Active Root Caries Research Articles

The diagnosis of active root caries is difficult.

The diagnosis of active root caries is difficult.

Effects of Domiciliary Professional Oral Care for Care-Dependent Elderly in Nursing Homes - Oral Hygiene, Gingival Bleeding, Root Caries and Nursing Staff's Oral Health Knowledge and Attitudes.

PurposeThe primary aim was to describe the effects for nursing home residents of monthly professional cleaning and individual oral hygiene instruction provided by registered dental hygienists (RDHs), in comparison with daily oral care as usual. The secondary aim was to study the knowledge and attitudes among nursing staff regarding oral health care and needs.Patients and MethodsIn this randomised controlled trial (RCT), 146 residents were recruited from nine nursing homes in Regions of Stockholm and Sörmland and were randomly assigned (on nursing home level) to either intervention group (I; n=72) or control group (C; n=74). Group I received monthly professional cleaning, individual oral hygiene instructions and information given by an RDH. Group C proceeded with daily oral care as usual (self-performed or nursing staff-assisted). Oral health-related data was registered with the mucosal-plaque score index (MPS), the modified sulcus bleeding index (MSB), and root caries. The nursing staff’s attitudes and knowledge were analysed at baseline and at six-month follow-up. Statistical analysis was performed by Fisher’s exact test and two-way variance analysis (ANOVA).ResultsImprovements were seen in both Group I and Group C concerning MPS, MSB and active root caries. The nursing staff working with participants in Group I showed significant improvements regarding the Nursing Dental Coping Beliefs Scale (DCBS) in two of four dimensions, oral health care beliefs (p=0.0331) and external locus of control (p=0.0017) compared with those working with Group C. The knowledge-based questionnaire showed improvement (p=0.05) in Group I compared with Group C.ConclusionMonthly professional oral care, combined with individual oral health care instructions, seems to improve oral hygiene and may reduce root caries among nursing home residents. This may also contribute to a more positive attitude regarding oral hygiene measures among nursing home staff, as compared with daily oral care as usual.

Characterizing Microbiota from Sjögren's Syndrome Patients.

To compare the oral microbiota of Sjögren's syndrome (SS) with that of healthy subjects (HS). Supragingival and subgingival biofilm samples were collected from the mesial-buccal tooth surfaces of SS patients (n = 57) and age- and sex-matched HS (n = 53). Unstimulated saliva and 8 oral tissue samples were taken using a buccal brush. Caries and periodontal measures were recorded. All supragingival samples and a subgroup of 24 SS and 28 HS subgingival samples, as well as 32 SS and 11 HS saliva and oral tissue samples, were analyzed for their content of 41 bacterial species using checkerboard DNA-DNA hybridization. Mean levels (×105 ± SEM) and percentage of DNA probe counts of each species were determined for each sample site and averaged within subjects in the 2 clinical groups. Kruskal-Wallis tests, adjusting for multiple comparisons and cluster analysis, were used for soft tissue and microbial analysis, and the Mann-Whitney test was used to compare caries and periodontal measures. Mean (×105 ± SEM) total DNA probe counts in supragingival samples were significantly lower (P < 0.001) in the SS (13.3 ± .7) compared to the HS (44.1 ± 6.8) group. In supragingival samples, Veillonella parvula, Fusobacterium nucleatum ss vincenti, and Propionibacterium acnes were markedly elevated in the SS compared to the HS group in both mean (×105 ± SEM) and mean (± SEM) percentage DNA probe counts (P < 0.001). In subgingival samples of SS, V. parvula was significantly different compared to HS (P < 0.05). SS was characterized by high levels of purple and low levels of orange and red complexes. Cluster analysis of oral tissues and saliva demonstrated that the mean microbial profiles for SS patients and the HS group clustered separately. Active root caries (P < 0.003) and attachment loss were significantly higher (P < 0.029) in the SS group compared to the HS group. These findings indicate that saliva is a major controlling factor of intraoral biofilm. V. parvula may be a unique microbial biomarker for Sjögren's syndrome. The microbiome characterized for Sjögren's syndrome in salivary hypofunction is shown to be under stress and reduced. Veillonella parvula can be a possible identification of a biomarker for Sjögren's syndrome.

