Caries de superficies radiculares: etiología, diagnóstico y manejo clínico / Root caries lesions: etiology, diagnosis and clinical managment

Como todas las lesiones de caries, la caries de superficies radiculares (CSR) refleja un cambio tisular continuo. Es esencial diagnosticar los síntomas antes que esas lesiones lleguen a estar cavitadas. Por la misma razón, y para poder decidir entre modalidades invasivas y no-invasivas, deberá ser perfectamente comprendida la dinámica de la formación de la lesión cariosa. Este artículo revisa la etiología, los criterios de diagnóstico y los factores de riesgo en caries de superficies radiculares, y también discute la prevención y la terapéutica, haciendo un especial énfasis en procedimientos de remineralización y en un enfoque no-invasivo de este problema.

As all caries lesions, root caries reflect a continuous tissue change. It is essential to diagnose symptoms before these lesions become cavitated. For the same reason, and in order to be able to decide between invasive and non-invasive modalities, the dynamics of the formation of the carious lesion must be perfectly understood. This paper reviews the etiology, diagnostic criteria and risk factors for root surface caries, and also discusses prevention and therapeutics, with a special emphasis on remineralization procedures and a non-invasive approach to this problem.

A clinical investigation of the efficacy of a dentifrice containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, on primary root caries.

OBJECTIVE: The purpose of this six-month study was to assess the ability of a new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, to arrest and reverse primary root caries lesions in adults. METHODS: Three test groups used dentifrices which contained either: 1) 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate in a calcium base (experimental); 2) 1450 ppm fluoride as sodium fluoride in a silica base (positive control); or 3) no fluoride in a calcium base (negative control). The study participants were residents of the city of Chengdu, Sichuan Province, China. In order to take part, subjects had to have at least one non-cavitated primary root caries lesion. A total of 412 subjects completed the study. They were aged from 50 to 70 years (mean age 64 +/- 4.1 years) and 53.6% were female. Efficacy for arresting and reversal of primary root caries was assessed by clinical hardness measures and through the use of the Electrical Caries Monitor. RESULTS: After three months of product use, clinical hardness measures showed that 27.7%, 24.6%, and 13.1% of lesions had improved in the experimental, positive, and negative control groups, respectively, and 0.7%, 4.5%, and 16.8% had become worse, respectively. The differences in the distribution of lesion change between the negative control group and both the experimental (p < 0.001) and positive control (p = 0.001) were statistically significant. The Electrical Caries Monitor was also used as an objective measure of lesion severity. The end values increased from baseline to the three-month examinations, but none of the differences between the groups attained statistical significance. After six months, clinical hardness measures showed that only one lesion (0.7%) was worse than at the baseline examination-in the experimental group compared to 9.0% and 18.2% in the positive and negative control groups, respectively. In addition, 61.7%, 56.0%, and 27.0%, respectively, showed improvement for the three groups. The differences in the distribution of lesion change scores between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant, as was the difference between the experimental group and the positive control (p = 0.006). The Electrical Caries Monitor end values for the experimental, positive, and negative control groups at the six-month examination were 7.9, 1.9 mega omega(s), and 387 kilo omegas(s), respectively. The differences between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant. The difference between the experimental and positive control groups was also statistically significant (p = 0.03). CONCLUSION: It is concluded that the new toothpaste containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, provided greater anticaries benefits than a conventional toothpaste containing 1450 ppm fluoride. Both fluoride toothpastes demonstrated greater benefits than non-fluoride toothpaste.

Results from the Xylitol for Adult Caries Trial (X-ACT).

BACKGROUND: Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries. METHODS: The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months. RESULTS: Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect. CONCLUSIONS: Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries. CLINICAL IMPLICATIONS: These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly.

Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT).

