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PubMed2001

The diagnosis of root caries.

The most commonly used clinical signs of root caries are visual (color, contour, surface cavitation) and tactile (surface texture) descriptions of a lesion. The traditional methods of visual-tactile diagnosis for root caries can produce a correct diagnosis but usually not until the lesion is at an advanced stage. Despite the subjectivity inherent in interpreting the clinical signs of root caries diagnosis, good to excellent inter-examiner reliability has been reported in clinical studies; however, the presence of filled surfaces dramatically enhances the agreement. When only untreated root caries is diagnosed, examiner reliability is reduced considerably. Clinicians look to diagnostic tests in the hope that they will perform better (that is, be more reliable) than clinical diagnosis and, therefore, can be used to replace clinical diagnosis. From the limited data available on diagnostic tests for root caries, tests determining the presence or absence of mutans streptococci and Lactobacilli are the most clinically helpful, producing calibrated efficiency scores exceeding 40 percent. The risk assessment approach to root caries diagnosis involves the determination of a patient's risk through the interpretation of clinical signs and the selection and application of an appropriate diagnostic test if the clinician is unsure of the diagnosis.

Dental Caries Activity Tests↗
PubMed1994

Restorative treatment for geriatric root caries.

The restorative management of root caries poses many challenges to the clinician. The clinical features of root caries and current restorative techniques using new adhesive materials are discussed.

Aged↗
PubMed1989

[Is there a connection between coronal and root caries involvement?].

The relationship between coronal and root caries was analyzed in a sample of 963 people aged 25 to 64 years. Subjects with root caries had fewer teeth, more teeth with untreated coronal caries, and more teeth which need conservative treatments and extractions than did people with no root caries. In the age older than 55 years those with root caries had more teeth in the average of 2.5 teeth for both sexes. The other parameters of dental health showed the same differences compared with younger subjects.

Adult↗
PubMed1996

Evaluation of sodium fluorescein for quantitative diagnosis of root caries.

The diagnosis of root caries, in particular the judgment of the activity of a visually observed lesion, is difficult. Quantitative determination of lesion severity would allow the lesion to be monitored with time, so that an indication of lesion activity could be obtained. This paper describes a step in the development of a method that provides such a quantitative determination. Specifically, fluorescein sodium salt is used as a penetrating dye, the subject of study being the relationship between dye concentration and porosity in demineralized root dentin. Fourteen human third molars were demineralized in vitro (lactic acid CMC-gel, pH 5; in each of 6 groups for 4, 7, 11, 14, 18, and 21 days). Fluorescein sodium salt (0.2 g/L) was applied for 2 min. Thin slices (+/- 130 microns) were cut from the root surfaces without water cooling. The dye fluorescence radiance in the demineralized dentin was determined by means of a micro-Raman spectroscope and compared with the mineral loss profiles measured with transverse microradiography (TMR). The TMR data were corrected for the difference in measurement area between the two measurement systems. Corrected TMR profiles were compared with the corresponding fluorescence scans, showing linear correspondence. The correlation coefficient was r = 0.96. We conclude that, after uptake of fluorescein sodium salt for 2 min, the dye concentration in an artificially produced root-surface caries lesion is proportional to the amount of mineral lost from that lesion.

Dentin↗
PubMed1992

[Etiology and prevention of root caries ].

The prevalence of root caries is increasing. An optimal prevention is important because of the difficulties encountered in restoring these lesions. The pathogenesis of root and enamel caries have strong similarities. Consequently, for both the same preventive means should be applied. It is important to adjust the intensity of the preventive measures to the risk level of the individual patient. For high risk patients the use of chlorhexidine is advised.

Anti-Infective Agents↗
PubMed1997

Visualization of root caries lesions by means of a diazonium dye.

A diazonium dye was used to visualize caries lesions in root tissue. Root caries lesions were created in vitro according to a variety of protocols based on methylcellulose gel (6% w/v) and/or lactic acid buffer (0.05 M, pH 4.5). Teeth containing lesions were soaked overnight in an alkaline solution of 2% (w/v) 2-naphthol or resorcinol, rinsed with distilled water, and immersed in a diazonium solution (prepared by titration of aniline with sodium nitrite in 1 M HCl at 5 degrees C) for up to 10 min, prior to being thoroughly rinsed with distilled water. The area of the caries lesion on the anatomical surface was clearly marked with a red/orange color following 5 minutes' incubation in the diazonium solution. The diazonium complex formed with 2-naphthol was found to be more resistant to leaching during rinsing and sectioning than that formed with resorcinol. Microscopic examination of sections taken in the apicalcoronal plane showed that the depth of area of the lesion was also marked by the red/orange coloration. Chemical changes in root mineral monitored during lesion formation showed some degree of correlation between lesion area and mineral dissolution. Visualization of coronal caries by this technique is currently under investigation. The visualization technique provides a simple means of determining the extent and severity of root caries lesions and may be a useful first step in their classification.

Calcium↗
PubMed1997

Root caries in the older patient: significance, prevention, and treatment.

