Relationship between root caries and coronal decay

The relationship between caries on root surfaces and untreated coronal lesions was analyzed. A representative sample of 5028 persons was examined, their mean ages being 47.3 years for men and 47.7 for women. Poor dental health on root surfaces was associated with poor dental health in the coronal areas of the teeth. Subjects with root caries had fewer teeth and fewer fillings, more retained roots and more teeth with untreated coronal decay than did people with no root caries. Compared with the subjects without untreated coronal decay, those with from one to three decayed coronal surfaces showed an odds ratio of 4.5 of having caries on root surfaces. This ratio was 10.1 for the subjects who had more than three decayed coronal surfaces. It was concluded that factors related to the occurrence of decay are of a similar type whether caries is situated on root surfaces or in the coronal areas of the teeth, and therefore the prevention of caries in both sites may be accomplished by similar means.     

Coronal and Root Decay Experience in Older Adults in Ontario, Canada

This paper describes the coronal and root caries experience of subjects aged 50 years and older living in four communities in Ontario, Canada. The data were obtained as part of a comprehensive epidemiologic study of the oral health and treatment needs of this population. Caries experience was defined as the number of decayed and filled coronal and root surfaces per subject. Of 907 subjects interviewed and clinically examined, 78.3 percent were dentate and retained a mean of 18.9 teeth. The mean number of coronal decayed and filled surf aces was 23.9; 95.6 percent of subjects had at least one coronal DFS. The mean number of decayed and filled root surfaces was 3.6; 70.9 percent had at least one root DFS. The percent D/DFS was 3.5 for coronal and 20.0 for root caries. In linear regression analysis the number of teeth, making regular preventive visits, being born in Canada, and educational status emerged as predictors of coronal DFS. Predictors of root DFS were the number of surf aces with recession, the number of coronal DFS, the number of teeth, age, sex, and smoking status. These variables accounted for 42 percent and 35 percent of the variance in the number of coronal and root DFS, respectively.     

Type 1 diabetes mellitus and oral health: assessment of coronal and root caries

OBJECTIVES: The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). METHODS: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. RESULTS: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. CONCLUSIONS: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.     

Consequences of Success: Do More Teeth Translate into More Disease and Utilization?

Objectives : Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this "more teeth, therefore more dental disease" theory using cross-sectional data. Methods : In-home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis. Results : Analysis of variance on subjects with 1–10 (Group 1), 11–24 (Group 2), and 25–32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1,33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surfaces were significantly higher in Group 1 (mean root DS=1.3) than Group 3 (mean root DS=0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1). Conclusion : These cross-sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.     

Prevalence and intraoral distribution of coronal and root caries in middle-aged and older adults.

This work describes the prevalence and intraoral distribution of coronal and root caries in 326 predominantly white, educated, middle-aged and older adults. Study participants were recruited from Tufts Geriatric Outreach Program, Nutritional Status Study (NSS), and the Forsyth Root Caries Study. Eighty-five percent of participants reported visiting their dentist in the last year. The median number of teeth was 21 in the 65+ age-group, and 40% of participants had coronal caries and 33% had root carious lesions. The mean coronal and root caries (DFS) was higher and the proportion of decayed surfaces to all decayed and filled surfaces (%D/DFS) was lower than in other comparable studies. A comparative analysis of intraoral distribution of coronal and root caries and their relation with age is discussed.     

Twenty-four month coronal caries incidence: the role of dental care and race

OBJECTIVES: To describe for a diverse sample of dentate middle-aged and older adults: (1) the 24-month incidence of coronal caries, and (2) its association with a broad range of clinical, behavioral, financial, attitudinal, and sociodemographic factors. METHODS: The Florida Dental Care Study is a prospective observational longitudinal cohort study of 873 persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline and 24 months, with 6-monthly telephone interviews between those times. A multinomial logistic regression was done to predict whether a participant was in one of four mutually exclusive groups at the 24-month examination (new decay only [NDO]; new filling(s) only [NFO]; both new decay and filling(s) [BOTH]; or neither [NONE]). RESULTS: Only 33% of the 24-month participants were in the NONE group. There was no significant difference in caries incidence between regular attenders and problem-oriented attenders, regardless of whether teeth crowned at baseline, incident crowns, or incident root fragments were excluded. However, once differences in incident tooth loss and baseline clinical, behavioral, financial, and attitudinal differences were taken into account, regular attenders did appear to benefit by developing fewer coronal lesions and fewer dental symptoms than problem-oriented attenders. Baseline carious surfaces, filled surfaces, number of teeth, and bulk restoration fractures predicted caries incidence, but baseline cusp fractures did not. Persons with negative dental attitudes were more likely to be in the NDO and BOTH groups, and negative attitude toward brushing and flossing (but not their frequency) also predicted caries incidence. CONCLUSION: Certain baseline clinical conditions, approach to dental care, ability to pay for dental care, dental attitudes, race, and age group were predictive of coronal caries incidence, and regular attenders appeared to benefit from regular attendance.     

