non-antimicrobial property of tetracyclines.

The incidence of root caries has been found to increase as the population ages and as edentulism becomes less prevalent due to improved dental awareness and care, and as exposure of roots due to gingival recession has also increased in the elderly. The mechanism of root caries is thought to be mediated by both bacterial and mammalian proteases produced by plaque and the periodontal tissues, respectively. In the current study, a rat model of periodontal disease was used in which gnotobiotic rats were infected intra-orally with a periodontal pathogen (P. gingivalis). Infecting the rats with P. gingivalis increased the collagenase activity in the gingival tissue in association with severe alveolar bone loss. Treating P. gingivalis-infected rats with doxycycline or CMT-1 prevented the destruction of the periodontium by MMPs, thus preventing exposure of roots to subgingival bacterial plaque and host tissue collagenases and the subsequent development of root caries. In addition, a low-dose doxycycline (LDD, 20 mg bid, non-antimicrobial dose) for 3 months was used in humans predisposed to increased root caries as the result of heavy use of smokeless (chewing) tobacco, causing gingival recession, subgingival plaque accumulation with Gram-negative bacteria, increased gingival crevicular fluid flow (GCF), and elevated GCF collagenase. Daily administration of LDD in smokeless tobacco patients reduced the GCF collagenase and prevented the further development of root caries.

Adult↗
PubMed1999

Molecular pathogenesis of root dentin caries.

Human dentin has a higher content of organic matrix and more non-ideal hydroxyapatite than human enamel. Ultrastructural studies indicate that root caries involves both mineral dissolution and breakdown of the organic matrix. Factors involved in the root caries process seem more complicated than those in enamel caries. Moreover, the distinct roles of acids and enzymes and the sequence of events in the root caries process are not well-understood. Although Streptococcus mutans and Actinomyces viscosus are considered to be major pathogenic micro-organisms of root caries, their roles in degradation of the organic matrix components of root dentin need clarification. The purpose of this paper is to review the basic composition of root dentin and the roles of acids and both endogenous and bacterial enzymes in the root caries process.

Collagen↗
PubMed1992

Acid production by Actinomyces viscosus of root surface caries and non-caries origin during glycogen synthesis and degradation at different pH levels.

Actinomyces viscosus strains, freshly isolated from root surface caries lesions and intact root surfaces, were studied for their glycogen synthetic and degradative activities at pH 4.5, 5.0, and 7.0 in a pH-stat. At all three pH levels, root caries origin of A. viscosus synthesized up to three times as much glycogen compared to non-root caries origin. Since root caries origin of A. viscosus strains initially synthesized large amounts of glycogen, a longer period of time was required to deplete this polymer, resulting in an extended period of acid production, even at pH 4.5 and pH 5.0. This study suggests that the ability of A. viscosus of root caries origin to synthesize large quantities of glycogen and subsequently degrade this stored polymer slowly with acid production, at acidic pH levels, may play an important role in the root caries process.

Acids↗
PubMed2004

Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability.

OBJECTIVE: To analyse whether cognitive function and functional ability are related to oral health among community-dwelling older people over the age of 80 years. BACKGROUND: This cross-sectional study is based on the Kungsholmen Elders Oral Health Survey (KEOHS). The study included oral examinations carried out in two local clinics by standardised examiners and interviews using structured questionnaires. MATERIALS AND METHODS: Altogether 159 individuals were included in this study. Coronal caries and root caries were assessed using the National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) index and functional ability was assessed by a global measure of self-reported changes. RESULTS: Older adults with a low MMSE score (< or = 23) tended to have a higher risk of coronal caries than those with higher scores. Participants with mild cognitive decline (MMSE = 24-26) and with a decrease in functional ability had a significantly higher risk of root caries. These associations changed little when adjusted by the covariates. In addition, people with a low MMSE (0-23) had a four times higher risk of not using dental services regularly. This result was unchanged after adjusting for the variables studied. CONCLUSIONS: This study revealed associations between the cognitive and functional status of the individual and aspects of oral health, that may contribute to a deeper understanding of the background of oral health status in older adults.

Activities of Daily Living↗
PubMed1990

The epidemiology of root surface caries.