OBJECTIVE: This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults. MATERIALS AND METHODS: Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires. We examined associations between baseline characteristics and (1) the presence of any root caries using Mantel-Haenszel hypothesis tests and odds ratio (OR) estimators and (2) the number of root surfaces with caries among study participants with exposed root surfaces (n = 349) using Mantel-Haenszel mean score tests and Mann-Whitney estimators. RESULTS/CONCLUSIONS: Adjusting for study site and age, male gender [OR, 1.72; 95% confidence interval (CI), 1.08, 2.78], white race (OR, 2.39; 95% CI, 1.43, 3.98), recent dental visit (OR, 1.98; 95% CI, 1.07, 3.66), poor self-described oral health (OR, 2.65; 95% CI, 1.10, 6.39), and recent professional fluoride treatment (OR, 1.85; 95% CI, 1.06, 3.25) were significantly associated with increased odds to have any root caries, and study participants with exposed root surfaces characterized by male gender [Mann-Whitney probability estimate (MW) = 0.57; 95% CI, 0.51, 0.63), white race (MW, 0.61; 0.55, 0.68), recent dental visit (MW, 0.58; 0.50, 0.67), poor self-described oral health (MW, 0.61; 0.53, 0.69), and flossing at least once per day (MW, 0.57; 95% CI, 0.51, 0.62) were significantly more likely to have a greater number of root surfaces with caries than a randomly selected study participant from their respective complementary subgroups (female gender, non-white, etc.). CLINICAL RELEVANCE: Our findings may help identify individuals at higher root caries risk.

The oral health of older people: general dental practitioners' beliefs and treatment experience.

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long-term care (LTC) facility during the previous 2 years. Over three-quarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist-acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.

A proposal for a new classification of lesions of exposed tooth surfaces.

In the presence of improved methods of identification and treatment of lesions on the exposed surfaces of teeth, it should now be acknowledged that the GV Black "classification of carious cavities" is out of date. This paper describes a new system, proposed in 1997, discussed broadly throughout the profession, and eventually modified. The system has been adopted in several regions around the world as being a useful corollary to the current developing concept of minimal intervention dentistry. It is now desirable to adopt a new approach to the identification and recording of the lesions caused by both caries and non-carious tooth loss. A major advantage arising from its adoption would be that it would encourage the profession to minimise the amount of normal healthy tooth structure that is often sacrificed in pursuit of the cavity designs as suggested by Black. The authors are members of a Project Group of the FDI Science Committee, and this paper explains the concept and offers justification for the adoption of the system.

Root caries in periodontally treated patients in relation to their compliance with suggested periodontal maintenance intervals.

The purpose of this study is to investigate the correlation between the degree of patient compliance with the suggested periodontal maintenance treatment intervals and the new root caries development 5 years after the completion of the active periodontal treatment. The percentage of root surfaces with new root caries was low for both the erratic and the complete compliance patient groups. Erratic compliance with the suggested maintenance intervals 5 years after the active periodontal treatment leads to greater root caries prevalence, greater percentages of patients and root surfaces with new root caries, greater root caries prevalence for smokers, and greater percentages of new defects in root surfaces with further clinical attachment loss and plaque retention. The prevention of root caries development is based on the daily plaque removal and the high patient compliance with the therapist's suggestions for periodontal maintenance intervals.

Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial.

OBJECTIVE: To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non-cavitated leathery primary root carious lesions (PRCL's), in an older population group. DESIGN: A total of 89 subjects, (age range 60-82, mean +/- SD, 70.8 +/- 6 years), each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. RESULTS: There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed (p<0.01). CONCLUSIONS: Leathery non-cavitated primary root caries can be arrested non-operatively with ozone and remineralising products. This treatment regime is an effective alternative to conventional "drilling and filling".

Oral health condition in southern Chinese after radiotherapy for nasopharyngeal carcinoma: extent and nature of the problem.

OBJECTIVE: To measure the oral health status of southern Chinese nasopharyngeal carcinoma (NPC) survivors 1-4 years after radiotherapy. SUBJECTS AND METHODS: A total of 109 subjects participated in this cross-sectional study. Thirty-eight subjects were NPC survivors, 40 subjects were patients newly diagnosed with NPC and 31 were healthy subjects. Verified clinical examination techniques were used to assess limitation of jaw opening, the presence of mucositis, candidiasis, dental caries, periodontal disease [community periodontal index (CPI)] including attachment loss (ALoss) and prosthetic status/need. Differences among three groups were tested by chi-squared and Kruskal-Wallis tests. Relationships between selected clinical variables and radiation parameters were analysed using Spearman's rank correlation coefficients. RESULTS: The NPC survivors attended for dental treatment more frequently than the other groups (P < 0.01). NPC survivors had significant xerostomia (92%, P < 0.01), trismus (29%, P < 0.01), a higher prevalence of clinical candidiasis (24%, P < 0.01), a greater DMFT (16.4 +/- 7.0, P < 0.01), more decay/filled roots (2.1 +/- 2.9, P = 0.01) compared with new NPC patients and controls. No difference was found in CPI, ALoss, prosthetic status and need between groups. Dry mouth and tooth hypersensitivity were the most common oral problems perceived by the NPC survivors. CONCLUSION: Despite having regular dental follow-ups, oral health was compromised in NPC survivors 1-4 years postradiotherapy.

