GeneHealth - Your precision medicine

Root Caries

Disease Details

Family Health Simplified

Buy Membership

Description: Root caries is a type of tooth decay that occurs on the root surface of a tooth, typically exposed due to gum recession.
Type: Root caries is a type of dental condition. It is not genetically transmitted. It primarily results from localized decay caused by bacteria that produce acid, leading to the demineralization of the tooth root surfaces. Prevention includes good oral hygiene practices and regular dental checkups.
Signs And Symptoms: A person experiencing caries may not be aware of the disease. The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion or a "micro-cavity". As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated.
A lesion that appears dark brown and shiny suggests dental caries were once present but the demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull in appearance.As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through the enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed, resulting in pain that can be transient, temporarily worsening with exposure to heat, cold, or sweet foods and drinks. A tooth weakened by extensive internal decay can sometimes suddenly fracture under normal chewing forces. When the decay has progressed enough to allow the bacteria to overwhelm the pulp tissue in the center of the tooth, a toothache can result and the pain will become more constant. Death of the pulp tissue and infection are common consequences. The tooth will no longer be sensitive to hot or cold but can be very tender to pressure.
Dental caries can also cause bad breath and foul tastes. In highly progressed cases, an infection can spread from the tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and Ludwig angina can be life-threatening.
Prognosis: The prognosis for root caries can vary based on the stage of the decay, the patient's overall oral hygiene, and the promptness of treatment. Early-stage root caries, when detected and treated promptly, generally have a good prognosis. Treatment often involves removing the decay and restoring the tooth with appropriate materials. Improved oral hygiene and routine dental care are essential to prevent recurrence. If the decay progresses without intervention, it can lead to more severe damage, requiring more extensive treatments and potentially negatively impacting the prognosis. Regular dental check-ups are crucial to monitor and manage the condition effectively.
Onset: 1. **Onset**: Root caries typically begin to develop in adults, especially in older adults, as the gums recede and expose the roots of the teeth to decay.

