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Diagnosis and Prediction of Root Caries
Abstract
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.
... Yet, such a technique cannot readily be implemented to detect root caries. 45,46 The main concern using the traditional method in diagnosing root caries is related to the subjectivity between the examiners; nevertheless, clinical studies demonstrated good to excellent inter-examiner reliability. 46,47 Slight clinical disagreement was clearly evident due to factors such as presbyopia and colour blindness, which could impact the interpretation of the lesion colour, as well as the presence or absence of cavitation. ...
... 45,46 The main concern using the traditional method in diagnosing root caries is related to the subjectivity between the examiners; nevertheless, clinical studies demonstrated good to excellent inter-examiner reliability. 46,47 Slight clinical disagreement was clearly evident due to factors such as presbyopia and colour blindness, which could impact the interpretation of the lesion colour, as well as the presence or absence of cavitation. 46,47 Additionally, the difference in tactile sensation between examiners has created conflict due to the sensitivity and minimal difference involved in determining whether particular root dentine is soft or firm. ...
... 46,47 Slight clinical disagreement was clearly evident due to factors such as presbyopia and colour blindness, which could impact the interpretation of the lesion colour, as well as the presence or absence of cavitation. 46,47 Additionally, the difference in tactile sensation between examiners has created conflict due to the sensitivity and minimal difference involved in determining whether particular root dentine is soft or firm. 42 While many of the root lesions are shallow, deep root cavities may be located proximally or subgingivally, where cleaning is difficult, and the visual examination is overlooked. ...
Background
Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.
Objective
This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.
Materials and Methods
MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.
Results
Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in‐office and home remineralisation tools. The use of non‐invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin‐based restorations can be placed.
Conclusion
The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries–affected patients.
... Dental plaque is the main etiologic factor of dental diseases and one of the most frequently reported risk factors for development of root caries (Ravald et al. 1986, 1993, Ravald & Birkhed 1992, Reiker et al. 1999). The addition of fluorides to oral hygiene products is one of the cornerstones of prevention and oral health promotion. ...
... By adding AmF to SnF 2 , the latter becomes more stable and both fluorides demonstrate synergistic plaque-reducing effect (Mühlemann 1981, Brecx et al. 1990, 1993, Zimmerman et al. 1993. The combined use of these fluorides has shown to be effective even when microorganisms were incorporated in biofilms (Arweiler et al. 2001, Shapiro et al. 2002. ...
... The clinical diagnosis of root caries is based on a number of signs both visual (color, contour, surface cavitation) and tactile (surface texture) (Banting 1993(Banting , 2001. The major component of the caries experience indices is the number of the restored root surfaces (Banting 2001). ...
... In contrast to coronal caries, root caries lack a valid diagnostic standard, such as radiography [2]. Investigators have not developed a reliable relationship between root caries' appearance and activity [3,4]. Most experts agree that active root lesions are soft, yet tactile hardness assessments remain subjective and lack reliability [3]. ...
... Investigators have not developed a reliable relationship between root caries' appearance and activity [3,4]. Most experts agree that active root lesions are soft, yet tactile hardness assessments remain subjective and lack reliability [3]. Multifactorial root caries scoring systems have been developed with mixed success [5,6]. ...
The active surveillance of root caries lesions to monitor potential remineralization or decay progression is challenging for the clinician, due to unreliable diagnostic information. The conventional visual and tactile methods for assessing the lesion activity are not reliable, and the clinician is often unable to determine if the lesion is progressing or has been arrested. An important marker of an arrested lesion is a highly mineralized transparent surface zone (TSL) that forms when the mineral is deposited in the outer layer of the lesion. The purpose of this study was to determine if cross-polarization optical coherence tomography (CP-OCT) could be used to detect changes in the lesion severity and activity during active monitoring. In total, 18 subjects with 22 suspected active root caries lesions were evaluated using CP-OCT at the baseline, 3 months, and 6 months. All subjects were instructed to use a high fluoride dentifrice at the baseline. The results showed that CP-OCT was able to discriminate the active from the arrested lesions by identifying the presence of a TSL on arrested lesions. The results also indicated that the mean TSL thickness increased significantly (p < 0.05) for the nine lesion areas. In addition, CP-OCT was able to show the progression of demineralization, erosion, and changes in gingival contours in scanned areas. CP-OCT was valuable for monitoring the activity and severity of root caries lesions in vivo. CP-OCT can be used to assess the activity of root caries lesions at a single time point by detecting the presence of a TSL at the lesion surface indicative of the lesion arrest.
... Traditional methods of visual-tactile diagnosis for root caries can result in a correct diagnosis, but not until the lesion is at an advanced stage [5]. In addition, investigators have not developed a reliable relationship of appearance with lesion activity [6][7][8]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [6]. ...
... In addition, investigators have not developed a reliable relationship of appearance with lesion activity [6][7][8]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [6]. Multifactorial root caries scoring systems have been developed with mixed success [9,10]. ...
New imaging technologies are needed for the clinical assessment of lesions on root surfaces. It is not sufficient to simply detect caries lesions; methods are needed to assess lesion depth, structural composition and activity to determine if chemical intervention has the potential to be effective and if remineralization has occurred. Lesions were monitored using CP-OCT during lesion dehydration to assess the lesion structure and any shrinkage. Thermal imaging at 6-10 μm wavelengths and short wavelength-IR imaging at 1450-1750-nm were used to monitor thermal emission during lesion dehydration to assess lesion activity. Imaging probes were custom fabricated for clinical use. We present the first clinical results of a small feasibility study employing CP-OCT, thermal and SWIR imaging to assess lesion activity in vivo on thirty test subjects with suspected root caries lesions.
... Traditional methods of visual-tactile diagnosis for root caries can result in a correct diagnosis, but not until the lesion is at an advanced stage [1]. In addition, investigators have not developed a reliable relationship between lesion appearance and activity [2][3][4]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [2]. ...
... In addition, investigators have not developed a reliable relationship between lesion appearance and activity [2][3][4]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [2]. Multifactorial root caries scoring systems have been developed with mixed success [5,6]. ...
New imaging methods are needed to assess the activity of caries lesions on tooth surfaces. Recent studies have shown that thermal imaging of lesions on root surfaces during dehydration with air can be used to determine if the lesions are active or arrested. In this study changes in the thermal emission of root caries lesions on extracted teeth during dehydration with air was monitored using an imaging system with a miniature thermal camera and a 3D printed handpiece with an integrated air nozzle suitable for clinical use. This study evaluated the performance of the thermal camera for imaging root caries on extracted teeth prior to it's use for in vivo studies. There was a significant difference in the thermal response of sound and root lesion areas of human teeth under dehydration at constant airflow.