Although a secular decline is being seen in coronal caries in children in industrialized countries, there appears to be a relatively high prevalence of root caries, with chronologically older adults exhibiting the highest prevalences. This paper reviews the descriptive and analytical epidemiology of root caries as found in recent national, regional, and local studies. A review of the variety of study designs, populations surveyed, and epidemiologic criteria for root caries comprising recent studies is presented as a background for comparison of prevalence rates which range from 7.3% to 69.7% of the population with root decay. In the few incidence studies reported, attack rates range from 1.6 surfaces per 100 surfaces at risk to 6.3 per 1000 surface-months at risk. Risk indicators for root caries are also reviewed with studies applying multivariate techniques implicating age, fluoride, educational level, use of dental services, coronal caries, loss of attachment, and number of teeth as possible risk factors. Although incidence studies have isolated risk factors, the small number of studies result in little agreement. Risk factor models from the Iowa 65+ Oral Health Study and a Risk Indicator model from the Piedmont 65+ Dental Study are presented to illustrate the variety of factors that may be involved in the expression of root surface caries in human populations.

Cohort Studies↗
PubMed2003

Social relations as determinants of oral health among persons over the age of 80 years.

OBJECTIVE: To analyze whether social relations during a 7-year follow-up influence oral health among generally healthy, community-dwelling persons over the age of 80 years. METHOD: The present investigation is based on a subsample of 129 dentate community-dwelling individuals from The Kungsholmen Elders Oral Health Study (KEOHS), which included data from interviews and oral examinations. Social relations were measured in terms of marital status, living alone, frequency of contacts, number of confidants, and satisfaction with social contacts and with the frequency of contacts. Oral health was measured in terms of coronal caries and root caries. RESULTS: The primary findings of the adjusted multivariate logistic regression analysis were that persons who lived alone or who became alone during the 7 years prior to the dental examination had greater odds of having coronal caries (odds ratio (OR): 2.4, 95% CI: 1.0-5.7) than those who continually lived with others, and that persons who were continuously dissatisfied with the frequency of their social contacts were more likely to have root caries than those who reported a sustained satisfaction with the frequency of their social contacts (OR: 2.9, 95% CI: 1.2-7.2). CONCLUSION: This study suggests that social relations are related to the oral health status of old-old individuals. From a psychosocial perspective, our findings contribute to a deeper understanding of the background of oral health status in older adults.

Activities of Daily Living↗
PubMed1990

Histopathology of root surface caries.

The histopathology of active and arrested human root caries was examined in extracted teeth by different optical methods. Significant differences were observed between the mechanisms operating on the various dental structures. Three different patterns of initial cementum and dentin lesions could be distinguished, depending on the severity of the cariogenic attack, the degree of sclerosis of the peripheral dentin, and the presence of calculus. Advanced lesions were characterized by various patterns of demineralization. In particular, a massive lateral spread of bacteria into intertubular dentin was observed. Consequently, unaffected dentinal areas became continuously undermined. In arrested lesions, either a partial or complete mineralization of the intertubular dentin was apparent. Dentinal tubules were sclerosed passively by re- or precipitation of Ca and PO4 ions. In contrast, tubules filled with ghosts of bacteria appeared mineralized by fine-granular crystals. Our observations indicate that both the arrestment and the remineralization of active lesions depend on (1) the degree of active sclerosis of dentinal tubules in areas underlying the lesion, (2) the degree of the bacterial infection of the dentin, (3) the degree of progression of the lesions, and (4) the location of the lesions at the various root surfaces. It is suggested that remineralization of active lesions can occur. This supports the concept of non-invasive treatment of root caries lesions without cavitation.

Dental Caries↗
PubMed1994

Root surface caries.

Epidemiologic studies have shown that root surface caries are present worldwide. The prevalence and incidence of root surface caries differ widely among different populations but also among individuals within the same group. Differences in diagnostic criterias and reporting of data substantially influence epidemiologic data. The prevalence of decayed and filled root surfaces generally increases with age. However, age per se is not considered to be the main reason for caries development on root surfaces. The same main factors as for coronal caries, ie, cariogenic microorganisms, diet, saliva, and fluoride exposure, seem to play important roles in root caries development. Due to different anatomy, histology, and chemical composition of the tissues, there may be a higher risk of caries development on root surfaces than on coronal surfaces. In treatment of root surface caries, a causative treatment strategy should be determined. Prevention and treatment should focus on oral hygiene, fluoride exposure, and restriction of intake frequency of foods containing sugars or other easily fermentable carbohydrates.

Humans↗
PubMed2002

[Effect of sodium chloride treatment on remineralization of human root dentine caries in vitro].

OBJECTIVE: To investigate the influence of soluble phosphoprotein removal from artificial dentin caries lesions by pretreatment of NaCl on subsequent remineralization. METHODS: Human root dentin samples were demineralized in an acidic gel (pH = 4.4) at 37 degrees C for 48 hours. Samples were pretreated with 0.5 mol/L NaCl solution and 0.5 mol/L disodium EDTA solution respectively. The histomorphologic changes of root caries surface were examined by scannings electronic microscope. Mineral profiles were assessed by means of microradiography. RESULTS: No histomorphologic changes were present on root caries surface after treated with 0.5 mol/L NaCl solution, while many opened dentin tubules were seen after treated with 0.5 mol/L disodium EDTA solution. The remineralization results showed that pretreatment with 0.5 mol/L NaCl solution increased more remineralization than pretreated with 0.5 mol/L disodium EDTA solution. CONCLUSION: 0.5 mol/L NaCl solution has no damage on the root caries surface. The in vitro results suggested that removal of soluble phosphoprotein from dentin lesions is an interesting approach to enhance remineralization.

