Epidemiology of root caries

Many epidemiological studies have been conducted on a variety of populations. Unfortunately, comparison of the prevalence data, and to a lesser degree of the incidence data, between the various studies is of little use due to the lack of standardised diagnostic criteria, reporting methods and population diversity. In the few incidence studies which have been conducted around 30–40% of people developed root caries, although many adults in the population appear to have been affected by root caries. Many risk factors associated with the occurrence of root caries have been identified and these include oral, medical, mental, behavioural and psychosocial conditions.     

Root caries incidence and associated risk factors in middle-aged and older adults

Data from population-based longitudinal studies required to assess the incidence of root caries and associated risk factors are sparse in the literature. To this end, a group of 130 middle-aged and older adults were examined for root caries at baseline and at a follow-up visit between nine and 24 months (median: 16 months). Dental examinations were conducted by one examiner at a Tufts dental clinic using NIDR defined diagnostic criteria. Fifty percent of subjects in this study population developed one or more new root caries lesions over the follow-up period. Also, an annualised increment of 0.60 (SD: 0.72) decayed and filled surfaces per person was observed for the 45–59 year old group while the 70+ group showed an annualised increment of 1.38 (SD: 1.97) DFS in this study. Multivariate logistic regression analysis identified past root caries experience, high plaque score, and high number of teeth (>= 22) to be positively associated with new root caries (p < 0.05).     

Partial dentures as an independent indicator of root caries risk in a group of older adults.

Objectives: To estimate the independent association between the wearing of removable partial dentures (RPD) and the presence of root caries in a population of older adults. Design: Multivariate logistic regression modeling of root caries prevalence using different measures of root caries as dependent variables. The model included measures of disease history as indicators of historical risk. Setting: Data collected in the field from three areas of England. Subjects: Random sample of adults aged 60 years and over, drawn from lists of patients registered with general medical practitioners. Intervension: Field measurements of a range of oral health variables including oral disease, disease history, oral status and various social and demographic measures. Main outcome measures: The presence of root caries, unsound and sound root restorations. Results: Of the five different models of root caries prevalence which were used, RPDs featured as an independent risk indicator for root surface cades in the three which were related to the presence of untreated disease. The odds ratios for the contribution made by RPDs were all over 1.6, and when considered alone was in excess of 2 in one model. These models were generally well fitting. RPDs did not feature as a risk indicator in the two models which related only to the presence of root surface restorations. Conclusions: In this study, where RPDs were present, the odds of untreated disease being present increased substantially     

Clinical and behavioural risk indicators for root caries in older people

Objective: To investigate the clinical and behavioural factors indicating root caries risk among older people. Desing: Cross sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators, including sugars intake. Setting: A national sample of older British adults, free‐living and institutionalised. Participants: 462 dentate adults aged 65 years or over. Results: Nine or more intakes of sugars per day more than doubled the odds of root caries being present (OR 2.2–2.4). Other clinical and behavioural factors affecting root caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1–2.6) and infrequent tooth brushing (OR 2.8 – 4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root caries, as measured by the RCI(d). Conclusions: Of the factors open to possible clinical or behavioural intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.     

Number of teeth and risk of root caries

Objective: This study aimed to investigate the association between number of natural teeth and prevalence of root caries. Design: A cross‐sectional design was adopted. A stratified multi‐stage purposive sampling method was used to select a wide range of elderly people from all social classes, educational levels and sexes. Data was collected through interviews and clinical examinations. Setting: Urban area in Chiang Mai‐Thailand. Participants: 549 elderly dentate aged 60‐74 years. Main Outcome Measures: Teeth with decay and filled roots (DF‐T). Results: The prevalence of root caries was 18.2% with a mean DF‐T of 0.58 (S.D. 2.02). Results of multiple logistic regression showed that number of teeth, DMF‐S scores, sex, and socio economic factors were statistically significantly associated with root caries (P<0.05). Adjusted odds ratios demonstrated a 14% increase in the chance of having root caries when the number of teeth increased one unit. Similarly, a 3% increase was observed for each unit increase in the DMF‐S scores (p<0.001). Being male, having more than four years of education and earning more than 1500 baht/month increased the chances of root caries by 76%, 139% and 85% respectively (p<0.001). Recession and age were not statistically significantly associated with root caries. Conclusions: Having more teeth, higher DMF‐S scores, earning more than 1500 baht/month, having more than 4 years of education and being male increased the likelihood of having root caries.     

Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years

Objectives: (i) Initially, to devise and examine the validity of a system for determining lesion activity on root surfaces, and (ii) compare the effectiveness of two preventive programmes in controlling root caries in elderly people using the devised system. Materials and methods: (i) Four clinical variables: texture, contour, location and colour of root caries lesions were selected to evaluate lesion activity. The intraexaminer reproducibility of the scoring system was assessed on 28 elderly patients. The accuracy was assessed on 10 of these persons using an impression material (Clinpro, 3M ESPE). (ii) Of total, 215 homebound 75+ year olds were randomly assigned to one of three groups: group 1, once a month a dental hygienist brushed the teeth of the participants and applied Duraphat vanish to active root caries lesions. The participants in groups 2 and 3 received 5000 and 1450 ppm F‐toothpaste, respectively, to use twice a day. This study included an interview, a baseline examination and a final follow‐up examination after 8 months. Results: (i) Intraexaminer reproducibility of the root caries scoring system was 0.86 (Kappa). The sensitivity and specificity was 0.86 and 0.81. (ii) Data from those 189 (88%) who completed the study disclosed that there were no inter‐group differences at the baseline examination concerning relevant conditions. At the end of the study, the root caries status of participants in groups 1 and 2 had improved significantly when compared with group 3 (p < 0.02). No significant difference was observed between groups 1 and 2 (p = 0.14). Conclusion: The data suggest that the root caries scoring system is reliable. Both the intervention programmes controlled root caries development; the hygienist in eight of 10 persons, the 5000 ppm F‐toothpaste in seven of 10. In contrast, five of 10 participants who only brushed with 1450 ppm F‐toothpaste had root caries progression.     

Relationship of cariogenic bacteria levels with periodontal status and root surface caries in elderly Japanese

Objective: The relationship of the levels of cariogenic bacterial species with periodontal status and decayed root surfaces was investigated in elderly Japanese subjects. Methods: Three hundred and sixty‐eight individuals (each 75 years old) were examined for periodontal status (pocket depth, attachment loss), root surface caries and salivary levels of mutans streptococci (MS) and lactobacilli (LB). Results: Values >4 mm of attachment loss (rAL4) and for average attachment loss (aAL) of sites measured were significantly higher in subjects with LB than those without. Multiple regression analysis also showed a correlation between aAL and rAL4 values with the presence of LB (aAL p = 0.003; rAL4 p = 0.002). Further, multiple regression analysis of interacting factors regarding decayed root surfaces showed that LB carriers had a greater incidence of decayed root surface caries (p = 0.003), while MS and LB levels were correlated to the number of decayed root surfaces (LB p = 0.010; MS p = 0.026). Conclusion: Our results indicate that considerable attachment loss elevates the possibility of having LB, thus increasing the risk of root surface caries. It was also found that LB and MS measurements may be useful indicators of decayed root surfaces in elderly individuals with attachment loss.     

Ten-year cross-sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals

Objective: The 10‐year incidence of dental caries was related to some associated factors in a random sample of 65, 75 and 85‐year‐old inhabitants of Gothenburg. Subjects: Of the 208 persons examined at baseline, 102 (49%) participated in the follow‐up examination; 56, 37 and nine, respectively, in the different age groups. For the purpose of time‐trend comparisons, a new random sample of 98 individuals aged 55 years was examined. Results: Ninety‐five per cent of the participants had developed one or more carious lesions during the 10‐year period and the incidence of coronal and root caries increased with age. In the 65‐year‐olds, 9% of the root surfaces had decayed during the period, compared with 25% in the 85‐year‐olds. Secondary caries predominated over primary caries and prosthetic crowns accounted for 70% of the restored tooth surfaces. Twenty per cent of the individuals were daily smokers and 61% were taking drugs with hyposalivatory side‐effects. The mean saliva secretion rates were lower in the older groups compared with the ‘younger’ ones. The overall salivary counts of mutans streptococci and lactobacilli had increased during the period and the values were highest in the oldest age groups. Salivary levels of lactobacilli and mutans streptococci, number of teeth, daily numbers of cigarettes and drugs and oral hygiene were the best predictors of the incidence of caries. Conclusion: The findings indicate that there is an increased risk of dental caries with age owing to unfavourable caries‐related factors.     

