Search

A promising approach for managing root caries is the use of cross‐linking agents to stabilize collagen. However, despite testing various natural and synthetic agents in vitro, their efficacy remains uncertain. The aim of this review was to examine which cross‐linking agent performs better in reducing root caries lesion depth and the release of hydroxyproline, which is a marker of collagen degradation. Studies evaluating the impact of cross‐linking agents on dentin were included, while studies performed on enamel surface/cell cultures and studies evaluating collagenase inhibitors were excluded, among others. A comprehensive search covered eight databases, and study quality was assessed using the QUINN Tool for in vitro dental studies. Synthesis of the results was done using a Bayesian network meta‐analysis to compare agents. Fifty studies involving 31 cross‐linking agents were included for qualitative synthesis. The network meta‐analysis for lesion depth involved 284 samples across 36 comparisons and ranked cross‐linking agents in terms of their caries lesion depth‐reducing effect (from best to worst): naringin > quercetin > riboflavin > proanthocyanidins > hesperidin > glutaraldehyde > cranberry > grape seed extract > untreated controls. Only naringin, quercetin, proanthocyanidins, and glutaraldehyde showed statistically significant efficacy over untreated controls. Cranberry extract excelled in reducing hydroxyproline release, followed by proanthocyanidins. In conclusion, proanthocyanidins positively affected both outcomes, suggesting they are prime candidates for translational research. Clinical studies are now essential to evaluate their real‐world effectiveness against root caries. PROSPERO‐CRD42023404911. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Compare different behavioural, environmental and socioeconomic factors for caries with transversal data to decompose the direct and indirect effects of body mass index (BMI) in relation to coronal and root caries.This cross‐sectional study used a representative sample of 1002 individuals aged ≥ 35 years living in Porto Alegre. Questionnaires recorded age, sex, educational level, tooth brushing frequency and access to dental services. Oral examination assessed gingival bleeding and recession, coronal and root caries. Height and weight were collected to calculate the BMI. The structural equation modelling approach was used, and standardised coefficients (SC) to direct, indirect and total effects were calculated.The prevalence of excessive body weight was 71.17%, of which 40.09% were overweight and 31.07% were obese. The overall prevalence of coronal and root caries was 99.83 and 36.95, respectively. No direct link between BMI and coronal or root caries was observed. For coronal caries, positive SC was found for age (0.56; p < 0.01) and sex (female) (0.14; p < 0.01). For root caries, positive SC was detected for age (0.34; p < 0.01), smoking exposure (0.17; p < 0.01) and gingivitis (0.08; p < 0.01).Overweight and obese adults should not be regarded at higher risk for dental caries. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinical parameters that affect the performance of root‐supported overdentures (ROD) and to identify the possible factors that may affect it. Background: ROD still serve as an alternative and successful treatment plan nowadays for partially edentulous patients. Nonetheless, there is not yet conclusive evidence about their clinical evaluation. Materials and Methods: A search strategy was developed following a PIO (Population, Intervention, Outcome) framework including an electronic search in the following databases: PubMed, Cochrane Library and Scopus. The systematic search included only randomised controlled clinical trials (RCTs), published until January 2023 in English language and was performed by two independent reviewers. Quality assessment of the included studies was conducted according to the Cochrane Risk of Bias tool. Results: The final selection of studies included 11 RCTs. Clinically relevant variables derived from this search were: Complications, with caries being the most frequently reported, periodontal aspects and bone changes around abutment teeth. Additionally, methods and clinical suggestions for the maintenance of these restorations and patient‐related outcomes were assessed. According to the risk of bias assessment, nine studies were considered of high risk, whereas only 2 of low risk. A meta‐analysis was not feasible. Conclusion: Within the limitations of this systematic review, ROD remain a viable treatment plan, offering better denture stability and bone preservation around abutment teeth and high patient satisfaction. Thorough oral hygiene and regular follow‐ups are of utmost importance. Further well‐designed RCTs are necessary for firmer conclusions. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the intricate relationship between salivary IgA antibody levels to PAc (361–386) (PPA), mutans streptococci colonization, and root caries development in older adults. Materials and Methods: This study included 307 participants aged 76 years residing in Niigata city, Japan. Clinical oral examinations were performed at baseline in 2004 and 1 year later, during which the total number of untreated and treated root caries was assessed using the root decayed, filled tooth (DFT) index. The stimulated saliva samples were collected using the spitting method during the baseline survey. Salivary IgA antibody levels to amino acid residues 361–386 of Streptococcus mutans PAc were quantified using an enzyme‐linked immunosorbent assay. Statistical analyses, including the χ2 test, Mann–Whitney U test, and logistic regressions, were performed to examine the association of increased root DFT with the independent variables. Results: Among the 307 participants (53.1% men), the mean root DFT at baseline was 3.77 ± 3.66, and 36.5% of the study sample exhibited increased root DFT after 1 year with a mean increment of 0.36 ± 0.48. Participants with increase in root DFT after 1 year had significantly higher rates of low PPA levels (≤ 25th percentile) than those without increased root DFT (p = 0.020). Low PPA levels (≤ 25th percentile) were significantly more likely to have an increased risk of root caries development compared with PPA levels > 25th percentile (adjusted OR: 1.88, 95% CI: 1.09–3.25). Conclusion: Low PPA levels and root caries incidence correlated significantly, suggesting that low levels of salivary IgA antibody to PAc (361–386) may serve as a risk factor for increased root caries in older adults. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries‐related treatment in high caries risk Veterans. Methods: This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009–2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first‐last restoration in the index year. Results: Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32–40% less likely to receive caries‐related treatment for root caries during the follow‐up period. Once Veterans had root caries, fluorides did not exhibit a positive effect. Conclusion: In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment. [ABSTRACT FROM AUTHOR]

Objective: Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single‐blinded, placebo‐controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. Method: Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. Results: Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. Conclusion: Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk‐based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities. [ABSTRACT FROM AUTHOR]

Background: This study compared natural root caries lesions with artificial root caries lesions prepared with one of the two demineralising solutions. Methods: Twelve natural root caries lesions on upper incisors and 24 artificial root lesions were prepared on sound root surfaces using 50 mM acetic acid, 1.5 mM CaCl2, 0.9 mM KH2PO4 at pH 5.0 or 80 mL/L Noverite K‐702 polyacrylate solution, 500 mg/L hydroxyapatite, 0.1 mol/L lactic acid at pH 4.8 (n = 12/group) for 96 hours. Lesions were scanned using micro‐CT. Inciso‐gingival oriented images were analysed and mineral density calculated at 7.5 μm increments from the surface to 225‐μm deep. Sectioned lesions were analysed by Knoop microhardness up to 250 μm from the lesion surface. Data were analysed by the Dunn's test with Bonferroni correction. Results: Natural and artificial lesion mean mineral densities were not statistically different (P > 0.05). Mineral density from the surface to 75 μm was greater in natural lesions and from 150 to 225 μm was greater in artificial lesions (P < 0.05). Microhardness values were statistically higher in artificial lesions (P < 0.05); no difference was found among artificial lesions produced by the two solutions (P > 0.05). Mineral density and microhardness of natural and artificial root caries are different from each other. A greater mineralized surface layer existed on natural lesions. [ABSTRACT FROM AUTHOR]