Dental Caries↗
PubMed1989

Oral health status in an adult Swedish population. Prevalence of caries. A cross-sectional epidemiological study in the Northern Alvsborg county.

The aim of the present epidemiological study was to describe prevalence, distribution and type of caries in an adult Swedish population. After stratification with respect to age (20-29, 30-39,.....greater than 79 years of age), sex and location of residence (city, village, rural region), a random sample of 967 individuals was drawn (0.75% of the total adult population greater than 19 years). The results were based on radiographic and clinical examination of 919 individuals, of whom 750 were dentate (participation rate: 95%). The examinations were carried out from November 1983 to December 1984. The caries registrations distinguished between enamel caries and root caries, subdivided into manifest and initial caries. Despite lower number of remaining teeth in older ages, the mean number of surfaces with manifest caries (DS) was relatively even in all age groups (4.1-5.1 DS), except for the youngest age group ("20-29 years": mean 3.1 DS). When the number of decayed teeth (DT) were expressed as a percentage of remaining teeth, the ratio (%) was markedly higher in the older age groups than in the younger age groups. Initial caries was more frequent in the younger age groups. In the age groups above forty years the majority of the observed carious lesions involved root surfaces. In the oldest age group ("greater than 79 years of age"), 95% of the lesions were root caries. The mean number of filled surfaces (FS) was higher among women than men, while untreated caries (DS) showed a tendency of higher values for men. No significant differences in caries prevalence related to location of residence could be demonstrated.

Adult↗
PubMed1986

Long-term evaluation of root surface caries in periodontally treated patients.

Caries development on exposed root surfaces was evaluated in 31 patients who had been subjected to surgical and/or nonsurgical periodontal treatment 8 years earlier due to advanced chronic periodontitis. Besides assessments for evaluation of the periodontal treatment, a number of examinations and tests were carried out in order to assess variables presumed to influence the root surface caries development. Both statistical and graphical analyses were carried out to test differences between groups of subjects and to evaluate the variables studied as possible risk factors for root surface caries. The variables studied were: salivary lactobacillus count, salivary Streptococcus mutans count, plaque score, salivary secretion rate, salivary buffer effect, oral sugar clearance time, dietary habits and the age of the subject. The final results support previous findings from an initial 4-year period that root surface caries occurs, though to a minor extent, in this patient category demonstrating good or excellent periodontal conditions after periodontal treatment. A positive correlation was found between the baseline and final root surface caries scores. After the second 4-year period, the salivary counts of S. mutans and lactobacilli, the plaque score and the dietary habits differed significantly between groups of subjects who had developed 0 or greater than 5 new DFS %. Root surface caries was far more prevalent when risk values of the variables studied were present than when they were absent. The important variables in this respect differed considerably between the subjects. No single variable was found to be discriminative in all subjects.

Adult↗
PubMed1994

The predominant cultivable flora of sound and carious human root surfaces.

Little detailed knowledge exists about the composition of the human root flora. Therefore, the predominant cultivable flora (PCF) was determined for samples of: (1) plaque from sound root surfaces (SRS) in eight subjects without root caries, (2) plaque from incipient root lesions (IRL) in eight subjects with root caries, and (3) carious material from advanced root lesions (ARL) in nine other subjects with root caries. Generally, one root surface was sampled per subject, and organisms-358, 512, and 389 for SRS, IRL, and ARL, respectively-were identified by standard methods. It was found that: (1) streptococci, actinomyces, and veillonellae constituted 84.2, 57.8, and 65.7% of the PCF of SRS, IRL, and ARL samples, respectively; (2) a wide variety of other Gram-positive cocci and Gram-positive and -negative rods was also present; (3) the PCF of many samples was often dominated by few organisms, the identity of which differed from sample to sample; (4) a negative and no association with root caries existed for the PCF levels of the non-mutans streptococci (non-MS) and the actinomyces; and (5) mutans streptococci (MS) and lactobacilli (L) were not always present among the PCF of IRL and ARL, respectively, and non-MS were isolated from the PCF of most lesions and actinomyces from all lesions. Our findings illustrate the complexity of the root surface flora and suggest that root caries development involves organisms other than MS and L.

Actinomyces↗