Caries In Older Adults Research Articles

Low Salivary IgA Levels Against PAc (361-386) as a Risk Factor for Root Caries in Older Adults.

This study aimed to assess the intricate relationship between salivary IgA antibody levels to PAc (361-386) (PPA), mutans streptococci colonization, and root caries development in older adults. This study included 307 participants aged 76 years residing in Niigata city, Japan. Clinical oral examinations were performed at baseline in 2004 and 1 year later, during which the total number of untreated and treated root caries was assessed using the root decayed, filled tooth (DFT) index. The stimulated saliva samples were collected using the spitting method during the baseline survey. Salivary IgA antibody levels to amino acid residues 361-386 of Streptococcus mutans PAc were quantified using an enzyme-linked immunosorbent assay. Statistical analyses, including the χ2 test, Mann-Whitney U test, and logistic regressions, were performed to examine the association of increased root DFT with the independent variables. Among the 307 participants (53.1% men), the mean root DFT at baseline was 3.77 ± 3.66, and 36.5% of the study sample exhibited increased root DFT after 1 year with a mean increment of 0.36 ± 0.48. Participants with increase in root DFT after 1 year had significantly higher rates of low PPA levels (≤ 25th percentile) than those without increased root DFT (p = 0.020). Low PPA levels (≤ 25th percentile) were significantly more likely to have an increased risk of root caries development compared with PPA levels > 25th percentile (adjusted OR: 1.88, 95% CI: 1.09-3.25). Low PPA levels and root caries incidence correlated significantly, suggesting that low levels of salivary IgA antibody to PAc (361-386) may serve as a risk factor for increased root caries in older adults.

The Association of Vitamin D Levels and Dental Caries in Older Adults: A Cross-Sectional Study.

Most research examining vitamin D and dental caries focuses on children and younger adults. This study investigated the association between vitamin D levels and dental caries in older adults using data from the United States National Health and Nutrition Examination Survey from 2011 to 2016. Data were analyzed from 2723 participants aged 65 years and older who completed both dental examinations and serum 25(OH)D tests. Dental caries assessments included the decayed, missing, and filled teeth (DMFT) index and the presence of untreated dental caries. Vitamin D levels were measured as serum 25(OH)D concentrations and categorized as severely deficient (<25 nmol/L), deficient (25-49.9 nmol/L), insufficient (50-74.9 nmol/L), and normal (≥75 nmol/L). Logistic regression and Poisson regression models were used to assess the association between vitamin D levels and dental caries, adjusting for demographic factors. The mean DMFT score was 17.73 ± 8.34, with 35.1% of participants having untreated dental caries. Vitamin D deficiency was associated with a 1.44 times higher likelihood of untreated caries (95% CI: 1.15, 1.81), which weakened after adjustment for demographic factors (adjusted OR: 1.23, 95% CI: 0.97, 1.55). Severe vitamin D deficiency correlated with a 1.13 times higher DMFT score (95% CI: 1.06, 1.20), with the association remaining similar after adjustment (adjusted RR: 1.12, 95% CI: 1.05, 1.20). Significant differences in vitamin D levels were observed across gender, race/ethnicity, and country of birth. This study suggests the potential importance of adequate vitamin D levels for maintaining dental health among older adults. Vitamin D deficiency is associated with a higher risk of poorer DMFT scores. Public health strategies that include vitamin D screening and supplementation, particularly for high-risk groups, may improve oral health outcomes in the older adult population. Further research is needed to elucidate the mechanisms by which vitamin D influences dental health and the potential for vitamin D supplementation to reduce the burden of dental caries in older adults.

Root caries in older adults: A co-citation network analysis (1980-2023).

Root caries affect the oral health and quality of life of older adults. This study examines the breadth of global research on this topic, aiming to clarify its expansive scope and to shed light on pertinent trends for new researchers in the field. To identify key advances in root caries research as highlighted in high-quality articles from the Social Science Citation Index (SSCI) as well as to explore emerging trends and perspectives. Using the Web of Science (WoS) database, we conducted a comprehensive review of articles related to root caries in older adults. Our focus was on finding high-quality SSCI articles, identifying major contributors, journals and research trends and exploring areas such as dentistry, oral surgery and medicine for potential future research. Our analysis included 192 articles, each of which was subjected to bibliometric and VOS viewer evaluations. The results revealed a concentration of studies in dentistry, oral surgery and medicine, with gaps identified in areas like anthropology, biochemistry, molecular biology and chemistry. A notable deficiency was found in root caries management. We discuss research gaps and propose future directions based on our findings, emphasising interdisciplinary research approaches.

