The association of selected bacteria with the lesions of root surface caries

Plaque from the root surfaces of 165 subjects (mean age 65.5 years, 22-26 teeth/subject) was analysed for specific bacteria. Five subject groups were defined: A (DMFS 16.4), B (DMFS 55.9), C1 (DMFS 55.6), C2 (DMFS 57.0) and C3 (DMFS 48.1). Groups C1 and C2 had unrestored root surface lesions; Group A, B and C3 were free of unrestored root caries and differed in their coronal caries experience. Streptococcus mutans was isolated more frequently from the root lesions in Groups C1 and C2 than from intact root surfaces in Group A. Streptococcus oralis, Streptococcus mitis 1 and Streptococcus sanguis were isolated more frequently from Group A. The percentage contribution that S. mutans made to plaque from lesions in Groups C1 and C2 was higher than that from plaque in Group A and Actinomyces viscosus serovar 2 contributed more to plaque in Group C1 than in samples from Group A. The percentage counts of Lactobacillus in plaque from lesions in Groups C1 and C2 were higher than those from intact roots in Groups A, B, and C3. Subjects were also grouped on the presence of Lactobacillus and S. mutans in plaque samples. Samples with both organisms (n = 17) showed significantly higher isolation frequencies of specific strains of S. mitis 1 and also A. viscosus serovar 2 compared with samples of plaque containing S. mutans or Lactobacillus. Actinomyces naeslundii serovar 1 was not isolated from samples containing both S. mutans and Lactobacillus. The results confirm an association of S. mutans and Lactobacillus with root surface lesions and suggest a relationship between lesions and A. viscosus serovar 2.     

Prevalence of root surface caries among institutionalized older persons

Fifty-nine residents of a chronic hospital (average age 67.9 years) were examined visually for root surface caries. Root lesions were found to be present in 44 of the residents and were located most frequently on the proximal surfaces of anterior teeth. The number of coronal DF surfaces, age and number of retained teeth were the factors found to be helpful in discriminating between persons with and without root surface caries.     

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.     

Proportions of Streptococcus mutans, lactobacilli and Actinomyces spp in root surface plaque

Abstract – The incidence of Streptococcus mutans, lactobacilli and Actinomyces was examined in root surface dental plaque from 24 subjects with root surface caries and in 24 subjects with exposed root surfaces as a consequence of periodontitis but without root surface caries. Plaque was collected from the most posterior teeth in each quadrant: in the caries group from carious lesions and in the periodontitis group from buccal root surfaces. There were significantly higher proportions of S. mutans and lactobacilli in dental plaque samples taken from subjects suffering from root surface caries than in samples from subjects without root surface caries. The level of the group A. viscosus/naeslundii in the periodontitis group was higher than that found in the root surface caries group, but the difference was not statistically significant.     

Proportions of Streptococcus mutans, lactobacilli and Actinomyces spp in root surface plaque

The incidence of Streptococcus mutans, lactobacilli and Actinomyces was examined in root surface dental plaque from 24 subjects with root surface caries and in 24 subjects with exposed root surfaces as a consequence of periodontitis but without root surface caries. Plaque was collected from the most posterior teeth in each quadrant: in the caries group from carious lesions and in the periodontitis group from buccal root surfaces. There were significantly higher proportions of S. mutans and lactobacilli in dental plaque samples taken from subjects suffering from root surface caries than in samples from subjects without root surface caries. The level of the group A. viscosus/naeslundii in the periodontitis group was higher than that found in the root surface caries group, but the difference was not statistically significant.     

Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars – a multilevel approach

Braga MM, Martignon S, Ekstrand KR, Ricketts DNJ, Imparato JCP, Mendes FM. Parameters associated with active caries lesions assessed by two different visual scoring systems on occlusal surfaces of primary molars – a multilevel approach. Community Dent Oral Epidemiol 2010; 38: 549–558. © 2010 John Wiley & Sons A/S Abstract – Objective: The aim of this in vivo study was to evaluate the association between several parameters related to children and to their teeth, and the presence of active carious lesions assessed by two different visual indices on occlusal surfaces of primary molars. Methods: Occlusal surfaces of 757 primary molars in 139 children (3–12 years old) were classified as sound, or having inactive or active carious lesions using the Nyvad criteria (NY) and the International Caries Detection and Assessment System (ICDAS‐II) and a supplemental lesion activity assessment system (ICDAS‐LAA). Several parameters related to the tooth and to the child were recorded. Associations between these parameters and the presence of active carious lesions on occlusal surfaces were evaluated using logistic multilevel analysis. Results: Second primary molar teeth and children with high caries experience were more frequently with active occlusal carious lesions compared to sound and inactive occlusal carious lesions classified by both visual scoring systems. Teeth with a mature dental plaque on the occlusal surface and younger children had more active caries than inactive occlusal carious lesions (excluding sound teeth in the analysis). A previous visit to a dentist was related to a lower frequency of active occlusal carious lesions classified by NY only, and upper primary molars presented with higher numbers of active occlusal carious lesions classified by ICDAS‐LAA. Conclusions: Presence of mature dental plaque and tooth type are tooth‐related variables associated with active carious lesions on occlusal surfaces of primary teeth, as well as anterior caries experience and age are variables related to the child.     

Explorer probing of root caries lesions: an in vitro study

Probing with a dental explorer is the preferred method of root caries diagnoses. However, studies suggest that use of a dental explorer in coronal caries detection may damage tooth structure. This pilot study investigated the effect of probing on remineralization of root surface lesions in vitro .
Root-surface lesions were created on 10 extracted teeth by exposing them to a demineralizing solution for 21 days. One side of each lesion was then randomly selected and probed with an explorer, while the other side was not probed. The teeth then were placed in a remineralizing solution containing 10 parts per million (ppm) fluoride for 21 days.
Of the 9 teeth with usable sections, all showed frank evidence of defects on the probed halves. Sites of remineralization were seen in the non-probed halves and adjacent to the probed defects, but not within or at the base of these defects. These results suggest that probing of root surfaces may create defects that do not fully remineralize.     

Subgingival debridement of root surfaces with a micro-brush: macroscopic and ultrastructural assessment

AIM: The aim of this study was to assess the use of a micro-brush to remove plaque deposits from subgingival, periodontally involved root surfaces in vivo. METHODS: 30 periodontally involved teeth requiring extraction for periodontal or prosthetic reasons in 26 adult patients were utilised. For inclusion, teeth had to display at least 30% bone loss radiographically. Following the establishment of local anaesthesia, grooves were cut on the proximal root surface adjacent to the gingival margin at the line angles. For each tooth, 1 proximal root surface was rubbed with the micro-brush for 2 min to the depth of the pocket whilst the other root surface acted as an undebrided control. The teeth were then extracted, rinsed in 0.85% NaCl, stained with 2% erythrosine solution and photographed. The amount of erythrosine staining on each subgingival, periodontally involved root surface was assessed by tracing the areas of stain on a colour photograph and scanning the tracings into a computerised image tracing program. RESULTS: Results were expressed as the % of the periodontally involved root-surface area that exhibited staining. Stained areas were further examined with the scanning electron microscope (SEM). The undebrided root surfaces each displayed 100% staining. The debrided surfaces (with probing pocket depths of 4-10 mm) displayed mean staining of 16.1% (SD +/-7.1%) of the proximal surface area. SEM assessment showed that undebrided root surfaces were covered with thick deposits of bacteria. On debrided surfaces, stain-free areas were free of plaque whilst areas of faint staining exhibited either no plaque, calculus deposits or scanty, isolated islands of bacteria. Bacteria had been partially removed from the surface of calculus in some areas. CONCLUSIONS: The findings indicate that subgingival debridement with a micro-brush is effective in removing plaque deposits from periodontally involved root surfaces.     

Active and inactive root surface caries lesions in a selected group of 60- to 80-year-old Danes.

