Dental Caries in the Elderly

Studies in the United States and other countries have shown that there is continued caries activity with advancing age. These studies, however, do not elaborate on the nature of the dental caries nor its anatomical location on the tooth. It has been assumed that dental caries occur on the coronal portion of retained teeth and that recurrent decay around existing restorations represents the major form of the disease. In addition to continued coronal caries activity in adults, the problem of carious lesions occurring on the exposed roots of teeth has been identified in a number of recent surveys. The exposure of the root surface to the oral cavity is a consequence of the apical migration of the periodontal attachment through periodontal disease and dental treatment which renders this part of the tooth at risk of the dental caries process. However, there are several distinct differences between coronal and root caries. The continued occurrence of coronal caries in adults and the projected increase m the prevalence of root caries suggests an expanded role for the restorative and preventive services for the older adult patient. Although the techniques relating to coronal caries are well-established, those relating to root caries are just beginning to be explored and developed. Many of the principles, materials and philosophies which have proved to be effective for coronal caries are not equally efficacious when the tooth root is involved. This area represents a fertile field for research and development in the older adult patient.     

Dental caries in a Portuguese identified skeletal sample from the late 19th and early 20th centuries

Dental caries was investigated in 600 adult dentitions belonging to the identified osteological collections of the Museum of Anthropology, University of Coimbra, Portugal (late 19th/early 20th centuries). The main advantage of this sample compared to an archaeological source is the presence of known demographic parameters such as age, sex, and occupation. The aim of this study is to investigate the issues involved in comparing caries data derived from archaeological death assemblages with statistics compiled from clinical studies of the living. When only the upper dentition was considered, higher rates were observed in females than in males. No differences were found between sexes for lower teeth. In both sexes, both the percentage of carious teeth and the severity of lesions were found to increase with age, demonstrating that caries activity continued throughout life. The slight decrease observed for the age group 70–79 years is probably due to the increased antemortem tooth loss in the elderly. Caries was most common at contact areas (32.9%) and rarest at smooth crown surfaces (6.5%). Root surface caries was graphed in relation to the exposure of roots, and it was confirmed that the degree of root exposure was not strongly related to the frequency of carious lesions on the exposed root surface, although both increased with age. Molars were attacked more frequently by caries as a whole than premolars, canines or incisors. The results are similar to studies of recent living populations with a limited access to professional dental care. Am J Phys Anthropol, 2009. © 2009 Wiley‐Liss, Inc.     

The prevalence of root surface caries amongst Irish adults

In a national survey of adult dental health conducted in the Republic of Ireland in 1989/90 a total of 1,527 subjects aged 25 and older were examined for root surface caries. It was found that the prevalence of root surface caries was highest in older age groups and also amongst males, residents of non-fluoridated communities and those earning low incomes. Tooth loss masked the potential prevalence of root surface caries. With more persons retaining their natural teeth into middle and old age the prevalence of root surface caries is likely to increase in the future.     

The Diagnosis of Root Caries – A Review

Interest in root caries has grown among dental caries research workers over the past 20 years. However, many studies, either in the fields of microbiology, pathology, epidemiology or clinical trials, have used differing definitions in their diagnosis of root caries. These differences mean that comparison between studies is difficult, if not impossible. Most of the criteria currently in use are neither sufficiently specific to allow the identification of the initial root caries lesion, not detailed enough to assess the progression of lesions. Furthermore, most definitions provide no information on treatment need within the populations studied. In this paper, the criteria which have been used to diagnose root caries, and their individual components – texture, cavitation, position, size, colour and radiolucency – are reviewed. It is concluded that there is a need to standardise terminology and definitions used for the diagnosis of root caries.     

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     

Caries incidence and increments in community-living older adults with and without dementia

Objectives: The Oral Health of Older Adults with Dementia was instigated in the late 1990s to quantify and compare coronal and root caries incidence and increments in community‐living older Australians with and without dementia. Methods: A longitudinal design was used to conduct dental inspections at baseline and one‐year, for two groups of randomly selected community‐living older adults ‐ one group of 116 people with dementia and a comparison group of 116 people without dementia. Results: At one‐year there were 103 dementia and 113(112 dentate) non‐dementia participants. Coronal and root surface caries incidence was higher for dementia participants (p<0.05). Dementia participants had higher coronal and root caries adjusted caries increments (ADJCI) (p<0.01). Both coronal and root ADJCI were evident in half of dementia participants, compared with one‐quarter of non‐dementia participants. Dementia participants with higher coronal ADJCI were those who had visited the dentist since baseline, who were taking neuroleptics with high anticholinergic adverse effects, and whose carer had high carer burden score (p<0.01). Dementia participants with higher root ADJCI were those needing assistance with oral hygiene care and whose carers had difficulties with oral hygiene care (p<0.05). Baseline characteristics predictive in linear regression for: (1) coronal caries increments among all participants were ‐ dementia participants, those with cognitive testing scores indicative of moderate‐severe dementia, those with private health insurance; (2) root caries increments among all participants were ‐ dementia participants, and those who had 1 decayed/filled root surface at baseline. Among dementia participants, being male was the baseline characteristic predictive in logistic regression for coronal caries increments, and having 1 decayed coronal surface was the baseline characteristic predictive for root caries increments. Conclusions: Coronal and root caries incidence and increments were significantly higher in the community‐living older adults with dementia over the one‐year follow‐up period. Dementia participants had high levels of coronal and root caries increments; characteristics related to high caries increments included sex (males), dementia severity (moderate‐severe), high carer burden, oral hygiene care difficulties, use of neuroleptic medication (with high anticholinergic adverse effects) and previous experience of caries.     