... Traditional methods of visual-tactile diagnosis for root caries can result in a correct diagnosis, but not until the lesion is at an advanced stage [1]. In addition, investigators have not developed a reliable relationship between lesion appearance and activity [2][3][4]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [2]. ...
... In addition, investigators have not developed a reliable relationship between lesion appearance and activity [2][3][4]. Even though most experts agree that active root lesions are soft, tactile hardness assessments remain subjective and lack reliability [2]. Multifactorial root caries scoring systems have been developed with mixed success [5,6]. ...
Demineralized root dentin and cementum are mostly collagen that shrinks significantly upon dehydration. Active root caries lesions manifest shrinkage upon dehydration, however during the remineralization of root caries lesions mineral is deposited on the outside of the lesion arresting the lesion and arrested lesions no longer manifest shrinkage upon dehydration. Optical coherence tomography is ideally suited for the measurement of that shrinkage for the assessment of lesion activity. In this study the shrinkage of natural root caries lesions on extracted teeth were measured using a CP-OCT system with a 3D printed appliance with an integrated air nozzle suitable for clinical use.
... [13][14][15][16][17][18][19][20] The most commonly used clinical signs to describe root caries utilized visual (color, contour, surface cavitation) and tactile (surface texture) specifications. 21 There are no reported clinical symptoms of root caries although pain may be present in advanced lesions. ...
... When only untreated root caries is diagnosed, examiner reliability is reduced considerably. 21,22 Intra-examiner reliability has been shown to be slightly, but not dramatically, better than interexaminer reliability. 22 Clinical disagreement can be attributed to several factors. ...
Interest in root caries has grown among dental caries research workers over the past 20 years. However, many studies, either in the fields of microbiology, pathology, epidemiology or clinical trials, have used differing definitions in their diagnosis of root caries. These differences mean that comparison between studies is difficult, if not impossible. Most of the criteria currently in use are neither sufficiently specific to allow the identification of the initial root caries lesion, not detailed enough to assess the progression of lesions. Furthermore, most definitions provide no information on treatment need within the populations studied. In this paper, the criteria which have been used to diagnose root caries, and their individual components – texture, cavitation, position, size, colour and radiolucency – are reviewed. It is concluded that there is a need to standardise terminology and definitions used for the diagnosis of root caries.
... Further, the hardness of root carious lesions also depends on its stage of progression; active lesions tend to be soft/leathery whilst arrested lesions are hard [4]. It should also be noted that arrested lesions remain unchanged during several years of observation [5]. ...
Purpose
The aim of this study was to quantify surface roughness of carious dentine using noncontact optical profilometry (NCOP) in vitro.
Methods
A total of 20 extracted teeth with root caries were examined according to clinical assessment criteria. NCOP (Proscan 2000, Scantron, Taunton, UK) was used to carry out the surface roughness measurements in vitro. Selection of sampling rate measurements were subsequently performed.
Results
Results showed that the surface roughness (Ra) values were most accurately obtained at a sampling rate of 30 Hz. All lesions had rough texture, with cavitation ranging from 0.5 to 4 mm. Most lesions were leathery, whilst remaining few were soft. There was a significant difference in surface roughness between the carious and sound dentine (p < 0.05). Pearson’s correlation coefficient tests failed to show any significant linear correlation between surface roughness measurements and cavitation (r 0.39; p > 0.05) whilst there was a significant correlation between the hardness and surface roughness (r 0.47, p = 0.04). There was an inverse relationship trend between surface roughness measurements and severity of root caries.
Conclusions
There are limitations due to the sophisticated layout of collage network within the root carious dentine especially cavitated lesions. The NCOP could be considered for the quantification of surface roughness on noncavitated carious dentine in a laboratory setting.
Clinical significance
The effect of different oral health care products on root caries using the NCOP without causing any potential damage to the noncavitated root surface could be assessed prior to the large-scale clinical studies.
... These relate to the classification of such lesions for some think they should be classed as root surface caries extending onto the crown or indeed as coronal caries extending onto the root or even both. This however is more a measurement issue than a diagnostic one [3]. ...
Aims
Placement of a restoration to treat root caries disrupts many tissues. There is scope for the restorative material to interact with these to augment reductions in micro leakage afforded by an adhesive restorative material.
Objectives
1) To investigate the effects of incorporating bioactive molecules into a glass polyalkenoate (GPA) 2) To quantify the changes in physical properties of the material.
Methods
Biocompatibility of the GPA cement (Chemfil Superior, Dentsply De Trey, Konstanz, Germany) in unmodified and modified forms was ascertained using cell culture techniques. The optimum concentration of bioactive components required to promote cell attachment was determined indirectly by quantification and localisation of the fibroblast marker vimentin. The properties of surface hardness, compressive strength and adhesive bond strength were also determined prior to and following addition of the bio-additives: collagen type I and a pentapeptide containing Arg-Gly-Asp (RGD).
Results
Addition of Type I Collagen (100 μg/ml) and RGD (5 mg/ml) to ChemFil Superior had no statistically significant effect upon the compressive strength and bond strength to bovine enamel but significantly (P < 0.05) increased the materials shore hardness. The addition of RGD to ChemFil Superior increased most the expression of vimentin, indicating that the cells had become more fibroblastic. This may be indicative of increased synthesis of extracellular matrix macromolecules with the potential to foster adhesion of the modified glass polyalkenoate to distracted gingival tissues.
Conclusions
The results suggest that addition of bioactive molecules to GPA cement for subgingival restorations has potential clinical applications.
Clinical significance
It is possible to envisage that the additions, as described in this paper, could foster the attachment of displaced gingival tissues to GPA restorative materials placed subgingivally where root caries has been treated. This would offer potential to form a seal around the restoration by the attached gingival tissues avoiding a periodontal pocket and depriving residual cariogenic bacteria of a nutrient supply. Further investigation of the effects upon other similar materials of such additions is warranted.
... Root caries is an area on the surface of the tooth, at or apical to the CEJ, that has undergone clinically apparent dissolution of mineral of the calcified tissues. [8] Clinically, root caries appears as white (in the earliest stage) or discolored (tan, brown, or black) areas of irregular outline, with or without cavitation, on an exposed root area, along an exposed CEJ, or at a margin of a restoration that is supragingival but within root structure. [9] Studies have demonstrated that DBA when applied to demineralized dentin surface forms finger -like resin tags protruding into the entrance of the patent dentin tubules. ...