Root caries is an emerging challenge to the dental professions because of the growing number of increasingly aging adults who have retained many or all of their teeth. Risk factors for developing root caries point to both intraoral and environmental factors, making the management of root caries complex and multidisciplinary. Prevention based on a composite of risk factors is the most desirable approach for management. Patients who have developed caries of the roots can be treated with remineralization strategies, recontouring techniques, intracoronal restorations of a variety of established and recently introduced materials, or extracoronal restoration. Dental professionals need to keep abreast of new approaches that are emerging for the management of root caries.

Adult↗
PubMed2001

Clinical and behavioural risk indicators for root caries in older people.

OBJECTIVE: To investigate the clinical and behavioural factors indicating root caries risk among older people. DESIGN: Cross-sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators, including sugars intake. SETTING: A national sample of older British adults, free-living and institutionalised. PARTICIPANTS: 462 dentate adults aged 65 years or over. RESULTS: Nine or more intakes of sugars per day more than doubled the odds of root caries being present (OR 2.2-2.4). Other clinical and behavioural factors affecting root caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1-2.6) and infrequent tooth brushing (OR 2.8-4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root caries, as measured by the RCI(d). CONCLUSIONS: Of the factors open to possible clinical or behavioural intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.

Aged↗
PubMedDate not supplied

Root caries in the elderly: an update for the next century.

Root caries is an emerging challenge to the dental professions because of the growing number of increasingly aging adults who have retained many or all of their teeth. Risk factors for developing root caries point to both intraoral and environmental factors, making the management of root caries complex and multidisciplinary. Prevention is the most desirable approach for management, but patients who have developed caries of the roots can be treated with remineralization strategies or a variety of restorative approaches. Dental professionals need to keep abreast of new approaches emerging for the management of root caries.

Aged↗
PubMed1990

Clinical signs of root caries: measurement issues from an epidemiologic perspective.

The measurement of root caries using a relatively precise, utilitarian, and universally-acceptable methodology based upon clinical signs is a critical and necessary step in the progression of the epidemiologic study of this oral disease. While a clinician directly involved in the care of a patient will always incorporate spontaneous judgment-based-upon-experience into the diagnostic process, the clinical investigator must rely upon a much more standardized approach to the diagnosis of root caries. A comprehensive overview of the current epidemiologic research findings and methodologic literature for root caries precedes a series of discussions on methodologic issues that relate to the measurement of root caries in epidemiologic study conditions. Topics discussed include: (1) appropriate categories of lesions for inclusion (active vs. inactive and supragingival vs. subgingival lesions), (2) surface visibility issues (clinical treatment effects and oral debris accumulations), and (3) examination techniques (examination instruments and use of radiographs). The final section of this article proposes seven diagnostic conventions for use by investigators when they are diagnosing root caries in descriptive, analytical, and experimental epidemiologic studies.

DMF Index↗
PubMed1988

Occurrence of root caries in relation to dental health behavior.

We studied the relationship between the occurrence of untreated root caries and a subject's dental health habits, such as the frequency of tooth-brushing, the avoidance of sugar, and regularity of dental visits. A representative sample of 5028 adults was examined. Information on dental health habits was collected by professional interviewers one to six weeks before the clinical examination. A high frequency of tooth-brushing was strongly related to a low occurrence of root caries. The use of sugar in coffee or tea was strongly associated with root caries occurrence among men. The use of sweets was related to root caries occurrence moderately in men but not at all in women. Regular dental check-up behavior was strongly related to an infrequent occurrence of root caries. It was concluded that dental health behavior influences root caries occurrence and that caries on root surfaces is associated with poor dental health habits. Age and gender differences in root caries occurrence, reported earlier, may relate to different dental health behavior of women and men.

Adult↗
PubMed1993

Root caries in a sample of elderly persons.

With the anticipated increase in the aged adult population and the associated gingival recession, the prevalence of root caries is expected to increase. The purpose of this study was to determine the experience and distribution of root caries in a group of aged adults living in Kayelitsha. All non-institutionalized elderly black adults participating in a community geriatric programme were examined. Root caries was recorded using visual and tactile criteria and expressed as the root caries index (RCI) rate. The mean age of the subjects was 65.2 years, the mean number of teeth present was 17.3 and the mean RCI rate was 2.2 per cent. All subjects had gingival recession while only 23.8 per cent had root caries. No surfaces with restored root caries lesions were found. In the maxilla the highest RCI rate was observed on the interproximal surfaces of the posterior teeth (4.4 per cent) but in the mandible the buccal surfaces of the posterior teeth had the highest RCI rate (4.2 per cent). In both the maxilla and the mandible the lingual surfaces of the anterior teeth showed no root caries. Maxillary teeth did not have a significantly higher root caries attack rate than mandibular teeth. Root caries does not appear to be a public health problem in the sampled population.

Age Distribution↗
PubMed1993

Preventive aspects of root caries.

Several factors are responsible for an increasing number of exposed root surfaces, resulting in a higher root caries risk. Assuming that the pathogenesis of root and enamel caries have strong similarities, the same preventive methods could be applied for root caries and for enamel caries. However, due to a higher critical pH for dentine/cement, the prevention for root caries should be more intensive. Several studies indicate that fluoride is the cornerstone of root caries prevention. In addition, antimicrobials, in particular chlorhexidine, can be helpful in inhibiting root caries development. This paper proposes the use of three different risk categories for root caries to help adjust the intensity of preventive measures to the needs of the individual patient.