Although the use of fluoride for root caries control is reported to be effective, the mechanism of maintaining hydroxyapatite is still unclear. This study elucidates the roles of fluoride in the recrystallization of hydroxyapatite, and the impact of calcium to maintain the abundance of hydroxyapatite on acid‐challenged root dentin with a novel approach – using synchrotron radiation. Root dentin samples obtained from 40 extracted human premolars were subjected to pH challenge in combination with fluoride treatment. The effect of fluoride on hydroxyapatite regeneration on the root was investigated by using a range of fluoride concentrations (1000–5000 p.p.m.) and the EDTA‐chelation technique in vitro. Synchrotron radiation X‐ray micro‐computed tomography and X‐ray absorption spectroscopy were utilized to characterize the chemical composition of calcium species on the surface of prepared samples. The percentage of hydroxyapatite and the relative abundance of calcium species were subsequently compared between groups. The absence of calcium or fluoride prevented the complete remineralization of hydroxyapatite on the surface of early root caries. Different concentrations of fluoride exposure did not affect the relative abundance of hydroxyapatite. Sufficient potency of 1000 p.p.m. fluoride solution in promoting hydroxyapatite structural recrystallization on the root was demonstrated. Both calcium and fluoride ions are prerequisites in a caries‐prone environment. Orchestration of F− and Ca2+ is required for structural homeostasis of root dentin during acid attack. Sustainable levels of F− and Ca2+ might thus be a strict requirement in the saliva of the population prone to root caries. Fluoride and calcium contribute to structural homeostasis of tooth root, highlighting that routine fluoride use in combination with calcium replenishment is recommended for maintaining dental health. This study also demonstrates that utilization of synchrotron radiation could provide a promising experimental platform for laboratory investigation especially in the dental material research field. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and severity of periodontitis based on different diagnostic methods in a historical Austrian population from the early middle ages. Background: The description of the oral health status of archaeological material can provide interesting insights into prevalence, severity, and extent of oral diseases. Herein, the periodontal health status of the skeletal remains of medieval Avars (700‐800 AD), which were considered as one of the earliest Avarian settlements in Austria, was investigated. Methods: The skeletal remains of 128 Avars were examined; age and gender were estimated by standard forensic methods and tooth loss and root caries were recorded. Periodontitis was assessed by (a) measurement of the alveolar bone levels (ABL) and (b) evaluation of the interdental septa. Results: A mean ABL of 4.8 mm was determined, root caries tended to accumulate in teeth with a higher alveolar bone loss, and on average, 6.2 teeth were lost antemortem. Independent of the diagnostic method >90% of the subjects were judged as periodontally diseased, and age and tooth type were significant predictors. However, on the tooth level the presence of periodontitis varied considerably depending on the diagnostic method; that is, 7.6% versus 47.2% of the teeth were judged as healthy based on ABL or interdental septa, respectively. Conclusion: The periodontal status of the skeletal remains of medieval Avars revealed a considerable high prevalence of periodontitis (ie, >90% of this population displayed periodontal tissue breakdown). However, the diagnostic method, disease definition, and data presentation should be considered when comparing results of archaeological material. [ABSTRACT FROM AUTHOR]

Aim: There are no nationally representative epidemiological studies available reporting on the different recession types according to the 2018 classification system or focusing on the aesthetic zone. The aims of this cross‐sectional study were (a) to provide estimates on the prevalence, severity and extent of mid‐buccal GRs according to the 2018 classification and (b) to identify their risk indicators in the adult U.S. population from the NHANES database. Materials and Methods: Data from 10,676 subjects, representative of 143.8 millions of adults, were retrieved from the NHANES 2009–2014 database. GR prevalence was defined as the presence of at least one mid‐buccal GR ≥1 mm. GRs were categorized following the 2018 World Workshop classification system (RT1, RT2, RT3) and according to different severity cut‐offs. An analysis for GR risk indicators was also performed, selecting subjects without periodontitis. Results: The patient‐level prevalence of mid‐buccal GRs (all types) was 91.6%, while it decreased to 70.7% when considering only the aesthetic zone. When focusing on RT1 GRs, the patient‐level prevalence (whole mouth) was 12.4%, while it was 5.8% considering only the aesthetic zone. The majority of RT1 GRs were considered as mild (1–2 mm). The whole‐mouth patient‐level prevalence of RT2 and RT3 GRs was 88.8% and 55.0%, respectively. Age (35–49 years), gender (female), ethnicity (non–Hispanic Whites), last dental visit (>6 months before), tooth type (incisors) and the arch (mandible) resulted as risk indicators associated with the presence of RT1 GR. Conclusions: Mid‐buccal GRs affect almost the entire US population. Age, gender, ethnicity, dental care exposure, tooth type and arch were identified as risk indicators for RT1 GRs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18.Methods: A stratified random sample of 15 731 Australians aged ≥15 years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1 mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries.Results: Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2).Conclusions: Root caries was associated with older age, living outside a major city and lower income. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether there is an association between periodontal disease and each of root caries and coronal caries among adults (aged 35 and over), using a nationally representative sample of adults in England, Northern Ireland and Wales. Material and Methods: In this cross‐sectional study, data from the Adult Dental Health Survey 2009 were used. Adults aged 35 years or older who had periodontal and caries assessment were included. Two sets of negative binomial regression were conducted for each of coronal caries and root caries adjusting for periodontal diseases, dental visits, country, sex, age, education, job classification, oral hygiene and smoking. Results: Overall, 4738 were included in the analysis. Periodontal disease was significantly associated with each of coronal and root caries. In the fully adjusted model, those with PD/ LoA ≥ 4 mm had 1.03 rate ratio (RR) for coronal caries (95% CI: 1.01‐1.05). In the model pertaining to root caries, the RR for those with periodontitis was 1.23 (95% CI: 1.16‐1.30). Smoking, sex, age and oral hygiene were the variables that showed a consistent and significant association with coronal and root caries. Conclusion: Individuals with periodontal diseases appeared to be at higher risk of coronal and root caries. While root exposure could be a plausible explanation for the relationship between periodontitis and root caries, the association with coronal caries could be attributed to the irritation of carious cavities, or common risk factors such as poor oral hygiene, or co‐occurrence of different health risk behaviours related to both caries and periodontitis and socioeconomic conditions. [ABSTRACT FROM AUTHOR]