In 90, 60- to 80-year-old patients with teeth retained in both jaws (mean 20.4 +/- 4.3), a total of 1,092 root surface lesions were recorded. Of these 156 were diagnosed as active caries lesions, whereas 509 were considered inactive, and 427 were filled. About 60% of the elderly had one or more active lesions and 79% had fillings. Seventy percent had more than 8 filled or carious (active or inactive) surfaces. The percentage of carious and filled root surfaces in relation to surfaces at risk demonstrated that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected (RCI = 70%) with fillings predominating on easily accessible surfaces. A constant relationship between active and inactive lesions was found on all other surfaces but third molars and upper incisors. The data suggest that active and inactive root caries lesions must be diagnosed as separate entities if the dynamic nature of root surface caries is to be explored in epidemiological studies and clinical trials.     

Prevalence of root surface caries in 55,65, and 75-year-old Swedish individuals

The prevalence and intraoral distribution of decayed and filled root surfaces were evaluated in 55, 65, and 75-yr-old inhabitants of Gothenburg. From randomly selected groups, 88, 72, and 48 dentate persons in the respective age groups participated and as many as 85, 93, and 90% respectively had one or more decayed or filled root surfaces. In the two oldest age groups 32-35% were free from root carious lesions, while 20% had five or more decayed root surfaces. The corresponding figures for the youngest group were 63% and 8%. The prevalence of root surface caries was evaluated using the Root Caries Index (RCI), excluding prosthetic crowns. The mean RCI value increased with age (P less than 0.05, ANOVA on age groups) from 14% to 16% and 22% in the 55, 65, and 75-yr-olds, respectively. The root surfaces of the molars were most frequently affected by caries and fillings, the incisors least frequently. In the maxilla the proximal surfaces were most affected, in the mandible this applied to the buccal surfaces, while the lingual surfaces had the lowest proportion of carious lesions and fillings in both jaws.     

Glycogen synthetic abilities of Actinomyces viscosus and Actinomyces naeslundii freshly isolated from dental plaque over root surface caries lesions and non-carious sites

Relative glycogen synthetic abilities of resting cells of fresh clinical isolates of Actinomyces viscosus and Actinomyces naeslundii originating from dental plaque samples over root surface caries lesions and non-carious sites were studied under anaerobic conditions at a constant pH of 7.0, with U-(14C)-glucose used as the carbon source. Although the rates of glucose utilization and total acid formation were essentially the same, A. viscosus strains isolated from root surface caries lesions showed glycogen synthetic abilities approximately two to seven times higher than did A. viscosus strains originating from non-carious sites, and also two to four times higher than did A. naeslundii strains originating from both carious and non-carious sites.     

Association between clinical parameters and the presence of active caries lesions in first permanent molars

The aim of the present study was to evaluate the association between clinical parameters and the presence of active caries lesions on the occlusal surface of first permanent molars. Forty eight children (5.8-13.8 years-old) with at least one first permanent molar present were selected. The clinical parameters evaluated were gender, age, DMF-T and dmf-t, presence of active white spots in other teeth, general plaque index, tooth's dental arch (upper or lower), tooth's side (right or left), presence of visible plaque and eruption degree of the first permanent molars. The first permanent molars were evaluated through visual inspection by two examiners in order to assess the presence of active or inactive caries lesions on the occlusal surface. Univariate and multivariate analyses for determination of the association between clinical parameters and the presence of active caries lesions in these teeth were performed. The presence of active white spots in other teeth was associated with the presence of active caries lesions in the first permanent molars, in both univariate and multivariate analyses (Odds ratio = 8.8 and 1.9, respectively). The presence of abundant visible plaque on the occlusal surface of the first permanent molars (Odds ratio = 3.5 in the univariate analysis, and 3.9 in the multivariate one) also presented a significant association. In conclusion, the presence of active white spots in other teeth and the presence of considerable visible plaque were associated with the presence of active caries lesions on the occlusal surfaces of first permanent molars.     

