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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

Diabetes and Dental Care: Learn Everything You Need To Know

Diabetes, affecting millions of Americans, increases the risk for multiple dental problems. If you are diabetic, be sure your health condition is reflected in your dental records. Your dentist will want to carefully monitor your oral health needs.

Diabetics must pay special attention to the following conditions related to oral health:

Tooth Decay

High glucose levels in saliva help bacteria to thrive, repeatedly attacking teeth with cavity-causing acids. Brushing at least twice a day with fluoride toothpaste and flossing daily is vital.

Gum Disease

Diabetes reduces the body's resistance to infection and gum tissues are frequently affected. Diabetics may experience more frequent and severe cases of periodontal disease. See your dentist if you notice any of these symptoms: your gums are tender, red, swollen, or bleed easily; your gums have pulled away from the teeth; or you notice any pus between the teeth and gums when the gums are pressed. Other indicators are chronic bad breath or a bad taste in your mouth; any changes in your bite or fit of partial dentures; or permanent teeth that become loose. Since diabetes can impair the healing process, abscesses can develop, so it is important to schedule regular periodontal exams.

Oral Fungal Infections

People with high glucose levels who smoke or frequently take antibiotics are more prone to develop oral candidiasis, or thrush. This is a condition where white or red patches in the mouth become ulcerated and attack the tongue with a painful, burning sensation. Swallowing can be difficult and your ability to taste can be impaired. Antifungal medications can be prescribed by your dentist.

Taste Impairment

A diminished sense of taste can influence food choices. Diabetics have reported that their perception of sweetness is lessened. As a result, selecting sweet-tasting, refined carbohydrate foods puts diabetics at greater risk for developing both general health and dental problems.

Dry Mouth: Diabetic patients often complain about dry mouth due to salivary gland dysfunction related to the disease. Constant dryness irritates the soft tissues causing inflammation and pain. It can also increase the likelihood of tooth decay and gum disease.

Saliva substitutes available in pharmacies can relieve discomfort. Sugarless gum, sugarless mints, and drinking plenty of water also are useful in combating dry mouth. Additionally, restrict consumption of caffeine and alcohol.

Mouth Lesions

Pimple-like sores, generally painless, dot the mouth tissues. In a more severe condition, the tissue becomes painfully ulcerated. No permanent cure is available, but your dentist can prescribe medication to relieve the condition.

Since diabetics are more prone to conditions that jeopardize oral health, regular dental check-ups and periodontal screenings are essential. More frequent evaluations may be needed to ensure optimum oral health.

Bad breath, or halitosis, is a signal that something is not right inside your mouth. It may be as simple as the need to pay more attention to your daily oral hygiene, or it may indicate tooth decay, gum disease, or another medical problem. Whichever it is, bad breath is a red flag: take another look at your mouth!

Bad breath is a social problem; if you have bad breath, you may notice that people actually back away as you talk to them. Mouth odors are embarrassing, and they tell other people that you aren't taking care of yourself. Sometimes people are not aware that their breath smells bad; be alert to how other people react when they're close to you, and be grateful if a friend or family member lets you know about the problem.

Commercial products claim they will make your breath fresher, but the only way to make sure your breath permanently fresh is to practice good oral hygiene. In fact, too many breath mints and hard candies with sugar will lead to tooth decay. If you are constantly using breath mints, breath sprays, or mouth rinses in an effort to cover up your bad breath, realize that you may have a dental or medical problem that needs addressing.

There are a number of reasons you may experience a bad taste in your mouth, and even be able to smell your own breath. Food may be lodged between your teeth if you are not brushing at least twice daily and flossing regularly. Food particles can be very tiny and can wedge themselves between teeth and below the gum line; brushing after meals is important and flossing is imperative to get at the particles that the brush can't reach. Brush your tongue or use a tongue scraper. As odd as it will feel at first, bacteria collects on the tongue and can contribute to bad breath. If you wear removable dentures, take them out at night and clean them thoroughly before you wear them again.

If you neglect your daily hygiene over time, bad breath can become a symptom of more serious dental problems. Teeth that are not cleaned properly become a place for bacteria to reside as food particles stay in your mouth and decay. Bacteria attack your teeth and gums and cause cavities and gum disease. If this is happening, gum disease will cause an unpleasant odor.

Perhaps you believe that you are brushing and flossing on a regular basis, but are still experiencing bad breath. If you have teeth that are crooked or crowded, it may be hard for you to clean between them. If you wear dentures that are not fit properly, they may be trapping food or irritating your mouth. Or perhaps your bad breath is caused by another medical problem: drainage from your sinuses, gastrointestinal problems, kidney or liver problems, or other medical conditions.

Here's what you can do to "investigate" on your own. Write down what you're eating and notice whether your breath smells bad because of certain foods. Garlic and onions actually cause odor, but the odor is coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.

Are you dieting? Hunger can contribute to bad breath, because of the chemical changes as your body turns fat and protein into the energy it needs. Taking prescription or over-the-counter medications? Add these to the record of what you're eating to see whether there's a relationship between your medications and your bad breath. And don't forget to tell your dentist if there's been a change in your overall health since your last visit.

Suffering from dry mouth? Saliva provides constant rinsing in our mouths and washes away food particles. Your dentist may recommend more liquids, sugarless candy to stimulate natural saliva, and perhaps some of the commercial products that are available to combat dry mouth.

If bad breath continues after you have done your best job of regular brushing and flossing, start with your dentist. He or she can tell you whether the odor is caused by an oral problem; if it is not, then your dentist will suggest you see your doctor for a physical check-up.

Regular dental check-ups will help keep your mouth healthy and working well. Your dentist can spot dental problems before they cause trouble, including problems that cause bad breath.

By Brian J. Gray, DDS, MAGD, FICO