Gingival recession and root caries in the ageing population: a critical evaluation of treatments

Abstract

Aim: To review evidence for the treatments of gingival recession and root caries in older populations. Materials & Methods: A systematic approach was adopted to identify reviews and articles to allow us to evaluate the treatments for gingival recession and root caries. Searches were performed in PubMed, Medline and Embase, the Cochrane trials register and bibliographies of European and World Workshops. Observations: Gingival recession: We identified no articles that focussed specifically on older populations. Conversely, no evidence suggested that Miller class I and II lesions should be managed differently in older patients when compared to younger cohorts. Six systematic reviews included older patients and suggested that connective tissue grafts are the treatment of choice, alone or in combination with enamel matrix derivative. Root caries can be controlled at the population level by daily brushing with fluoride-containing toothpastes, whilst active decay may be inactivated using professional application of fluoride varnishes/solutions or selfapplied high-fluoride toothpaste. Active root caries lesions that cannot be cleaned properly by the patient may be restored by minimally invasive techniques. Conclusions: Gingival recession and root caries will become more prevalent as patients retain their teeth for longer. Whilst surgical (gingival recession) and nonoperative approaches (root caries) currently appear to be favoured, more evidence is needed to identify the most appropriate strategies for older people.

Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations

“…“Improper” toothbrushing method has been proposed as the most important mechanical factor contributing to the development of gingival recessions . A recent systematic review however, concluded that the “data to support or refute the association between toothbrushing and gingival recession are inconclusive” .…”

“…“Improper” toothbrushing method has been proposed as the most important mechanical factor contributing to the development of gingival recessions . A recent systematic review however, concluded that the “data to support or refute the association between toothbrushing and gingival recession are inconclusive” . Among the 18 examined studies, one concluded that the toothbrushes significantly reduced recessions on facial tooth surfaces over 18 months, two concluded that there appeared to be no relationship between toothbrushing frequency and gingival recession, while eight studies reported a positive association between toothbrushing frequency and recession.…”

“…3,25-28 A recent systematic review however, concluded that the "data to support or refute the association between toothbrushing and gingival recession are inconclusive". 28…”

Wurzelkaries – kennen, erkennen, erfolgreich therapieren

“…Wurzelkaries zeichnet sich häufig durch eine intakte, hypermineralisierte Schicht mit darunterliegendem Läsionskörper aus. Aufgrund der geringeren Größe und weniger dichten Anordnung von Apatitkristallen im Vergleich zu Schmelz können Mineralien im Remineralisationsprozess besser ins Hartgewebe des Wurzeldentins diffundieren [23]. Durch konsequente Biofilmentfernung und die Anwendung einer fluoridhaltigen Zahnpasta können aktive, klinisch weich-ledrige Läsionen in inaktive, sondenharte Läsionen überführt werden (▶ Abb.…”

Root caries: A geriatric challenge

“…Regular use of dentifrices containing 5000 ppm fluoride and quarterly professional application of chlorhexidine or silver diamine fluoride varnishes have been found to be effective in decreasing the progression and initiation of root caries. 33 Silver nitrate and silver diamine fluoride are more effective in arresting active caries lesions and preventing new caries than fluoride varnish. It has antimicrobial activity against Streptococcus mutans and Actinomyces naeslundii found on dentin surfaces and slows down dentin demineralization.…”