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Dental adhesives might be applied as sealants to exposed root surfaces to prevent root caries. One resin adhesive system significantly reduced the incidence and severity of lesions in an artificial caries system.
BACKGROUND: A patient developed root surface caries and loss of teeth following the jejunoileal (JI) bypass. We attempted to confirm the association of root surface caries with the JI bypass and explore the mechanisms by which it occurs. METHODS: The number of root surface caries per year after, and an equal period of time before, a JI bypass was determined in 18 patients. These 18 patients and 5 normal controls gave stimulated saliva samples for measurement of chloride, bicarbonate and pH. 4 JI bypass patients and 4 normal controls gave timed stimulated saliva samples for measurements of volume. RESULTS: 7 of 18 JI bypass patients had >0.5 root surface caries per year after the operation but none before (p<.01). Salivary chloride was > 12 meq/l in 3 of the 18 JI bypass patients but in none of 5 controls (p<.05). The salivary pH and bicarbonate were 6.38+/-0.48 vs 6.92+/-0.21 and 2.81+/-2.1 meq/l vs 5.8+/-1.2 meq/l in the JI bypass group and the control group respectively (p<.05). The stimulated saliva was 2.3+/-1.2 vs 4.5+/-1.4 cc/min in the JI bypass group and control group, respectively (p<.02). CONCLUSIONS: Root surface caries are more frequent after JI bypass. This may be due to decreased saliva flow and a reduced salivary buffering capacity.
Root surface caries is a specific clinical entity which has been receiving increasing attention in recent years. It has a complex, multi-factorial aetiology, but all the causal factors, and their relative contributions, are not yet clear. There appears to be a role for one or more microbiological agents, particularly in association with a diet involving frequent ingestion of fermentable sugars. Gingival recession is almost certainly a pre-requisite for the development of root surface caries, but intra-oral, site-specific differences in prevalence confuse the picture. Figures of between 20 and over 70 percent for gross prevalence have been reported, with demonstrated attack rates of between 15 and 28 percent of susceptible surfaces being affected. Difficulties in diagnosis may limit the reliability of these figures. The prevention of root surface caries is a two-phase process; the initial emphasis is on the prevention of gingival recession, and the later approach involves measures aimed at reducing the frequency of intake of known cariogenic foodstuffs, and increasing the resistance of susceptible root surfaces with topical fluoride. Medicines which can cause dry mouth must also be examined. The treatment of root surface caries involves a range of procedures, from topical fluoride to multi-surface, glass ionomer cement restorations.
Mutans streptococci have been strongly implicated in the initiation of dental caries on coronal surfaces. Their role in development of root-surface caries is less clear. The etiologic agents of both types of dental caries are likely to elicit systemic immune responses. The objective of the present study, therefore, was to study the association of clinical variables of disease with humoral IgG antibodies to nine oral micro-organisms in 314 adult subjects, aged 45-65 years, who were at risk for root-surface caries. Antibody activity to Streptococcus mutans strain Ingbritt, S. mutans/S. sobrinus GTFs, S. faecalis strain 19433, Actinomyces viscosus strain WVU 626, Actinomyces naeslundii strain 12, Lactobacillus casei, Actinobacillus actinomycetemcomitans strain Y4, Porphyromonas gingivalis strain 381, Eikenella corrodens strain 1073, and Wolinella recta strain 371 was measured by ELISA. Pearson correlation coefficients among log10 antibody levels within subjects revealed marked positive correlations among subgingival bacteria, generally weak positive correlations among supragingival micro-organisms, and no correlations between elements of the supragingival battery with the subgingival battery. IgG antibody levels to mutans streptococcal antigens were significantly correlated with subject DMF scores (r = 0.23; p less than 0.0001). No significant correlation was seen between DMF scores and antibody to any other supragingival micro-organism tested. Further relationships between levels of S. mutans antibody and individual clinical variables were analyzed by step-wise multiple linear regression, resulting in a model that was highly significant (p = 0.0001), with an r2 = 0.14. Numbers of missing teeth, coronal caries, root-surface caries, and root-surface restorations were each positively associated with antibody levels to mutans streptococci.(ABSTRACT TRUNCATED AT 250 WORDS)
Little information is available on the prevalence and clinical appearance of root surface caries. The literature shows that root surface caries is thought to be similar to coronal caries, but that certain diet-bacterial interactions might predispose to root surface caries. A scan of the literature concerning the epidemiology, etiology, microbiology, periodontology, as well as reporting methods and restoration treatment of root surface caries shows current practices and suggests future research.