2. **Nan**: Nan is not a recognized term related to root caries. Please specify if you need information on another aspect such as symptoms, prevention, or treatment.
Prevalence: Root caries, often affecting the root surface of teeth, has a prevalence that increases with age. In older adults, the prevalence can range significantly depending on the population and region. Studies have shown that it can affect 20% to over 60% of elderly individuals. This increased prevalence is mainly due to factors such as gum recession, which exposes the root surface, as well as changes in saliva production and oral hygiene practices in older age.
Epidemiology: Worldwide, approximately 3.6 billion people have dental caries in their permanent teeth. In baby teeth it affects about 620 million people or 9% of the population. The disease is most common in Latin American countries, countries in the Middle East, and South Asia, and least prevalent in China. In the United States, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary pathological cause of tooth loss in children. Between 29% and 59% of adults over the age of 50 experience caries.Treating dental cavities costs 5–10% of health-care budgets in industrialized countries, and can easily exceed budgets in lower-income countries.The number of cases has decreased in some developed countries, and this decline is usually attributed to increasingly better oral hygiene practices and preventive measures such as fluoride treatment. Nonetheless, countries that have experienced an overall decrease in cases of tooth decay continue to have a disparity in the distribution of the disease. Among children in the United States and Europe, twenty percent of the population endures sixty to eighty percent of cases of dental caries. A similarly skewed distribution of the disease is found throughout the world with some children having none or very few caries and others having a high number. Australia, Nepal, and Sweden (where children receive dental care paid for by the government) have a low incidence of cases of dental caries among children, whereas cases are more numerous in Costa Rica and Slovakia.The classic DMF (decay/missing/filled) index is one of the most common methods for assessing caries prevalence as well as dental treatment needs among populations. This index is based on in-field clinical examination of individuals by using a probe, mirror and cotton rolls. Because the DMF index is done without X-ray imaging, it underestimates real caries prevalence and treatment needs.Bacteria typically associated with dental caries have been isolated from vaginal samples from females who have bacterial vaginosis.
Intractability: Root caries is not generally considered intractable. It can often be managed or treated effectively through a combination of good oral hygiene practices, dietary modifications, regular dental check-ups, and professional treatments such as fluoride therapy, dental sealants, and restorative procedures.
Disease Severity: Disease_severity: Root caries can range from mild to severe based on factors such as the depth of the lesion and the extent of tooth structure affected. Mild cases involve superficial demineralization, while severe cases may lead to significant structural damage and potential tooth loss if left untreated.
Healthcare Professionals: Disease Ontology ID - DOID:14089
Pathophysiology: Teeth are bathed in saliva and have a coating of bacteria on them (biofilm) that continually forms. The development of biofilm begins with pellicle formation. Pellicle is an acellular proteinaceous film which covers the teeth. Bacteria colonize on the teeth by adhering to the pellicle-coated surface. Over time, a mature biofilm is formed, creating a cariogenic environment on the tooth surface. The minerals in the hard tissues of the teeth – enamel, dentin and cementum – are constantly undergoing demineralization and remineralization. Dental caries result when the demineralization rate is faster than the remineralization, producing net mineral loss, which occurs when there is an ecologic shift within the dental biofilm from a balanced population of microorganisms to a population that produces acids and can survive in an acid environment.
Carrier Status: Root caries refers to decay that occurs on the root surfaces of teeth, primarily affecting individuals with receding gums. Carrier status is not applicable in this context, as root caries is not a condition related to a carrier state but rather a result of factors such as poor oral hygiene, dry mouth, high sugar intake, and inadequate fluoride exposure.
Mechanism: **Mechanism:**
Root caries primarily occurs when the root surfaces of teeth are exposed due to gum recession, which is common in older adults. The main mechanism involves the demineralization of the tooth root's dentin by bacterial acids. These acids are produced when oral bacteria, particularly from the biofilm (dental plaque), metabolize fermentable carbohydrates such as sugars and starches.

**Molecular Mechanisms:**
1. **Bacterial Metabolism:**
- Oral bacteria such as *Streptococcus mutans* and *Lactobacillus* species metabolize dietary sugars and produce acids, mainly lactic acid.

2. **Acid Production and Demineralization:**
- The produced acids lower the pH in the oral environment.
- When the local pH drops below the critical level (around 5.5), it leads to the dissolution of hydroxyapatite crystals in the tooth's root dentin. This demineralization process weakens the tooth structure.

3. **Matrix Metalloproteinases (MMPs):**
- MMPs are proteolytic enzymes present in saliva and dentin, and they can become activated in an acidic environment.
- Activated MMPs degrade the collagen matrix in dentin, further contributing to tooth degradation and the progression of caries.