Root Caries Prevalence in Black and White North Carolina Adults over Age 65

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.     

Effects of hyposalivatory medications on saliva flow rates and dental caries in adults aged 65 and older

Institutionalized adults aged 65 or older often receive medications that have been associated with decreased saliva flow. Flow rates depressed by hyposalivatory medications are thought to increase susceptibility to dental caries. In this study, a cross-sectional comparison was made of stimulated whole saliva rates and coronal and root caries prevalence in a group of older adults, in a long-term care facility, taking hyposalivatory medications vs. a control group. No significant differences were found between the two groups in masticatory or gustatory stimulated flow rates or in mean decayed coronal or root surfaces.     

The Distribution of Root Caries in Community-dwelling Elders in New England

An in-home examination of a probability sample of elders aged 70 and older living in the six New England states was conducted to estimate the prevalence and extent of root caries. Oral examinations were conducted by the visual-tactile method using a portable lamp, explorer, and a mouth mirror. Fifty-two percent of the study participants showed root caries experience and 22 percent had untreated root caries. In contrast to previous studies, this analysis showed that buccal root surfaces were no more likely than proximal surfaces to be affected by root caries. Logistic regression analysis showed that gingival recession and number of teeth were positively associated with root caries, while better oral hygiene maintenance and regular dental visits were negatively associated with root caries lesions (all factors: P <.05). The prevalence of root caries was found to increase with higher numbers of teeth except for a minority subgroup— i.e., those who retained 25 or more teeth. This study provides much-needed data on prevalence and extent of root caries in a probability sample of the oldest old in an entire region of the United States.     

Root surface caries and associated factors

Abstract – The prevalence of root surfaces caries in 208 randomly selected 55, 65, and 75-yr-old Swedes was related to the frequency of coronal caries, the number of remaining teeth and to bacteriologic, salivary, and dietary variables. At least one decayed or filled root surface was found in 89% of the individuals and all of those had also experienced coronal caries. The frequency of root surface caries was positively correlated to the frequency of coronal decay and negatively correlated to the number of remaining teeth and exposed root surfaces. The study shows that the same factors which are associated with enamel caries seem to be of importance in determining the development of root surface caries. The variation in the frequency of root surface caries was best explained by the salivary levels of mutans streptococci and lactobacilli, the percentage of surfaces harboring plaque and the frequency of carbohydrate intake. Other contributory factors were the saliva secretion rate and the buffer capacity.     

Root surface caries and associated factors

The prevalence of root surfaces caries in 208 randomly selected 55, 65, and 75-yr-old Swedes was related to the frequency of coronal caries, the number of remaining teeth and to bacteriologic, salivary, and dietary variables. At least one decayed or filled root surface was found in 89% of the individuals and all of those had also experienced coronal caries. The frequency of root surface caries was positively correlated to the frequency of coronal decay and negatively correlated to the number of remaining teeth and exposed root surfaces. The study shows that the same factors which are associated with enamel caries seem to be of importance in determining the development of root surface caries. The variation in the frequency of root surface caries was best explained by the salivary levels of mutans streptococci and lactobacilli, the percentage of surfaces harboring plaque and the frequency of carbohydrate intake. Other contributory factors were the saliva secretion rate and the buffer capacity.     

Incidence of Coronal and Root Caries in an Older Adult Population

Incidence rates for new root caries and new coronal caries in noninstitutionalized older adults are unknown. In this study, a representative sample of 451 elderly Iowans received dental examinations at the start of the study and again after 18 months. This dentate cohort had a mean of 0.87 new surfaces of coronal decay per person per year and a mean of 0.57 new surfaces of root decay per person per year. Coronal caries occurred at an annual rate of 1.4 surfaces per 100 susceptible coronal surfaces. Root caries occurred at an annual rate of 2.6 surfaces per 100 susceptible root surfaces. This study shows that both coronal and root caries were active in this older population, indicating a need for emphasis on the prevention and treatment of dental caries in older adults.     

