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PubMed1999

The predominant Actinomyces spp. isolated from infected dentin of active root caries lesions.

Actinomyces are Gram-positive pleomorphic rods (GPPR) which form a large proportion of the oral microflora of all mammals. They have been implicated in root caries, although their role in dental caries initiation and progression is not well-understood. Many studies have focused on Actinomyces naeslundii, but few reports have documented other members of the GPPR. Therefore, we investigated the GPPRs isolated from infected dentin of active root caries lesions (n = 9) to determine which species were the most frequently isolated. The GPPR were isolated under both aerobic and anaerobic conditions and identified by biochemical and physiological tests to the species level according to the new taxonomy. Of 654 GPPR isolates investigated, 607 were identified as belonging to the genus Actinomyces. Of these, 242 were identified as A. israelii, 225 as A. gerencseriae, 109 as A. naeslundii, 15 as A. odontolyticus, and 13 as A. georgiae. Individual strains of A. israelii (n = 56) and A. gerencseriae (n = 46) were also investigated at the DNA level by means of Repetitive Extragenic Palindromic polymerase chain-reactions (REP-PCR) for the study of clonal diversity. Although only a small number of isolates was investigated, REP-PCR showed that the genotypes of both A. gerencseriae and A. israelii populations were heterogeneous within individual root caries lesions. A. gerencseriae and A. israelii strains from the same lesions did not share the same REP-PCR patterns, showing the robustness of the identification scheme. A significantly greater proportion of A. gerencseriae was isolated from the aerobic plates (p < 0.05), while the proportion of A. israelii was significantly (p < 0.05) greater from anaerobic plates. The role of individual Actinomyces spp. in the root caries process remains unclear, since various populations of GPPRs were isolated from individual active root caries lesions.

Actinomyces↗
PubMed1993

Diagnosis and prediction of root caries.

Diagnosis is the process of recognizing diseases by their characteristic clinical signs and symptoms. Diagnostic ability varies considerably between and among examiners, and, consequently, the accuracy of the diagnosis can be questioned. Root caries is a disease for which there are several clinical signs (location, color, surface texture, and surface cavitation). Unfortunately, these signs are open to broad clinical interpretation. As a result, estimates of disease occurrence (incidence rate) have ranged from 0.87 to 8.20/100 surfaces at risk/year or 0.15 to 0.43 lesions/person/year for adults living independently in the community. When multiple examiners are utilized, interexaminer agreement has been reported to be relatively good but could be further improved by minimizing the effects of several sources of examiner disagreement, including the absence of a global consensus on the signs which indicate the presence of root caries. The use of a diagnostic test can enhance the diagnosis and prediction of root caries, but the development of useful tests is hindered by the lack of an accurate clinical standard of diagnosis. At this time, diagnostic tests for root caries are quite limited and of questionable value. A powerful predictive tool for root caries would result from the combination of risk assessment measures and a valid diagnostic test developed with use of standardized and accurate methods of clinical diagnosis.

Humans↗
PubMed2001

Type 1 diabetes mellitus and oral health: assessment of coronal and root caries.

OBJECTIVES: The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). METHODS: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. RESULTS: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. CONCLUSIONS: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.

Adult↗
PubMed1989

Three-year root caries increments: implications for clinical trials.

Seven hundred and ninety-six adult subjects (mean age, 39.9 years) received visual-tactile examinations for root caries over a three-year period. All subjects were employed or were the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. During the three-year observation period, 81.4 percent of the subjects did not develop root caries. The 18.6 percent who developed root caries averaged 0.8 DFS/year. The subjects' ages and baseline root DFS status were associated with the development of a root DFS increment. The older the patient, especially aged 45 and older, the greater was the risk of developing root lesions or having root fillings placed. Subjects who had a root DFS score at baseline also were more likely to experience a root DFS increment. It is recommended that when designing clinical trials of agents purported to inhibit root caries, preselection criteria for the study population should consider the subjects' ages and past history of root lesions.

Adult↗
PubMed1995

The clinical diagnosis of root caries: issues for the clinician and the researcher.

This paper, after presenting a brief case for the relevance of root caries to today's practitioner, describes the differing diagnostic needs of clinical practitioners and clinical researchers. The goal is to inform the clinician of the state-of-the-art that exists today for the diagnosis of root caries in both clinical and research settings. Differing definitions for the diagnosis of root caries are presented that are useful, respectively, for the clinician and for the clinical researcher. Reasons for why there are differing definitions for clinicians and researchers are presented. Finally, eight critical issues are presented that will have to be resolved if clinical research on root caries is to improve its rigor: (1) active vs. inactive lesions, (2) supra- vs. sub-gingival lesions, (3) lesions crossing the CEJ, (4) prior clinical treatment: a visibility issue, (5) oral debris: a visibility issue, (6) instruments for tactile clues, (7) radiographs, and (8) diagnostic conventions.