4. **Fluoride Influence:**
- Fluoride aids in remineralization by forming fluoroapatite, which is more resistant to acidic conditions than hydroxyapatite.
- It inhibits bacterial metabolism and acid production, thus stabilizing the demineralized areas and helping in the prevention of root caries progression.
Treatment: Most importantly, whether the carious lesion is cavitated or non-cavitated dictates the management. Clinical assessment of whether the lesion is active or arrested is also important. Noncavitated lesions can be arrested and remineralization can occur under the right conditions. However, this may require extensive changes to the diet (reduction in frequency of refined sugars), improved oral hygiene (toothbrushing twice per day with fluoride toothpaste and daily flossing), and regular application of topical fluoride. More recently, Immunoglobulin Y specific to Streptococcus mutans has been used to suppress growth of S. mutans. Such management of a carious lesion is termed "non-operative" since no drilling is carried out on the tooth. Non-operative treatment requires excellent understanding and motivation from the individual, otherwise the decay will continue.
Once a lesion has cavitated, especially if dentin is involved, remineralization is much more difficult and a dental restoration is usually indicated ("operative treatment"). Before a restoration can be placed, all of the decay must be removed otherwise it will continue to progress underneath the filling. Sometimes a small amount of decay can be left if it is entombed and there is a seal which isolates the bacteria from their substrate. This can be likened to placing a glass container over a candle, which burns itself out once the oxygen is used up. Techniques such as stepwise caries removal are designed to avoid exposure of the dental pulp and overall reduction of the amount of tooth substance which requires removal before the final filling is placed. Often enamel which overlies decayed dentin must also be removed as it is unsupported and susceptible to fracture. The modern decision-making process with regards the activity of the lesion, and whether it is cavitated, is summarized in the table.Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level. For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth. Aggressive treatment, by filling, of incipient carious lesions, places where there is superficial damage to the enamel, is controversial as they may heal themselves, while once a filling is performed it will eventually have to be redone and the site serves as a vulnerable site for further decay.In general, early treatment is quicker and less expensive than treatment of extensive decay. Local anesthetics, nitrous oxide ("laughing gas"), or other prescription medications may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. A dental handpiece ("drill") is used to remove large portions of decayed material from a tooth. A spoon, a dental instrument used to carefully remove decay, is sometimes employed when the decay in dentin reaches near the pulp. Some dentists remove dental caries using a laser rather than the traditional dental drill. A Cochrane review of this technique looked at Er:YAG (erbium-doped yttrium aluminium garnet), Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) and Nd:YAG (neodymium-doped yttrium aluminium garnet) lasers and found that although people treated with lasers (compared to a conventional dental "drill") experienced less pain and had a lesser need for dental anaesthesia, that overall there was little difference in caries removal. Another alternative to drilling or lasers for small caries is the use of air abrasion, in which small abrasive particles are blasted at decay using pressurized air (similar to sand blasting). Once the cary is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to function and aesthetic condition.
Restorative materials include dental amalgam, composite resin, glass ionomer cement, porcelain, and gold. Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great. When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.
For children, preformed crowns are available to place over the tooth. These are usually made of metal (usually stainless steel but increasingly there are aesthetic materials). Traditionally teeth are shaved down to make room for the crown but, more recently, stainless steel crowns have been used to seal decay into the tooth and stop it progressing. This is known as the Hall Technique and works by depriving the bacteria in the decay of nutrients and making their environment less favorable for them. It is a minimally invasive method of managing decay in children and does not require local anesthetic injections in the mouth.

In certain cases, endodontic therapy may be necessary for the restoration of a tooth. Endodontic therapy, also known as a "root canal", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. In root canal therapy, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of root canal therapy, the tooth is non-vital, as it is devoid of any living tissue.
An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth. Extractions may also be preferred by people unable or unwilling to undergo the expense or difficulties in restoring the tooth.
Compassionate Use Treatment: For root caries, compassionate use treatments and off-label or experimental treatments might include:

1. **Silver Diamine Fluoride (SDF)**: Often used off-label to arrest root caries, SDF is a topical medicament that has antimicrobial properties and can help harden softened dentin.

2. **Chlorhexidine Varnish**: Although primarily used for its antibacterial effects in periodontal treatment, chlorhexidine varnish may be applied off-label to reduce caries-causing bacteria at the root surfaces.

3. **Probiotic Therapy**: Experimental treatments involving probiotics aim to balance the oral microbiome and reduce cariogenic bacteria, though more research is needed to confirm efficacy.

4. **Ozone Therapy**: An experimental approach where ozone gas is used to kill bacteria and promote remineralization of carious lesions on the root surface.

5. **Bioactive Glass**: Off-label use of bioactive glass materials (such as Novamin) can help in remineralization by releasing essential ions like calcium and phosphate.