A new system was devised for scoring root surface caries. The roots were divided circumferentially and apically into areas. Each exposed area and any carious involvement was given a score of 1. Root surface caries was expressed as total areas affected and as a percentage of the exposed root surface.
In recent years there has been a pronounced change in the epidemiology and disease pattern of dental caries. In the current context, traditional methods of caries assessment, discriminating lesions at cavitation, are clinically inappropriate, and obsolete for research requiring detection of a very early phase of mineral loss. Modern prospective caries studies require sensitive methods permitting the measurement of small changes in tooth mineral content, and objective, quantitative measurements of such changes are now possible in a single caries lesion. For longitudinal studies there are noninvasive methods for assessment of new lesions as well as quantitative changes (progression or regression) in existing lesions. Among as yet unresolved issues are improved methods to assess the current activity of a lesion, methods for detection and quantification of secondary caries and root caries, calibration of methodologies between different research institutes, and methods capable of assessment of the whole continuum in the development of a caries lesion, from initial loss of mineral to cavitation.
Demographic projections show an important increase of the elderly population. The percentage of complete edentulous elderly patients is decreasing but their total number will remain constant. The prevalence of caries (essentially root caries) and of periodontal disease is, actually, very important. The increase of remaining teeth in the aging population, is a risk for a higher prevalence of these problems. It's time to become aware of this situation and to develop prevention and adapted treatments for this population.
The nation's health care system is currently under scrutiny. A topic of great interest to the dental community is whether dentistry should be included in a plan for national health reform, and if so, what procedures should be covered. To answer this question, 1) the current oral disease burden in the United States should be assessed, and 2) factors associated with this burden should be described. This paper reviews several recent large-scale epidemiologic surveys of oral health in the United States, summarizes their major findings, outlines important risk factors for oral disease, and makes recommendations regarding future oral epidemiologic surveys. The discussion is limited to the following conditions: dental caries, periodontal diseases, tooth loss, edentulism, oral cancer, and orofacial clefts. Five out of six 17-year-olds have at least one decayed, missing, or filled tooth surface (DMFS), with a mean of eight DMFS per 17-year-old. However, 25 percent of the country's children have 75 percent of the dental caries; minority children, rural dwellers, those with minimal exposure to fluoride, and those from less educated or poorer families tend to have a greater caries experience. Root caries, gingivitis, periodontal pockets, and loss of periodontal attachment are more common among older individuals. Whites have more teeth than do Blacks of similar ages, and edentulism is more common among those with less education and income. Of those age 65+, over 40 percent are edentulous and only 2 percent have all 28 teeth. An estimated 30,000 new cases and 8,000 deaths were attributed to oral cancer in 1991, with Black males having higher incidence and mortality rates than other subgroups. Oral clefts occur in about one in 700 total births, with Native Americans having the highest incidence.
The caries-protective effect of milk and fluoridated milk on enamel has been reported; however, few data are available concerning the role of milk and/or fluoridated milk on root surfaces. The aim of this study was to compare the effect of plain and fluoridated milk on root surface caries. Artificial root surface lesions were created, sectioned and analyzed using polarized light microscopy (PLM) and microradiography (MRG). The sections were covered except for the original surface and assigned to a treatment group. The samples were immersed in 2% plain milk or fluoridated milk for 40 hours and re-evaluated. Changes were measured and mean differences were compared with an unpaired t-test. Both techniques revealed a reduction in lesion depth for each milk group; however, a significantly greater reduction (p<0.05) was observed with the fluoridated milk. These results suggest that fluoridated milk may have a beneficial effect on the remineralization of root surface caries.