Objective: To evaluate the caries-protective effect of three recent dentin bonding agents (DBAs) on demineralization of root surface in vitro . Materials and Methods: The root surface of 70 freshly extracted caries-free human teeth was thoroughly cleaned and polished, thereby removing the cementum. The root surfaces were coated with acid-resistant nail polish and 2 mm × 3 mm rectangular window was prepared on the buccal surface. The samples were then divided randomly into three experimental groups; Group 1 (Xeno-V), Group 2 (Tetric N Bond), and Group 3 (Gluma Self-etch) which were further divided into two Subgroups (A and B) with 10 samples each in which second layer of adhesive was cured without air thinning and with air thinning respectively. Subsequently, all specimens were demineralized for 6 days with acidified gel (hydroxyethylcellulose, pH 4.8, 37°C). Each tooth samples were sliced in plano parallel section (80 ± 20 μm) by safe sided diamond disc and examined for caries-like lesions (demineralized area) under a polarized microscope. Data were analyzed using one-way ANOVA, Student's t - and Tukey honestly significant difference tests. Results: All control group specimen exhibited lesions with a mean depth of 86.15 μm. In Group 1–3, the lesion depth was reduced significantly, Subgroup A results were better than B. Conclusion: Demineralization on root surface can be impeded by DBA tested. Gluma Self-etch showed maximum caries-protective effect.
... (71). Las variaciones inter -examinador se asocian principalmente a la agudeza visual, que puede afectar la interpretación de la presencia de cavidad o cambio de coloración; sin embargo, existe menor desacuerdo a la hora de valorar la dureza o reblandecimiento de las superficies (71). ...
La caries radicular (CR) se define como una lesión progresiva, crónica, con tejido reblandecido y originada en las raíces dentales expuestas al medio oral. Los adultos mayores son más susceptibles a presentar esta patología que otros grupos etarios, dada su mayor prevalencia de recesiones gingivales. El objetivo del presente artículo es realizar una revisión narrativa de la literatura sobre la caries radicular en el adulto mayor, con el fin de presentar una puesta al día que sirva de guía a los odontólogos para la toma de decisiones clínicas sobre su manejo. Se realizó una búsqueda de artículos en inglés y español, mediante los términos MESH Root Caries (AND) Elderly en las bases de datos Pubmed, ScienceDirect, Google Scholar y Scielo, sin restricción para año de publicación. Se incluyeron artículos de investigación en seres humanos y revisiones sistemáticas sobre el tema. Inicialmente se obtuvieron 127 publicaciones de las que se descartaron 13 documentos, luego de la lectura de los resúmenes. Se encontró una alta prevalencia de CR en Colombia y en América Latina (27.6% y 23.71% respectivamente). Entre los factores de riesgo asociados, se reportaron la conservación de un mayor número de dientes en edades avanzadas, la recesión gingival, el acúmulo de biofilm, el uso de prótesis, la ingesta frecuente de azúcares refinados y las alteraciones físicas y cognoscitivas. Se encontró, igualmente, que la localización, el color, la textura superficial y la profundidad de la cavidad son factores determinantes del diagnóstico y el tratamiento de la CR y que la determinación del enfoque terapéutico parte de la clasificación del paciente en un nivel de riesgo.
... Root caries is a disease that affects an area on the surface of the tooth, at or apical to the cementoenamel junction (CEJ) that has undergone clinically or radiographically apparent demineralization of the exposed surfaces 1,2 . This process involves the cementum first, although in some cases it begins in dentine. ...
Since past few years, there have been many strategies to combat dental caries, erosion, hypersensitivity, and many other oral conditions. The last decade has seen many advanced researches in the field of dentistry. The scope of dentistry has evolved from only a curative one to a largely preventive one. There have been technologies available for the minimal invasive cure of dental caries, early diagnosis and early reversal of the initial carious lesion using nonoperative techniques. There has also more focus being made to treat dental caries as a process rather than curing the lesion only. The role of saliva, demineralization and remineralization has been better understood. The aim of this paper is to review the contemporary nonfluoridated systems available for remineralization therapy and ideas for their implementation into clinical practice. A search of articles from "PubMed" and "Medline" and databases like Google and Google scholar, ScienceDirect and Wiley with the keywords remineralization, demineralization, nonfluoridated demineralizing agents was conducted in the month of August 2012 out of a total 114 articles, 86 articles have been used in the present evidence-based review.
... Published reports on the clinical measurement of root caries were consulted in developing the ICDAS criteria [Hellyer and Lynch, 1991;Banting, 1993;Banting, 2001;Leake, 2001]. Given the paucity and generally low level of the scientific evidence, the ICDAS Coordinating Committee, recommends that the following clinical criteria be used for the detection and classification of root caries: ...
... These relate to the classification of such lesions for some think they should be classed as root surface caries extending onto the crown or indeed as coronal caries extending onto the root or even both. This however is more a measurement issue than a diagnostic one [3]. ...
The American Academy of Operative Dentistry cites glass polyalkenoates (Glass Ionomer) as the material of choice to restore root surface caries lesions. Although apparently successful in the majority of cases, it is not always possible to achieve a reliable seal from the oral environment when such lesion extends subgingivally. This is due to haemorrhage impeding placement and attachment of displaced gingival tissues.
Objective:
To investigate, via a biomaterials approach, the properties of glass ionomer in manufactured form and a biologically modified form to promote cellular attachment.
Method:
1. The properties of surface hardness, strength [compressive, diametral, flexural (3 point and biaxial)], diametral fatigue strength and adhesive bond strength of commercial available glass ionomer (GC Fuji VIII, ChemFil Superior) were determined prior to and following addition of bio-additives (Collagen Type I, RGD, Emdogain).
2. Biocompatibility was ascertained using cell culture techniques (observation under the microscope, Cell viability testing (MTT Assay) and Examination the expression of Vimentin) the potential and optimum concentrations of bioactive additional components, required to promote relevant cell attachment, to the modified restorative materials were investigated.
Result:
GC Fuji VIII was shown by cell observation and viability tests to be less biocompatible than ChemFil Superior.
The addition of Type I collagen to ChemFil Superior increased the expression of Vimentin as determined by Immunocytochemistry and western blotting, indicating that the cells had become more fibroblastic. This increase was not seen to the same level with Emdogain.