Oral diseases and conditions in community-living older adults with and without dementia.

This study compared the prevalence and experiences of oral diseases and conditions, as well as tooth loss and retained root status, in community-dwelling older adults with and without dementia. Dental examinations were conducted at baseline and at one-year for randomly selected samples of 116 dentate community-living older adults with dementia and a comparable group of 116 adults without dementia. Participants with dementia had significantly higher experiences of oral diseases and conditions at baseline and one-year compared with participants without dementia: decreased use of dentures; increased prevalence of denture-related oral mucosal lesions; increased plaque accumulation; increased prevalence and experiences of coronal and root caries; and increased numbers of decayed retained tooth roots. These higher experiences of oral diseases and conditions were related to dementia severity, not to specific dementia diagnoses. Participants with dementia already had a compromised oral health status when admitted into institutional long-term care between baseline and one-year; of concern were the high plaque levels on the natural teeth of the group of institutionalized participants with dementia.

Social relations as determinants of oral health among persons over the age of 80 years.

OBJECTIVE: To analyze whether social relations during a 7-year follow-up influence oral health among generally healthy, community-dwelling persons over the age of 80 years. METHOD: The present investigation is based on a subsample of 129 dentate community-dwelling individuals from The Kungsholmen Elders Oral Health Study (KEOHS), which included data from interviews and oral examinations. Social relations were measured in terms of marital status, living alone, frequency of contacts, number of confidants, and satisfaction with social contacts and with the frequency of contacts. Oral health was measured in terms of coronal caries and root caries. RESULTS: The primary findings of the adjusted multivariate logistic regression analysis were that persons who lived alone or who became alone during the 7 years prior to the dental examination had greater odds of having coronal caries (odds ratio (OR): 2.4, 95% CI: 1.0-5.7) than those who continually lived with others, and that persons who were continuously dissatisfied with the frequency of their social contacts were more likely to have root caries than those who reported a sustained satisfaction with the frequency of their social contacts (OR: 2.9, 95% CI: 1.2-7.2). CONCLUSION: This study suggests that social relations are related to the oral health status of old-old individuals. From a psychosocial perspective, our findings contribute to a deeper understanding of the background of oral health status in older adults.

Root caries prevalence in a group of Brazilian adult dental patients.

The aim of this study was to measure the caries prevalence in the root surface in a group of Brazilian adults. The prevalence and their intraoral distribution of caries lesions of root surface were assessed in dental patients ranging in age from 35 to 44 and from 50 to 59 years of age of both sexes (n=360). A total of 98.9% had root surfaces with gingival recession and 78.1% had at least one root caries lesion. The prevalence of the disease was analyzed using the Root Caries Index (RCI). The average value was greater for women (18.6%) than for men (13.4%) (p<0.01) and similar in both age groups (p>0.01). The maxillary canines and first premolars and the mandibular molars presented the greatest RCI values. The RCI was greater in the proximal surface of the maxilla and buccal surface of the mandible. We conclude that caries of the root surface are present in the Brazilian population and deserve attention concerning their actual role in the epidemiology of principal oral diseases of the adult population.

