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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

Dental Emergencies and First Aid Procedures

The following first aid procedures are important steps for handling dental emergencies or facial injuries. They provide temporary relief and help in their proper repair or healing. As with any injury, always follow up with personal care from your dentist or physician.

Bitten Tongue/Cut Lip

Clean gently with a cloth. Apply cold compresses to reduce swelling. If bleeding is severe, go to an emergency services provider. After bleeding has subsided, rinse with warm salt water.

Broken Jaw (Possible)

Don't move the jaw. Secure it in place by tying a scarf, necktie, or towel around the jaw and over the top of the head. Apply cold compresses to reduce any swelling. See your dentist or emergency services provider immediately.

Broken Tooth

Rinse the mouth with warm water. Try to remove any dirt, blood, or debris from the injured area using sterile gauze or a clean cloth and warm water. Apply cold compresses on the face next to the injured tooth to reduce swelling. See the dentist immediately. Place the broken piece in a small container of whole milk.

Knocked-Out Tooth

Annually, more than two million teeth are knocked out accidentally; more than 90% of them can be saved with proper treatment.

Holding the tooth from the crown (top part), rinse off the root. Don't scrub or remove any attached tissue fragments. Gently hold the tooth in its socket. (Young children may accidentally swallow; use your judgment.) If this isn't possible, place the tooth in a cup of cold whole milk. Avoid using low fat milk, powdered milk, or milk products like yogurt. Never put the tooth in mouthwash or alcohol. Avoid scrubbing the tooth or touching the root end. Get to the dentist immediately (within 30 minutes) and take the tooth!

Objects Trapped Between Teeth

Try gliding dental floss between teeth (dental tape is often useful in removing shredded dental floss.) Sometimes tying a small knot in the floss may help, too. Avoid using any sharp or pointed objects. See a dentist if object can't be removed.

Toothache

Toothaches can result from different causes. Rinse mouth with warm water. Remove any food trapped between teeth with dental floss. Avoid applying aspirin on the tooth or gum tissues. If a cavity is suspected, insert a small cotton ball or cotton tip soaked in oil of cloves (eugenol). Do not cover a cavity with cotton if there is facial swelling or pus. See a dentist as soon as possible.

Always consult with a dentist if you have questions regarding any dental problem.

By Brian J. Gray, DDS, MAGD, FICO

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