root caries

Question 1

What are the risk factors for root caries?

Answer 1

• Oral hygiene
• More exposed root surfaces - perio
• drug addiction
• hyposalivation (radiotherapy, medication, autoimmune disorders, smoking, idiopathic
  systemic diseases
• decreased saliva quantity
• diet - soft and short meals high in carbs
• poor manual dexterity
• polypharmacy - causing dry mouth and can often contain sugar
• Institutionalisation/movement disorders/diminished cognititve skills

Question 2

What signs of root caries may be visible?

Answer 2

-Demineralisation of root surface, leading to an increasingly soft consistency, not always a change in colour.

Darkening of root surface often from extrinsic staining into softened, more porous dentine

Question 3

What bacteria may be more prevalent in root caries?

Answer 3

Actinomyces spp.
Mutans streptococci
Lactinobacilli

Question 4

Where do root caries lesions tend to spread?

Answer 4

along CEJ without being too deep (encircle)

Question 5

Where can advanced root caries lesions spread to?

Answer 5

Towards the pulp but can spread coronally to enamel

Question 6

What special tests can help in diagnosing root caries?

Answer 6

Radiographs
Pulp sensibility tests (cold, hot, electric)
Salivary tests (stimulated/unstimulated/buffering capacity/ bacterial load)

Question 7

What type of root caries is easily seen on a radiograph?

Answer 7

Mesial/distal root caries (not buccal or lingual)

Question 8

What is the appearance of an active root caries lesion?

Answer 8

Lighter/matte colour
softer/rougher surface
gingival inflammation/plaque buildup
Inaccessible area

Question 9

What is the appearance of an inactive root caries lesion?

Answer 9

dark and shiny
harder surface
clean surface

Question 10

What is the best predictor of root caries?

Answer 10

Past caries experience

Question 11

How can you manage hyposalivation?

Answer 11

Oral hygiene instructions
• High fluoride toothpaste, mouthwash, varnish
• Diet sheet to minimise sugar intake
• Sip water frequently
• Extreme caries risk - very short recall 2-3 months
• Saliva stimulation - xylitol
• Saliva substitutes (Biotene®)
• GP can prescribe salivary stimulant medication - pilocarpine

Question 12

When should you restore a root caries lesion (or any lesion?)

Answer 12

If it is cavitated and renders plaque removal difficult then requires intervention

Question 13

What is retraction cord?

Answer 13

A cord that is packed into the gingival sulcus to retract the gingivae to improve visibility, access and moisture control

Question 14

Which hand piece would you typically use to access root caries?

Answer 14

Slow speed and rosebud

Question 15

When should you use GIC to restore a root lesion?

Answer 15

-Use if suboptimal isolation (still need a dry as possible substrate)
• Lesion at gingival margin
• Substrate to bond to mainly dentine and of poor quality
• Lower aesthetic concerns

Question 16

When should you use composite for restoring root caries lesions?

Answer 16

Use if optimal isolation (rubber dam gold standard, if not possible - cotton wool rolls, high-volume aspiration at all times, retraction cord if necessary)
• Lesion above gingival margin
• Some enamel to bond to or good quality dentine
• Higher aesthetic concerns