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Root Caries: A Significant Dental Problem

People are living longer and keeping their natural teeth more than ever before. The advances in tooth retention, the desire to look one's best, and higher expectations about oral health have raised dental awareness among older adults.

With the significant increase in the older portion of society, with even greater increases expected, more older adults will have more teeth that are susceptible to root caries. Root caries may emerge as one of the most significant dental problems among older adults during the next decade. A recent study conducted by the National Institute for Dental and Craniofacial Research (NIDCR) showed that over half of older adults have decayed or filled root surfaces. The frequency of root caries is strongly age-dependent and will continue to be a major dental problem among the elderly.

Root caries lesions can be caused by new or primary root caries, caries around existing dental fillings or recurrent caries, and abrasion or erosion of the root surfaces. Root caries progress quickly due to the relatively soft nature of the root surface, as well as the risk factors associated with the incidence of root caries.

Risk factors associated with the high prevalence of root caries among older adults include decrease salivary flow or xerostomia, exposure of root surfaces due to periodontal (gum) disease, chronic medical conditions, radiation treatment for head and neck cancer, physical limitations, and diminished manual dexterity due to stroke, arthritis, or Parkinson's disease, cognitive deficits due to mental illness, depression, Alzheimer's disease or dementia, Sjögren's syndrome (an autoimmune disease), diabetes, poor oral hygiene, multiple medication use, and changes in dietary habits. One or more of these risk factors or life changes, which are more common among older adults, can increase root caries in an individual who has not had dental caries for many years.

Root caries can be a challenge for the dentist to treat depending on the size and the type of root caries lesion, the extent and rate of caries activity for that person, the physical and mental condition of the individual, and where the root caries are located in the mouth. Many root lesions have limited accessibility and visibility, are often more complicated by pre-existing extensive dental work, and are difficult to isolate from oral fluids during the restoration process. Also, many people who have widespread root lesions have limited tolerance for dental treatment because of medical conditions, illness, and mental health problems.

By Denise J. Fedele, DMD, MS

Oral Health Care And Menopause

When women enter menopause, changing hormone levels bring about a variety of symptoms and raise new oral health issues. Women and their doctors must consider the entire range of physical and emotional health implications, including their oral health.

Bone Loss and Oral Health

As natural levels of estrogen decline, women may find themselves at risk for loss of bone density. Jawbones are no different; these structures hold our teeth in place, and loss of jawbone density can lead to tooth loss.

When women lose teeth, there are other immediate considerations. One is the potential loss of nutrition, as people with fewer teeth or with problem teeth tend not to eat well. Second is the loss of confidence or self-esteem that results from any cosmetic changes to our bodies. And third, the financial cost of replacing one or more teeth can stretch even the best-planned budget.

Gum Disease and Tooth Decay

Hormonal changes also can have an impact on the health of gums and teeth. Women may find that their gums become inflamed and bleed easily, and may discover that their teeth are more cavity-prone. Both gum disease and tooth decay can result in losing teeth, another good reason to consider your oral health during this significant time of your life.

Signals of Change

Women may notice a burning sensation or dryness in their mouths. They also may discover that these changes cause food to taste different, leading to a loss of appetite. Be alert to an appetite loss that persists, particularly if you begin to lose weight.

If gums become inflamed or bleed easily, alert your dentist who will check for early signs of gum disease. A receding gum line may indicate bone loss in your jaw, so ask your dentist to examine your mouth and jaw carefully.

Preventive Medicine

Both you and your doctor should discuss prevention techniques, including calcium and vitamin D supplements, and replacement therapy for hormones. These are personal decisions that vary from woman to woman, and your doctor is best equipped to advise you.

What you can do is pay attention to your nutritional needs. Make sure you eat a wide assortment of healthy foods. Fruits and vegetables provide essential vitamins, minerals, and other nutrients. Exercise also is important to maintain your oral health and a healthy lifestyle.

Finally, keeping tabs on your emotional health as you enter menopause is important. A healthy outlook on life enables women to value themselves and seek the care required including: maintaining good oral health, seeing the doctor and dentist regularly, and focusing on healthy eating and exercise.

By Brian J. Gray, DDS, MAGD, FICO