Assessment of Root Caries Lesion Activity and Its Histopathological Features.

Despite certain similarities in the etiology of root caries (RC) and coronal caries, there are notable differences in their histology, namely with regard to the demineralization process, which should be taken into consideration when assessing lesion activity. In this chapter, we present the histological changes to the dentin and pulp, occurring physiologically or in response to caries lesions. We focus on the histological features specific to RC lesions, discussing the assessment of lesion activity. The physiological changes occurring to the dentin and pulp are the formation of secondary dentin and the sclerosis of dentin tubules, while tertiary dentin is formed during pathologic stimuli from caries lesions. Already in the early stages of active RC, the lesions seem softer, and bacteria are easily found within the dentin tubules. Inactive lesions, on the contrary, are characterized by fully remineralized tissue, with irregular mineral precipitation and containing ghost cells of microorganisms. Lesion activity is determined by observing their tactile sensation and their position with respect to the gingival margin.

Flujo salival y caries radicular en adultos mayores autovalentes

IntroductionAlthough the role of saliva in the protection against root caries has been widely controversial, few studies have examined the association with salivary flow. ObjectiveTo determine if a decreased salivary flow is related to increased prevalence and activity of root caries in the elderly living in the community. Materials and methodsA cross-sectional study was conducted on 332 elderly participants. Subjects were interviewed, completed a sociodemographic questionnaire, were orally examined, and donated a sample from unstimulated and stimulated salivary flow. Clinical examinations were carried out to assess prevalence and activity of root caries using ICDAS criteria. The ‘Root Caries Index’ (RCI) and percentage of Active Root Caries (ARC) were calculated. Data were analysed using the Student t test, ANOVA and Kruskal Wallis, with a significance level of .05. ResultsSalivary flow was significantly lower in women and in subjects with high drug consumption and systemic diseases (P<.05). Although neither RCI nor the percentage of ARC differed in relation to unstimulated salivary flow, they were slightly higher in people with normal stimulated salivary flow (P<.05). ConclusionSalivary flow does not appear to be numerically associated with the prevalence or the activity of root caries in independent older adults.

Actinomyces spp. gene expression in root caries lesions

BackgroundThe studies of the distribution of Actinomyces spp. on carious and non-carious root surfaces have not been able to confirm the association of these bacteria with root caries, although they were extensively implicated as a prime suspect in root caries.ObjectiveThe aim of this study was to observe the gene expression of Actinomyces spp. in the microbiota of root surfaces with and without caries.DesignThe oral biofilms from exposed sound root surface (SRS; n=10) and active root caries (RC; n=30) samples were collected. The total bacterial RNA was extracted, and the mRNA was isolated. Samples with low RNA concentration were pooled, yielding a final sample size of SRS=10 and RC=9. Complementary DNA (cDNA) libraries were prepared and sequenced on an Illumina® HiSeq 2500 system. Sequence reads were mapped to eight Actinomyces genomes. Count data were normalized using DESeq2 to analyse differential gene expression applying the Benjamini-Hochberg correction (false discovery rate [FDR]<0.001).ResultsActinomyces spp. had similar numbers of reads (Mann-Whitney U-test; p>0.05), except for Actinomyces OT178 (p=0.001) and Actinomyces gerencseriae (p=0.004), which had higher read counts in the SRS. Genes that code for stress proteins (clp, dnaK, and groEL), enzymes of glycolysis pathways (including enolase and phosphoenolpyruvate carboxykinase), adhesion (Type-2 fimbrial and collagen-binding protein), and cell growth (EF-Tu) were highly – but not differentially (p>0.001) – expressed in both groups. Genes with the most significant upregulation in RC were those coding for hypothetical proteins and uracil DNA glycosylase (p=2.61E-17). The gene with the most significant upregulation in SRS was a peptide ABC transporter substrate-binding protein (log2FC=−6.00, FDR=2.37E-05).ConclusionThere were similar levels of Actinomyces gene expression in both sound and carious root biofilms. These bacteria can be commensal in root surface sites but may be cariogenic due to survival mechanisms that allow them to exist in acid environments and to metabolize sugars, saving energy.