Oral health status in an adult Swedish population. Prevalence of caries. A cross-sectional epidemiological study in the Northern Alvsborg county

The aim of the present epidemiological study was to describe prevalence, distribution and type of caries in an adult Swedish population. After stratification with respect to age (20-29, 30-39,.....greater than 79 years of age), sex and location of residence (city, village, rural region), a random sample of 967 individuals was drawn (0.75% of the total adult population greater than 19 years). The results were based on radiographic and clinical examination of 919 individuals, of whom 750 were dentate (participation rate: 95%). The examinations were carried out from November 1983 to December 1984. The caries registrations distinguished between enamel caries and root caries, subdivided into manifest and initial caries. Despite lower number of remaining teeth in older ages, the mean number of surfaces with manifest caries (DS) was relatively even in all age groups (4.1-5.1 DS), except for the youngest age group ("20-29 years": mean 3.1 DS). When the number of decayed teeth (DT) were expressed as a percentage of remaining teeth, the ratio (%) was markedly higher in the older age groups than in the younger age groups. Initial caries was more frequent in the younger age groups. In the age groups above forty years the majority of the observed carious lesions involved root surfaces. In the oldest age group ("greater than 79 years of age"), 95% of the lesions were root caries. The mean number of filled surfaces (FS) was higher among women than men, while untreated caries (DS) showed a tendency of higher values for men. No significant differences in caries prevalence related to location of residence could be demonstrated.     

Clinical and radiological examination of root surface caries. An in vitro study.

The better knowledge of prevention and treatment of periodontal diseases is expected to give rise to retention of more number of teeth in future. However, the periodontal surgery and also the intensive mechanical oral hygiene may expose the root surfaces to cariogenic environment. The present study was intended to evaluate and compare the clinical and radiological examination of root surface caries on extracted teeth. One hundred and twenty extracted teeth, both anteriors and posteriors, collected from the Department of Oral Surgery, Pb. Govt. Dental College & Hospital, Amritsar, were examined clinically as well as radiographically from all the four surfaces. Mesial surfaces were found to be more susceptible to caries and the lingual surfaces the least. Approximately eighty percent agreement was observed in clinical and radiological examination. Thorough probing is suggested especially on buccal and lingual surfaces since radiographs of these surfaces may be difficult in vivo. It was concluded from the study that early detection of root caries is of paramount importance; and the preventive technique should be considered for elderly patients even if there is not detectable root caries.     

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.     

The predominant microflora of nursing caries lesions.

The predominant microflora recovered from infected dentine of 52 carious teeth from 14 children with nursing caries was determined using both selective and non-selective media for the isolation of specific genera and acidified media (pH 5.2) to isolate the predominant aciduric microorganisms, and compared with the microflora of sound enamel surfaces in caries-free children. Streptococcus mutans formed a significantly greater proportion of the lesion flora while Streptococcus oralis, Streptococcus sanguis and Streptococcus gordonii formed a significantly greater proportion of the plaque flora from sound tooth surfaces. The proportions of Actinomyces naeslundii and Actinomyces odontolyticus were significantly greater in the plaque samples than in the lesion samples. Actinomyces israelii formed 18.2% of the flora from the lesions, but was not isolated from the plaque samples. The proportions of Candida albicans, Lactobacillus spp. and Veillonella spp. were also significantly greater in the carious dentine than in the plaque samples. The most frequently isolated lactobacilli were Lactobacillus casei, Lactobacillus fermentum and Lactobacillus rhamnosus. The predominant aciduric flora was S. oralis, S. mutans and A. israelii and these taxa were also isolated from a similar proportion of the lesions at pH 7.0. Strains of S. mutans, L. casei, L. fermentum and L. rhamnosus isolated from individual carious teeth were genotyped using PCR-based methods. Each species was genotypically heterogeneous and different genotypes were recovered from different carious teeth in the same child. These data indicate that the microflora of lesions in the same child is microbiologically diverse and support a non-specific aetiology for nursing caries in which the physiological characteristics of the infecting flora, not its composition, is the major determinant underlying the disease process.     