Always consult with a healthcare professional before considering any off-label or experimental treatments.
Lifestyle Recommendations: Lifestyle recommendations for preventing and managing root caries include:

1. **Oral Hygiene**: Brush teeth at least twice daily with fluoride toothpaste. Use a soft-bristled toothbrush and gently clean along the gumline to prevent gum recession.
2. **Flossing**: Floss daily to remove food particles and plaque between teeth and along the gumline.
3. **Diet**: Limit sugary and acidic foods and beverages to minimize plaque buildup and acid exposure that can erode tooth enamel and roots.
4. **Regular Dental Visits**: Schedule regular dental check-ups and professional cleanings to monitor dental health and catch any early signs of root caries.
5. **Fluoride Treatments**: Consider professional fluoride treatments or using fluoride mouth rinses to strengthen tooth enamel and root surfaces.
6. **Hydration**: Drink plenty of water, especially fluoridated water, to help wash away food particles and reduce the risk of decay.
7. **Lifestyle Habits**: Avoid tobacco use, which can increase the risk of gum disease and root exposure.

These practices contribute to overall oral health and can help prevent the development or progression of root caries.
Medication: There is no specific medication for root caries. Treatment typically involves removing the decayed portion of the tooth and restoring it with a filling material. Preventive measures include maintaining good oral hygiene, such as brushing with fluoride toothpaste, flossing, and regular dental check-ups. In some cases, fluoride treatments or dental sealants may be recommended to protect the tooth surface and prevent further decay.
Repurposable Drugs: Root caries, a form of dental decay located on the roots of teeth, currently lacks repurposable systemic drugs specifically approved for its treatment. Instead, management typically focuses on local therapies including:

1. **Topical Fluorides**: Fluoride varnishes and gels are used to remineralize affected areas.
2. **Silver Diamine Fluoride (SDF)**: An antimicrobial agent that arrests caries.
3. **Chlorhexidine**: An antimicrobial mouth rinse that can reduce bacterial load.

Preventive measures such as good oral hygiene practices, reduced sugar intake, and regular dental checkups are crucial in managing and preventing root caries.
Metabolites: Root caries is the decay of the root surface of a tooth. The metabolites primarily involved in root caries are acids produced by bacteria, such as lactic acid, resulting from the fermentation of dietary sugars. These acids demineralize the tooth structure, leading to decay.
Nutraceuticals: Nutraceuticals (products derived from food sources that provide health benefits in addition to their basic nutritional value) can play a role in preventing or managing root caries by enhancing overall oral health. Examples include:

1. **Xylitol:** A sugar substitute that inhibits the growth of decay-causing bacteria.
2. **Green Tea Extract:** Rich in catechins, which have antibacterial properties that can reduce oral bacteria.
3. **Probiotics:** Beneficial bacteria that help balance the oral microbiota and reduce harmful bacteria levels.
4. **Cranberry Extract:** Contains proanthocyanidins that prevent bacteria from adhering to tooth surfaces.

Nanotechnology in root caries primarily focuses on:

1. **Nanofilled Resins:** Provide better mechanical properties and aesthetic results in restorative materials.
2. **Nano-hydroxyapatite:** Used in remineralizing agents to repair early carious lesions by mimicking the natural tooth structure.
3. **Antimicrobial Nanoparticles:** Silver nanoparticles and other nanomaterials with antimicrobial properties can be incorporated into dental products to reduce bacterial colonization and biofilm formation.
4. **Nano-encapsulated Drug Delivery:** Targeted delivery of antibacterial and remineralizing agents directly to carious lesions.
Peptides: Root caries is a dental condition involving decay on the root surface of a tooth. Research has explored the use of antimicrobial peptides and nanotechnology to combat this issue. Antimicrobial peptides (AMPs) possess the ability to target and kill harmful bacteria, which could help prevent or reduce root caries. Nanoparticles, such as those composed of silver or calcium phosphate, can be incorporated into dental materials, enhancing their antimicrobial properties and aiding in the remineralization of decayed dentin. Both these approaches show promise as innovative strategies for managing and preventing root caries.