The Risk Factors and Interventions of Dental Caries in the Elderly: A Narrative Review

As the human lifespan increases, older adults are known to retain their teeth for longer. Dental clinicians will see an increase in the number of elderly patients as the population’s life expectancy rises. The loss of periodontal attachment is a common risk factor for root surface caries development in older adults. Other risk factors include an increase in the number of missing teeth and restorations, prosthesis wearing, reduced manual dexterity, a shift in diet from complex to simple sugars, salivary gland dysfunction and increased salivary glucose levels. Dental caries is one of the causes leading to tooth loss in older adults and tooth loss significantly impacts the oral health-related quality of life for this vulnerable age group. Furthermore, the treatment of root caries is complicated by the adhesion of restorative materials to dentin and cemental layer. To curb these issues, understanding the risk factors for dental caries in the elderly, as well as its prevention and treatment strategies, is therefore crucial. This narrative review aims to provide an understanding of dental caries in older adults and an evidence-based prevention and management of this dental disease.

Caries and the older patient

Population ageing is global and pervasive and in Ireland, we can expect to see the proportion of the population aged over 65 grow to nearly 30% in the next thirty years. Along with this we have seen a reduction in tooth loss. Therefore we will be managing increasing numbers of partially and fully dentate older adults in dental practice. Older adults in Ireland have high levels of past caries experience and, in particular, root caries is almost exclusively a disease seen in this cohort. Preventing and managing caries in older adults with heavily restored dentitions will bring both treatment planning and operative challenges to the dental profession.

EBD spotlight: The evidence for professionally applied fluoride varnish to prevent and arrest caries in older adults

EBD spotlight: The evidence for professionally applied fluoride varnish to prevent and arrest caries in older adults

Is professionally applied fluoride effective in preventing or arresting caries in older adults?

Design Systematic review of clinical trials.Case selection Clinical trials with adults 60 years of age or older who professionally received fluoride therapy for caries prevention or arrest. Controls were adults of the same age group who received another professionally applied fluoride agent, placebo, or nothing.Data analysis The expected outcomes were the mean difference in the number of new caries, caries prevented fraction and caries arrest rate. Independently, two researchers assessed the risk of bias in the included studies.Results Seven studies met the selection criteria where 5% sodium fluoride varnish, 38% sodium diamine fluoride solution and 1.23% acidulated phosphate fluoride gel were used with root caries and coronal caries. Given the nature of the studies, the three agents were effective in preventing root caries in older adults. None of the agents were particularly superior to the others.Conclusions Professionally applied fluoride is effective in preventing dental caries in older adults.

Efficacy of non-invasive and minimally invasive techniques for the prevention/management of root caries in older adults - A literature review

Efficacy of non-invasive and minimally invasive techniques for the prevention/management of root caries in older adults - A literature review

Is there a preferable management for root caries in middle-aged and older adults? A systematic review.

Aim This systematic review aimed to critically summarise the results of clinical studies investigating agents able to: stop the progression of carious lesions; stop the development of new root carious lesions; preserve the vitality of the infected dental tissues; and increase the surface hardness or change of surface texture, in middle-age and older adults.Methods PubMed, Scopus, and Web of Science were searched systematically, following PRISMA guidelines. Clinical trials published from 2011 to 2020 (March) were included. This systematic review is registered in the PROSPERO database (CRD42018104399). Languages were restricted to English.Results Thirteen of 312 studies were eligible for this review. Eight agents were identified in the studies and their efficacy was assessed using different methods. The agents that presented valuable results on preventing or arresting root caries were 38% silver diamine fluoride (SDF), arginine-containing toothpaste and high-fluoride toothpastes.Conclusions Based on the selected studies' findings, annual applications of 38% SDF could be the most effective treatment for root caries in older adults. In addition, the daily use of a 1.5% arginine toothpaste or a high-fluoride toothpaste could also be recommended. More research on root caries-specific diagnostic methods, especially at very early stages, is necessary.

Contemporary Challenges and Management of Dental Caries in the Older Population

The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.