Periodontal awareness, health, and treatment need in dental school patients. II. Periodontal conditions

The present study aimed to evaluate the periodontal conditions in a group of randomly selected patients scheduled for periodontal treatment in a dental school. The patients' age, sex, and responses to interview questions were used as predictors. About 64% of the lateral tooth surfaces had visible plaque after disclosure with erythrosine, and males had significantly more plaque-covered surfaces than females. All subjects had some areas showing 'bleeding on probing', and a total of 58% of the gingival units bled. About 99% of the subjects, 61% of the teeth, and 33% of the gingival sites had probing depths greater than or equal to 4 mm, whereas 70% of the subjects, 19% of the teeth, and 8% of the gingival sites had probing depths greater than or equal to 6 mm. Mean individual bone score for the 'Ramfjord teeth' was 5.60. Yearly dental visitors tended to keep their teeth to a greater extent than patients with a less regular treatment pattern. This is probably because irregular and emergency patients more often ask for extraction instead of restorative treatment. Since periodontal treatment usually is not offered, the periodontal conditions in the three regularity groups were not considerably different.     

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.     

Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque and calculus

The purpose of the study was two-fold: to determine the nature of stainable deposits on periodontally diseased root surfaces subsequent to in vivo scaling and root planing procedures, and to quantify the distribution of residual plaque on instrumented root surfaces. Thirty molar and 30 nonmolar teeth which were condemned for periodontal or prosthetic reasons and had proximal probing depths of 4 to 7 mm were treated. Half of these were instrumented with I.U. curettes and the other half with an ultrasonic scaling device. Instrumentation was continued until the root surface felt hard and smooth to an explorer tip. The location of the gingival margin was recorded by notching the treated proximal surface with a No. 1/2 round bur. Twenty control teeth, 10 molar and 10 nonmolar, were extracted without instrumentation. Control and experimental teeth were irrigated with saline and stored in a 2.5% glutaraldehyde fixative solution until the time of assessment. All teeth were stained with a 0.5% solution of toluidine blue, and the amount of residual stained material and calculus was assessed under the stereomicroscope using an eyepiece fitted with a 10 X 10 optical grid. Stained deposits were marked by placing small V-shaped notches in the adjacent root surface as an aid to identification after the specimens were processed for scanning electron microscopic (SEM) examination. The nature of stained deposits on selected teeth was then characterized using the SEM. Treated root surfaces were also surveyed in detail to assess the quantity and extent of residual plaque deposits. The findings showed that although a large percentage of the treated proximal root surface may possess stainable deposits, these surfaces were often unexpectedly free of microbial organisms. In this study, the majority of stained deposits were composed of adherent fibrin and instrumentation debris. When bacterial plaque was present, it was usually found in small "mini-colonies" smaller than 0.5 mm across. Such findings cast doubt on the validity of using histologic and disclosing stains as an indicator for the presence of bacterial plaque immediately after instrumentation. Although only partially effective in removing subgingival calculus, both methods of instrumentation in this study appeared to be remarkably effective in bacterial debridement of subgingival root surfaces.     

Microbial flora associated with presence of root surface caries in periodontally treated patients

Abstract — Examination of saliva and dental plaque was carried out in 35 adults who had been treated for periodontal disease 3 yr earlier. Plaque samples were collected from approximal and buccal sound and carious root surfaces. The samples were analyzed for the presence and proportions of members of Streptococcus, Lactobacillus and Actinomyces. The results showed a low prevalence of root surface caries and a low level of salivary mutans streptococci and lactobacilli. From subjects with root caries there was a not statistically significant tendency to higher proportional levels of mutans streptococci in plaque from carious root surfaces than from caries-free surfaces. An inverse significant relationship between noncarious and carious root surfaces was noted for S. sanguis. The population of A. viscosus and A. naeslundii was similar in plaque samples from sound and carious sites but showed elevated levels in the subjects with five or more new root surface lesions.