Cementum Caries

Root caries starts as subsurface mineral loss like enamel caries, but the surface becomes soft at an earlier stage. These lesions can look extensive while remaining only 0.5 to 1 mm deep.

Frequent sugar intake can shift the biofilm toward acid-producing bacteria and cause mineral loss. Root surfaces exposed by periodontal support loss are more susceptible to plaque accumulation, which can be difficult to remove.

Root caries progresses slowly enough to allow plaque-control measures aimed at arresting it. Both cavitated and non-cavitated root lesions can be reached with cleaning implements.

Older adults can have exposed root surfaces after periodontal support loss. Dry mouth, radiation therapy, frailty, cognitive impairment and limited manual dexterity are risk indicators or barriers to plaque removal.

Visual-tactile examination, radiographs and fibreoptic illumination can be used to identify caries. ICDAS records lesions in six categories, and higher scores correspond with more advanced disease.

Management begins by assessing activity, caries risk and the ability to keep the lesion clean. Remineralisation, biofilm removal and sealing are non-invasive approaches that can preserve tooth tissue.

The needed care depends on lesion activity, whether the root surface can be cleaned, and whether tooth structure has been lost. Conservative care aims to preserve the tooth for as long as possible.

Progressing caries can lead to loss of tooth structure and a need to fill and rebuild the tooth. Reported complications include apical periodontitis, periapical abscess, cellulitis and osteomyelitis.

Daily brushing and flossing remove the plaque microorganisms needed for caries to progress. Fluoride inhibits mineral loss and supports remineralisation, while plaque control can arrest a root lesion.