Root caries prevalence in a group of Brazilian adult dental patients

O objetivo deste estudo foi medir a prevalência de cárie na superfície radicular em um grupo de adultos. A prevalência e a distribuição intra-oral de lesões de cárie de superfície radicular foram avaliadas em um grupo de pacientes odontológicos com idade variando de 35 a 44 e 50 a 59 anos de ambos os sexos (n=360). Observou-se uma proporção de 98,9 por cento das pessoas possuindo superfícies radiculares com recessão gengival e 78,1 por cento apresentaram pelo menos uma lesão de cárie radicular. A prevalência da doença foi analizada utilizando-se o Índice de Cárie Radicular (ICR). O valor do ICR médio foi maior para as mulheres (18,6 por cento) que para os homens (13,4 por cento) e semelhante em ambas as faixas etárias (p>0,01). Os caninos e primeiros pré-molares na maxila e os molares na mandíbula apresentaram os maiores valores para o ICR. Em relação às superfícies, o ICR foi maior nas proximais da maxila e vestibulares da mandíbula. A cárie de superfície radicular atinge grupos da população brasileira e merece atenção quanto ao seu papel atual na epidemiologia das principais doenças bucais que atingem a população adulta.

Classification and management of dental caries. New concepts.

There has been a tremendous change in the understanding of carious lesion in all aspects from pathogenesis to prevention. The profession has also seen a revolutionary change in the material science and technology. In spite of these changes, the caries classification provided by Dr. G. V. Black remains unchanged, deterring the radical changes needed in the understanding of caries as a disease process. This article propose a new classification of dental caries to suit the present day changes in the related area. The article opens by highlighting the changes and limitations in the existing classification. The logical and advantageous outcome of the new classification is projected at the end emphasizing the need to change in conservative dentistry and education.

Evaluation of a glass-fiber-reinforced, bonded, inlay-supported fixed partial denture--4-year results.

Glass-fiber-reinforced composite resin systems may be used as conservative alternatives to conventional fixed partial dentures (FPDs) for the replacement of a single missing tooth. This article describes a clinical technique and 4-year evaluation of an inlay bonded FPD. The patient presented with a missing maxillary right second premolar. A high-caries risk and moderate-to-advanced attachment loss around the abutment teeth, which were clinically stable, were noted. The patient had a strong desire to maintain his remaining dentition. Advantages of supragingival margins and minimal tooth structure removal made the bonded inlay bridge a viable alternative to a conventional FPD for this compromised restorative situation. The clinical performance of this glass-fiber-reinforced resin inlay FPD at the 4-year follow-up is provided. The restoration has served satisfactorily for more than 4 years and holds promise as a conservative, esthetic alternative to the conventional FPD in certain clinical cases.

Caries experience in existing and new nursing home residents in Adelaide, Australia.

OBJECTIVES: The Adelaide Dental Study of Nursing Homes was instigated to provide comprehensive information concerning oral disease experience, incidence and increments in a random sample of those older South Australians residing in Adelaide nursing homes. METHODS: This paper presents caries experience results for existing and new nursing home residents, and caries incidence and increments for existing residents, from dental inspections conducted at the baseline and one-year data collections. RESULTS: The residents in this study were very functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults, the great majority of whom had moderate to severe cognitive impairment. Residents gave their carers many complex and challenging behavioural problems during oral hygiene care provision. Existing and new residents had similar dental history, oral hygiene, and sociodemographic characteristics, and similar cognitive, medical, functional, and nutritional status. Oral disease experience was high in both existing and new residents. There were no significant differences between existing and new residents for their dentate status, tooth status, coronal caries experience, or root caries experience, with the exceptions that new residents had significantly greater mean number of teeth, more filled coronal and root surfaces, and also new residents had significantly fewer decayed retained roots. Large numbers of tooth surfaces were covered in plaque and debris that negated more precise assessment of caries. The existing residents had caries increments on both coronal (2.5 surfaces) and root surfaces (1.0 surfaces) over the one-year period. Coronal caries incidence was 64% and root caries incidence was 49% of existing residents. CONCLUSIONS: Oral disease experience was high in both existing and new residents. There were few significant differences between existing and new residents' oral health status. New residents were being admitted to nursing homes with a compromised oral health status. Coronal and root caries increments and incidence were high for existing residents over the one-year period.

A clinical follow-up study of magnetically retained overdentures (Dyna-system).

This study reports on 99 magnetic retention units (root caps and minimagnets) were used to stabilise overdentures in 66 patients. Tooth mobility, root caries, periodontal health, denture function, integrity of root caps and minimagnets were evaluated 4-12 years after insertion. The results showed a marked reduction in root mobility (increased stability in 86% of the roots), but extraction of 8% of the roots. After 116 months the survival rate calculated according to Kaplan and Meier was 79% for roots, 90% for caps and 77% for minimagnets. Nine per cent of the roots demonstrated caries and 10% discoloration of the root caps.