Prevention of Root Caries1

Primary prevention of root caries should focus on preventing periodontitis and the concomitant loss of gingival attachment. This requires a regimen of plaque control consisting of scrupulous oral hygiene, supplemented, if necessary, by antimicrobial agents. Once gingival recession has occurred, available data from human and animal studies indicate that to prevent root caries, patients should limit their dietary sucrose intake both in amount and frequency. The cornerstone of any preventive regimen for patients at high risk for caries is some mode of topical fluoride therapy. No controlled clinical data exist that show one agent (sodium fluoride versus stannous fluoride) or one vehicle (gel versus rinse) as more effective than another. When used daily at home, these topical fluoride agents reduce caries in patients with xerostomia. Some reports claiming efficacy are anecdotal, but ethical considerations preclude the use of an untreated control group. As no studies exist documenting an effect of topical fluoride in controlling root caries per se, current recommendations are based on extrapolation from studies of these xerostomic patients. Limited studies, both in humans and animals, indicate that drinking fluoridated water helps in reducing root caries. Progression of early root caries lesions can be arrested by a combination of mechanical/chemical therapy, recontouring and smoothing the roots, and applying topical fluoride to these surfaces.     

Evaluation of the strain identity between isolates from caries lesions and root canals in early childhood caries cases

Early childhood caries (ECC) has become a serious medical problem worldwide in the last decade. Bacterial microflora of the dental plaque and oral cavity is considered an important factor in the formation and progression of dental caries. The aim of this study was strain typing and comparison of bacterial isolates retrieved from caries lesions and root canal contents of the same teeth. In total, 18 pairs of presumptive streptococci and lactobacilli retrieved from dental caries and root canals isolated from ECC-affected children, were selected on the basis of biotyping results and rep-PCR fingerprinting with (GTG)₅ primer. Strain typing was further done using the RiboPrinter microbial characterization system (DuPont Qualicon). The automated ribotyping determined 14 pairs of the strains (77.8 %) to be identical. The results obtained confirmed that identical bacterial strains colonized both the decayed dental surface and the necrotic content of the dental pulp cavity during the cariogenesis. Our finding supports the assumption that bacteria could penetrate through the damaged dental surface to the inner parts of the teeth.     

Comparison of the crystal structures and intersubunit interactions of human immunodeficiency and Rous sarcoma virus proteases

The crystal structures of the proteases (PRs) encoded by the Rous sarcoma virus (RSV) and the human immunodeficiency virus (HIV) have been compared. The crystallographic monomer of HIV PR superimposes on the two crystallographically independent subunits of the RSV PR dimer with root mean square deviations of 1.45 and 1.55 A for 86 and 88 common C alpha atoms, respectively. There is a conserved structural core consisting of seven beta-strands forming two perpendicular layers, a helix, and the amino- and carboxyl-terminal beta-strands. PRs from related retroviruses fold into similar structures with surface turns of variable length between the beta-strands. Both HIV and RSV PR dimers have significant subunit-subunit interactions in three regions: the "firemen's grip" at the active site; the salt bridges involving Arg8, Asp29, and Arg87 of HIV PR; and the termini of the two subunits, which form a four-stranded antiparallel beta-sheet. The specific interactions of the termini differ in the two PRs. The carboxyl termini, residues 96-99 of HIV PR and residues 119-124 of RSV PR, contribute approximately 50% of the intersubunit ionic and hydrogen bond interactions and approximately 45% of the buried surface area involved in dimer formation. This information may be useful in the design of site-directed mutations or inhibitors of dimer formation.     