Aim: The epidemiological relationship between periodontitis and caries remains controversial, and evidence synthesis is currently lacking. Therefore, this systematic review was designed to answer the following PECO question: 'In human adults (P), do subjects suffering from periodontitis (E) have higher presence/number of untreated carious lesions and caries experience (O) than subjects not suffering from periodontitis (C)?'., Materials and Methods: Observational studies that met specific inclusion criteria established to answer to the PECO question were included. Two review authors independently searched for eligible studies, screened the titles and abstracts, carried out the full text analysis, extracted the data and performed the risk of bias assessment. In case of disagreement, a third review author took the final decision during ad hoc consensus meetings. Data synthesis was carried out through random-effects meta-analyses., Results: A total of 18 studies on 21 cohorts, involving 135,018 participants, were included. Meta-analyses showed a significant association between periodontitis and the presence of at least one tooth with either untreated carious lesions (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.32-2.01; p <.00; I 2  = 83.0%) or caries experience (decayed and filled teeth ≥ 1) (OR = 1.27; 95% CI: 1.01-1.59; p = .038; I 2  = 90.0%). Moreover, subjects with periodontitis exhibited a higher number of surfaces (difference in means [MD] = 0.86; 95% CI: 0.46-1.27; p <.001; I 2  = 0.0%) and teeth (MD = 0.35; 95% CI: 0.28-0.42; p <.001; I 2  = 69.6%) with untreated carious lesions, as well as a higher number of teeth with caries experience (standardized difference in means  [SMD] = 1.46; 95% CI: 0.15-2.78; p = .029; I 2  = 98.9%) compared with those without periodontitis. Sensitivity analyses focusing on severe periodontitis as exposure mostly showed consistent results. Estimates for caries experience were only slightly attenuated in adjusted models compared with crude models. Subgroup analyses by caries location also indicated that periodontitis was associated only with root caries, while it was not with caries affecting the anatomical crown., Conclusions: Periodontitis was found to be associated with the presence and number of treated/untreated root carious lesions. Therefore, caries-specific preventive measures (e.g., fluorides) should be considered for individuals with periodontitis., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Objective: This study sought to utilise machine learning methods in artificial intelligence to select the most relevant variables in classifying the presence and absence of root caries and to evaluate the model performance.Background: Dental caries is one of the most prevalent oral health problems. Artificial intelligence can be used to develop models for identification of root caries risk and to gain valuable insights, but it has not been applied in dentistry. Accurately identifying root caries may guide treatment decisions, leading to better oral health outcomes.Methods: Data were obtained from the 2015-2016 National Health and Nutrition Examination Survey and were randomly divided into training and test sets. Several supervised machine learning methods were applied to construct a tool that was capable of classifying variables into the presence and absence of root caries. Accuracy, sensitivity, specificity and area under the receiver operating curve were computed.Results: Of the machine learning algorithms developed, support vector machine demonstrated the best performance with an accuracy of 97.1%, precision of 95.1%, sensitivity of 99.6% and specificity of 94.3% for identifying root caries. The area under the curve was 0.997. Age was the feature most strongly associated with root caries.Conclusion: The machine learning algorithms developed in this study perform well and allow for clinical implementation and utilisation by dental and nondental professionals. Clinicians are encouraged to adopt the algorithms from this study for early intervention and treatment of root caries for the ageing population of the United States, and for attaining precision dental medicine. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA).Background: Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients.Methods: Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors.Results: A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA.Conclusions: For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART. [ABSTRACT FROM AUTHOR]

Objectives: Root caries has increased as a clinical problem in recent decades. However, the use of multiple waves of longitudinal follow‐up data in estimating root caries increment has not been previously attempted. The aims of this study were to quantify root caries increment from a longitudinal study of older adults with 4 oral examinations over 11 years and to examine behavioural factors associated with root caries. Methods: A secondary analysis was undertaken using data collected in 4 waves (baseline, 2‐year, 5‐year and 11‐year) of the South Australian Dental Longitudinal Study which began in 1991/92. The study group consisted of a stratified random sample of people aged 60+ years at baseline. A total of 358 participants with complete oral examinations in all 4 waves were included. The examinations were performed by trained and calibrated dentists. Baseline behavioural risk factors (toothbrushing frequency, flossing frequency, dental visiting pattern, reason for dental visiting and tobacco smoking status) and time in years across the 4 waves were the main exposures. Baseline clinical oral conditions (gingival condition and gingival recession), demographic and socio‐economic risk factors served as covariates. Root caries was measured as mean number of untreated root surfaces (root DS) and decayed/filled root surfaces (root DFS) at each wave of examinations. Multivariable multilevel growth model using linear regression analysis was used to get an estimate for root caries increment and associated oral health‐related behaviours adjusting for all the covariates. Results: Findings from the multivariable models indicated that the annual increment of root DS and root DFS were 0.07 (SE = 0.01) and 0.11 (SE = 0.02) surfaces, respectively. Irregular brushing (E [SE] = 0.25 [0.12]), visiting the dentist only for problems (E [SE] = 0.30 [0.13]) and smoking (E [SE] = 0.33 [0.12]) were risk factors for the increase in root DS. Irregular flossing and more frequent dental visit were associated with the increase in root DFS. Conclusions: Root caries increased slowly across time among relatively healthier Australian older adults. Irregular brushing, unfavourable dental visiting and tobacco smoking were risk factors for the increase in untreated root caries, while irregular flossing and more frequent dental visiting were associated with the increase in root DFS. [ABSTRACT FROM AUTHOR]

An institutionalized high care dementia patient, who is unable to maintain his own oral health, presented with five lower anterior carious root stumps supporting a lower overlay denture. Due to limited cooperation, his root stumps were treated with only silver fluoride followed by stannous fluoride applied topically on a 4-monthly cycle. Almost one and a half years after his initial application, there were unexpected calculus formations on the root stumps accompanied by marked gingival inflammation and gingival hyperplasia. At this point prognosis was considered very poor. Because the patient's cooperation was so poor, no attempt was made to remove the calculus deposits. Following continued topical applications directly to the area, there was evidence of a marked and unexpected improvement in gingival health. Some 4 years and 4 months after the initial application, the root stumps demonstrated a hard glossy surface surrounded by healthy gingival tissue. There had been no change in the patient's oral care, minor changes to medications and there had been no operative or periodontal interventions. [ABSTRACT FROM AUTHOR]