Predictors of caries in old age

This study measured the incidence of dental caries for one year and identified factors associated with the risk of caries in a sample of 156 elderly subjects. The subjects were examined at baseline and after one year to record the number of missing, filled and decayed teeth, to measure oral hygiene and flow of saliva, and to estimate the numbers of Streptococcus mutans and Lactobacilli cultured from samples of saliva. All subjects were interviewed on both occasions for information on their use of medications and dental services and on their ingestion of sugar. At baseline the elders had a mean of 19 natural teeth with 5 decayed surfaces (DS), 38 filled surfaces and a mean Plaque Index (PI) of 1. The independent group, on average, had more teeth and fillings but a lower PI and less caries. At the end of the year more than two-thirds (71%) of the 98 institutionalised subjects and over half (59%) of the 58 independent subjects had at least one new decayed/filled surface (DFS). The mean net DFS increment per subject was 4.6 and 2.0 respectively. Regression analyses on multivariate models identified caries at baseline, residence in long term care facilities, high numbers of Lactobacilli, poor oral hygiene and frequent sugar consumption as the variables contributing most significantly to the risk of caries in old age.     

A comparison of four home-care fluoride programs on the caries incidence in the elderly

Objective : To estimate the caries preventive effect of 4 fluoride programs over 2 years in the elderly. Setting : The Public Dental Clinics of Balsta and Knivsta and the Faculty of Odontology in Göteborg, Sweden Subjects : One hundred and sixty-four individuals, aged 60 years and older (mean age 71.5 years) who were considered to be at risk from caries. Design : The participants were randomly assigned either to: 1) rinse twice a day with a 0.05% NaF solution (n=49; rinsing group), 2) suck twice a day on a 1.66 mg NaF tablet (n=51; tablet group). 3) brush their teeth three times a day using a toothpaste slurry rinsing technique (n=32; slurry group), or 4) brush their teeth in their usual manner (n=32; control group). The participants in all 4 groups used a fluoride toothpaste (containing 0.32% NaF) at least twice daily. Results : No new carious lesions were found in 67% of the participants in the rinsing, 43% in the tablet, 25% in the slurry and 16% in the control group over the 2 years. The mean (± SD) 2-year caries increment was 0.8±1.4, 1.4±1.7, 1.9±1.9 and 2.3±2.1 DFS in the rinsing, tablet, slurry and control groups, respectively; it was significantly lower in the rinsing than in the control group (p<0.01). A lower incidence of DFS was also found in the tablet group than in the slurry group, but only for the lingual surfaces (p<0.05). Conclusion : The type of fluoride program may be of importance in the reduction of new caries lesions in an older population.     

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study

Objectives: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community‐dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. Design: In this cross‐sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. Setting: Examinations were carried out in two local clinics by standardized examiners. Subjects: One hundred twenty‐nine dentate persons were examined. Main Outcome Measures: The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. Results: More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14–20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14–20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). Conclusions: Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.     

Non-invasive management of superficial root caries lesions in disabled and infirm patients

In disabled and infirm patients with limited, if any, capacity for independent oral self‐care, it is difficult to control progression of root caries lesions. Objective: To evaluate the effect of non‐restorative cariostatic treatment on progression of active superficial root caries lesions (n =56). Design: Pilot study. Setting: Department of Cariology, Institute of Odontology, Karolinska Institutet, Huddinge. Subjects: 15 physically‐dependent patients. Intervention: The patients were allotted to one of the following groups. Group 1, professional tooth cleaning and application of tap water flavoured with eucalyptus oil; Group 2, professional tooth cleaning and application of Cervitec, (1% chlorhexidine in thymol‐containing varnish), Group 3, professional tooth cleaning and application of Cervitec and Fluor Protector (varnish containing 0.1% fluoride). Every three months for 18 months, each subject received the treatment twice within a 10‐day interval. Measurements: The status of the 56 root caries lesions was evaluated every six months using a root caries index based on visual and tactile criteria. The examiners were blind to which treatment group the patients belonged. Results: In most subjects (14 out of 15), progression of root caries lesions was arrested. No statistically significant differences could be demonstrated between the three treatment groups. However, regardless of treatment regimen, there was a statistically significant difference between the greater number of subjects exhibiting no progression of root caries lesions and those with lesion progression, at 6 (p=0.022), 12 (p=0.006) and 18 months (p<0.001). Conclusion: This pilot study suggests that in disabled and infirm patients regular professional tooth cleaning with a fluoride containing paste, with or without supplementary varnishing with chlorhexidine‐thymol and/or fluoride can prevent further progression of existing superficial root caries lesions.     