Root caries, root surface restorations and lifestyle factors in adult Danes

Aim. To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults. Materials and methods. Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21–89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively. Results. The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p < 0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR = 1.7; p < 0.001). Conclusions. Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.

Silver Diamine Fluoride and Education to Prevent and Arrest Root Caries among Community-Dwelling Elders

Background/Aims: Root caries among elderly communities is of growing public health concern globally. This controlled clinical trial investigated the effectiveness of silver diamine fluoride and oral health education in preventing and arresting root caries. Methods: Two hundred sixty-six elderly subjects who had at least 5 teeth with exposed root surfaces and did not have serious life-threatening medical diseases were allocated to 3 groups according to a computer-generated random list: group 1 (the control group) received oral hygiene instructions (OHI) annually; group 2 received OHI and silver diamine fluoride (SDF) application annually, and group 3 was given OHI and SDF application annually, plus an oral health education (OHE) programme every 6 months. Results: Two hundred twenty-seven elderly subjects were followed for 24 months. The mean numbers of new root caries surfaces in groups 1, 2 and 3 were 1.33, 1.00 and 0.70, respectively (ANOVA, p < 0.05). Group 3 had fewer root surfaces with new caries than group 1 (Scheffé multiple-comparison test, p < 0.05). The mean numbers of arrested root caries surfaces in groups 1, 2 and 3 were 0.04, 0.28 and 0.33, respectively (ANOVA, p < 0.01). Group 3 and group 2 had a greater number of active root caries surfaces which became arrested than group 1 (Scheffé multiple-comparison test, p < 0.05). Conclusion: Annual application of SDF together with biannual OHE was effective in preventing new root caries and arresting root caries among community-dwelling elderly subjects.

A comparison of root caries diagnosis based on visual-tactile criteria and DIAGNOdent in vivo

Objectives This clinical study aimed to evaluate the validity of using DIAGNOdent in diagnosing root caries, and to assess the sensitivity and specificity of different cut-off DIAGNOdent values in assessing root caries with reference to visual-tactile criteria. Methods Exposed root surfaces were assessed by one examiner for root caries on 266 subjects using visual-tactile criteria and DIAGNOdent 2095 after dental scaling. Associations between DIAGNOdent values and visual-tactile diagnosis of root caries were determined. The cut-off level for statistical significance was 0.05. The sensitivity and specificity of DIAGNOdent with difference cut-off points were analysed compared to visual-tactile diagnosis of root caries. Results There was significant difference between DIAGNOdent values obtained from sound and carious root surfaces ( p < 0.001). On carious surfaces, active root caries obtained significantly higher DIAGNOdent values than inactive root caries ( p < 0.001). With increasing cut-off point DIAGNOdent values from 5 to 35, sensitivity decreased from 91.4% to 16.2% and specificity increased from 64.4% to 98.2%. A cut-off point of DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity. Conclusions There was a significant difference in DIAGNOdent values between sound and carious root surfaces diagnosed by visual-tactile criteria supporting the validity of DIAGNOdent for assessing root caries. A DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity when visual-tactile assessment of root caries was regarded as the criterion. These findings have implications in using and explaining DIAGNOdent values in assessing root caries.

The Strength of Two Indicators of Social Position on Oral Health Among Persons Over the Age of 80 Years

The objective of the present study is to analyze how two dimensions of social position, education and social class, are associated with oral health among generally healthy, community-dwelling persons over the age of 80 years. The present investigation is based on a sample of 157 community-dwelling individuals from The Kungsholmen Elders Oral Health Study (KEOHS) and included data from interviews and oral examinations. Social position was measured by education and social class. Oral health was measured by active coronal caries, active root caries, edentulism and use of dental services. The primary findings of the adjusted multivariate logistic regression analysis were that, compared to persons who had been in higher positions, persons who had been blue-collar/ white-collar workers had significantly greater odds of having coronal caries and high, but nonsignificant odds of being edentulous. Further, persons with elementary/ medium education tended to forego regular dental services more than persons with high education. The study identified social inequalities in oral health even in a population of independently living, generally healthy very old Swedes and in a country where the public health policies have tried to minimize these inequalities.