Chlorhexidine and preservation of sound tooth structure in older adults. A placebo-controlled trial

The Trial to Enhance Elderly Teeth Health (TEETH) was designed to test the impact of regular rinsing with a 0.12% chlorhexidine (CHX) solution on tooth loss, and the causes of tooth loss (caries, periodontal disease and trauma) were also investigated. This paper reports on the effectiveness of a 0.12% CHX solution for controlling caries using a tooth surface (coronal and root) survival analysis. A total of 1,101 low income elders in Seattle (United States) and Vancouver (Canada), aged 60-75 years, were recruited for a double-blind clinical trial and assigned to either a CHX (n = 550) or a placebo (n = 551) mouth rinse. Subjects alternated between daily rinsing for 1 month, followed by weekly rinsing for 5 months. All sound coronal and root surfaces at baseline were followed annually for up to 5 years. At each follow-up examination, those tooth surfaces with caries, restored, or extracted were scored as 'carious'. The hazard ratio associated with CHX for a sound surface to become filled, decayed, or extracted was 0.87 for coronal surfaces (95% confidence interval: 0.71-1.14, p = 0.20) and 0.91 for root surfaces (95% confidence interval: 0.73-1.14, p = 0.41). These findings suggest that regular rinsing with CHX does not have a substantial effect on the preservation of sound tooth structure in older adults.     

Contribution of preventive methods in controlling caries among Saudi primary schoolchildren: a population-based cross-sectional study

Objective: This study assessed the association between caries preventive measures including regular dental checkups, twice a day tooth brushing using fluoridated toothpaste and pit and fissure sealants on one side and the presence of caries among primary schoolchildren in the Eastern Province of Saudi Arabia.

Materials and methods: A cross-sectional study was conducted in 2016 including 1198, 6–12-year-old children from 13 randomly selected schools. The outcome variable was caries presence. The explanatory variables were brushing twice a day using fluoridated toothpaste, the presence of sealant and regular dental checkups. Multivariable logistic regression model was conducted to assess the associations controlling for confounders (age, gender, ability to get treatment, being health insured and school) using SPSS version 20.0.

Results: Data of 921 participants (83.8%) were available. The prevalence of caries was 63.5%, whereas 67.6% brushed their teeth twice a day, 28.3% visited the dentist for regular checkups and 7.6% had sealant. In multivariable regression, out of the three main explanatory variables, only having regular checkups was significantly associated with caries presence (OR?=?0.65, 95% CI?=?0.48, 0.88).

Conclusions: Lower odds of caries presence were associated with regular dental checkups but not with regular brushing or having sealant.     

Prevalence of root caries in a selected population of older adults in Japan

In this study, the prevalence of root caries in a sample of Japanese elders was investigated along with various aetiological factors. Two hundred and eighty-seven independently living elderly people over the age of 60 years were examined for the prevalence of active, inactive, and filled root lesions as well as the number of teeth. General health, oral status and brushing habits were surveyed, and salivary flow was determined in terms of flow rate and subjective feeling of dry mouth during eating. About 39% of the subjects had one or more decayed roots and 53.3% had at least one decayed or filled lesion. Root caries was seen most frequently on canine teeth followed by the first premolar. The number of decayed or filled lesions increased with increasing number of residual teeth (Kruskal-Wallis test, P = 0.033), however, there was no association between the proportion of teeth with root decay and the number of teeth. For subjects with 20 or more teeth, the number of decayed roots is likely to be lower in subjects who reported brushing frequently (P = 0.058), and higher in subjects with low salivary flow (P = 0.059) or subjective feeling of dry mouth (P = 0.052) (Chi-squared). The presence of decayed lesions is likely to be related to dry mouth (P = 0.057, odds ratio 3.13) and brushing frequency (P = 0.088, odds ratio 1.76) (Multiple logistic regression analysis). The results indicate a high frequency of root surface caries in this Japanese community-dwelling older population. Oral hygiene status and low salivary flow or perceived dry mouth were potential risk factors for disease.     

Root surface and coronal caries in adults with type 2 diabetes mellitus

OBJECTIVES: To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries. METHODS: A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured. RESULTS: Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries. CONCLUSION: Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.     