Abstract: The presence of endogenous acids from bacteria acting on a suitable substrate combined with sources of exogenous biocorrosives such as exogenous acids and proteolytic enzymes in areas of stress concentration are hypothesized to lead to the development and progression of cervical and root caries (RC). Quantifying the effects of each of the mechanisms (stress and biocorrosion) is a daunting task to investigate since so many factors are involved at various times in the etiology of noncarious cervical lesions (NCCLs), cervical caries (CC), and RC. Frictional action of the tongue has a cleansing effect and lingual serous saliva, which has a high flow rate buffering capacity from bicarbonates seem to account for the paucity of lingual NCCLs, cervical, and RC in these areas of teeth. Future studies are indicated to determine the effects of stress and biocorrosion and their factors in the etiology of CC and RC. Clinical significance: This manuscript presents hypothetical and literary information that the combined effects of stress concentration and biocorrosion contribute to the formation as well as progression of cervical and root caries. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study aimed to assess the incidence density (ID) of new root caries lesions and restorations among community‐living south Brazilian older adults and to assess its association with predictor variables. Methods: We conducted a prospective cohort with a random sample of elders from the municipality of Carlos Barbosa, in south Brazil. Trained dentists performed interviews and oral examinations in 388 individuals at baseline, of which 273 were retained at follow‐up 4 years later. Our outcome was root caries ID, with 100 root‐years as its unit of measure. Demographic, biological and lifestyle predictors were tested with Poisson regression. Results: The mean number of roots at baseline among participants was 7.0 (SD ± 4.9) and the incidence rate per 100 root‐year 4.9 (SD ± 8.9). Incidence of root caries among these older Brazilians was of 47.3%. The associated factors with the incidence of root caries were age, geographic location of residence, frequency of tooth brushing and stimulated saliva flow rate. Conclusion: Age, external environment, personal practices and oral status were predictors of the incidence of root caries. Preventive strategies including the use of fluorides and instruction to improve the attitude and behaviour towards oral hygiene are needed. [ABSTRACT FROM AUTHOR]

The aim of this literature review is to explore the treatment methods for root caries in laboratory and clinical research in the last decade. A systematic search of publications in PubMed and Web of Science databases was performed. The timespan was limited to the last 10 years and English language. Further retrieval was conducted using the search terms of specific therapies or treatments. Eighty-two articles were included in this systematic review and full texts were retrieved. Types of studies included laboratory studies and clinical trials. Therapeutic approaches for root caries without risk of pulp exposure can be categorized into non-invasive and restorative treatment. Non-invasive treatments which targeted different causative factors of root caries have been developed in the last decade. Accordingly, several artificial caries model systems have been proposed for the study of root caries in the laboratory. Carious tissue excavation techniques and restorative materials and procedures have been modified to improve the prognosis of invasive treatment. It is of importance to determine the most appropriate therapy for root caries and further clinical trials are needed to draw firm conclusions concerning the efficacy and consistency of the various treatment methods proposed. [ABSTRACT FROM AUTHOR]

Dental care, dental caries, errors, older adults, bias, root caries, silver diamine fluoride (SDF), statistical, outcome measurement Keywords: bias; dental care; dental caries; errors, older adults; outcome measurement; root caries; silver diamine fluoride (SDF); statistical EN bias dental care dental caries errors, older adults outcome measurement root caries silver diamine fluoride (SDF) statistical 406 406 1 08/17/23 20230901 NES 230901 The paper by Ericson and colleagues "Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults - A randomised clinical trial"[1] demonstrates a fundamental failure of peer review: the paper should be retracted. The paper by Ericson and colleagues "Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults - A randomised clinical trial" demonstrates a fundamental failure of peer review. [Extracted from the article]

Background: Increase in life expectancy and tooth retention in contemporary Australian adults may increase population-level burden of having root caries. This study aimed to describe patterns and evaluate associations of root caries with socio-demographic, socio-economic, clinical and behavioural factors.Methods: A secondary analysis was undertaken using data from the National Survey of Adult Oral Health 2004-2006, which included 5505 randomly general adults 15+ years old. Participants underwent an oral examination and completed an interview and a questionnaire. Prevalence and mean number of decayed/filled root (root DFS), untreated root (root DS), filled root (root FS), gingival recession, oral hygiene and gingival status were derived from examinations. Socio-demographic, socio-economic and behavioural factors were self-reported. Multivariable models were generated to estimate prevalence ratios (PR), mean ratios (MR) and confidence intervals (95% CI), adjusting for number of surfaces with gingival recession. Additional analysis for older adults 60+ years old was presented.Results: The prevalence of root caries was 25.3% (CI=23.6-27.1) and 62.0% [CI=58.7-65.1] among general and older adults, respectively. Risk factors found were similar in both populations. Smokers had higher prevalence and mean number of root DFS, DS and FS than never-smokers. In contrast with poor oral hygiene, high income and frequent brushing were significantly associated with lower mean root DS. Frequent dental visiting was associated with higher root FS and DFS.Conclusions: Root caries affected about a quarter of Australian general adults and more than a half of older adults. People who were smokers presented a significantly higher prevalence and severity of root caries. [ABSTRACT FROM AUTHOR]

Throughout lifetime, the teeth are continuously exposed to numerous chemical and physical impacts, which cause the wear of the dental hard tissues, gingival recession and other oral changes with sometimes subsequent problems. Age-related wear of tooth surfaces reduces the dental enamel thickness and exposes deeper layers of enamel, which have different physical and chemical properties than the surface enamel. Gingival recession is the main causal factor of root caries and dentine hypersensitivity. Age-related changes in dentine include the formation of secondary dentine and the reduction in tubular lumen diameter (dentine sclerosis), which lead to a reduction in the volume of the pulp chamber. In addition to the reduction in the volume of pulp chamber, changes to the dental pulp also include dental pulp calcifications. The age-related physiological changes to the teeth should be carefully distinguished from pathological changes, especially when they induce pain or a negative impact on the oral health-related quality of life ( OHRQoL) of the older individuals. Therefore, regular oral examinations coupled with early preventive measures should aim at maintaining oral health until old age. [ABSTRACT FROM AUTHOR]

Aim To review evidence for the treatments of gingival recession and root caries in older populations. Materials & Methods A systematic approach was adopted to identify reviews and articles to allow us to evaluate the treatments for gingival recession and root caries. Searches were performed in PubMed, Medline and Embase, the Cochrane trials register and bibliographies of European and World Workshops. Observations Gingival recession: We identified no articles that focussed specifically on older populations. Conversely, no evidence suggested that Miller class I and II lesions should be managed differently in older patients when compared to younger cohorts. Six systematic reviews included older patients and suggested that connective tissue grafts are the treatment of choice, alone or in combination with enamel matrix derivative. Root caries can be controlled at the population level by daily brushing with fluoride-containing toothpastes, whilst active decay may be inactivated using professional application of fluoride varnishes/solutions or self-applied high-fluoride toothpaste. Active root caries lesions that cannot be cleaned properly by the patient may be restored by minimally invasive techniques. Conclusions Gingival recession and root caries will become more prevalent as patients retain their teeth for longer. Whilst surgical (gingival recession) and non-operative approaches (root caries) currently appear to be favoured, more evidence is needed to identify the most appropriate strategies for older people. [ABSTRACT FROM AUTHOR]

