Exposed tooth root surfaces and root caries

The root surface of the tooth is significantly less resistant to the development of caries than the crown surface of the tooth, which is covered by the hardest tissue of the human body, enamel, and the root surface of the tooth is harder to reach and clean. The cement surface of the tooth roots begins to soluble in an environment with a pH of 6.7 compared to enamel, which only begins to soluble around pH 5, so there is a much greater risk of root hearts developing on exposed roots.

Risks to the development of root caries:

1. Dental root surfaces exposed due to gum recession (gum retreat) and periodontal diseases;
2. Dental application;
3. Excessive use of sugar and other simple carbohydrates, frequency is far more important than quantity.
4. Changes in saliva composition, which reduce saliva’s ability to maintain a constant pH of the environment, decrease the amount of saliva immunoglobulin A, reduce the concentration of calcium and phosphate ions in saliva.
5. Total or partial failure or unwillingness of the patient to ensure good oral hygiene (movement disorders, paresis, paralysis, mental illness);
6. The loss of adjacent teeth, jawbone retreat and removable prostheses and their clamps contribute to gum retreat and build-up of plaster;
7. Reduction in saliva and xerostomy (dry mouth). Drug use, radiation and chemotherapy in the jaw area of the face, these factors reduce the release of saliva into the mouth. Dehydration, insufficient water intake or urinary drinks (coffee, tea, caffeinated beverages). In patients with reduced saliva, the tooth application contains a higher number of acid-releasing bacteria.
8. The most common groups of medicines that reduce saliva release are blood pressure lowering agents, cholesterol lowering agents, uretics, painkillers, muscle relaxants, antihistamine preparations, asthma preparations, etc.
9. Diseases: rheumatoid arthritis, Segrena syndrome, diabetes mellitus, stroke, cardiovascular disease, hepatitis C, obesity, epilepsy, asthma, mental illness. These diseases affect saliva composition, saliva volume, hand dexterity, chewing perfection, immunity. Reduced saliva and xerostomy often accompany type 2 diabetes, resulting in an increase in the amount of pathogenic (oral disease-causing) microflora in saliva (oral streptococcus, Lactobacillus and Candida).

Four guidelines for root caries prevention:

1. increase saliva and improve its characteristics.
2. reduce the amount of micro-organisms causing tooth caries and gum disease.
3. reduce the use of sugars.
4. remineralisation of the superficial caries of the original teething necks and halting their subsequent progression.

Advice for patients with exposed root surfaces and root caries.

1. Drug review, dose and frequency adjustment related to saliva reduction potential. Consultation with the treating physician on options to replace or reduce drought-worsening medicines. Transfer, if possible, the duration of medication from evening to morning.
2. Stimulate saliva flow and use artificial saliva substitutes: Xerostom, Kin Hidrat, Gum Hydral preparations in the form of toothpastes, sprays, rinses and gel etc.
3. Sealing of existing root caries (if possible) using suitable sealing materials.
4. Treatment of periodontal diseases to reduce the rate of root neck exposure and damage progression. Regular removal of tooth plaster and denture by a specialist (hygienist or periodontologist) 1 every 3 months.
5. Dietary control, analysis of the amount and frequency of use of refined carbohydrates, restriction of use. Recommendation to use sugar-free sweets or tablets to stimulate saliva flow.
6. Professional application of 5% Sodium fluoride (22500 ppm F) protective varnish to exposed root surfaces, repeat this procedure in 1 x 3 months. This varnish promotes the remineralisation of tooth tissue and reduces the amount of pathogenic bacteria on the surface of the tooth.
7. Mouthwash with 0.12% chlorohexidine gluconate solution 30 seconds 2 times a day for 2 weeks to reduce the formation of tooth plaque (by prescription only). The side effects of this product are the repainting of teeth surfaces and seals (the hygienist can clean) and changes in the sense of taste. Daily use of sodium lauryl sulfate (SLS) free toothpastes with fluorides (3 times daily) as this substance interacts negatively with chlorhexidine.
8. Administration of xylitol/xylitol-containing chewing gum 3 times daily for 5 min after each meal. Xylitol is also available in toothpastes, lollies or pills, rinses, sprays, gels and dental floss.
9. Before you go to bed after brushing your teeth on the surfaces of your teeth roots, applying an amorphous calcium phosphate-containing paste (MI paste, GC) with your finger will encourage remineralisation.
10. It is difficult for people with physical mobility limitations, reduced hand dexterity and visual impairment to clean their teeth well enough, and especially interdental and root surfaces, and therefore electrical toothbrushes and special water irrigators are recommended, which, even if not completely removed, nevertheless improve the microbial composition of the circumstance, reduce the cardiac potential.
11. It is mandatory for people with exposed root surfaces and root caries to follow controls every 3 months during which dental condition assessment, dental hygiene and the application of fluoride-containing protective varnishes should be carried out.

Above all!!!

Teeth should be cleaned properly and with a soft toothbrush. Daily use of high fluoride toothpaste (5000 ppm), such as the Colgate Duraphat 5000 ppm Fluoride Toothpaste purchased at our clinic.