Root caries

Question 1

Why are older patient more susceptible to root caries?

Answer 1

1. Accumulation of attachment loss overtime results in exposed root surfaces
2. Lifestyle changes that might occur during the later part of life
3. Polypharmacy - a greater number of medications - xerostomia causing medication!

Caries is the most important reason for tooth loss in older adults rather than periodontal diseases

Question 2

What are some of the risk factors for root caries and why?

Answer 2

1. Root surface exposure - cementum and dentine are less minirelised thus begin to demineralise at a higher salivary pH comparing to enamel
2. Very poor saliva quality and/or quantity - REALLY IMPORTANT FACTOR
3. Wearing of partial dentures
4. Other factors are similar to normal caries factors

Question 3

What are some of the key questions we should ask a patient who we think has root caries?

Answer 3

1. What is going on? - Diagnosis + evaluation of specific risk factors
2. Evaluation of disease state - understanding of remin/demin balance
3. Impact and implications of disease
4. Risk and benefit analysis
5. What are the patient expectations?
6. What is the plan for monitoring and ongoing care?

Question 4

Can a root caries lesion be restored or remineralised?

Answer 4

In all situations, try to avoid operative interventions before prevention has been given a chance to work

1. Address risk factors
2. Apply needed chemicals for remin
3. Consider silver fluoride
4. Restorative work might be needed in some cases

Because root caries restoration have a really poor prognosis

Question 5

What are the basic steps to preventing root caries?

Answer 5

1. Identifying cariogenic biofilm with tri-plaque disclosing gel
2. Disrupt the biofilm mechanically
3. Disrupt the biofilm chemically - high strngth fluoride or chlorexedine
4. Evaluate saliva - replace the building blocks of tooth structure - MORE FLUORIDE
5. Raise the pH

Question 6

What is silver fluoride?

Answer 6

A material has been used since the 60s.

It is an antimicrobial, mineralising agents that inhibits dentine demineralisation.

It is also cause the formation of sclerotic coating on the surface of carious dentine thus block dentinal tubules.

Question 7

What are some of the silver fluoride products available in Australia?

Answer 7

1. Creighton Dental CSDS silver fluoride
2. SDI Riva Star
3. SDI Riva Star Aqua (ammonia free - thus does not irritate soft tissue as much)

Question 8

What determines the effectiveness of silver fluoride?

Answer 8

1. Site consideration - type of lesion and size
2. Material selection - concentration
3. Control of caries risk factors
4. Monitoring and reapplication

Question 9

What are the key considerations to understand when restoring a root caries lesion?

Answer 9

1. Size and type of lesions
2. Extent and rate of caries activity
3. Physical and mental condition of the patient
4. Aesthetic requirements