Addition of Type I Collagen and RGD to ChemFil Superior improved all of its physical properties significantly (p > 0.05), except for shear bond strength where no detriment was observed.
Conclusion:
This approach has clinical potential to improve the restoration of root caries but before application further investigations is warranted.
The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.
Improved methods are needed to assess the structure and activity of lesions on root surfaces in order to improve clinical decision making. Conventional visual and tactile methods for assessing lesion activity are not reliable, and the clinician is often unable to evaluate if the lesion is progressing or has remineralized. An important marker of an arrested lesion is a highly mineralized surface zone that forms when mineral is deposited in the outer layer of the lesion. In vitro studies have shown that a mineralized surface zone influences the kinetics of water evaporation and the surface temperature while drying. Temperature changes can be monitored by measuring the thermal emission with thermal imaging. Studies have also shown that the depth and severity of demineralization and the thickness of the highly mineralized transparent surface zone on arrested lesions can be measured nondestructively with optical coherence tomography (OCT). Thermal imaging at 8-µm to 13-µm wavelengths was completed on 30 test subjects with a suspected active root caries lesion by monitoring thermal emission from the tooth surfaces during 30 s of air drying. Lesions were also evaluated using cross-polarization OCT (CP-OCT) during lesion dehydration to identify transparent surface zones indicative of arrested lesions and determine if shrinkage occurred during drying. The overall thermal emission recorded during drying was significantly different (P < 0.001) when comparing sound tooth surfaces, lesion areas identified as arrested, and lesion areas identified as active, demonstrating that thermal imaging is a promising approach for the clinical assessment of lesion activity on root surfaces. Ten of the lesions in this study had distinct areas with transparent surface zones that were visible in CP-OCT images. Shrinkage was detected with CP-OCT during drying for 12 lesions. This study confirms that these novel approaches for assessing lesion activity on root surfaces can be implemented in vivo.
Objectives:
Demineralized root dentin and cementum is made up of mostly collagen that shrinks significantly upon dehydration or drying with air. During remineralization mineral is deposited on the outside of the lesion creating a highly mineralized surface layer that inhibits diffusion, arrests the lesion and prevents shrinkage. Previous studies suggest that active root caries lesions manifest shrinkage, while arrested lesions no longer manifest shrinkage upon dehydration. The purpose of this study was to demonstrate that the shrinkage of root caries lesions can be monitored during dehydration using an optical coherence tomography probe suitable for clinical use.
Methods:
In this in vitro study the shrinkage of simulated and natural root caries lesions on extracted teeth was measured using a cross polarization optical coherence tomography (CP-OCT) system and a 3D printed appliance with an integrated air nozzle suitable for clinical use. Two methods were employed to assess shrinkage, changes in the position of the lesion surface and changes in the thickness of the lesion.
Results:
CP-OCT was successful in measuring a significant (P < 0.05) contraction of the lesion surface, significant decrease in the lesion thickness and increase in the reflectivity per micron upon drying natural lesions on extracted teeth.
Conclusions:
In this preclinical study, we have demonstrated that a CP-OCT handpiece modified for infection control with an attached air nozzle suitable for in vivo use can be used to monitor the shrinkage of root caries lesions. In addition, we have developed a new approach to measuring lesion shrinkage with OCT, namely monitoring changes in the lesion thickness as opposed to the position of the lesion surface, that does not require an initial reference position and is more easily implemented in vivo.
Background and objectives: An area on the surface of tooth, apical to CEJ, where root caries are bound to occur undergoes clinically apparent dissolution of the calcified tissues. When dentin bonding agent is applied, it forms finger like resin tags protruding into patent dentin tubules When this resin penetrates the superficially demineralized collagen matrix, it forms a hybrid layerand prevents root surface lesions. Aim: To evaluate the caries protective effect of three recent DBAs on demineralized root surface. Materials and methods: 88 single rooted extracted human teeth were selected, root surfaces apical to CEJ were polished .Acid resistant nail paint wascoated over root surfaces exposing a rectangular window on the buccal surface. Three experimental groups made: Group 1 (XENO V PLUS), Group 2 (TETRIC N BOND), Group 3 (ONE COAT 7 UNIVERSAL). These groups were divided into 2 Subgroups (A and B). Adhesive was applied and light cured with air thinning. Over this second layer of adhesive was applied, light cured with /without air thinning. Each tooth samples were sliced. A light microscope was used to examine the caries like lesions.The statistical analysis was carried out. Results:All control group specimen showed lesions with a mean depth of 177.74μm. Subgroup B results were better than A and C. Summary and Conclusion: Demineralization on root surface can be impeded by DBA tested TetricN Bond which showed maximum cariesprotective effect Key words:Cementum, demineralization, dentine bonding agent
The identification of root caries and calculus on tooth roots is of increasing importance with our aging population. Exposed root surfaces are often impacted by erosion, abrasion, calculus and staining which can make the identification and management of caries challenging. Identification of dental calculus on root surfaces and verification of its removal is also important for patient education and to decrease susceptibility to caries and periodontal disease. The objective of this study was to determine how the contrast of root caries lesions and dental calculus varies with wavelength in the visible to near‐infrared (NIR). The contrast of suspected root caries lesions and dental calculus on thirty extracted teeth was measured using cross‐polarization reflectance measurements at wavelengths from 400‐2350‐nm. Significantly higher (P<0.05) lesion contrast was measured at wavelengths greater than 1460‐nm. Stains interfered significantly at wavelengths less than 850‐nm yielding non‐diagnostic contrast for root caries lesions. We postulate that the high absorption of water at longer wavelengths reduced the light scattering from the surrounding and underlying normal dentin, thus increasing the lesion contrast. This study indicates that wavelengths beyond 1400‐nm are advantageous for imaging calculus and caries lesions on root surfaces due to the high contrast and lack of interference from stain.
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The diagnosis of root caries and root fractures is of increasing importance due to our aging population. The objective of this study is to show that optical clearing agents can be used to increase the visibility of subsurface structures in tooth roots to aid in the diagnosis of root caries depth and extension and to differentiate from subsurface defects. Previous studies have shown that high refractive index fluids can increase the depth penetration of optical coherence tomography (OCT) for imaging caries lesions on tooth enamel. Extracted teeth with suspected root caries were imaged with (OCT) with and without the addition of water (W), glycerol (G), and propylene glycol (PG). The reflectance was monitored in sound and demineralized areas before and after application of W, G, and PG. The visibility of subsurface root canals was also measured before and after application of the respective fluids. In addition, shrinkage in lesion areas was measured after lesion dehydration to aid in the assessment of lesion activity. This study shows that optical clearing agents can be used to increase the performance of OCT for the diagnosis of root caries and other defects on root surfaces.