Dental caries prevalence and dental care utilization among the very old

BACKGROUND: This article reports on coronal and root caries prevalence and dental care utilization patterns of elderly Iowans aged 79 years or older. METHODS: The sample for this study was 449 people who were surviving members of the Iowa 65+ Rural Health Study cohort originally recruited in 1981. The authors focused their analyses on the 342 of these who were dentate. Examinations were conducted in subjects' homes by trained and calibrated examiners, using a halogen headlight, a mouth mirror, a color-coded periodontal probe and a no. 23 explorer. RESULTS: The mean age of subjects was 85.1 years (range 79-101 years), and they had a mean of 19.4 remaining teeth. Nearly all subjects (96 percent) had coronal decay experience, while 23 percent of the subjects had untreated coronal decay, about one-fourth of which was recurrent. Nearly two-thirds (64 percent) of the sample had root caries experience, with 23 percent having untreated root caries. Utilization of dental services was high among the dentate elderly, with nearly three-quarters reporting having visited a dentist within the past year. Nearly all reported that they paid for dental care themselves with no third-party coverage. CONCLUSIONS: The findings from this study of the very old suggest that coronal and root caries remain prevalent, with high levels of dental care utilization among those who have retained natural teeth. CLINICAL IMPLICATIONS: As the U.S. population ages, and more teeth are retained, demand for dental services in the population of the oldest elderly people is likely to increase.     

Incidence of tooth loss and dental caries in 60-, 70- and 80-year-old Swedish individuals

Abstract The retention of natural teeth among the elderly is increasing and, in recent studies, dental caries has been identified as the main reason for teeth being extracted. The 5-year incidence of tooth loss and dental caries and the most crucial dental factors for tooth extraction were studied in a random sample of 60-. 70- and 80-year-old inhabitants of Gothenburg, Of the 208 persons examined at baseline, 148 (71%) participated in the follow-up examination: 69, 51 and 28 respectively in the different age groups. In all. 110 teeth had been extracted during the period in 40% of the participants. Only 9 persons had lost three or more teeth. The mean numbers of remaining teeth were 22, 18 and 15 respectively in the 60-, 70- and 80-year age groups and the mean numbers of teeth lost during the 5-year period increased with age from 0.4 in the 60-year-olds to 0.8 and 1.4 in the 70- and 80-year-olds (P<0.05). The major reason for tooth extraction was dental caries and it was found in 60% of all cases and at a higher rate of 77%i in the oldest age group. Fifty-one per cent had developed new coronal carious lesions and 61% had new root carious lesions, while 27% had not developed caries during the period. The mean 5-year increment in decayed and filled coronal surfaces increased with age from 2.3 in the 60-year-olds to 3.7 and 5.3 in the 70- and 80-year-olds (N.S.). The increment in decayed and filled root surfaces was higher in women than men, 3.4 compared with 1.8 (N.S.), which also increased with age from 1.4 in the 60-year-olds to 2.4 and 5.5 in the 70- and 80-year-olds (P<0.0001). It was concluded from this study that few teeth had been lost during the 5-year period but that dental caries still appeared to be a serious problem among some very elderly people.     

Risk factors for and the prevention of root caries in older adults

With the absolute and relative number of elderly people rising in most countries, it is essential that dental practitioners be knowledgeable about the normal changes and disease processes that occur in aging individuals. Especially prevalent in the aging population is root surface caries. Several variables may increase the risk of developing root surface caries. Among these are poor oral hygiene, microbial plaque, periodontal disease, gender (male), coronal caries, dietary habits, xerostomia, low socio-economic status, and infrequent dental visits. While each of these has an effect, plaque seems to have the greatest influence on the susceptibility of teeth to root decay. Improved oral hygiene and regular dental visits, combined with the use of fluoride, may continuously convert active root caries lesions to inactive. In fact, prophylactic programs are more effective in converting active to inactive rather than preventing the development of new lesions. The conscientious dental practitioner must identify his/her older patients at risk for developing root lesions and place a major emphasis on the prevention and treatment thereof.     

Root caries in older people attending a general dental practice in East Sussex

With increasing numbers of older people retaining their natural dentitions, dentists are becoming increasingly aware of the problem of dental caries occurring on exposed root surfaces--root caries. This study reports the prevalence of root caries in a selected older population, living in the community and attending a general dental practice in Bexhill, East Sussex. A total of 146 non-institutionalised people, aged at least 55 years with at least 12 teeth, were examined. Most of the subjects (88.4%) had evidence of root caries, males and denture wearers having more lesions than females and non-denture wearers, respectively. Active coronal caries was present in only 11.6% of the subjects, whereas active (soft or leathery) root caries lesions were present in 31.5% of the subjects. The teeth and surfaces most commonly affected by root caries were found to be similar to those seen in previous epidemiological surveys. The majority of active root caries lesions were within 1 mm of the gingival margin, while inactive lesions tended to be greater than or equal to 1 mm from the gingival margin. Colour of root caries lesions was not diagnostic of caries activity. A more detailed method of recording root caries lesions is also described.