La caries radicular en el paciente mayor / Rooot caries is elderly patients

En este artículo, se pretende realizar una puesta al día de la problemática que supone la caries ele raíz en el paciente mayor El papel que juegan distintos microorganismos, tales con Estreptococo, Lactobacilos y levaduras queda suficientemente documentado. Las distintas formas de presentación de las caries radiculares (cavltadas y no cavitadas) así como la identificación del riesgo de sufrir caries que tiene un paciente (riesgo bajo, moderado o alto) condicionarán definitivamente el tratamiento. Queremos destacar la importancia que tienen los tratamientos conocidos como médico-preventivos tanto en lesiones incipientm como en la prevención en aquellos paciente considerados de riesgo, utilizando flúor a altas concentraciones y barnices de clorhexidina. Por último, er aquellos pacientes con caries cavltadas, recomendamos el uso cie antisépticos y obturaciones provisionales como punto de partida del tratamiento, con la finalidad de reducir. La retención de placa bacteriana y consecuente reservorio de bacterias, antes de pasar a a obturación definitiva (AU)

Relationship between oral hygiene practices and oral status in dentate elderly people living in residential homes.

OBJECTIVES: To investigate the relationship between the oral hygiene practices of dentate elderly people living in residential homes, their requests for assistance and their oral health status. METHODS: 164 people (81.2+/-7.4 years) participated in an interview and oral examination, and provided a stimulated saliva sample. RESULTS: The mean number of coronal decayed surfaces (CDS) was 2.4+/-5.9, stimulated salivary levels (log(10)cfu/ml) of mutans streptococci, lactobacilli and yeasts were 1.6+/-2.1, 3.0+/-2.2, 2.1+/-1.7, respectively, and 53% had root decayed surfaces (RDS). Plaque (PI) and gingival (GI) Indices were 2.3+/-0.7 and 1.6+/-0.4 and denture debris scores (DDS) were high. 31% of the population cleaned their mouths twice daily without requesting help and they had significantly fewer yeasts, RDS, restorations on root surfaces, lower PI, GI (P<0.005) and DDS (P<0.0001) than the 69% who cleaned less often. 50% of those who cleaned less frequently requested assistance with oral hygiene but only 5% said that their carers supported them. Those residents who requested help had significantly higher levels of yeasts, lactobacilli (P<0.001), retained roots, DDS, RDS (P<0.005), PI and GI (P<0.0001). CONCLUSION: The elderly residents' perceived need for assistance with oral hygiene was related directly to oral hygiene status and to clinical indicators of mucosal and dental diseases.

Dental and periodontal status of Sjögren's syndrome.

BACKGROUND: Sjögren's syndrome (SS) is one of the most common systemic autoimmune diseases in middle-aged women. The present study had the aim to examine the dental and periodontal condition in patients with SS in comparison with disease controls and to evaluate the influence of reduced salivary flow in the periodontal tissues. METHOD: We examined 24 patients with primary or secondary SS in comparison with 27 patients who had another autoimmune disease but no signs or symptoms of SS, as well as with 29 subjects who had a subjective feeling of xerostomia or xerophthalmia without exhibiting an underlying disease. The clinical evaluation included examination of the oral mucosa, determination of missing, decayed and filled teeth, fixed or removable prosthetic appliances, plaque index, gingival index, probing pocket depth, probing attachment level, oral hygiene habits and frequency of dental visits. Statistical analysis was performed using the 2-tailed Fisher exact and Kruskal-Wallis tests. RESULTS: No significant difference was found in the dental or periodontal condition of the 3 groups. The number of teeth, feelings and distal or mesial decay lesions correlated negatively with age, while the number of fixed prosthetic appliances correlated positively. The salivary flow was statistically lower in patients with SS and exhibited a negative correlation with the number of cervical decay lesions. It was also found that SS patients had better oral hygiene habits than subjects of the control groups. CONCLUSIONS: No significant,difference could be detected concerning the dental and periodontal status of SS patients, compared with that of patients with other immune diseases as well as with that of controls who had subjective xerostomia.