Adult↗
PubMed1991

The prevalence of root caries in a diabetic population.

The objective of this study was to assess the level of root caries in a population of diabetic adults. Diabetics are of special interest because they are alleged to be periodontally compromised and have atypical patterns of refined carbohydrate ingestion. Diabetic subjects were patients of the Joslin Diabetic Center in Boston and had significantly elevated blood glucose and glycosylated hemoglobin levels over at least a ten-year period. Eligible subjects had to be between the ages of 45 and 65 and have a minimum of ten teeth and three sites with recession. Data were collected on coronal caries, oral hygiene, gingivitis, pocket depth, recession, and root caries and were compared with data from control subjects from a larger non-diabetic study group. There were 88 diabetics and 185 controls with mean ages of 55.7 and 56.3 years, respectively. The groups were found to be similar with respect to the numbers of buccal surface sites with gingival recession and the numbers of carious root lesions. There was a distinct difference, however, with respect to restored root surfaces: 1.76 mean filled surfaces were observed in the controls, as compared with 0.49 in the diabetics. A Katz Root Caries Index (for which lesions are calculated as a percentage of the numbers of exposed root surfaces) was determined to be 15.2 for the controls and 7.1 for the diabetics. A reasonable inference is that these differences are the result of a restricted ingestion of refined carbohydrates by the diabetic group. This was confirmed by a dietary survey of subsamples from the diabetic and non-diabetic groups.

Aged↗
PubMed1998

Issues in the treatment of root caries in older adults.

Increased life expectancy, improvements in tooth retention, and higher expectations about oral health will continue to result in an increased demand for esthetic restorative dental care. Using demographics as a predictor of future dental treatment needs, root caries may be one of the most significant patient management issues of the next decade. Root caries also can present the clinician with challenging restorative problems. The best treatment option is determined by the lesion, the caries rate, the condition of the patient, and the esthetic requirement or desire. Material selection is critical for successful restoration of root caries. The treatment of root caries also should include methods for the prevention of future lesions. Although caries risk assessment is not a perfected science, models can assist in estimating caries risk and then guide the clinician toward the most suitable preventive approach.

Aged↗
PubMedDate not supplied

A clinical evaluation of the restoration of root surface caries.

Root surface caries is of growing importance because its prevalence increases with age, and the population of the United States is growing older while edentulism and tooth loss rates have declined. Few clinical studies have evaluated materials used for the restoration of active root caries lesions. This study evaluated a Type II glass ionomer cement and a microfilled composite resin, both placed in preparations without mechanical retention or acid etching of enamel, in the restoration of root caries. Fifty adult volunteers with active root caries received one or both materials with the material chosen randomly. Patients were recalled after 24 months to evaluate restorations for retention, additional caries, marginal integrity, and overall clinical acceptability. Seventy-seven restorations were available for reevaluation. Forty-five percent of the glass ionomer and 73% of the composite restorations were clinically acceptable after 24 months. Of the glass ionomers, 39% were fully retained compared with 73% of composite restorations. Among those partially or fully retained, 25% of the glass ionomer restorations had minimal loss of marginal integrity and 30% had extensive loss while 53% and 9% of composite restorations had minimal and extensive loss, respectively. Most restorations were clinically unacceptable because of restorative material loss. Substantial numbers of glass ionomer cement and composite resin restorations were lost. This may be the result of difficulties in maintaining isolation and obtaining a proper gingival seal. Thus, routine use of mechanical retention is still highly recommended to reduce the loss of restorative material.

Adult↗
PubMed1995

Comparison of selected microflora of plaque and underlying carious dentine associated with primary root caries lesions.

The composition of the microflora recovered from superficial dental plaque sampled from 81 primary root caries lesions requiring restoration was compared with the microflora of the underlying, infected carious dentine. The numbers of bacteria in the plaque samples were significantly greater than in the dentine samples, and the frequency of recovery of mutans streptococci, streptococci, lactobacilli, gram-positive pleomorphic rods (primarily Actinomyces spp.), and yeasts was not significantly different between the paired samples. However, the proportion of lactobacilli and gram-positive pleomorphic rods was significantly greater in the dentine, while the proportions of streptococci and yeasts did not differ significantly; the proportions of mutants streptococci were similar in both samples. These data indicate that the microflora overlying primary root caries lesions is significantly different from that associated with the infected root dentine. The method of sampling and culturing the microflora of root caries lesions must, therefore, discriminate between the microflora of the superficial supragingival plaque and the microflora associated with destruction of the infected underlying dentine.

