Root caries: prevention and chemotherapy.

PURPOSE: Root caries is a problem of importance among dentate elderly. Greater life expectancies at both birth and age 65, combined with improvements in tooth retention across all age groups, have resulted in an increasing number of Americans who have retained their teeth into old age. This increase in numbers of teeth combined with the increase in the percent of teeth with recession has in turn resulted in older persons with more root surfaces at risk for caries than ever before. The purpose of this article is to review the literature on the prevention and chemotherapeutic approach to root caries. METHODS: A review of the literature and synthesis of this information resulted in recommendations for the improved root caries risk assessment and the development of clinical examination protocols and strategies for prevention and treatment. RESULTS: Clinicians can better identify persons at risk for root caries in their practice. People who are older, have moderate to severe periodontal bone loss and gingival recession, are impaired, have poor oral hygiene, take multiple medications, have partials, have retained root tips and the recently unemployed or retired are all at increased risk for root caries. Examination strategies should include the use of at least annual bite-wing radiographs (vertical bite-wings in persons with significant attachment loss) and careful examination of the proximal tooth surfaces. Once identified as low, moderate or high risk, daily and professionally applied fluoride therapies should be combined with dietary modifications, and in high risk individuals, antimicrobial agents for both the remineralization of early lesions and prevention of further root caries.