Assessment of Risk and Protective Factors for Root Caries in Older Adults

Assessment of Risk and Protective Factors for Root Caries in Older Adults

Flossing Is Associated with Improved Oral Health in Older Adults

The effect of preventive oral habits is largely unexplored in older individuals. The purpose of this study was to evaluate the associations between home use of flossing and prevalence of periodontal disease and caries in older adults. Five-year incident tooth loss was also evaluated. Data on 686 individuals ≥65 y-old from the Piedmont 65+ Dental Study were examined including: 1) interproximal clinical attachment level (iCAL), 2) interproximal probing depth (iPD), 3) numbers of caries, and 4) missing teeth. Flossing behavior was evaluated according to the Periodontal Profile Class (PPC) system. Five-year follow-up data (n = 375) was evaluated for incident tooth loss. Dichotomous and categorical variables were analyzed using Pearson chi-square tests as well as covariate-adjusted Cochran-Mantel-Haenszel tests. Multiple linear regression compared clinical parameters based on flossing behavior. Elderly flossers had lower (mean, SE) %iCAL≥3 mm (38.2, 2.38 vs. 48.8, 1.56) and %iPD≥4 mm (8.70, 1.41 vs. 14.4, 0.93) compared to nonflossers (P ≤ 0.005). Flossers showed less coronal caries compared to nonflossers (P = 0.02). Baseline number of missing teeth (mean, SE) was 11.5 (0.35) in nonflossers compared to 8.6 (0.53) in flossers (P < 0.0001). Regular dental visitors had lower oral disease levels compared to episodic dental users. The majority of flossers classified into PPC-Stage I (health) whereas nonflossers classified as PPC-Stages V, VI, and VII (disease). At the 5-y follow-up visit, the average tooth loss for flossers was ~1 tooth compared to ~4 teeth lost for nonflossers (P < 0.0001). Among all teeth, molars showed the highest benefit (>40%) for flossing behavior (P = 0.0005). In conclusion, the extent of oral disease for older individuals was significantly less in flossers than in nonflossers. Flossers showed less periodontal disease, fewer dental caries, and loss of fewer teeth over a 5-y period. These findings further support flossing as an important oral hygiene behavior to prevent oral disease progression in older adults.

Minimum intervention dentistry for the management of caries in older adults: a review of the literature

##Statement of the problem The population is ageing and the proportion of older adults retaining their natural teeth is increasing. This means that there are increasing numbers of older adults at risk of and from dental caries for longer. This challenges traditional concepts of care delivery for older adults. With advances in the understanding of the pathogenesis of dental caries, there is increasing evidence to support a shift from traditional mechanical ‘drill and fill’ techniques to the management of dental caries biologically as a complex ecological process. Minimum intervention dentistry (MID) has become an increasingly mainstream model of caries management, which minimises the need for treatment that destroys dental tissues. In contrast to traditional management of caries, MID focuses on prevention and risk reduction, while surgical intervention is limited to cases where it is absolutely necessary. This paper reviews the evidence to support adoption of MID, particularly for older adults in Ireland. ##Purpose of the study To review the evidence regarding aspects of MID for caries management among older adults. ##Materials and methods A structured search strategy was undertaken using PubMed, Google Scholar and the Cochrane Library, with additional searching of reference lists. A total of 25 articles were deemed relevant to this literature review. The data was extracted and tabulated. The outcomes and quality of the studies were reported narratively. Weaknesses and clinical implications are discussed. ##Conclusions MID can be recommended for older adults. This review supports the use of topical fluorides in varnish, rinses and high-fluoride toothpaste to prevent dental caries in older adults, and the restoration of caries adopting the atraumatic restorative technique (ART). There was insufficient evidence regarding the effectiveness of oral health education. No studies were identified looking at the effectiveness of caries removal techniques, the resin infiltration technique, or the repair rather than replacement of restorations for older patients.

Risk indicators for root caries in older adults using long‐term social care facilities in Hong Kong

To investigate risk indicators associated with root caries among the Hong Kong older adults who attended long-term care facilities regularly. Nonfrail older adults with at least six natural teeth from 10 long-term social or residential care facilities were examined. The clinical examinations were conducted by two calibrated dentists in the institutions. Portal dental chairs, intra-oral LED lights, disposable mouth mirrors, periodontal probes and CPI probes were used in the examinations. Negative binomial regression analyses were performed to identify the risk indicators associated with root caries. Multilevel logistic regression analyses were conducted to detect the associations between DF-root and D-root, and selected person-level and tooth surface-level factors. A total of 353 older adults (mean age 74.9years) were examined. The prevalence of DF-root and D-root was 43.1% and 30.0%, respectively. The mean DF-root and D-root scores were 1.3 and 0.7, respectively. Relative to participants without DF-root, those with root caries experience were older and had more exposed root surfaces, and a higher proportion were partial denture wearers. There was a positive correlation between the DF-root score and the age of the participant, and with the numbers of exposed root surfaces, missing teeth and teeth with coronal caries. Higher prevalence of DF-root was observed among the older participants, and caries experience of root surfaces with greater gingival recession and visible plaque was higher. Lingual root surfaces and roots in the mandibular anterior region had the lowest rates of DF-root. People who are older have a higher prevalence and severity of root caries. Coronal caries experience, maxillary teeth, buccal root surfaces, gingival recession and plaque on the root surface are positively associated with root caries in older adults.