Clinical reversal of root caries using ozone, double-blind, randomised, controlled 18-month trial

Objective : To assess the effect of an ozone delivery system, combined with the daily use of a remineralising patient kit, on the clinical severity of non‐cavitated leathery primary root carious lesions (PRCL's), in an older population group. Design : Atotal of 89 subjects, (age range 60–82, mean ± SD, 70.8 ± 6 years), each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double‐blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. Results : There were no observed adverse events. After three months, in the ozone‐treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six‐month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone‐treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed (p<0.01). Conclusions : Leathery non‐cavitated primary root caries can be arrested non‐operatively with ozone and remineralising products. This treatment regime is an effective alternative to conventional “drilling and filling”.     

含氟复合体充填材料充填根面龋对局部菌群变化的影响研究

目的观察根面龋充填后细菌分布变化,以及不同充填材料与主要致龋菌比例变化之间的关系。方法选择根面龋患者60例,采自身前后对照设计,采用细菌分离鉴定及菌落形成单位记数的检测方法,以充填前患牙龈沟菌丛为基线,追踪观察牙体复合体充填和银汞合金充填后即刻、1个月、6个月充填体周围1 mm范围内菌丛变化情况。结果根面龋充填后即刻充填体周围菌斑中的数量与种类显著减少,且放线菌、乳酸杆菌和变形链球菌3种菌落数量降低和占总菌落的百分率下降(P<0.01);根面龋充填后1个月细菌数量仍低于充填前水平,差异有显著性(P<0.05);且复合体组3种主要致龋菌落占总菌落的百分率低于银汞合金充填组,差异有显著性(P<0.05);根面龋充填后6个月细菌丛与充填前差异无显著性(P>0.05)。不同充填材料组3种菌落占总菌落的百分率无明显变化,差异无显著性(P>0.05)。结论无论采用何种材料,根面龋充填本身可改善菌斑的微生态环境,复合体充填根面龋后短期内可以有效地抑制充填体龋洞周围菌斑中主要致龋菌的比例。     

Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides

BackgroundSuccessful oral health interventions must be based on the specific needs of the population that they serve. Evaluation of habits related to dental caries development and estimation of fluoride exposure in a target group of young patients helps to plan effective and safe caries prevention strategies.ObjectivesThe study aimed to evaluate factors affecting dental caries experience and sources of fluoride exposure in preschool children living in two areas: with optimal and low natural content of fluoride in drinking water.Materials and methodsThe study included a group of 73 children of both sexes aged 4–7 years attending two kindergartens in Środa Wielkopolska and Turek (Wielkopolska Voivodeship, Poland), where the content of fluoride in drinking water according to data obtained in the sanitary station ranged from 0.68 to 0.74 mg/L (optimal concentration of fluoride) and from 0.19 to 0.30 mg/L (low concentration of fluoride), respectively. Parents of patients completed a survey about diet, hygiene, and dental care, taking into account the child's fluoride exposure. The calibrated dentist assessed the oral health condition using a mirror, a CPI probe, and a headlamp. Oral hygiene was recorded using the Silness and Löe plaque index, caries experience by calculating the numbers of decayed, missing, and filled primary, and permanent teeth (dmf and DMF, respectively) while caries frequency by calculating the percentage of children with caries experience above 0. In order to assess the fluoride concentrations in urine and drinking water, parents were asked to provide a urine sample collected on fasting and a tap water sample. Fluoride concentrations were assessed using a 09–37 (MARAT) fluoride ion-selective electrode and a RAE 111 silver-chloride reference electrode. Statistical analysis was conducted using the data analysis software system Statistica (version 12, StatSoft, Inc. 2014), assuming a statistical significance level p < 0.05.ResultsNo statistically significant differences were found between caries indices of the examined children in each kindergarten (p > 0.05). Urinary fluoride levels were higher in children who tended to swallow toothpaste or used fluoride rinses and positively correlated with fluoride concentrations in the drinking water. Dental caries experience in the examined children depended on the effectiveness and frequency of oral hygiene procedures and dietary habits.ConclusionsThe strategy aimed at improving the oral health of the examined group of children should include accomplishing oral hygiene, promoting a non-cariogenic diet, and, finally, controlling fluoride exposure from at-home fluoride products. Caries prevention program ought to be adjusted to individual characteristics of each child, taking into consideration oral hygiene practices, dietary habits and total fluoride intake.     