Background Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. Aims The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. Methods Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. Results Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. Conclusions Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate thermal and near-infrared (NIR) reflectance imaging methods for the assessment of the activity of root caries lesions. In addition, changes in the lesion structure were monitored with polarization sensitive optical coherence tomography (PS-OCT). Artificial bovine and natural root caries lesions were imaged with PS-OCT, and their dehydration rate was measured with thermal and NIR cameras. The lesion activity of the natural root caries samples was also assessed by two clinicians by conventional means according to ICDAS II guidelines. The thickness of the highly mineralized transparent surface layer measured using PS-OCT increased and the area enclosed by the time-temperature curve, Δ Q, measured with thermal imaging decreased significantly with longer periods of remineralization in simulated dentin lesions, but the NIR reflectance intensity differences, Δ I, failed to show any significant relationship with the degree of remineralization. The PS-OCT algorithm for the automated assessment of remineralization successfully detected the highly mineralized surface layer on both natural and simulated lesions. Thermal imaging provided the most accurate diagnosis of root caries lesion activity. These results demonstrate that thermal imaging and PS-OCT may be ideally suited for the nondestructive root caries lesion activity during a clinical examination. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review was to compare cumulative failure rates of different restorative materials in carious class V lesions on the root surfaces of adult patients.Background: The prevalence of root caries is set to increase in the coming years as a result of ageing of the population and a concomitant reduction in levels of edentulousness. Evidence is needed to assist practitioners to select the most appropriate restorative material for use in these lesions.Methods: A search of the literature was undertaken using the electronic databases of PubMed, Embase, CENTRAL and OpenSIGLE using keywords relevant to the search question. Two review authors conducted the electronic search independently, and any conflict was resolved by discussion. The references quoted in the full text articles extracted were hand searched for any further eligible studies.Results: Sixty non-duplicate citations were screened. Following review of the titles, abstracts, texts and application of the pre-determined inclusion/exclusion criteria, five studies remained.Conclusion: There is a need for more research in this area as many of the studies identified in this systematic review treated post-radiation, xerostomic patients which are not typical of the general population. Increased adherence to CONSORT guidelines for reporting is also advised to facilitate future systematic review and meta-analysis in this area. [ABSTRACT FROM AUTHOR]

Background: This study compared the effects of three flavonoids, including proanthocyanidin, naringin and quercetin on remineralization of artificial root caries.Methods: Demineralized root fragments (n = 75) were randomly divided into five groups for treatment with the remineralizing agents for 10 minutes: (1) 6.5% proanthocyanidin; (2) 6.5% naringin; (3) 6.5% quercetin; (4) 1000 ppm fluoride; and (5) deionized water (control). The demineralized samples were pH-cycled through treatment solutions, acidic buffer and neutral buffer for eight days at six cycles per day. The remineralization effects were evaluated using Knoop microhardness, transverse microradiography (lesion depth and mineral loss) and confocal laser scanning microscopy. Microhardness at different lesion depths was analysed with two-way ANOVA and Tukey's test, while lesion depths and mineral loss were analysed with one-way ANOVA and Tukey's test.Results: Artificial caries lesions treated with fluoride and flavonoids showed significantly greater hardness than the control group (p < 0.05). Both lesion depths and mineral loss of the flavonoid treated groups were significantly lower than the control group (p < 0.05), but significantly higher than the fluoride treated group. No significant difference in lesion depth and mineral loss was found among the three flavonoids (p > 0.05).Conclusions: All three flavonoids showed positive effects on artificial root caries remineralization, which are significantly lower than that of 1000 ppm fluoride. [ABSTRACT FROM AUTHOR]

An alternate technique of care to prevent, arrest and manage root caries using aqueous silver fluoride followed by stannous fluoride (AgF+SnF2) in aged care is demonstrated by three case studies. With increasing age, the inability to maintain ones own oral care from dementia, illness or frailty and polypharmacy induced salivary gland hypofunction will result in dental caries becoming a progessively greater burden for the elderly. Future generations of elders will live longer and need to maintain many more teeth longer than earlier generations. Both silver diamine fluoride (SDF)and AgF+SnF2 arrest and prevent caries and are easy to use in residential aged care facilities. Clinical differences between SDF and AgF+SnF2 are discussed. However, in aged care, AgF+SnF2 may offer advantages over SDF. AgF+SnF2 used to arrest and prevent caries in children can be modified to provide effective but minimally invasive care for an ageing and frail population. These techniques are rapid, inexpensive and nonthreatening suited to treat frail elders, dementia patients exhibiting challenging behaviours and patients with multiple rapidly progressing decay. Silver fluoride, applied before placing glass-ionomer cement (GIC) restorations is an important adjunct to the atraumatic restorative technique and may retard caries reactivation more than GIC used alone. [ABSTRACT FROM AUTHOR]

Purpose To measure the pH values of commonly used oral moisturizers and to evaluate their erosive potential using a gravimetric analysis. Materials and Methods A pH analysis was performed for seven commercially available oral moisturizers using a calibrated pH meter. The pH recording was repeated three times, from three different bottles each of the same product. The gravimetric analysis was performed by submerging human dentin blocks in 5 ml of each of the moisturizers for a total of 2 weeks, with gravimetric measurements made at baseline, 24 hours, 48 hours, 96 hours, 1 week, and 15 days. Tap water was used as positive control and citric acid as the negative control. The erosive potential was descriptively analyzed, and a Spearman correlation coefficient was used to assess the relationship between the erosive potential and the pH values. Results The average pH values are as follows: Oasis, 6.3, Bioténe Moisturizing Mouth Spray, 6.1, CTx2 Spray, 9.1, Mouth Kote, 3.0, Thayer's, 6.3, Bioténe Oral Balance, 6.6, Rain, 7.1, tap water 6.99, and citric acid 1.33. The results (% of tooth structure lost) of the gravimetric analysis were as follows: Mouth Kote, 9.6%, Bioténe Moisturizing Mouth Spray, 4.6%, Oasis, 3.2%, Thayer's, 2.0%, Bioténe Oral Balance, 0.0%, Rain, 0.0%, CTx2 Spray, 0.0%, tap water 0.0%, and citric acid 18.8%. There was a significant negative correlation between the pH values and the erosive potential (rs = −0.73; P ≤ 0.0001). Conclusions There is large variation in the composition and pH values of commonly used oral moisturizers, and there is a strong correlation between pH values and erosive potential of commonly used oral moisturizers. Clinical Significance: Patients with dry mouth are at increased risk for erosion and root caries. Oral moisturizing agents are often prescribed for patients with hyposalivation to be used as needed for symptomatic relief. This study shows that there is large variation in the pH values and erosive potential of commonly used oral moisturizing agents. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the synergistic effect of proanthocyanidin (PA) and casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) on remineralization of artificial root caries.Methods: Demineralized root fragments (n = 90) were randomly divided into six groups based on treatments: (1) 6.5% PA; (2) CPP-ACP; (3) CPP-ACFP; (4) CPP-ACFP + 6.5% PA; (5) 1000 ppm fluoride; and (6) deionized water (control). Each specimen was immersed in demineralizing solution for 14 h, testing solutions/pastes for 2 h, remineralizing solution for 8 h and pH cycling was performed at 37 °C for 8 days. Specimens were evaluated using transverse microradiography (lesion depth and mineral loss), Knoop microhardness and confocal laser scanning microscopy.Results: Lesion depth was significantly lower in CPP-ACFP+PA and 1000 ppm fluoride groups (p < 0.001) with no significant difference between the two groups (p > 0.05). Mineral loss was the lowest in CPP-ACFP+PA group (p < 0.05). Fluoride and CPP-ACFP groups showed similar mineral gain (p > 0.05). Artificial caries lesions treated with CPP-ACFP+PA showed significantly higher microhardness values at 130 μm and 150 μm from the surface (p < 0.05).Conclusions: Combined use of PA and CPP-ACFP has a synergistic effect on root caries remineralization by enhancing mineral gain and increasing hardness of artificial root caries. [ABSTRACT FROM AUTHOR]