Actinomyces↗
PubMed1989

[The frequency of root caries in Slovenia].

In the pilot study carried out in 1989 in Slovenia 410 persons of both sexes aged above 30 were examined. It was found out, that primary root caries was present in 41.9%, secondary root caries in 5.6% and root fillings in 18.8% of examined persons. More root caries was found in persons consuming more carbohydrates and having bad mouth hygiene.

Adult↗
PubMed2006

Effects of Er:YAG laser on the sealing of glass ionomer cement restorations of bacterial artificial root caries.

OBJECTIVE: The aim of this study was to test the effect of Er:YAG laser irradiation on the marginal sealing of root cavities restored with two glass ionomer cements. BACKGROUND DATA: For preventing secondary root caries, new technologies for dental caries removal, such as the Er:YAG laser irradiation, have been proposed. METHODS: Forty-five human teeth were used. Artificial root caries were induced using a microbiological model (Streptococcus mutans). The lesions were removed by three different methods: conventional technique using burs (controls; groups 1 and 2); Er:YAG laser irradiation using dentine preparation parameters (250 mJ, 4 Hz, 80.6 J/cm2; groups 3 and 4); irradiation with the dentine preparation parameters followed by surface conditioning parameters (60 mJ, 2 Hz, 19.2 J/cm2; groups 6 and 7). After each preparation method, three teeth were prepared for scanning electron microscopy morphological observation. The remaining teeth were restored by conventional glass ionomer cement (G1, G3, and G5) or resin modified glass ionomer cement (G2, G4, and G6). After restoration, the samples were thermocycled (1,000 cycles) and prepared for microleakage test. RESULTS: Scores of less infiltrated samples were observed in groups treated by Er:YAG laser, and the smallest infiltration occurred in the group treated by the dentine preparation parameter, followed by cavity restoration with resin-modified glass ionomer (p < 0.05). CONCLUSION: Our results suggest that root caries removal by Er:YAG laser irradiation, followed by restoration with resin-modified glass ionomer cement, is a suitable choice for dental root caries restoration.

Dental Caries↗
PubMed1995

Comparisons of in vitro root caries models.

The purpose of this article is to compare various model systems for the production of in vitro root caries and to assess their ability to simulate the naturally occurring root caries process. Partially saturated buffer models and gel models were evaluated using polarized light microscopy and both qualitative and quantitative microradiography. All model systems showed very similar lesion formation when examined under polarized light. When microradiographs were compared, the systems which contained fluoride, showed clear radiopaque bands within the lesion. The bands, which occurred only in the presence of fluoride, appeared to be due to remineralization. When using an in vitro system that simulates the natural root caries process, it is imperative to understand the components of the particular model, as well as its limitations, and to be aware of the need for more than one evaluative technique.

Buffers↗
PubMed1986

Predictors of root caries in the elderly.

In an attempt to determine the association between overall health status, medication history, and oral hygiene status and root caries, 24 older persons residing independently in the community and 23 residents of a nursing home were interviewed and received oral examinations, using the Oral Hygiene Index and the Root Caries Index. The mean age of this population was 80 yr, with the nursing home subjects somewhat older than community-dwelling subjects. Only six persons had no root surface caries; three subjects had caries on all tooth surfaces with gingival recession. Mandibular teeth, particularly molars and premolars, showed the greatest attack rate. The best predictors of root caries were number of teeth remaining, calculus, plaque, and the use of medications with xerostomic effects. Medications were most predictive of maxillary root caries. The results point to the need to provide interceptive dental therapeutics for high risk geriatric populations such as those using multiple medications and with a poor history of oral care.

Aged↗
PubMed1991

Salivary levels of mutans streptococci, lactobacilli, yeasts, and root caries prevalence in non-institutionalized elderly dental patients.

