Root Caries: Overview and Management

👉 Root Caries MCQs

Definition:
Root caries is a soft, progressive lesion found on root surfaces exposed due to gingival recession or periodontal attachment loss. It typically occurs at or below the cementoenamel junction (CEJ) and appears discolored compared to healthy root surfaces.

🔹Key Features of Root Caries

• Initiated when periodontal attachment is lost → root exposed.
• Lesions are soft, irregular, and progressive.
• Shape: round or oval, may spread radially and merge with other lesions.
• Color: white, light brown, or dark, sometimes with cavitation.
• More common in males.
• Teeth most affected:
  • Mandibular: molars → premolars → canines → incisors
  • Maxillary: reversed order

🔹Etiology of Root Caries

Microbial Factors:

• Key bacteria: Streptococcus mutans, Lactobacillus, Actinobacillus
• Mechanism: sugars → organic acids → demineralization
• Root demineralization occurs at pH 6.4 (higher than enamel pH 5.5)
• Root demineralizes faster due to lower mineral content (55%) vs enamel (99%)

Intraoral Risk Factors:

• Xerostomia, low salivary buffer
• Poor oral hygiene
• Gingival recession, periodontal disease, or surgery
• Frequent carbohydrate intake
• Malocclusion, tipped teeth
• Abfraction lesions
• Unrestored or restored teeth
• Overdentures and removable partial dentures

Extraoral Risk Factors:

• Advanced age
• Medications reducing saliva (antipsychotics, antihistamines, sedatives)
• Low socioeconomic/educational levels
• Diabetes, Sjögren’s syndrome, autoimmune disorders
• Radiation therapy
• Limited manual dexterity
• Limited exposure to fluoridated water
• Alcohol or narcotics consumption

🔹Diagnosis of Root Caries

• Clinical Examination: Clean surface, use explorer for soft/leathery areas.
• Radiographs: Accurate, free from overlap or burnout.
• Special Dyes: Highlight infected dentin for detection.

Differential Diagnosis:

Feature	Active Root Caries	Arrested Root Caries	Extrinsic Stain
Color	Light brown	Dark brown/black	Dark color
Texture	Soft, leathery, elastic	Hard, cannot compress	Hard, rough

🔹Prevention of Root Caries

• Proper plaque control and oral hygiene
• Diet modification → reduce sugar intake
• Use of topical fluoride
• Educate prosthesis-wearing patients → manage soft tissues and avoid subgingival margins
• Stimulate saliva in low-flow patients (e.g., xylitol chewing gum)

🔹Treatment of Root Caries

Factors Affecting Treatment Plan:

• Lesion size, type, site
• Clinical examination results
• Patient’s esthetic needs
• Physical & mental condition

Treatment Steps:

1. Clean root surface with pumice.
2. Excavate carious tissue.
3. Prepare restoration walls depending on material.
   • Amalgam: retention grooves occlusally & gingivally
   • Composites: bevel coronal margins

Challenges: Subgingival location → need adequate access and isolation.

👉 Root Caries MCQs

🔹Restorative Materials for Root Caries

Material	Pros	Cons	Special Notes
Direct Gold	Excellent marginal adaptation	Isolation difficult	Less used now
Dental Amalgam	Easy to manipulate, self-sealing	Aesthetic limitation	Good for hard-to-isolate areas
Traditional Glass-Ionomer	Biocompatible, chemical bond, fluoride release	Poor aesthetics, wears easily	Used for non-aesthetic zones
Resin-Modified Glass-Ionomer	Biocompatible, fluoride release, aesthetic	Less brittle than traditional GIC	Matches tooth thermal expansion
Resin Composites	Highly aesthetic, bonds to enamel/dentin	No anti-caries effect	Microfilled composites recommended for flexibility on root surfaces

✅Summary / Key Points

• Root caries is common in older adults due to gingival recession.
• Early detection allows preventive therapy and conservative management.
• Treatment choice depends on lesion location, size, esthetics, and material properties.
• Fluoride, diet, and hygiene are key to prevention.
• Microbial control is essential, as demineralization occurs at a higher pH than enamel.