Root caries Flashcards
What is primary root caries?
A lesion that originates wholly on root surface
What is secondary root caries?
Recurrent
Occurs adjacent to an existing restoration
Where does it occur?
Occurs supragingivally, within 2mm of cemento-enamel junction
Prodemoninantly interproximal, but often on smooth surfaces also
Often lower canines and premolars
Where do early lesions spread?
Along cementoenamel junction or root surface
Where do advanced lesions spread?
Progress towards pulp
Prevalent bacteria involved in root caries
Strep. mutans
Lactobacillus
Actinomyces
Who does root caries affect?
20-40% of healthy adults
Very prevalent in older patients
Most prevalent in
-insitutionalised pxs
-pxs who have been treated for perio disease
-pxs with poor saliva flow and quality (xerostomia -radiation, medicines)
Risk assessment
Age Gender Oral hygiene Diet Saliva Systemic fluoride Previous caries experience Previous periodontal treatment
Clinical signs of root caries
Colour
-very early lesions colourless
-established yellow/ brown - extrinsic stain
-inactive/ arrested lesions may appear black
Surface
-may be roughened surface or cavitated
-may be covered in plaque
Extent
-may be extensive - circumferential or small and discrete
Texture: may be soft, leathery or hard
Site: near gingival margin
Clinical diagnosis of root carious lesions
Visual Tactile Bacteriological testing - S. mutans, Lactobacilli etc Radiological Saliva secretion rate Saliva buffering rate: root caries initiated at pH6 Oral sugar clearance time FLuorescent dye take up
Prevention of root caries
OH
Removal of risk factors e.g. partial denture clasp
Fluoride regimes - high F toothpastes (5,000ppm), gel or varnishes (Duraphat)
Chlorhexidine m/w gel if appropriate and/ or remineralising products calcium phosphopeptide - amorphous calcium phosphate (CCP-ACP)
Stimulate salivary flow - chewing gum (xylitol based), sucking sugar free sweets, using systemic cholinergic drugs e.g. pilocarpine
Saliva substitutes - gels, liquids (Biotene)
Treatment of root caries
Depends on depth and extent of lesion and px factors
Remineralisation (OHI, fluoride etc)
Removal of softened tissue (surface recontouring, self cleansing, chemo-mechanical)
Restoration (RMGIC, GIC, composite)
Extraction
Chemo-mechanical treatment (Carisolv)
2 syringes
-0.5% sodium hypochlorite
-amino acids plus dye, water, preservatives- pH 11
Less invasive
Still need drill but less so
Dissolves softened dentine, then remove with special hand instruments
Benenfits of RMGIC and composite
Fluoride releasing Range of shades Adhesive to enamel and dentine Biocompatible Good surface finish Bacteriostatic
Effects of fluoride gels on glass ionomer
Low pH of fluoride gels
Regular regimen for use
Erosion and degradation of glass ionomer surface
Increased failure rate of restoration
Very important in pxs undergoing radiotherapy or with xerostomia