Humans↗
PubMed1993

Prevalence of root caries in a Japanese adult population aged 20-59 years.

The purpose of the present study was to investigate the prevalence of root caries in an adult population in Japan. A total of 770 company employees aged 20-59 were examined in 1990. The subjects were all dentate and had 27.2 present teeth on the average. The proportion of gingival recession in this population ranged from 20.1% for the 20-29 year old group to 75.2% for the 50-59 year old group, with an average of 44.0%. In the present study, 3.2% of the subjects showed one or more active root caries. The prevalence of active root caries ranged from 0.4% at age 20-29 to 7.1% at age 50-59. The proportion of persons with active root caries and/or root fillings ranged from 1.3% at age 20-29 to 36.3% at age 50-59. The percentage of subjects with active and/or inactive caries and/or root fillings varied from 3.1% at age 20-29 to 43.4% at age 50-59. The prevalence of active root caries in the subjects at risk (with gingival recession) was 7.4% on the average and ranged from 2.2% at age 20-29 to 9.4% at age 50-59. The percentage of persons with active root caries and/or root fillings in the subjects at risk ranged from 6.7% at age 20-29 to 48.2% at age 50-59. The mean number of teeth with active root lesions was 0.09 per person, and the mean number of teeth with root fillings was 1.25 at age 50-59.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Association between root caries occurrence and periodontal state.

To analyze the occurrence of root caries in relation to the periodontal state, we examined clinically a representative sample (n = 4,777) of Finish adults, aged 30 years and older. Our definition of root caries included primary decay on root surfaces, and a subject's periodontal state was described according to the presence or absence of gingival inflammation or periodontal pockets and subgingival calculus and/or overhangings. Subjects with a healthy periodontium seldom (4%) had any caries on root surfaces, whereas 15% had caries in conjunction with gingival inflammation, and 17% in conjunction with deepened pockets. The deeper the pockets, the greater the frequency of root caries for men, but not for women. Subgingival plaque retention showed a strong association with root caries. As the study population represented Finnish adults, the results can be generalized with reasonable confidence.

Adult↗
PubMed1990

[Will root caries become a treatment problem of the future?].

Based upon the present prevalence of root caries an attempt is taken to evaluate the future importance of this carious type. A population sample of 2,261 men and women aged 35 to 74 years were examined. The participation rate was 81%. Root caries was recorded when the lesion was obviously soft and located on cementum. The prevalence of root caries increased for both sexes almost consistently with age and ranged between 49 and 73%. In the mean 1.8 to 2.9 teeth were affected. Root caries was found more often among men than women. Over the sixth decades the reduction of the relative frequency of root caries was stated. Up to this age the rates of tooth extraction were higher than the rates of incidence. If it succeeded that in the future aged people will retain more teeth than nowadays a increase of root caries can be expected.

Adult↗
PubMed1995

The microbiology and histopathology of human root caries.

Based on numerous microbiological studies performed over the past several decades, it is clear that mutans streptococci can cause human root caries. S. mutans fulfills the criteria for implicating bacteria in the etiology of a mixed infection. For example, S. mutans is found in high numbers in lesion sites, higher than on sound root surfaces in the same subject. Subjects make elevated antibody levels to S. mutans antigens. The organism produces a number of virulence factors including metabolic acid from dietary sucrose and extracellular polysaccharides which facilitate bacterial colonization of tooth surfaces. Eliminating or reducing the number of S. mutans reduces the number of root caries lesions and can even result in "healing" of incipient lesions. There is also data demonstrating the cariogenic potential of S. mutans in animal models. Clearly, S. mutans fulfills the aforementioned requirements. Further, there is also evidence to implicate Lactobacillus as being important in the pathogenesis of root caries by virtue of its association with S. mutans in these lesions. There is less recent evidence regarding the importance of Actinomyces in this disease. While this microorganism is present in root caries and while animal studies clearly point to their cariogenic potential, more recent studies with few exceptions fail to find much association between Actinomyces and root caries. There is an important caveat, however. The Actinomyces may have subspecies groups which are more highly virulent and more closely involved in the etiology of root caries than other groups. For example, A. viscosus serovar 2 is associated with root caries. This and other subspecies groups may produce certain virulence factors not found within Actinomyces species as a whole. For this group of microorganisms and for other potential pathogens, techniques in molecular biology such as 16S ribosomal RNA sequencing offers the hope of more precisely defining species and unraveling what may be largely problems in bacterial taxonomy. Ribosomal RNA sequencing may reveal taxonomic relationships not apparent with classical phenotypic or serologic analyses. Other molecular methods, such as DNA or RNA probes to specific virulence factors may also reveal relationships between clinical lesions and microorganisms possessing these virulence factors. Finally, there are clearly a number of additional species which may have importance in root surface caries as shown in some studies. These techniques can be used to identify the distribution of novel, even uncultivable bacteria in root caries lesions and in this way establish their role in this important disease.

Actinomyces↗