Background and objectiveA prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.Material and Methods
The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.ResultsAlthough there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.Conclusion
Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.
The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender, Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.
The reliable and reproducible detection of dental caries by clinical examination has been recognized as a problem for decades with very variable approaches being taken to recognize and stage lesions along the continuum of caries--from very small initial lesions, just visible to the human eye, through more established white- and brown-spot lesions, to shadowing beneath the enamel and different extents of cavitation. Clinical caries lesion detection implies some objective method of determining whether or not disease is present, and many systems have been developed to improve the objectivity of examiners. The existence of a large number of different systems, using different definitions of caries detection thresholds, lesion staging and examination conditions has led to problems in comparing between studies and communicating across different dental domains. The International Caries Detection and Assessment System (ICDAS) has been developed from the best elements of previously published systems and is based upon the most robust evidence currently available to address the incompatibility of the systems currently used across the full breadth of cariology. The inherently visual ICDAS lesion detection codes are outlined for use with primary coronal caries, caries adjacent to restorations and sealants and for root surface caries. The ICDAS detection codes for primary coronal caries have been demonstrated to have the capability to record both enamel and dentinal caries in a reliable, valid and reproducible manner in both permanent and deciduous teeth and are being adopted increasingly in the domains of research, epidemiology, clinical practice and education.
Interest among researchers in the diagnosis, aetiology, prevention, and treatment of root caries has increased substantially over the past two decades. However, there are some fundamental problems impeding the advancement of the field which remain to be addressed and resolved. A universally acceptable definition of root caries is not yet available. The relationship of root caries to coronal caries has not been established. The underlying disease process is still not clearly understood. The optimal utilisation of preventive/therapeutic agents for the treatment or prevention of root caries has not been determined. New treatment materials and preventive agents have not yet been tested in controlled clinical trials. These are a few of the issues and problems which we address in this paper.
The oral health and concerns of elderly residents were surveyed in a stratified random selection of 41 long-term care facilities in Vancouver. The residents who could participate were examined and interviewed to determine their oral health and concerns about dental treatment. The need and time required for treatment were estimated in six groups to reflect the propensity for treatment in dentate and edentate subjects. The propensity for treatment was high in about one-third of the participants whereas it was unlikely that one-tenth of those examined would ever use a dental service. In general, there was a widespread need for a diagnostic service because so few had been examined by a dentist in the previous year. Prosthodontics accounted for most of the treatment in all of the propensity groups, with substantially more time required by the dentate residents. There was also a substantial need for management of mucosal pathoses and oral hygiene and, to a lesser extent, for dental restorations and endodontics. Overall, our estimates indicate a substantial need for dental treatment among residents of long-term care facilities, although the need is reduced by half if the propensity for treatment is considered.
Indices used to evaluate plaque accumulation and coronal caries have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of clinical criteria used in coronal and root caries diagnosis and oral hygiene evaluation as applied in elders. Nineteen elderly subjects, 73 years old on average, were examined at a first appointment by two independent examiners. They were re-examined two weeks later. Plaque accumulation was evaluated using the Plaque Index (PI) and coronal and root caries were detected according to the WHO criteria and Fejerskov et al. (1991), respectively. Recurrent caries was recorded as recommended by WHO and by probing at the interface tooth-restoration. Inter- and intra-examiner agreement was evaluated using kappa statistics. The PI score showed good reliability except for examiner b, for whom a simplification of the 4-point scale in 3-point scale improved significantly the reliability. The prevalence of coronal caries was very low and intra- and inter-examiner agreement was poor. Most of the root caries lesions were covered by plaque and the kappa values indicated only poor agreement. Recurrent caries were found with good agreement using WHO criteria but the detection with the probe was not reliable. In conclusion, it seems that examiners should be trained carefully to maximise their reliability and that plaque should be removed to obtain reliable diagnoses of caries. Retraining and calibration may be necessary for surveys continuing over a long period.
This paper considers the question of whether, by using the currently available measures for assessing caries risk, one can identify with sufficient accuracy the high caries-risk susceptible individuals who need individual protection to avoid having an unacceptably high number of new cavities. In addition, the outline of a typical caries prediction study is presented with an example, Finally, the accuracy of an actual caries prediction is compared with the accuracy of predicting the onset of acute myocardial infarction in order to point out the fact that the risk of any disease is difficult to assess accurately.
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.
To relate the Electrical Caries Monitor (ECM) and Resilience Caries Monitor (RCM) readings with clinical criteria used to define primary root carious lesions (PRCLs) in vitro.
PRCLs were classified according to color, texture, hardness, cavitation, size and severity before ECM and RCM readings were recorded.
There was a poor but significant correlation between the ECM and RCM phase readings (P < 0.05). ECM readings for color, all five classes of severity and all three classes of hardness of lesions were significantly different from each other and from sound root tissue (P < 0.05). There was a significant correlation for ECM readings and cavitation (P < 0.05). There was a clear logarithmic relationship between ECM end values and size (P < 0.05). RCM amplitude measurements for hardness and all five classes of severity were significantly different from each other and from sound root tissue (P < 0.05). However, the RCM readings failed to correlate with color, cavitation or size (P > 0.05). In conclusion, the relationship between ECM and RCM data and some clinical detection criteria for PRCLs is promising and warrants further investigation in vitro and in vivo.
The ECM is capable of distinguishing the severity of PRCLs since it is a less invasive but accurate method of detecting carious lesions when compared to tactile methods. The RCM was able to differentiate sound root dentine from soft lesions in vitro but this device is currently in a very early stage of development, and many mechanical and electronic problems must be solved prior to application of the device in clinical practice.
This article, the third in a series, uses the tools described in the first 2 articles to examine some of the radiographic diagnostic procedures that are employed regularly in dental practice. With a general grounding in the meaning of terms such as sensitivity, specificity, thresholds, kappa coefficients, and predictive values, the reader should now be a more discerning user of the operating characteristic data for dental diagnostic procedures. By re-examining some of these procedures in terms of their effectiveness, accuracy and validity, dental practitioners should be able to use the procedures in a more targeted manner and gain the maximum benefit from their results. With a better understanding of the value of a diagnostic test, the clinician's decision-making process will be far better informed. For example, knowing that a certain radiographic view is associated with a 60% false-positive rate for identifying occlusal caries will preclude blind trust in the results and will help the informed clinician attribute a realistic weight to the radiographic findings. This article considers diagnostic procedures in common use in North American practice, with special emphasis on radiography.
