Tooth decay, also known as dental caries or cavities, is a breakdown of teeth due to acids made by bacteria. The bacteria gather on teeth and gums in a sticky, colorless substance called plaque. The plaque interacts with sugars and starches to produce acids that destroy tooth enamel, which is the hard, outer layer of the tooth. This results in softer, weakened areas that develop into cavities over time. Cavities range in severity from mild (early stage) to deep, which affect deeper parts of the tooth. Untreated cavities can lead to tooth decay, infection, pain, and tooth loss.
One type of severe tooth decay is known as root caries or cementum caries. This refers to decay at the root surface of a tooth, just below the gumline. The cementum is the tissue that covers the tooth root. Root caries occurs when plaque and bacteria gather in these areas and produce acids that dissolve cementum. This leads to erosion and cavities forming on the roots.
What Causes Root Caries?
There are several contributing factors to root caries:
Gum recession
As gums recede due to periodontal disease or aging, the root surfaces are exposed and become more vulnerable to plaque accumulation and decay. The roots have less hard tissue and are more prone to demineralization.
Reduced saliva flow
Saliva helps to neutralize acids and wash away food particles. When saliva production is reduced, plaque and bacteria can thrive. Certain medications and medical conditions can cause dry mouth.
Poor oral hygiene
Inadequate tooth brushing and flossing allows plaque to build up, especially in hard to reach areas near the gums and between teeth. This plaque traps sugars and produces enamel-damaging acids.
High-sugar diets
Frequent consumption of sugary foods and drinks provides more fuel for the bacteria to produce acids.
Root morphology
The grooves, indentations, and concavities that are present on some root surfaces provide reservoirs where plaque can easily accumulate.
Risk Factors
Certain individuals have a higher risk of developing root caries:
– Older adults – Due to gum recession and reduced saliva.
– Dry mouth – Caused by medications, health conditions, or aging.
– Poor oral hygiene – Inadequate brushing and flossing.
– High sugar intake – Frequent snacking and sugary beverages.
– Periodontal disease – Damages tissue and exposes roots.
– Worn enamel – Previous decay weakens enamel making roots more susceptible.
– Crowns or fillings with poor margins – Gaps allow decay near margins.
Related Health Issues
Root caries may indicate or lead to other health concerns including:
– Nutritional deficiencies – Problems chewing and tooth loss can impair nutrition.
– Respiratory infection – Bacteria can be inhaled and cause infection.
– Endocarditis – Bacteria enters bloodstream and damages heart.
– Diabetes – Gum disease is linked with higher diabetes risk.
– Osteoporosis – Tooth loss is associated with bone mineral loss.
– Oral cancer – Longstanding dental issues may indicate cancer.
Signs and Symptoms
Root caries may not cause symptoms at first, which is why regular dental exams are important for detection. As decay progresses, signs and symptoms may include:
At Early Stages
– White, black, or brown lesions on root surfaces
– Stains or discoloration near gumline
– Small area of decay near gumline or between teeth
– Sensitivity to hot or cold foods
At Later Stages
– Holes or breakdown of tooth structure
– Cavity formation under gums
– Exposed tooth roots
– Severe pain from pressure or temperature changes
– Loose teeth, changes in bite
– Swelling of gums near affected tooth
– Halitosis (bad breath)
– Metallic taste in mouth
– Tooth abscess
Diagnosing Root Caries
Root caries are often detected during a thorough oral examination by a dentist. Additional diagnostic tools may include:
Visual exam
The dentist looks closely for any signs of decay near the gumline. Stains, discoloration, lesions, or cavities may be visible.
Periodontal probe
A thin instrument checks for soft areas of decay and measures gum recession and space between tooth and gum.
Radiographs (X-rays)
Dental X-rays show decay between the teeth and under the gums that cannot be seen visually.
Fiber-optic transillumination
A light-conducting device transmits light under the gumline to illuminate areas of decay.
Treatment
Early intervention provides the best chance to restore a tooth damaged by root caries. Treatments include:
Fluoride
Fluoride helps remineralize tooth surfaces and reverse early decay. Sources include fluoride toothpaste, mouth rinse, gel or varnish.
Antimicrobial mouth rinse
Kills excess bacteria in the mouth and reduces gum inflammation.
Diet and habit changes
Reducing sugary foods, drinking more water, using a saliva substitute, and proper oral hygiene help manage root caries.
Root canal therapy
For more advanced decay, the tooth pulp and nerves may need to be removed and the tooth preserved.
Restorations
Fillings, crowns, or bonding agents may be options to restore damaged areas.
Tooth extraction
If the tooth cannot be saved, extraction may be necessary. Replacement options include bridges, implants or dentures.
Prevention
Good oral hygiene and regular dental care help prevent root caries. Key prevention tips include:
– Brush teeth twice daily for 2 minutes with fluoride toothpaste
– Clean between teeth daily with floss or interdental brushes
– Get oral cancer screenings from your dentist
– Use antiseptic mouthwashes to reduce bacteria
– Limit sugary foods and beverages
– Have any fillings or restorations checked for gaps annually
– Get dental cleanings and exams every 6 months
– Ensure proper fit of any dental appliances such as dentures or partials
– Report any symptoms like sensitivity, pain or bad breath to your dentist
Prognosis
With early detection and prompt treatment, root caries can often be remineralized or restored. The prognosis depends on:
– Extent of decay – Smaller lesions have better outcomes
– Overall dental health – Good hygiene improves prognosis
– Patient compliance – Follow recommended treatment and prevention
– Additional risk factors – Control issues like dry mouth or diet
Severe or advanced root caries may eventually require extraction, especially if the decay has led to an abscess or extreme discomfort. But in most cases, root caries can be managed with proper oral hygiene, professional treatment and regular dental visits. Maintaining diligent plaque control and gum health is key to reducing the likelihood of root caries development.
Key Takeaways
– Root caries refers to tooth decay occurring on the tooth roots near the gumline. It develops due to plaque buildup in these areas.
– Gum recession, dry mouth, poor hygiene, sugary diet and certain tooth conformations increase root caries risk.
– Signs and symptoms may include stains, tooth discoloration, temperature sensitivity, holes or cavities near the gums.
– Diagnostic tools include visual and radiographic dental exams. Early detection provides the best opportunity for remineralization and restoration.
– Treatments range from fluoride, antimicrobial rinses, dental work and tooth extraction for unsalvageable decay.
– Practicing excellent daily oral hygiene, reducing sugary foods, getting regular dental cleanings and reporting any concerns to your dentist helps prevent root caries.