Restoration of Carious Lesions of the Root1

This paper summarizes and evaluates the indications and limitations of various dental materials and techniques for the treatment and restoration of root surface dental caries. Development of a severity index for classifying and sorting lesions is described. Historical materials such as silver amalgam and gold foil are briefly discussed as are contemporary materials such as composite resins and dentin bonding primers. Emphasis is placed on materials and techniques requiring minimal invasion or preparation of the root surface. Eradication of root lesions by recontouring and smoothing the root surface is discussed at length. A new dental material, glass ionomer cement, which contains fluoride and forms a physicochemical bond with enamel and dentin. and requires no preparation of the root surface other than lesion debridement, is described in detail. Guidelines for managing arrested lesions are offered. In addition, the importance of topical fluoride in the treatment and management of root caries is discussed. Lastly, some suggestions are offered for future directions of research in this area.     

Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population

Objectives: The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients. Design: The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double-blind randomization. Test Products The products compared both contain equivalent quantities of fluoride (1150ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth. Subjects: On completion, 50 subjects who received >50 Gy of radiation to the head and neck. Measurements: Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year. Results: At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is −0.12 (±1.30) for coronal caries and 0.06 (±0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (±1.62) for coronal caries and 0.45 (±0.98) for root caries in subjects using the conventional fluoride dentifrice. Non-parametric analysis of rank scores for net root surface increments/month was statistically significant (p=0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces. Conclusions: The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients.     

Recent advances in Rhizobium-legume symbiosis

The research findings in the field of Rhizobium-legume symbiosis reported worldwide during the years 2002 and 2003 (up to September) have been summarized. The information is presented under the various topics, viz., isolation and characterization of rhizobial strains, physiological aspects of nitrogen fixation, rhizosphere interactions and root surface signals, genomics and proteomics, plant genes involved in nodule formation, bioremediation and biocontrol, and review articles and conference reports. The postal and e-mail addresses of the concerned scientists have also been included.     

Trends in Oral Disease and Health1

Geriatric dentistry researchers are building a basic knowledge basic pertaining to the oral health status of older adults. Important findings on the prevalence of disease that run counter to “conventional wisdom” surrounding the oral health of older adults are that edentulism is decreasing, that both coronal and root caries are prevalent, that serious periodontal disease is not as prevalent as thought, that chronological age is not strongly associated with disease in older adults, and that oral lesions, especially those related to dentures, are prevalent. An important finding has been that the majority of disease seems to occur in a minority of the population. While the prevalence of oral diseases have been shown to be associated with water fluoridation, systemic diseases, use of medications, social and behavioral factors, and a variety of other oral conditions, there is only preliminary information on the incidence of disease and actual risk factors. The data available on the incidence of disease come from a study of community-dwelling older adults in Iowa, and these data generally confirm the prevalence results. Coronal and root caries are active in this older population with caries being the best predictor of tooth loss. Furthermore, most disease occurs in a high risk group. Multivariate models predicting people at highest risk for root and coronal caries implicate stress and anxiety, use of tobacco, and recent onset of illness as risk factors. In addition, preliminary results indicate that some dental conditions may be predictive of general health status.     

Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease

doi: 10.1111/j.1741‐2358.2011.00560.x
Indicators for root caries in Danish persons with recently diagnosed Alzheimer’s disease Objective: To identify indicators of root caries among persons with newly diagnosed Alzheimer’s disease (AD). Background: Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD. Methods: Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records. Results: We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries. Discussion: Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions.     

Coca chewing in prehistoric coastal Peru: dental evidence

In this study, we describe the dental health of four prehistoric human populations from the southern coast of Peru, an area in which independent archaeological evidence suggests that the practice of coca-leaf chewing was relatively common. A repeated pattern of cervical-root caries accompanying root exposure was found on the buccal surfaces of the posterior dentition, coinciding with the typical placement of coca quids during mastication. To further examine the association between caries patterning and coca chewing, caries site characteristics of molar teeth were utilized as indicators for estimating the likelihood of coca chewing for adults within each of the study samples. Likelihood estimates were then compared with results of a test for coca use derived from hair samples from the same individuals. The hair and dental studies exhibited an 85.7% agreement. Thus, we have demonstrated the validity of a hard-tissue technique for identifying the presence of habitual coca-leaf chewing in ancient human remains, which is useful in archaeological contexts where hair is not preserved. These data can be used to explore the distribution of coca chewing in prehistoric times. Simultaneously, we document the dental health associated with this traditional Andean cultural practice.     