The aim of this study was to investigate the development of root surface caries in hamsters fed a high-sucrose diet over a 24-week period after inoculations of two types of cariogenic bacteria. Twenty-one day old male golden hamsters (n = 103) were divided into 5 groups. Four groups were given diet 2000, and one group was given a stock diet CE-2, Of the groups given diet 2000, three groups were infected with Actinomyces viscosus ATCC 15987 and Streptococcus mutans NTCC 10449 separately (AV and SM groups) or in combination (AVSM group), and one group remained uninfected. A grid method was used to evaluate the plaque accumulation, alveolar bone loss, and root surface caries. After 12 weeks, root surface caries developed mainly on the first mandibular molars in the three infected groups. At 24 weeks, the prevalence of root surface caries was highest in the AV group, but root caries scores were not significantly different among the three infected groups. In the groups SM and AVSM, the molar crowns were extensively destroyed by caries, while in the AV group the crowns were almost intact. It was concluded that challenge with Actinomyces viscosus may be appropriate to study root surface caries in hamsters.
The prevalence and intraoral distribution of decayed and filled root surfaces were evaluated in 55, 65, and 75-yr-old inhabitants of Gothenburg. From randomly selected groups, 88, 72, and 48 dentate persons in the respective age groups participated and as many as 85, 93, and 90% respectively had one or more decayed or filled root surfaces. In the two oldest age groups 32-35% were free from root carious lesions, while 20% had five or more decayed root surfaces. The corresponding figures for the youngest group were 63% and 8%. The prevalence of root surface caries was evaluated using the Root Caries Index (RCI), excluding prosthetic crowns. The mean RCI value increased with age (P less than 0.05, ANOVA on age groups) from 14% to 16% and 22% in the 55, 65, and 75-yr-olds, respectively. The root surfaces of the molars were most frequently affected by caries and fillings, the incisors least frequently. In the maxilla the proximal surfaces were most affected, in the mandible this applied to the buccal surfaces, while the lingual surfaces had the lowest proportion of carious lesions and fillings in both jaws.
The aim of this study was to assess the remineralizing effect of an amine fluoride (AmF)- and stannous fluoride (SnF2)-containing toothpaste and mouthrinse on exposed root surfaces. A total of 44 adults participated in the 20-week, double-blind study and were grouped as follows: (1) 20 participants (mean age 45.7 years) used an AmF/SnF2 experimental toothpaste plus AmF/SnF2 (Meridol) mouthwash, and (2) 24 participants (mean age 48.8 years) used an NaF-containing toothpaste and mouthrinse. Root caries index (RCI) and root surface scores were determined by a modified method of Katz (J Dent Res, 1984). RCI mean values showed decreases of approximately 47% in the AmF/SnF2 group, and 10% in the NaF group. With respect to root caries scores, the number of persons with decreased softened (non-carious) surfaces between the baseline and control examinations was statistically significant (p less than 0.05) in the AmF/SnF2 group but not significant in the NaF group. A statistically significant difference (p less than 0.05) in the results of the groups favored the AmF/SnF2 subgroup. Thus, the data point to a possible remineralizing effect of topically applied AmF/SnF2 on softened root caries surfaces.
