Caries can affect any surface of the teeth. The most commonly seen caries are found on the crown of a tooth, above the cemento-enamel junction, it is also possible for caries to form on the root surface, below the cemento-enamel junction. Dental root caries has received a great deal of attention in the past few decades. A variety of different patients are at risk for root surface caries. Dentists use several methods of treatment.
Root surface caries are also called cemental caries, cervical caries, or radicular caries. (Wilkins) Root surface caries only involves the roots of teeth. The cementum and dentin located just below the crown of the tooth is involved. No involvement of enamel is seen with root surface caries. Bone loss and corresponding gingival recession are the first symptoms to be seen in the caries process. These result in exposed root surfaces, which are more prone to forming caries because caries does not form in the root surface while periodontal fibers are still attached. Clinically, the lesion starts on the root surface. It has been found that root caries spreads in a lateral or circumferential manner, and over time can extend completely around the tooth, undermining the enamel. (Wilkins)
In general, root caries have the same etiology as coronal cavities. S. mutans, Lactobacilli, and sometimes, Actinomyces are involved and are found in high numbers in root caries, but there are two main differences between enamel and root surface caries. (Flaitz) These differences cause the lesion on a root surface to be more destructive than that in enamel. First, because the pH at which demineralization will occur is higher for root cementum (approx. pH 6.0) than for enamel (approx. pH 5.0).(Wilkins) Therefore, root cementum has potential for demineralization at an earlier point in time than enamel does. Secondly, once the cementum is demineralized, the dentin contains dentinal tubules which, if present, are potential methods of entry for the pathogenic microbes as mentioned previously, such as S. mutans, Lactobacilli, and sometimes Actinomyces; whereas, enamel consists of tightly-arranged crystal prisms, which have a much lower chance for bacterial entry. The process of caries formation begins with colonization by acid-producing bacteria plaque. In the next step, Gram-positive bacteria invade the dentinal tubules, which leads to the ...
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...at more tentatively, with fluoride gels and varnishes or a chlorhexidine varnish. Some dentists may restore root caries with amalgam restorations. Another treatment option used by some dentists to restore root caries is Glass Ionomer Cements. Glass ionomer cements were first introduced in the early 1970s. They have good adherence to mineralized tooth tissue, which keeps the removal of tooth structure to a minimum. Glass ionomer cements also have the ability to leak and absorb fluoride into the tooth, which decreases the rate of secondary caries. These factors have increased the potential for glass ionomer cements to replace amalgam as a restorative material. (Hammel)
Although the most common caries seen are coronal, root surface caries present just as much of a problem. Once root caries are detected, the bacteria have already begun to demineralize the cementum or dentin and create a great deal of damage. There are several different ways that root caries may appear clinically. A variety of different patients are at risk for root surface caries. Different measures can be taken to prevent root surface caries. Methods of treatment differ among dentists, but there are several choices.
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