Caries experience in existing and new nursing home residents in Adelaide,Australia

Objectives: The Adelaide Dental Study of Nursing Homes was instigated to provide comprehensive information concerning oral disease experience, incidence and increments in a random sample of those older South Australians residing in Adelaide nursing homes. Methods: This paper presents caries experience results for existing and new nursing home residents, and caries incidence and increments for existing residents, from dental inspections conducted at the baseline and one‐year data collections. Results: The residents in this study were very functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults, the great majority of whom had moderate to severe cognitive impairment. Residents gave their carers many complex and challenging behavioural problems during oral hygiene care provision. Existing and new residents had similar dental history, oral hygiene, and socio‐detnographic characteristics, and similar cognitive, medical, functional, and nutritional status. Oral disease experience was high in both existing and new residents. There were no significant differences between existing and new residents for their dentate status, tooth status, coronal caries experience, or root caries experience, with the exceptions that new residents had significantly greater mean number of teeth, more filled coronal and root surfaces, and also new residents had significantly fewer decayed retained roots. Large numbers of tooth surfaces were covered in plaque and debris that negated more precise assessment of caries. The existing residents had caries increments on both coronal (2.5 surfaces) and root surfaces (1.0 surfaces) over the one‐year period. Coronal caries incidence was 64% and root caries incidence was 49% of existing residents. Conclusions: Oral disease experience was high in both existing and new residents. There were few significant differences between existing and new residents’ oral health status. New residents were being admitted to nursing homes with a compromised oral health status. Coronal and root caries increments and incidence were high for existing residents over the one‐year period.     

Extensive Description and Comparison of Human Supra-Gingival Microbiome in Root Caries and Health

Knowledge of the polymicrobial etiology of root caries is limited. To conduct a comprehensive research study on root caries, we utilized 454-pyrosequencing of 16S rRNA gene libraries and quantitative PCR to compare supra-gingival bacterial communities from healthy sites and carious sites of 21 patients with root caries (Patient-controls and Patient-cases) and the sites of 21 healthy individuals (Healthy-controls) from two nursing homes. Healthy-controls and Patient-cases showed no significant differences in terms of biomass, species richness, and species diversity. However, as for beta diversity based on either community membership metric (unweighted UniFrac) or community structure metric (weighted UniFrac), Healthy-controls and Patient-cases were clearly distinguished from each other, appearing more variable in the community membership and structure in root caries microbiome but relatively conserved in the health microbiome. The Patient-controls group was at an intermediate stage between Healthy-controls and Patient-cases, but was more inclined to the former. Demonstrated in both relative abundance and prevalence of species in health and root caries, Propionibacterium acidifaciens, Streptococcus mutans, Olsenella profusa, Prevotella multisaccharivorax, and Lactobacillus crispatus were found to be most associated with root caries, whereas Delftia acidovorans, Bacteroidetes[G-2] sp., Lachnospiraceae[G-3] sp., and Prevotella intermedia are most associated with health. Our study provides a basis for further elucidating the microbial etiology of root caries in the elderly.     

In vitro and in vivo inhibition of Streptococcus mutans biofilm by Trachyspermum ammi seeds: an approach of alternative medicine

The aim of this study was to evaluate the influence of the crude and active solvent fraction of Trachyspermum ammi on S. mutans cariogenicity, effect on expression of genes involved in biofilm formation and caries development in rats. GC-MS was carried out to identify the major components present in the crude and the active fraction of T. ammi. The crude extract and the solvent fraction exhibiting least MIC were selected for further experiments. Scanning electron microscopy was carried out to observe the effect of the extracts on S. mutans biofilm. Comparative gene expression analysis was carried out for nine selected genes. 2-Isopropyl-5-methyl-phenol was found as major compound in crude and the active fraction. Binding site of this compound within the proteins involved in biofilm formation, was mapped with the help of docking studies. Real-time RT-PCR analyses revealed significant suppression of the genes involved in biofilm formation. All the test groups showed reduction in caries (smooth surface as well as sulcal surface caries) in rats. Moreover, it also provides new insight to understand the mechanism influencing biofilm formation in S. mutans. Furthermore, the data suggest the putative cariostatic properties of T. Ammi and hence can be used as an alternative medicine to prevent caries infection.     

The Clinical Profiles of Individuals With and Without Root Surface Caries1

As part of a collaborative multidisciplinary investigation of root surface caries (RSC), 273 subjects (median age = 57) were clinically evaluated for coronal caries, debris, calculus, gingivitis, periodontal pocketing, recession, abrasion, as well as RSC. The entire study group was divided into three subgroups: (1) subjects whose exposed root surface were without lesions or restorations (non-diseased individuals, n= 43); (2) subjects whose exposed root surfaces had one or more lesions and may or may not have had restorations (diseased individuals, n= 110); (3) subjects with one or more restorations but no lesions, since it was not known whether these restorations were preceded by RSC or abrasion the disease status of these individuals was unclear (n= 120). A comparison of Subgroup 1 (unequivocally non-diseased) and Subgroup 2 (unequivocally diseased) revealed that subjects without RSC had more teeth, less coronal caries, less recession, less debris, less calculus, less gingivitis, and more abrasion. We infer that the common factor underlying most if not all of the subgroup differences is oral hygiene which must therefore be a major disease determinant.