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Root Caries: A Significant Dental Problem

People are living longer and keeping their natural teeth more than ever before. The advances in tooth retention, the desire to look one's best, and higher expectations about oral health have raised dental awareness among older adults.

With the significant increase in the older portion of society, with even greater increases expected, more older adults will have more teeth that are susceptible to root caries. Root caries may emerge as one of the most significant dental problems among older adults during the next decade. A recent study conducted by the National Institute for Dental and Craniofacial Research (NIDCR) showed that over half of older adults have decayed or filled root surfaces. The frequency of root caries is strongly age-dependent and will continue to be a major dental problem among the elderly.

Root caries lesions can be caused by new or primary root caries, caries around existing dental fillings or recurrent caries, and abrasion or erosion of the root surfaces. Root caries progress quickly due to the relatively soft nature of the root surface, as well as the risk factors associated with the incidence of root caries.

Risk factors associated with the high prevalence of root caries among older adults include decrease salivary flow or xerostomia, exposure of root surfaces due to periodontal (gum) disease, chronic medical conditions, radiation treatment for head and neck cancer, physical limitations, and diminished manual dexterity due to stroke, arthritis, or Parkinson's disease, cognitive deficits due to mental illness, depression, Alzheimer's disease or dementia, Sjögren's syndrome (an autoimmune disease), diabetes, poor oral hygiene, multiple medication use, and changes in dietary habits. One or more of these risk factors or life changes, which are more common among older adults, can increase root caries in an individual who has not had dental caries for many years.

Root caries can be a challenge for the dentist to treat depending on the size and the type of root caries lesion, the extent and rate of caries activity for that person, the physical and mental condition of the individual, and where the root caries are located in the mouth. Many root lesions have limited accessibility and visibility, are often more complicated by pre-existing extensive dental work, and are difficult to isolate from oral fluids during the restoration process. Also, many people who have widespread root lesions have limited tolerance for dental treatment because of medical conditions, illness, and mental health problems.

By Denise J. Fedele, DMD, MS

Learn About Tooth Abrasion and Overbrushing

Recently, the issue of over brushing and its direct link to tooth abrasion has been a topic in many journal and news articles. A story in The Wall Street Journal (dated February 4, 2000) stated that in many cases, "the culprit in toothbrush abrasion is the toothbrush itself." This issue is particularly important because people can damage healthy teeth and gums by brushing too hard, oftentimes with a medium- or hard-bristled toothbrush. In fact, dentists and representatives of the American Dental Association have recommended for years that people use a soft-bristled toothbrush for their dental care.

Our teeth and gums are susceptible to wear and tear like all other parts of our bodies. In cases of improper brushing, such as brushing too vigorously, gum tissue can be worn away. Receding gums then lead to other significant dental problems such as sensitive teeth, periodontal disease, cavities, root canals, and potentially removal of teeth.

Solutions to brushing too hard and causing tooth abrasion include adjusting the angle of your toothbrush (it should be at a 45-degree angle), lessening the amount of pressure you use, monitoring the length of time, as well as making sure that you are using a soft-bristled toothbrush. In addition, always ask your dentist for specific recommendations related to your oral health care.

While the potential harm to teeth and gums through over brushing is significant, an even greater percentage of the population suffers damage to their teeth from occlusion (bad bite), genetic factors, and poor overall dental hygiene. It is critical to carefully maintain and monitor your oral health. The best approach to maintaining good oral health is to brush your teeth twice a day with a soft-bristled toothbrush to prevent tooth abrasion with fluoride toothpaste, floss or clean between the teeth using an interdental cleaner (special brushes, picks or sticks), and visit your dentist every six months. Follow your dentist's advice with regard to any changes to this regimen.

By Brian J. Gray, DDS, MAGD, FICO