To evaluate and compare remineralisation of root caries lesions after in vitro treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR).
Permanent human teeth were extracted and root surface specimens were sectioned, prepared (n = 35), and randomly allocated into seven different experimental groups (groups 1-7).
Root surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by various F treatments and stored in a standardised remineralising solution at 37 degrees C for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a neutral non-F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m. F as potassium fluoride (KF), once or twice per day respectively. ECM was used to measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks respectively. TMR technique was used to measure and compare root surface lesion depths and mineral loss.
Six weeks daily treatment with a dentifrice slurry containing AmF followed by rinsing with a combination of equal amounts of AmF and KF solution twice a day showed a statistical significant higher ECM values compared with the other groups. TMR data measuring lesion depths and mineral loss reduction supported the results of the ECM findings.
Daily application of a dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly remineralise primary root caries lesions in vitro. ECM and TMR are valuable complementary methods in order to analyse the remineralisation processes.
The purpose of the present study was to evaluate in a group of periodontal maintenance patients, the effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF2) as compared with a dentifrice and mouthrinse both containing sodium fluoride (NaF) with regard to their root caries experience.
In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1) the test group used an AmF/SnF2 dentifrice and mouthrinse and (2) the control group used an NaF-containing dentifrice and mouthrinse. Root caries was recorded at four sites per tooth at baseline and 24 months.
An increase in number of the exposed root surfaces was noted for both groups during the experimental period (p<0.05). The mean number of active caries lesions at baseline was 2.1 and 1.8 for the test group and control group, respectively. At 24 months, the corresponding values were 1.8 for the test and 2.2 for the control group. An increase of the mean number of restored surfaces was noted for the AmF/SnF2 group (from 7.3 to 13.4) and the control group (from 7.9 to 14.7) during the course of the study. This increase was found to be statistically significant for both groups in comparison with the baseline values (p< or =0.01). No statistically significant differences were noted between groups. Further analysis of the restored surfaces revealed that the major increase in number of the restorations was associated with restorations involving three to four root surfaces in the same tooth. Molars and premolars were the teeth receiving most new restorations.
The present study did not detect a difference in terms of root caries development between the two groups. Root caries development is a common finding associated with surfaces developing recession in patients once treated for periodontal problems.
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 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.
A 34-month clinical investigation of root caries was conducted using a hospitalized, chronically-ill population. Forty-five subjects with 150 caries-free surfaces were observed for at least 12 consecutive months. Clinical measurements included diagnosis of new root and coronal caries, gingival inflammation, pocket depth, recession, and distance of new lesions from the gingival margin. The overall root caries attack rate was 1.90 lesions per 100 person-months at risk, with the greatest rate occurring during the first year of study. Mesial and facial surfaces accounted for 84% of all new lesions. Sixteen subjects accounted for 26 new lesions; nine subjects had two or more new lesions. Subjects with new root lesions were found to have lower enamel caries experience but higher root caries experience at baseline and higher scores for gingival inflammation, pocket depth, and recession compared with those who did not develop root caries.
Abstract 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 > 5 new DPS %. 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.
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 the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. Incremental caries data were analyzed to provide descriptive information about the susceptibility of individual teeth and surfaces to root caries. Molars were most prone to root caries/fillings, followed in decreasing order by premolars, canines and incisors. While canines and incisors had a nearly identical increment, since there are half as many canines as incisors in a mouth, canines are actually twice as susceptible to root caries/fillings. Facial surfaces comprised 53 percent of the increment followed by distal, lingual and mesial surfaces. Approximately 70 percent of the DFS for facial and lingual surfaces were fillings, compared to approximately 50 percent for mesial and distal surfaces, suggesting that part of the increment for facial-lingual surfaces may be treated abrasion areas rather than caries.
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 (ORS) 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 ≥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.
Fifty-nine residents of a chronic hospital (average age 67.9 years) were examined visually for root surface caries. Root lesions were found to be present in 44 of the residents and were located most frequently on the proximal surfaces of anterior teeth. The number of coronal DF surfaces, age and number of retained teeth were the factors found to be helpful in discriminating between persons with and without root surface caries.
Abstract A sample of 8000 persons was drawn to represent the Finnish population aged 30 years and over. The participation rate was 89.9%. Root caries was recorded when the lesion was obviously soft and more than half of it was located on cementum. Lesions adjacent to fillings were not included. The reproducibility and the standard of the clinical recordings were tested by re-examining 20% of the studied population 2–6 months after the first clinical examination. The overall prevalence of root caries was 21.6% for men and 14.5% for women. The prevalence increased for both sexes almost consistently with age. Root caries was found 1.6 times more often among men than women. Among men 2.23% and among women 1.19% of teeth were affected by root caries.
Thesis (Ph. D.)--University of Western Ontario, 1989. Includes bibliographical references.
Two groups of patients were evaluated for the presence of active, restored, and recurrent root surface caries. One group of 120 subjects had received treatment for moderate to severe periodontitis. The second group consisted of 124 subjects who were affected by moderate to severe periodontitis but had received no treatment. The two groups were also evaluated for amounts of recession, pocket depth, and the presence of bacterial plaque. In addition, each subject was asked to compile a record of his/her dietary intake for a seven-day period. The treated group was found to brush and floss more frequently than the untreated group and had a lower mean plaque score (45.8), than the untreated group (61.4). There was no difference in the mean plaque scores for the subgroups with and without root surface caries within either the treated groups. The prevalence of root surface caries increased through age 59 in the treated group, then diminished after age 60. In the untreated group the prevalence increased steadily with age. Analysis of the data from the dietary hisories revealed that the subjects in both the treated and the untreated groups who were affected with root surface caries had a significantly higher (P less than 0.01) number of fermentable carbohydrate exposures per week.
In 90, 60- to 80-year-old patients with teeth retained in both jaws (mean 20.4 +/- 4.3), a total of 1,092 root surface lesions were recorded. Of these 156 were diagnosed as active caries lesions, whereas 509 were considered inactive, and 427 were filled. About 60% of the elderly had one or more active lesions and 79% had fillings. Seventy percent had more than 8 filled or carious (active or inactive) surfaces. The percentage of carious and filled root surfaces in relation to surfaces at risk demonstrated that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected (RCI = 70%) with fillings predominating on easily accessible surfaces. A constant relationship between active and inactive lesions was found on all other surfaces but third molars and upper incisors. The data suggest that active and inactive root caries lesions must be diagnosed as separate entities if the dynamic nature of root surface caries is to be explored in epidemiological studies and clinical trials.