Plaque samples were obtained from tooth surfaces exhibiting typical lesions of root surface caries and were immediately cultured by a continuous anaerobic procedure. The bacterial composition of root caries flora was determined on individual samples. Representative isolates from each specimen were characterized by morphological and physiological criteria. In addition, fluorescent antibody reagents were used to confirm the identification of Streptococcus mutans and Actinomyces viscosus. The plaque samples could be divided into two groups on the basis of the presence or absence of S. mutans in the plaque. In group I plaques, S. mutans comprised 30 percent of the total cultivable flora. S. sanguis was either not found or was present in very low number. In group II plaques, S. mutans was not detected, and S. sanguis formed 48 percent of the total plaque flora. A. viscosus was the dominant organism in all plaque samples, accounting for 47 percent of the group I isolates and 41 percent of the group II isolates.
The aim of this investigation was to compare two methods of scoring root surface caries in hamster teeth. The experimental material was mandibles from hamsters which had been infected with Actinomyces viscosus, fed a caries-promoting diet, and received either 0, 1, 10, or 25 ppm fluoride in the drinking water during an 18-week experimental period (Stookey, 1986). Root surface caries on the lingual surfaces of mandibular first molars was scored according to the grid method of Doff et al. (1977) and by the quantitative planimetric method of Firestone et al. (1986). Data from both methods confirmed that 25 and 10 ppm fluoride were significantly more caries-inhibitory than 1 ppm fluoride, which, in turn, significantly reduced root surface caries compared with the 0 ppm control group. Correlation coefficients for caries scores (0.92) and ranking of the scores (0.88) for each animal between the two methods were highly significant (p < 0.0001). The planimetric measurement of root surface caries in hamsters was as sensitive as the grid-scoring method.
The present investigation was undertaken (1) to analyze the prevalence of root surface caries prior to and after periodontal treatment and (2) to determine the feasibility of using simple clinical criteria for predicting a patient's risk of developing root surface caries following periodontal therapy. Thirty-one patients were given advanced periodontal treatment including periodontal surgery. At baseline they were examined for oral hygiene status, root surface caries experience and number of lactobacilli per ml saliva as evaluated by the Dentocult dip-slide method. Follow-up examinations 1, 2 and 4 years after baseline showed that a majority of the patients were treated successfully and maintained in periodontal health. Root surface caries developed in approximately two-thirds of the patients during the 4-year observation period. However, the total increment of root lesions during these years was mostly extremely low, i.e. less than 5% of exposed root surfaces. In higher risk patients developing new root surface caries, significant correlations were demonstrated with initial pretreatment scorings from (1) their previous root surface caries experience, (2) high lactobacillus counts and (3) advancing age. In addition, root surface caries incidence and low saliva secretion rats were found to correlate significantly during the course of the study.
Despite the increasing international interest in recent years in the epidemiology of root surface caries, there is no agreement on the diagnostic criteria to be used when the condition is recorded. In this paper the different methods used by dental epidemiologists are reviewed. It is shown that the wide variation in the levels of root surface caries recorded among different populations could be due to differences in the diagnostic methods as well as to inherent differences in the prevalence of the condition. It is recommended that an attempt be made to reach a global consensus on the methods of diagnosing root surface caries. Also, it is suggested that in reports of epidemiological studies of root surface caries, a basic set of tables including details of tooth loss be included.
With an increasing number of elderly people retaining natural dentition, the number of exposed root surfaces and root surface caries is increasing. A total of 100 people, aged from 38 to 86, were examined for exposed root surfaces and root surface caries. Denture wearers and non-denture wearers were examined. The following results were obtained; 1. The percentages of exposed root surfaces were significantly higher (P < 0.05) in the 60's and 70's age groups. Root surface caries showed a tendency to increase until people were in their 60's. 2. Denture wearers had more exposed root surfaces (P < 0.05) and were more likely to have root surface caries than non-denture wearers. Denture wearers showed a tendency to have more severe grades of root surface caries than non-denture wearers. 3. Concerning denture wearers, there were not significant differences in the percentages of exposed root surfaces of buccal and proximal surfaces facing edentulous space. However, proximal surfaces facing edentulous space were more prone to root surface caries than buccal surfaces (P < 0.05).