ABSTRACT The relationship between diabetes and root caries has not received much attention in the literature; therefore the objectives of the present study were to assess the root surface caries among type 2 diabetic patients and the factors affecting root surface caries. A hospital based cross-sectional study was done among type 2 diabetics visiting a medical hospital in Bangalore. Those who had been diagnosed from at least past 5 years and were above 35 years of age were included. Among the 400 study subjects, root caries were present among 42% of the subjects. There was a statistically significant association for the presence of root caries and age (p = 0.00023), presence of periodontal pockets (p = 0.0004) and presence of loss of attachment of more than 3 mm (p < 0.0001). These findings indicate that there is a need for implementation of caries preventive measures with increasing age, and among those with compromised periodontal status among those suffering from type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Methods: Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Results: Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Conclusions: Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services. [ABSTRACT FROM AUTHOR]

Objective The aim of this single - blind, multicenter, parallel, randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults. Methods Adult patients ( n = 130, ♂ = 74, ♀ = 56; mean age ± SD: 56.9 ± 12.9) from three participating centers, diagnosed with root caries, were randomly allocated into two groups: Test ( n = 64, ♂ = 37, ♀ = 27; lesions = 144; mean age: 59.0 ± 12.1; intervention: high-fluoride toothpaste with 5000 ppm F), and Control ( n = 66, ♂ = 37, ♀ = 29; lesions = 160; mean age: 54.8 ± 13.5; intervention: regular-fluoride toothpaste with 1350 ppm F) groups. Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals ( T0 - at baseline before intervention, T1 - at 3 months and T2 - at 6 months after intervention). Mean surface hardness scores ( HS) were calculated for each patient. Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni- Dunn correction. Results At T0, there was no statistical difference between the two groups with regard to gender ( P = 0.0682, unpaired t-test), or age ( P = 0.9786, chi-squared test), and for the overall HS (Test group: HS = 3.4 ± 0.61; Control group: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). The anova revealed significantly better HS for the test group than for the control groups ( T1: Test group: HS = 2.9 ± 0.67; Control group: HS = 3.1 ± 0.75; T2: Test group: HS = 2.4 ± 0.81; Control group: HS = 2.8 ± 0.79; P < 0.0001). However, the interaction term time-point*group was not significant. Conclusions The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes. [ABSTRACT FROM AUTHOR]

Objectives To compare the oral health status of adults aged 45-64 (baby boomers) and those aged 65 and older. Methods An observational, cross-sectional survey of adults living independently in rural and urban settings in Nova Scotia, Canada was conducted. Using random digit dialing, calibrated interviewers completed a telephone survey, and clinicians calibrated to WHO standards conducted clinical examinations. Weighting was used to correct for sampling bias. Results 747 community dwelling adults completed both the clinical exam and the questionnaire ( n = 411, age 45-64; n = 336, age 65 or older). Rates of edentulism were low (2.6% aged 45-64; 15.7% aged 65+; p < 0.001). Untreated root caries was greater in the older dentate group (19.7 vs. 10.1%; p < 0.001). Being 65 years of age or older was identified as a predictor of increased decayed, missing, filled teeth, presence of decayed and/or filled roots and presence of attachment loss ≥4 mm, but was not a significant predictor of presence of untreated coronal caries. Conclusions A falling rate of edentulism and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages. [ABSTRACT FROM AUTHOR]

Background and objective A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. Material and Methods The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. Results Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. Conclusion Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy. [ABSTRACT FROM AUTHOR]

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependancy and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients. [ABSTRACT FROM AUTHOR]

Background Root caries stands to be a significant burden for Australia's ageing population. The objective of this study was to describe Queensland dental practitioners' perceptions of root caries prevalence, presentation and predisposing factors as well as diagnosis and recording practices. Methods Using the Queensland Dental Board register, all 2 515 dentists and dental specialists practising in Queensland were invited to participate in a questionnaire-based postal survey. Results Of the 660 responses received, 638 were included for final analysis. Use of diagnostic measures such as surface elasticity and contour were reported frequently. A majority of respondents (77%) reported not recording root caries in a way that could be distinguished from coronal caries. Dietary analysis was the most commonly reported adjunctive aid for risk assessment. Recommendations for use of remineralizing agents were frequently reported (home use 90%; in office use 71%). Salivary impairment was reported to be an important risk factor for root caries by 93% of respondents, but only 18% reported performing salivary analysis. A large proportion of respondents (32%) considered patients with diabetes to be of low or no risk of root caries. Conclusions While the Queensland dental practitioners who participated in this survey demonstrated an awareness of root caries and its predisposing factors, clinical risk assessment particularly for patients with diabetes should be further examined. [ABSTRACT FROM AUTHOR]