Root caries prevalence was recorded for a consecutive sample of dental patients (n = 146), aged over 55 yr and with at least 12 natural teeth. The mean root DFS score of the males (n = 49) was 6.34 +/- 4.55 and for the females (n = 97) 3.76 +/- 3.31 (P less than 0.001). The salivary levels of mutans streptococci, lactobacilli, and yeasts were determined in addition to salivary flow rate and buffering capacity. Subjects with greater than 1 root DFS had significantly higher salivary levels of mutans streptococci, lactobacilli, and yeasts. They also had fewer teeth and more exposed root surfaces. In step-wise multivariate analyses the factors significantly related to the root DFS score were the number of exposed root surfaces, number of teeth, sex and salivary yeast levels (R2 = 0.41). In the multivariate analyses salivary levels of mutans streptococci were not significantly related to any clinical measurement of root caries experience due to the greater strength of association between the root DFS score and salivary levels of yeasts. Subjects prescribed medicines with a reported xerostomic effect had significantly fewer active root lesions than those not prescribed such medicines and salivary levels of all microorganisms studied were significantly elevated in subjects prescribed medications containing sucrose.

Aged↗
PubMed2000

[Root caries in patients in periodontal follow-up care. Prevalence and risk factors].

The aim of this cross-sectional study was to investigate the prevalence and several risk indicators of root cariës in 45 periodontal maintenance patients, who had been actively treated for adult periodontitis 11-22 years ago. These patients were part of a routine 3-6 monthly maintenance schedule. Active and inactive root caries and root fillings were recorded, as well as coronal caries experience. Plaque and bleeding scores, number of exposed root surfaces, rate of saliva secretion, saliva buffer capacity, S. mutans counts and Lactobacilli were also scored. From the total of 45 subjects, 37 patients (82%) showed root lesions (root caries and/or fillings), while only 8 patients were free of any root lesions. On average, there were 4.3 lesions per patient (range 0-19) in the present study. Of all damaged root surfaces, 9% were active lesions, mostly located on mandibular teeth at lingual and vestibular sites; 40% were inactive lesions often detected at vestibular sites. The remaining damaged root surfaces (51%) were restored; they were equally divided over both jaws. A higher number of root lesions was observed in those patients with > 106 S. mutans/ml saliva. Although the actual number of lesions per patient was low in relation to the large number of sites with gingival recession, the results from this cross-sectional study in periodontal maintenance patients indicate that: root cariës can be regarded as a complication in periodontal maintenance patients, that the individual number of root lesions correlate with individual dental plaque score, that a high number of root lesions is associated with counts of salivary S. mutans, and that no relation between root cariës and coronal caries experience, salivary secretion rate or salivary buffering capacity seems present. Therefore, repeated oral hygiëne instructions and adjunctive preventive measures including diet counseling and fluoride rinses, as well as fluoride and chlorhexidine varnishes, should be advocated in high-risk patients.

Adult↗
PubMed1992

Root caries prevalence in black and white North Carolina adults over age 65.

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

Aged↗
PubMed2006

The use of ozone in dentistry and medicine. Part 2. Ozone and root caries.

A previous paper, recently published in Primary Dental Care, gave an overview of the medical uses of ozone and outlined some of its uses in dentistry. The current paper focuses on a description of use of ozone in the management of root caries and considers recent studies in this area. There has been relatively limited research into the non-invasive (pharmaceutical) management of root caries. The best management strategy still remains to be developed. Initial studies have indicated that an application of ozone for a period of either 10 or 20 seconds is capable of clinically reversing leathery root carious lesions. It is suggested that, subject to confirmation from extensive trials, this simple and non-invasive technique may benefit many patients with root caries throughout the world since this approach to treat root caries can easily be employed in primary care clinics and in the domiciliary treatment of home-bound elderly people and immobile patients in hospices and hospitals.

Anti-Infective Agents↗
PubMedDate not supplied

Prevalence and distribution of root caries in Pomerania, North-East Germany.

The aim of this study was to assess the prevalence and distribution of root caries in the adult population of Pomerania, Germany. The study sample comprised 6,267 randomly selected subjects who were scheduled for examination from 1997 to 2001 (population-based cross-sectional study, response rate: 69%, age range 20-79 years). 499 edentulous persons were excluded from the dental examination (12%) performed according to WHO guidelines (1997). In the statistical analysis, frequency distributions, means and median values were calculated and subdivided for different age groups. The percentage of exposed and affected root surfaces increased with age (root caries index 4.6-10.6%). The mean number of carious/filled root surfaces (RDFS) rose from 0.4 per person (25-34 years) to 2.3 (55-64 years) and dropped for seniors due to the low number of retained teeth. Fillings comprised the largest proportion of the RDFS (69.5%). Most caries/fillings were found on buccal surfaces, the highest rate in mandibular premolars. With about half of over-45-year-olds having at least one carious/filled root surface and increasing number of retained teeth in seniors, root caries is a relevant and probably growing disease in Pomerania and East Germany.

Adult↗