The aim of this study was to analyze a number of microbial, salivary, and dietary factors in patients with clinically active and inactive root caries. 147 patients, aged 30-78 years, referred for specialist treatment of periodontal disease, were randomly selected. 645 decayed and 539 filled root surfaces were found. Out of the carious lesions, 372 (58%) were recorded as clinically active and 273 (42%) as inactive. 30 patients showed no lesions (group 1), 46 had only fillings or inactive lesions (group 2), and 35 showed 1-2 (group 3) and 36 greater than or equal to 3 active lesions (group 4). The lactobacillus count differed significantly between all groups, except group 1 vs. 2, and the mutans streptococcus count between groups 1 vs. 4 and 2 vs. 3 and 4. Group 4 differed in plaque score from the other groups, and the salivary buffer effect differed between the inactive groups 1 and 2 and the active group 4. By stepwise multiple regression analysis, it was shown that lactobacillus count, plaque index, salivary buffer effect, dietary habit index, and number of exposed root surfaces contributed significantly to the coefficient of determination.
The effects of fluoride and chlorhexidine varnishes on the microflora of dental root surfaces and on the progression of root-surface caries were studied. Forty-four patients, surgically treated for advanced periodontal disease, were distributed at random among three groups. All patients received a standardized preventive treatment. Furthermore, the dentition of the patients in the two experimental groups was treated, at three-month intervals, with chlorhexidine and fluoride varnish, respectively. Patients in the control group received no additional treatment.
In the experimental groups, plaque samples were collected from selected sound and carious root surfaces at baseline and at three, six, and nine months after the onset of the study. The presence of root-surface caries was scored at baseline and after one year. In addition, the texture, depth, and color of the root-surface lesions were monitored.
Mutans streptococci on root surfaces were suppressed significantly (p<0.05) during the whole experimental period in the chlorhexidine varnish group, but not in the fluoride varnish group. A non-significant increase in the number of Actinomyces viscosus/naeslundii was noted after treatment with chlorhexidine and fluoride varnish.
The increase in the number of decayed and filled root surfaces after one year was significantly lower in the experimental groups than in the control group. After treatment with chlorhexidine varnish, significantly more initial root-surface lesions had hardened than in the other groups.
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.
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 increasing numbers of older people retaining their natural dentitions, dentists are becoming increasingly aware of the problem of dental caries occurring on exposed root surfaces--root caries. This study reports the prevalence of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex. A total of 146 non-institutionalised people, aged at least 55 years with at least 12 teeth, were examined. Most of the subjects (88.4%) had evidence of root caries, males and denture wearers having more lesions than females and non-denture wearers, respectively. Active coronal caries was present in only 11.6% of the subjects, whereas active (soft or leathery) root caries lesions were present in 31.5% of the subjects. The teeth and surfaces most commonly affected by root caries were found to be similar to those seen in previous epidemiological surveys. The majority of active root caries lesions were within 1 mm of the gingival margin, while inactive lesions tended to be greater than or equal to 1 mm from the gingival margin. Colour of root caries lesions was not diagnostic of caries activity. A more detailed method of recording root caries lesions is also described.
For a comparative study of root caries, 502 adult lifelong residents of a naturally fluoridated community (1.6 ppm F) and 465 such residents of a nearby, comparable nonfluoridated community (0.2 ppm F) were examined. Substantially fewer carious lesions were found among adults in the fluoridated community relative to the nonfluoridated community. This was observed in virtually all age- and gender-specific groups. Given a cross-sectional design and considering only exposed root surfaces, root caries was related to age. In addition, the data from this study show that the number of root caries lesions is underestimated but that root caries prevalence is overestimated by the standard Root Caries Index (RCI). A less restrictive form of the RCI may lead to more valid estimation of root caries prevalence.
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 the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. Incremental caries data were analyzed to provide descriptive information about the susceptibility of individual teeth and surfaces to root caries. Molars were most prone to root caries/fillings, followed in decreasing order by premolars, canines and incisors. While canines and incisors had a nearly identical increment, since there are half as many canines as incisors in a mouth, canines are actually twice as susceptible to root caries/fillings. Facial surfaces comprised 53 percent of the increment followed by distal, lingual and mesial surfaces. Approximately 70 percent of the DFS for facial and lingual surfaces were fillings, compared to approximately 50 percent for mesial and distal surfaces, suggesting that part of the increment for facial-lingual surfaces may be treated abrasion areas rather than caries.
We collected data on the oral health status and treatment needs of a random sample of persons aged 50 years and over. Data on root decay were obtained from the 183 subjects who were dentate. All remaining teeth were examined for root decay and restorations, whether root surfaces were affected by recession or not. Analysis was undertaken by case and root surface, with separate analyses of decayed (DS), and decayed and filled (DFS) root surfaces. One or more root surfaces with untreated decay were found in 37.2% of subjects, while one or more decayed or filled root surfaces were found in 56.8%. The mean number of decayed surfaces was 1.3 per person, and the mean number of decayed and filled root surfaces was 2.6. Multiple and logistic regression analyses showed that oral health variables were more important predictors of the presence and severity of root decay than demographic, general health, or dental care factors.
The purpose of the study was to compare macroscopic and radiographic examination of proximal root surface caries of extracted teeth from patients aged 65-95 years. Although the study conditions for macroscopic and radiographic diagnosis favored more sensitive evaluations than routine clinical conditions, there was a 24% disagreement in diagnosis. This finding indicates that under routine clinical conditions it is difficult to register with certainty all superficial root carious lesions. Even in the absence of clinically detectable root surface caries, preventive measures should be considered for elderly people with exposed root surfaces.
Little information is available on the effect of fluorides on root surface caries in adults. This double-blind clinical study of 810 healthy adults, aged 54 and older, demonstrated decided cariostatic effects of a fluoridated dentifrice containing 1,100 ppm F as sodium fluoride. Statistically significant differences on both coronal (41%) and root surface caries (67%) incidence were produced in the test group and compared with a control dentifrice group during 1 year of study.