ABSTRACT The authors conducted a review to evaluate the current literature addressing root surface caries treatment in the vulnerable elderly, to identify any gaps in the literature that will need to be addressed in the future. The authors conducted a literature search of the electronic databases using MEDLINE, PubMed, to identify original clinical research articles regarding treatment of root caries lesions, with emphasis on research focused on the vulnerable elderly. Five articles were clinical studies of root caries restorations. Only one was conducted on a vulnerable elderly population. The results of the literature review show that there is a need for further studies addressing the restorative needs of the vulnerable elderly. With the aging of the American population, more research is needed to provide adequate care to this population. At this time, glass ionomers are a good treatment option. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. Method Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010. Results In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%. Conclusion For 1° prevention of root caries the recommended 'best choice' is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended 'best choice' is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months. [ABSTRACT FROM AUTHOR]

doi: 10.1111/j.1741-2358.2011.00560.x Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease Objective: To identify indicators of root caries among persons with newly diagnosed Alzheimer's disease (AD). Background: Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD. Methods: Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records. Results: We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries. Discussion: Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions. [ABSTRACT FROM AUTHOR]

This report reviews the current understanding of the relationship between diabetes and root caries, and investigates the evidence for dental chairside testing of gingival crevicular blood (GCB) glucose levels to assess risk for type 2 diabetes mellitus. Diabetes is linked with the progression of periodontal disease and a greater number of exposed root surfaces at risk for root caries. The rapidly increasing prevalence of type 2 diabetes coupled with a general trend towards retention of teeth means that the number of patients with increased risk for root caries is expanding significantly. Many patients with diabetes or abnormal blood glucose levels are unaware of their condition or that they are at increased risk for oral disease. Systemic blood glucose concentrations are comparable to those found in GCB and therefore may be a useful adjunctive clinical aid in determining appropriate care for patients and providing timely referrals to general medical practitioners. Use of GCB testing within the dental clinic is described. It is proposed that future studies be undertaken to provide clinicians with improved risk assessment strategies and to evaluate GCB glucose screening models. [ABSTRACT FROM AUTHOR]

doi: 10.1111/j.1741-2358.2010.00367.x Relationship between root caries and cardiac dysrythmia Background: Cardiac dysrhythmia are frequently found in the elderly population because of conduction system disease and ageing. Recent reports have suggested that dental caries and periodontal disease are predictors of coronary heart events. However, this hypothesis remains largely unproven. Objective: This study investigated the relationship between root caries and cardiac dysrhythmia in an elderly population. Subjects and methods: Among 600 subjects, 233 who were dentate at baseline underwent a baseline examination and subsequent annual investigations, including an oral examination and a 12-lead electrocardiogram, for a 4-year period. Analysis of covariance (ancova) was used to assess the number of sites with root caries between subjects with mean C-reactive protein (CRP) serum level of <3.0 mg/l and those with the mean CRP serum level ≥3.0 mg/l. Logistic regression analysis was performed to assess relationship between root caries and cardiac dysrhythmia. Results: A high mean CRP serum level group had a significantly higher number of sites with root caries than a low CRP group ( p < 0.001). Number of sites with root caries events was significantly associated with cardiac dysrhythmia among non-smokers (odds ratio, 5.84; p = 0.040). These results suggest that root caries is related to the incidence of dysrhythmias in non-smokers. Conclusions: We conclude that non-smoking elders with root caries lesions are at an elevated risk for dysrhythmias. [ABSTRACT FROM AUTHOR]

Marlow NM, Slate EH, Bandyopadhyay D, Fernandes JK, Salinas CF. An evaluation of serum albumin, root caries, and other covariates in Gullah African Americans with type-2 diabetes. Community Dent Oral Epidemiol 2011; 39: 186-192. © 2010 John Wiley & Sons A/S Associations between dental conditions and overall health have been previously reported. Investigators have also shown significant inverse relationships between serum albumin (a general health status marker) and root caries. This relationship was explored among a study population of Gullah African Americans (who have a considerably lower level of non-African genetic admixture when compared to other African American populations) with type-2 diabetes (T2DM) and self-reported history of normal kidney function ( N = 280). Root caries indices were defined as total decayed and/or filled root surfaces. The coronal caries index [total decayed, missing, and/or filled coronal surfaces (DMFS)], level of glycemic control, total number of teeth, and other covariates were also evaluated. Logistic regression models were used to evaluate the associations between these factors and hypoalbuminemia (serum albumin concentrations <4 g/dl). Serum albumin concentrations ranged 2.4-4.5 g/dl (mean = 3.8, SD = 0.3), with 70.4% exhibiting hypoalbuminemia. Root caries totals ranged 0-38 (mean = 1.3, SD = 4.5) surfaces decayed/filled, while total teeth ranged 1-28 (mean = 19.4, SD = 6.2). DMFS totals ranged 2-116 (mean = 55.2, SD = 28.0). We failed to detect significant associations for root caries; however, the final multivariable logistic regression models showed significant associations between hypoalbuminemia and total teeth [odds ratio (OR) = 0.93, P = 0.01], poor glycemic control (OR = 2.49, P < 0.01), elevated C-reactive protein (OR = 1.57, P < 0.01), glomerular filtration rates ≥60 (OR = 0.31, P = 0.03), and age (OR = 0.97, P = 0.03). Previously reported inverse relationships between serum albumin and root caries were not evident in our study population. We propose that these null findings are because of the considerably lower level of root caries as well as other differing characteristics (including oral health status, the chronic presence of T2DM, and predominantly younger age) within our study population compared to these previously assessed groups. [ABSTRACT FROM AUTHOR]

A study is presented which examined clinical indicators associated with the development of dental root caries in elderly patients who are enrolled in Family Medicine Unit Number 28 of the Mexican Institute of Social Security (IMSS) in Mexico City, Mexico. The data collection, instrument for data collection, clinical indicators for oral health and statistical analysis of the study are included. The study shows that patients who developed root caries have limited basic daily life activities (BDLA).

Ritter AV, Shugars DA, Bader JD. Root caries risk indicators: a systematic review of risk models. Community Dent Oral Epidemiol 2010; 38: 383–397. © 2010 John Wiley & Sons A/S Objective: To identify risk indicators that are associated with root caries incidence in published predictive risk models. Methods: Abstracts ( n = 472) identified from a MEDLINE, EMBASE, and Cochrane registry search were screened independently by two investigators to exclude articles not in English ( n = 39), published prior to 1970 (none), or containing no information on either root caries incidence, risk indicators, or risk models ( n = 209). A full-article duplicate review of the remaining articles ( n = 224) selected those reporting predictive risk models based on original/primary longitudinal root caries incidence studies. The quality of the included articles was assessed based both on selected criteria of methodological standards for observational studies and on the statistical quality of the modeling strategy. Data from these included studies were extracted and compiled into evidence tables, with information about the cohort location, incidence period, sample size, age of the study participants, risk indicators included in the model, root caries incidence, modeling strategy, significant risk indicators/predictors, and parameter estimates and statistical findings. Results: Thirteen articles were selected for data extraction. The overall quality of the included articles was poor to moderate. Root caries incidence ranged from 12% to 77% (mean ± SD = 45 ± 17%); follow-up time of the published studies was ≤ 10 years (range = 9; median = 3); sample size ranged from 23-723 (mean ± SD = 264 ± 203; median = 261); person-years ranged from 23 to 1540 (mean ± SD = 760 ± 556; median = 746). Variables most frequently tested and significantly associated with root caries incidence were (times tested; % significant; directionality): baseline root caries (12; 58%; positive); number of teeth (7; 71%; three times positive, twice negative), and plaque index (4; 100%; positive). Ninety-two other clinical and nonclinical variables were tested: 27 were tested three times or more and were significant between 9% and 100% of the times tested; and 65 were tested but never significant. Conclusions: The root caries incidence indicators/predictors most frequently reported were root caries prevalence at baseline, number of teeth, and plaque index. This finding can guide targeted root caries prevention. There was substantial variation among published models of root caries risk in terms of variable selection, sample size, cohort location, assessment methods, incidence periods, association directionality, and analytical techniques. Future studies should emphasize variables frequently tested and often significant, and validate existing models in independent databases. [ABSTRACT FROM AUTHOR]

