Prevention of root caries

Abstract

Root surface caries is often thought of as a modern disease, however examinations of the dental remains in prehistoric, Bronze Age (1800-700BC) populations have shown that root caries accounted for 68% of all carious teeth recorded 1 even in these ancient times.With this in mind it might be prudent to consider some current background knowledge of root surface caries disease before assessing the intricacies of this randomised controlled clinical trial (RCT).A recent systematic review estimated that root caries incidence was 23.3% (95% confidence interval, 17.1-30.2%) and suggested that older adults may experience similar or higher levels of new caries than do school children, who are the primary recipients of cariesprevention programmes. 2 It is possible that the magnitude of the root caries problem will grow in the coming years as the aging population swells and the retention of teeth increases. 3 When diagnosing root surface caries it is important to distinguish between active and inactive lesions. Fejerskov and colleagues described nine different diagnostic categories ranging from inactive to active lesions and including expectation of pulpal involvement and whether a root surface filling was already present. They also reported that the buccal surfaces of lower molars and premolars and upper canines were the most severely affected with root surface caries. 4 Modern diagnosis of root surface caries is based on tactile and visual criteria (colour and appearance) 5 and may be supported in the future with other methods such as electrical caries measurements 6 or laser fluorescence. 7 Already over 20 years ago it was shown that the activity of root caries lesions can be reduced using meticulous tooth brushing with a fluoride toothpaste. 8 SUMMARY TRIAL/CARIES Design Randomised controlled trialIntervention Elders having at least five teeth with exposed roots, no serious medical problems and basic self-care ability (including oral hygiene practices) were randomly allocated into one of four prevention groups. Individualised oral hygiene instruction was provided to each participant, focusing on effective brushing with a manual toothbrush, and use of fluoride toothpaste was recommended. Before applications of the study agents, a piece of gauze was used to clean and dry the teeth. In this RCT patients were recruited from an outreach dental program where dental care was provided to several thousand patients. 12This study population of 306 participants was derived from elders living in 21 residential and nursing homes for the aged in HongKong. The same research group described another randomised controlled trial comparing two restorative interventions to treat root surface caries in 103 elders from the same overall population. 13 The relationship of the two separate study groups to each other and to the overall population was not reported. Indeed it is not clear if any of the tooth root surfaces were filled prior to inclusion.The selection of elders with at least five teeth with exposed roots was reported but the extent ...