Root Caries: From Prevalence to Therapy (Volume 26)

Root Caries: From Prevalence to Therapy (Volume 26)

Root Caries: From Prevalence to Therapy is a specialist, multi-authored volume published as Volume 26 in the Monographs in Oral Science series by S. Karger AG in 2017. Edited by M. Rocha de Olivera Carrilho, this work brings together leading international experts to review root caries — a dental condition of growing importance, especially as global populations age and retain more natural teeth than in the past. The book is structured into four broad sections that examine epidemiology, biological factors, lesion assessment, and preventive/therapeutic strategies. It aims to serve both clinicians and researchers by summarizing current knowledge, identifying areas of controversy, and suggesting directions for future research.

1. Epidemiology and Prevalence

Root caries refers to decay affecting the root surfaces of teeth, which become exposed as gums recede due to age, periodontal disease, or other factors. Epidemiological evidence shows that the prevalence of root caries increases sharply with age — largely because older adults are more likely to have gingival recession and retain more teeth throughout life.

Root caries is not confined to high-income populations; studies show it affects adults worldwide. Meta-analyses estimate that around 40 % of adults may be affected by root caries globally, with prevalence rising substantially in older subgroups. In specific regions, prevalence can vary widely; for instance, systematic reviews in India report pooled prevalence estimates approaching 28 % among adult populations.

Despite this, one challenge highlighted in both the volume and related literature is the lack of a universally accepted definition and standard diagnostic criteria for root caries. Different studies use various thresholds for lesion detection (colour, softness, cavitation), making comparison across populations and time difficult.

2. Biological and Clinical Determinants

A core theme in the book is understanding why root caries develops and progresses. Unlike enamel caries, root caries affects dentin, a tissue that is more organic and less mineralized than enamel, making it inherently more susceptible to demineralization. Risk factors include:

• Gingival recession: exposes root surfaces vulnerable to cariogenic biofilms.

• Plaque accumulation: dental biofilms rich in acid-producing bacteria drive demineralization.

• Salivary changes: reduced salivary flow (common in older adults or medication use) diminishes natural buffering and protective effects.

• Lifestyle and health factors: smoking, diet high in fermentable sugars, and socioeconomic disparities influence disease risk.

Systemic conditions and medications that reduce salivary flow or alter oral ecology can further heighten risk. The book’s biological section also discusses the histopathological features of root lesions, how they differ from coronal caries, and how lesion activity can be assessed clinically.

3. Diagnosis and Lesion Assessment

Accurate diagnosis and monitoring are critical to effective root caries management. The volume includes chapters on:

• Clinical assessment strategies for identifying lesion activity.

• Histological correlates of active root caries.

• Standardization challenges, given the subjective nature of many criteria used in research and practice.

The volume underscores how subjective markers like softness or colour changes can vary between examiners, contributing to inconsistent prevalence estimates in the literature. Better diagnostic tools and consensus criteria remain a pressing need in the field.

4. Prevention and Therapeutic Approaches

Prevention is central to managing root caries, and much of this book’s later sections focus on how to reduce initiation and arrest progression of root lesions:

Preventive Measures

• Fluoride use: topical fluorides (toothpastes, gels, varnishes) strengthen root surface resistance and are supported by evidence as cornerstone preventive agents.

• Oral hygiene: meticulous plaque control reduces the substrate for acid production.

• Risk assessment: identifying high-risk patients (multiple teeth, plaque-rich biofilms, past root caries history) allows targeted preventive protocols.

Therapeutic Interventions

• Minimal intervention dentistry: focuses on arresting lesions rather than extensive restorations when possible.

• Restorative strategies: materials suitable for root dentin, such as glass ionomer cements, are discussed, though evidence on the best material is still evolving.

• Emerging technologies: functional peptides, lasers, dentin-modifying agents, and other novel approaches are reviewed, but the editors note that high-quality evidence for many new therapies remains limited.

Complementary clinical research indicates that agents like high-concentration silver diamine fluoride and arginine-containing toothpastes may have preventive or arresting effects for root caries, especially in older adults, but larger trials are needed.

5. Conclusions and Future Directions

The volume concludes that root caries is a growing global oral health challenge, driven by demographic shifts and changing oral health patterns. Although progress has been made in understanding epidemiology, biology, and management, the book stresses continuing gaps:

• Need for standardised definitions and diagnostic criteria.

• Stronger evidence for novel preventive and therapeutic agents.

• Better risk assessment models tailored to individual patient profiles.

Given the projected increase in elderly populations worldwide and the desire to preserve natural dentition into later life, effective root caries prevention and intervention strategies are essential for maintaining oral health and quality of life.