Prof. Asaad Javaid MCPS, MDS
Dept of Restorative Dental Sciences
College of Dentistry, Alzulfi
Majma University, KSA
ROOT CARIES
Learning Objectives
Define root caries
 Differentiate between class V
and root caries
 Define cervical caries
 List causes of root caries

Learning Objectives
Differentiate b/w active and
arrested root caries
 Differentiate b/w cervical burn
out and root caries
 Describe treatment of root
caries

Definition
Soft, irregularly shaped lesion
confined to root surface
Root caries with gingival recession
It may involve the enamel
at cemento-enamel
junction
Class V versus root caries
Root caries initiates
only when root is
exposed to oral
environment
It occurs on cementum
Class V
Enamel caries
It is enamel caries
and initiates in crown
Roots are not exposed
Cervical caries
It may be Root caries or Class V caries
Causes
Age
The aging population is seen at an
increasing risk of acquiring root caries for
various reasons
Xerostomia

Saliva offers a protective function to our
teeth. Without it they are at greater risk
for caries

Approximately 80% of medicines cause
dry mouth
Decreased manual dexterity
Lack of proper brushing and care for their
teeth and gums
Holding cup in two hands
Can not shave himself
Faulty brushing technique
Gums recede exposing the root to the oral
environment due to over brushing, under
brushing, or just wear on the teeth in general
Periodontal disease
In older people, gingival recession exposes root
surfaces to oral fluids. If plaque is allowed to form on
these exposed surfaces, bacterial invasion of
Cementum will occur
Microorganisms inhabits holes left by the detachment
of periodontal ligament and cementum decalcifies
Longer life span
People are living longer and retaining their
natural teeth longer. It prolongs exposure
of teeth to the oral environment, causing
erosion and wear
Past caries history
If the patient had root caries in the past,
they are more likely to acquire them in the
future
Partial dentures
They increase the risk of decay because of
the increased accumulation of bacteria
High sugar diet
Old people often suck on sugary candies
to relieve the effects of Xerostomia by
inducing salivary flow
Past fluoride exposure
Lack of fluoridated water as children or
adults
Malocclusion
Malocclusion helps in
retention of plaque
and subsequent root
caries
Diagnosis
Identify contributory factors
Perform prophylactic scaling to remove
plaque and calculus
…diagnosis
Displace tissues gently with triple syringe
Retract tissue with instrument
Examine subgingival and interproximal
areas
…diagnosis


Active lesions
Arrested lesions
Active lesions


Soft lesions and close to the gingival
margins
Yellow / brown
Arrested lesions
Harder lesions left abandoned by receding
gingival margins
Dark brown/ black
Radiographic diagnosis

Cervical burn out may be misinterpreted
as root caries
Contd…
In persons with greater attachment loss,
Bite-wing radiographs may be beneficial
Bone loss
Treatment


Chemotherapeutic
Restorative
Chemotherapeutic treatment

0.12% chlorhexadine mouth rinses
control plaque in active lesions

Use of topical fluoride arrests the active
lesion
Topical fluoride





Fluoridated dentifrice
Fluoride varnish
Fluoride chewing gums
Fluoride gels
Fluoride mouth rinses
Sugar substitute- Xylitol




Not metabolized by mutan streptococci
Reduces plaque formation
Increases Plaque pH
Increases remineralization
…xylitol
5 - 10 gm in chewing gums reduces caries
by 30-80%
Restorative treatment
Examine the lesion
It could be
 Inactive (arrested)
 Active
If
arrested caries
NO treatment
If the lesion is active
The general approach to active caries should be
preventive treatment
• Reduce sugar consumption/ reduce frequent
consumption by confining sugar to meal time
Use sugar substitutes
• Plaque control: brushing twice daily with
effective fluoride tooth paste. Use dental floss
• Application of topical fluoride gels, solutions,
and varnishes.
• Stimulate saliva by use of sugar free gums such
as Xylitol chewing gums
•
Re-hardened root caries by preventive
measure, leaves a brownish black discoloration
• Root caries should be restored where it
endanger the pulp, where cavitation is
encouraging plaque stagnation, or if sensitivity
or appearance are problems
Indication for restorative treatment
1. The tooth is sensitive to hot, cold or sweet……
2. The pulp is endangered
3. Previous attempts to arrest the lesion have failed
and the lesion is progressing
4. The pt. Ability to provide effective home care is
impaired
5. Drifting might occur due to loss of proximal
contact
6. Esthetic reasons
Dental amalgam


It is an old tested and tried material
It presents esthetics concerns
18 –yr old Ag restorations
Cohesive gold
It is an Excellent, well
tolerated material
Durability and longevity
is good
Dental composite
Tooth colored fluoride releasing
material
Discoloration and
polymerization occurs
Glass ionomers
Tooth colored fluoride releasing
material with bonding and
RECHARGING abilities
Material of choice for root caries
Recharging of GIC
Glass ionomer have the ability
to reload fluoride from outside
sources i.e fluoride containing
mouth rinse, chewing gum,
tooth paste etc
Thank you