Oral status in home-dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease

doi: 10.1111/j.1741‐2358.2011.00507.x Oral status in home‐dwelling elderly dependent on moderate or substantial supportive care for daily living: prevalence of edentulous subjects, caries and periodontal disease Objectives: The aim of this study was to compare the prevalence of edentulous subjects, caries and periodontal disease among the home‐dwelling elderly with moderate and substantial needs of support for daily living. Materials and method: A sample of 302 randomly selected elderly with moderate or substantial needs of supportive care were examined in Sweden. Several oral clinical variables were registered: number of teeth, dentures, caries, probing pocket depth, gingival bleeding and Eichner’s index. Results: Both in general and in oral health, the differences were small when comparing elderly with moderate and substantial care needs for daily living. Those with substantial needs had more caries lesions (p < 0.01) and more gingival bleeding (p < 0.05), while the number of teeth and prevalence of edentulous subjects did not differ in relation to the need of daily support. The elderly had, on average, 9.8–11.7 teeth, one‐third of whom had no natural teeth. According to Eichner’s index, half of the elderly in both groups had no opposing tooth contacts. Fifty‐five per cent used dentures. Conclusions: Elderly people with needs of supportive care have lost many teeth before they become dependent. Health promotion should be a priority in early ageing populations to prevent oral diseases and tooth loss.     

The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth

Objectives: This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth). Design: The study was a multicentred, randomized, parallel group, double blind, placebo‐controlled clinical trial. Setting: All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON. Subjects: Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates. Results: 236 subjects completed at least one post‐treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p=.02) and total caries increment (p=.03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co‐variables. These factors did not meaningfully alter the findings. Conclusions: The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).     

The prevalence and antimicrobial resistance phenotypes of Salmonella,Escherichia coli and Enterococcus sp. in surface water

Surface water is prone to bacterial contamination as it receives wastes and pollutants from human and animal sources, and contaminated water may expose local populations to health risks. This review provides a brief overview on the prevalence and antimicrobial resistance (AR) phenotypes of Salmonella, Escherichia coli and Enterococcus, found in natural freshwaters. These bacteria are frequently detected in surface waters, sometimes as etiological agents of waterborne infections, and AR strains are not uncommonly identified in both developed and developing countries. Data relating to Salmonella, E. coli and Enterococcus present in environmental water are lacking, and in order to understand their development and dissemination using the One Health approach, understanding the prevalence, distribution and characteristics of the bacteria present in surface water as well as their potential sources is important. Furthermore, AR bacteria in natural watersheds are not well investigated and their impacts on human health and food safety are not well understood. As surface water is a receptacle for AR bacteria from human and animal sources and a vehicle for their dissemination, this is a crucial data gap in understanding AR and minimizing its spread. For this review, Salmonella, E. coli and Enterococcus were chosen to evaluate the presence of primary pathogens and opportunistic pathogens as well as to monitor AR trends in the environmental water. Studies around the world have demonstrated the widespread distribution of pathogenic and AR bacteria in surface waters of both developing and developed countries, confirming the importance of environmental waters as a reservoir for these bacteria and the need for more attention on the environmental bacteria for emerging AR.