Dental Caries, Periodontal Disease, and Cardiac Arrhythmias in Community‐Dwelling Older Persons Aged 80 and Older: Is There a Link?

To examine whether caries or periodontitis is associated with cardiac arrhythmias in community-dwelling people aged 80 and older. Urban, community-based population in Stockholm, Sweden. Cross-sectional. Eligible persons were identified through the Kungsholmen Project, which is an ongoing, longitudinal, population-based study of the oldest old. The present study included 125 dentate individuals. Data from interviews, a medical examination, and an oral examination. The assessment of cardiac arrhythmia was based on a clinical examination by a physician or the Stockholm Inpatient Register. Active root caries, active coronal caries, and periodontitis were assessed using previously defined National Institute of Dental and Craniofacial Research diagnostic criteria. The primary finding of the multivariate logistic regression analysis was that persons with three or more active root caries lesions had more than twice the odds of cardiac arrhythmias than persons without active root caries. The results did not notably change after adjusting for age, medications that reduce saliva, and number of teeth. Persons with one to two active coronal caries lesions had 2.8 times higher odds (95% confidence interval=1.1-7.0) of arrhythmia than persons without active coronal caries, but there was no greater risk for persons with three or more coronal caries lesions. There was no association between periodontal disease and arrhythmia. The findings indicate that there may be a link between active root caries and cardiac arrhythmias in the oldest old. Nevertheless, although a biological pathway is not obvious, it is plausible that both are simply markers of declining general health. The results suggest the need for further study of these relationships.

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study.

The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. In this cross-sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. Examinations were carried out in two local clinics by standardized examiners. One hundred twenty-nine dentate persons were examined. The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14-20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14-20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons.

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.

老年者における根面う蝕の有病状況

The purpose of the present study was to investigate the prevalence of root caries in an elderly Japanese population. A total of 265 elderly people over 60 years of age were examined between 1990 and 1991. Of these subjects, 161 dentate elderly people, who had 12.8 present teeth on the average, were available for assessment. The proportion of sujects with gingival recession in this population was 62.3% in the 60-69-year-old group, 45.9% in the 70-79-year-old group, and 38.2% in the 80+-year-old group, with an average of 49.7%. The percentage of the subjects with one or more cases of active root caries was 13.7%. The prevalence of active root caries ranged from 10.8% at age 70-79 to 17.6% at age 80+. The proportion of persons with active and/or inactive root caries ranged from 18.9% at age 70-79 to 24.5% at age 60-69. The percentage of subjects with active and/or inactive caries and/or root fillings varied from 23.5% at age 80+ to 32.1% at age. 60-69. The prevalence of active root caries in the subjects at risk (with gingival recession) was 27.5% on the average and ranged from 23.5% at age 70-79 to 46.2% at age 80+. The percentage of persons with active and/or inactive root caries and/or root fillings in the subjects at risk ranged from 51.5% at age 60-69 to 61.8% at age 70-79. The mean number of teeth with active root lesions was 0.24 per person and the mean number of teeth with root fillings was 0.37 per person. The percentage of subjects with root abrasion ranged from 10.3% at age 60-69 to 37.0% at age 80+, and the mean number of teeth with root abrasion was 0.72 per person. These results suggest that the prevalence estimate of root caries varies with changes in the diagnostic criteria and definition, and seems to be influenced by filled abrasions and the number of present teeth as complicating factors. In an elderly population, we recommend that factors involving root lesions, such as active and inactive root caries, root fillings, root abrasion, and the number of teeth must be included in an estimate of root caries prevalence.