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Root Caries: Causes, Symptoms and Treatment

Root caries is a form of tooth decay that affects the exposed surface of the tooth root. It is common in older adults and requires prompt dental treatment.

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Things worth knowing about "Root caries"

Root caries is a form of tooth decay that affects the exposed surface of the tooth root. It is common in older adults and requires prompt dental treatment.

What is Root Caries?

Root caries is a specific type of dental decay that affects the root surface of a tooth rather than the crown. Normally, the tooth root is protected by the gum tissue. When the gums recede – a condition known as gingival recession – the root cementum becomes exposed. Unlike tooth enamel, root cementum is softer and more vulnerable to acid attacks from bacteria, making it particularly susceptible to decay.

Causes

Root caries develops through the interaction of several factors:

Gum recession: Exposed root surfaces are the primary prerequisite for root caries. Gum recession can result from periodontitis, aggressive tooth brushing, or natural aging.
Caries-causing bacteria: Bacteria such as Streptococcus mutans and Lactobacillus species produce acids that attack the root cementum.
High-sugar diet: Frequent consumption of sugars fuels the growth of harmful oral bacteria.
Dry mouth (xerostomia): Saliva plays a protective role by delivering minerals and antibacterial compounds to the tooth surface. Reduced saliva flow significantly increases caries risk.
Older age: Root caries is more prevalent in older adults due to the increased likelihood of gum recession and dry mouth.

Symptoms

Root caries is often painless in its early stages, which can make it difficult to detect. Possible symptoms include:

Sensitivity to cold, heat, or sweet foods and beverages
Visible dark or soft spots near the gum line
A rough or sticky surface at the root area
Toothache in more advanced stages
In severe cases: abscess or dental infection

Diagnosis

A dentist diagnoses root caries using the following methods:

Visual examination: Discoloration or soft spots on the root surface may be visible to the naked eye.
Probing: A dental explorer is used to test the hardness of the root surface. Soft or sticky tissue indicates active caries.
X-rays: Dental radiographs help assess the extent of decay, especially below the gum line.

Treatment

Treatment depends on the severity of the root caries:

Early Stage: Remineralization

In the early stages, root caries can be managed non-invasively through:

Application of high-concentration fluoride varnishes or gels to promote remineralization of the root surface
Improved oral hygiene practices and dietary counseling
Professional dental cleaning (scaling and root planing)

Moderate Stage: Filling

When the decay has progressed further, the damaged tissue must be removed and the cavity restored with a composite filling or another restorative material. If the lesion extends below the gum line, surgical exposure of the cavity may be necessary before restoration.

Severe Cases

If the decay has reached the dental pulp, a root canal treatment may be required. In the most severe cases, extraction of the affected tooth may be necessary.

Prevention

Root caries can be effectively prevented with the following measures:

Brushing twice daily with fluoride toothpaste
Regular use of dental floss and interdental brushes
Reducing sugar intake in the diet
Routine dental check-ups and professional cleanings
Treatment of gum disease and gum recession
Staying well hydrated to prevent dry mouth

References

Fejerskov O, Kidd E (eds.): Dental Caries – The Disease and its Clinical Management. 2nd ed., Wiley-Blackwell, 2008.
World Health Organization (WHO): Oral Health – Key Facts. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/oral-health
Huysmans MC, Chew HP, Ellwood RP: Clinical studies of dental erosion and erosive wear. Caries Research, 45(Suppl 1):60-68, 2011.

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