Treatment of early root caries using resin adhesives to stabilize demineralized dentine and deprive bacteria of nutrients is a recognized and conservative treatment option. Essential to its success is a stable resin‐dentine interface, with effective infiltration of demineralized dentine and adequate resin curing. The objective of this study was therefore to examine degree of cure (DoC) and depth of penetration of dentine adhesives in demineralized dentine using micro‐Raman spectroscopy. Three commercially available adhesives were applied essentially according to manufacturers' instructions to visibly wet demineralized dentine, with two coats of primer to reduce dilution. Specimens were sectioned perpendicular to the bonded interface and micro‐Raman spectroscopy performed on the cross section. Molecules associated with the adhesive were detected to depths greater than 100 μm indicating a thicker hybrid layer than seen in sound dentine. The hybrid layer showed an increase in proportion of aliphatic CC double bonds at the base of the hybrid layer, which may be a consequence of reduced DoC or phase separation. Micro‐Raman spectra suggest deep zones contain an increased concentration of HEMA and a lower concentration of BisGMA, which is likely to be less stable and may contribute to early breakdown of the dentine adhesive interface. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2010. [ABSTRACT FROM AUTHOR]

The objectives of this study were to describe root caries patterns of Chinese adults and to analyze the effect of selected demographic and socioeconomic factors on these patterns. A total sample of 1080 residents aged 35–44-years-old and 1080 residents aged 65–74-years-old from three urban and three rural survey sites in Hubei Province participated in both an oral health interview and a clinical oral health examination. Root surface caries prevalence rates were 13.1% in the middle-aged group and 43.9% in the elderly group. The mean number of teeth affected by caries in the middle-aged group was reported at 0.21 and 1.0 in the elderly group. Mean Root Caries Index (RCI) scores of the middle-aged were reported at 6.29 and elderly subjects were reported at 11.95. Elderly people living in rural areas reported a higher RCI score (13.24) than those living in urban areas (10.70). A significantly higher frequency of root surface caries was observed in elderly participants ( P < 0.001, OR = 3.80) and ethnic minorities ( P < 0.001, OR = 1.93). In addition, smokers, nontea drinkers, and those with an annual household income of 10 000 yuan or less tended to have higher caries prevalence. RCI figures for the different tooth types ranged from 1% to 16%, indicating a wide variation in attack rates. In conclusion, our study suggests that root surface caries occurrence is high among the Chinese adult population, especially older adults. With an increasing number of retained teeth in both middle-aged and elderly people, root caries is a growing disease in the People’s Republic of China which deserves more attention in future research. [ABSTRACT FROM AUTHOR]

Objective: We hypothesise that a difference in nutrition influences dental caries and periodontal disease. There are few previous studies especially longitudinal ones which have evaluated this hypothesis. This study investigated the relationship between nutritional intake, including milk and milk products (MMP), and dental disease, controlling for several confounding factors. Material and methods: A group of 600 subjects aged 70, randomly selected for this study, included approximately the same number of male and female subjects. The number of teeth on which root caries had occurred or where there was a periodontal event over a 6-year period was measured. To determine quantitative food intake at baseline, a semi-quantitative food frequency questionnaire was used during face-to-face interviews by dieticians. The stepwise method of multiple linear regression analysis was used to identify independent predictors of the number of root caries or periodontal disease events during the 6 years. Intake of the six food groups includes (i) fish, shellfish, meat, beans and eggs; (ii) MMP; (iii) dark green and yellow vegetables (DYV); (iv) other vegetables and fruits; (v) cereals, nuts and seeds, sugar and sweeteners, confectioneries (CNSC) and (vi) fats and oils. The alcohol, gender and anthropometric evaluation including measurements of weight and height for the calculation of body mass index, educational level, the number of family members and the number of remaining teeth were used as independent variables. Results: According to stepwise multiple regression analysis, two variables (quantity of MMP, and gender) were negatively associated with the number of root caries events during the 6 years. The standardised coefficients were −0.14 ( p = 0.035) and −0.17 ( p = 0.007) respectively. In addition, DYV were negatively, and three other variables (CNSC; alcohol; and the number of remaining teeth at baseline) were positively associated with the number of periodontal disease events during the 6 years. The standardised coefficients were −0.16 ( p = 0.001), 0.11 ( p = 0.042), 0.10 ( p = 0.041) and 0.58 ( p < 0.001) respectively. Conclusion: Our results suggest that the intake of MMP in this elderly population correlated with root caries events. In addition, intake of vegetables negatively correlated, and intake of ‘CNSC’ positively correlated with periodontal disease events. [ABSTRACT FROM AUTHOR]

Background: Fluoride and chlorhexidine (CHX) are state-of-the-art preventive measures for remineralizing teeth and for preventing plaque accumulation. The aim of this study was to examine the effects of fluoride and CHX varnishes on root caries and microbiota located on root surfaces. Methods: Thirty-three patients from a periodontal maintenance program, having at least one tooth with gingival recession in each quadrant, participated in this study. One tooth per quadrant was assigned randomly to the control group or to one of the test groups that were treated with fluoride varnish, 1% CHX, or 40% CHX. The varnish treatment and the tooth cleaning were repeated every 3 months. Clinical examinations were performed at baseline and once a year for 3 years. Caries status and oral hygiene indices were evaluated clinically. The total cultivable microbiota and percentage of Mutans streptococci (MS), Actinomyces (ACC), and lactobacilli (LB) were analyzed. Results: Oral hygiene was improved greatly during the course of the study. The percentage of MS, ACC, and LB of the total cultivable microbiota revealed a statistically significant reduction between baseline and final examination for each of the four groups. Conclusion: Professional tooth cleaning alone at 3-month intervals might be as effective in reducing MS, ACC, and LB as adjunctive treatment with fluoride or chlorhexidine. [ABSTRACT FROM AUTHOR]