Examination of saliva and dental plaque was carried out in 35 adults who had been treated for periodontal disease 3 yr earlier. Plaque samples were collected from approximal and buccal sound and carious root surfaces. The samples were analyzed for the presence and proportions of members of Streptococcus, Lactobacillus and Actinomyces. The results showed a low prevalence of root surface caries and a low level of salivary mutans streptococci and lactobacilli. From subjects with root caries there was a not statistically significant tendency to higher proportional levels of mutans streptococci in plaque from carious root surfaces than from caries-free surfaces. An inverse significant relationship between noncarious and carious root surfaces was noted for S. sanguis. The population of A. viscosus and A. naeslundii was similar in plaque samples from sound and carious sites but showed elevated levels in the subjects with five or more new root surface lesions.
Percent agreement and Pearson's correlation coefficient are frequently used to represent inter-examiner reliability, but these measures can be misleading. The use of percent agreement to measure inter-examiner agreement should be discouraged, because it does not take into account the agreement due solely to chance. Caution must be used in the interpretation of Pearson's correlation, because it is unaffected by the presence of any systematic biases. Analyses of data from a reliability study show that even though percent agreement and kappa were consistently high among three examiners, the reliability measured by Pearson's correlation was inconsistent. This study shows that correlation and kappa can be used together to uncover non-random examiner error.
The purpose of this study was to measure the prevalence and distribution of root caries in two New Mexico communities. One community, Deming, had a natural fluoride concentration of 0.7 mg/L in its drinking water, optimum for its climate. The other, Lordsburg, was naturally fluoridated at 3.5 mg/L, five times the optimum. Dental examinations were carried out on 151 adults in Deming (mean age, 39.8 years) and 164 in Lordsburg (mean age, 43.2 years); only persons born in the communities were included. Prevalence of root caries was 23.8% in Deming and 7.3% in Lordsburg; mean number of lesions was 0.69 in Deming and 0.08 in Lordsburg (p less than 0.0001). Although there was more gingival recession in Lordsburg, Root Caries Index scores were five times greater in Deming. Root caries was more prevalent in older age groups, and was correlated with coronal caries experience in both communities. Root caries was correlated with plaque and calculus scores in Deming only. Logistic regression showed that city of residence was the major predictor of root caries, with other significant predictors being age, education, gingival recession, and loss of periodontal attachment. When combined with previous research, these results confirm that root caries experience is directly related to the fluoride concentration in the drinking water.
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.
This paper describes the prevalence of coronal caries and root caries in a sample of 520 people representative of the noninstitutionalized, dentate population older than age 65 in two rural Iowa counties. The subjects were examined in their homes by trained dental examiners. All prevalence rates were age- and gender-adjusted. Both types of caries were prevalent in the population age 65 and older. If projections of increased numbers of older people and increased retention of teeth are reasonably accurate, caries in older populations may become a significantly greater dental problem, and increased prevention and treatment of caries will be needed for these people.
Two specific populations were surveyed for the presence of root surface caries. One group was composed of military personnel and their families living at a Coast Guard Base and the other group included patients and staff at a Veteran's Administration Hospital. An increase in prevalence of root surface caries was observed in the three age groups surveyed: 30-39 years, 40-49 years, and 50-59 years. The two populations were similar in the prevalence and severity of the disease, oral hygiene and average number of teeth per individual. Root surface caries affected 49.2% of the subjects surveyed. A distinctive distribution pattern of lesions was noted. Sixty percent of the total number of lesions were in the mandibular dentition. The frequency of lesions was found to be the greatest on the mandibular bicuspids and 75.7% of all lesions were located on the buccal surface. A high percentage of teeth with root surface caries (60%) did not show evidence of previous coronal carious attack. Subjects with and without root surface lesions did not show a significant difference in oral hygiene.
A sample of 8000 persons was drawn to represent the Finnish population aged 30 years and over. The participation rate was 89.9%. Root caries was recorded when the lesion was obviously soft and more than half of it was located on cementum. Lesions adjacent to fillings were not included. The reproducibility and the standard of the clinical recordings were tested by reexamining 20% of the studied population 2-6 months after the first clinical examination. The overall prevalence of root caries was 21.6% for men and 14.5% for women. The prevalence increased for both sexes almost consistently with age. Root caries was found 1.6 times more often among men than women. Among men 2.23% and among women 1.19% of teeth were affected by root caries.
This paper traces the history of the epidemiologic assessment of root caries over the past 30 years. This history clearly points out that a critical junction has been reached between the state-of-the art for the reporting of root caries and the demand placed on research and service components of the oral health system. If progress is to be made, it is imperative that a uniform reporting method for root caries be adopted. This paper introduces the Root Caries Index (RCI) as an index that should prove to be a feasible and utilitarian method for reporting root caries data in descriptive and analytic epidemiologic studies as well as assessing the results of preventive and treatment agents, clinical trials. The Root Caries Index represents, in the evolution of a root caries measurement method, a refinement of the delineation of the true intraoral "population at risk" to the disease process. The resulting index is a true attack rate for supragingival root caries lesions. This development should permit more meaningful comparison of populations, clearer interpretations regarding risk factors, and more precise assessment of preventive and treatment agents.
Fifty-nine residents of a chronic hospital (average age 67.9 years) were examined visually for root surface caries. Root lesions were found to be present in 44 of the residents and were located most frequently on the proximal surfaces of anterior teeth. The number of coronal DF surfaces, age and number of retained teeth were the factors found to be helpful in discriminating between persons with and without root surface caries.
A descriptive epidemiologic survey of root caries in 473 20- to 64-year-olds revealed an age- and sex-adjusted overall root caries index (RCI) rate of 11.4% indicating that approximately one in nine surfaces with recession exhibited root caries. Although age-adjusted RCI rates for males and females were similar, the sex-adjusted RCI rates for each decade of life between 20 and 60 increased from 1.1% to 4.7% to 13.0% to 22.0%. Intraoral distribution patterns for root caries revealed that the most frequently attacked tooth types were mandibular molars (RCI = 40%), mandibular premolars (RCI = 25%) and maxillary canines (RCI = 23%). The least frequently attacked tooth types were the mandibular incisors (RCI = 2%). The interproximal surfaces exhibited the highest RCI rates in the maxillary arch while the buccal surfaces showed the highest RCI rates in the mandibular arch.Copyright © 1982 S. Karger AG, Basel
A longitudinal study of root caries: baseline and incidence data Prevalence of root and coronal caries in a noninstitutionalized older population Root caries in an optimally fluoridated and a high-fluoride community
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