Silver diamine fluoride for managing carious lesions: an umbrella review

BackgroundThis umbrella review comprehensively appraised evidence for silver diamine fluoride (SDF) to arrest and prevent root and coronal caries by summarizing systematic reviews. Adverse events were explored.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, PubMed, Embase, Cochrane Library, PROSPERO register and Joanna Briggs Institute Database of Systematic Reviews were searched for systematic reviews investigating SDF for caries prevention or arrest (1970–2018) without language restrictions. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers, in duplicate. Corrected covered area was calculated to quantify studies’ overlap across reviews.ResultsEleven systematic reviews were included; four focussing on SDF for root caries in adults and seven on coronal caries in children. These cited 30 studies (4 root caries; 26 coronal caries) appearing 63 times. Five systematic reviews were of “low”, one “unclear” and five “high” risk of bias. Overlap of studies was very high (50% root caries; 17% coronal caries). High overlap and heterogeneity, mainly comparators and outcome measures, precluded meta-analysis. Results were grouped by aim and outcomes to present an overview of direction and magnitude of effect. SDF had a positive effect on prevention and arrest of coronal and root caries, consistently outperforming comparators (fluoride varnish, Atraumatic Restorative Treatment, placebo). For root caries prevention, the prevented fraction (PF) was 25–71% higher for SDF compared to placebo (two systematic reviews with three studies) and PF = 100–725% for root caries arrest (one systematic review with two studies). For coronal caries prevention, PF = 70–78% (two systematic reviews with two studies) and PF = 55–96% for coronal caries arrest (one systematic review with two studies) with arrest rates of 65–91% (four systematic reviews with six studies). Eight systematic reviews reported adverse events, seven of which reported arrested lesions black staining.ConclusionSystematic reviews consistently supported SDF’s effectiveness for arresting coronal caries in the primary dentition and arresting and preventing root caries in older adults for all comparators. There is insufficient evidence to draw conclusions on SDF for prevention in primary teeth and prevention and arrest in permanent teeth in children. No serious adverse events were reported.

Silver Diamine Fluoride May Prevent and Arrest Root Caries in Older Adults

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. J Am Dent Assoc 2018;149(8):671-9.e1. Government funding, partially supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, and partially funded through a Patient-Centered Outcomes Research Institute (PCORI) award. The Teacher Training Program of the University of the State of Rio de Janeiro also supported the work. Systematic review with meta-analysis on randomized clinical trials.

The pathway from cognitive impairment to caries in older adults: A conceptual model

BackgroundCaries significantly increases in people with cognitive impairment (PWCI). However, the interrelationships among cognitive impairment, dentally related function (DRF), oral hygiene, and caries remain unclear, increasing difficulties to care appropriately for PWCI. In this study, the researchers tested a conceptual model in which impaired DRF acts as a mediator between cognitive impairment and poor oral hygiene, which then leads to caries. MethodsThe researchers recruited 68 older adult dentate participants with normal to severely impaired cognition from 3 assisted-living communities in North Carolina. Within 1 week of a calibrated oral examination performed by a geriatric dentist, a trained examiner blinded to the oral examination results conducted cognitive and functional assessments. The researchers conducted statistical analyses to examine the mediating effect of DRF on the relationship between cognitive impairment and oral hygiene or caries. ResultsCognitive impairment (β = 0.05; standard error [SE], 0.02; P = .017) and DRF (β = −0.07; SE, 0.02; P = .005) were significantly associated with oral hygiene. However, the association between cognitive impairment and oral hygiene was greatly reduced and became nonsignificant after controlling for DRF (β = 0.01; SE, 0.03; P = .430), suggesting that the effect of cognitive impairment on oral hygiene was mediated by DRF. DRF accounted for 80% of the total effect of cognitive impairment on oral hygiene. The ratio of the indirect effect to the total effect was .8. Associations between either cognitive impairment or DRF and caries were not significant, but oral hygiene was significantly associated with caries (β = 0.87; SE, 0.28; P < .001). ConclusionsDRF mediated the association between cognitive impairment and oral hygiene. It accounted for 80% of the total impact of cognitive impairment on oral hygiene, which was associated with increased caries in PWCI. Practical ImplicationsAs a result of cognitive impairment, impaired DRF plays a critical role in the pathway from cognitive impairment to oral health decline. Therefore, DRF assessment should be a standard component of geriatric dental assessment. A functionally-tailored oral hygiene intervention is essential to improve oral health for persons with cognitive impairment.

Silver diamine fluoride seems to be effective in preventing and arresting root caries in older adults compared with placebo, but there is very low certainty in the magnitude of the benefit

Silver diamine fluoride seems to be effective in preventing and arresting root caries in older adults compared with placebo, but there is very low certainty in the magnitude of the benefit

Systematic review finds that silver diamine fluoride is effective for both root caries prevention and arrest in older adults.

Data sourcesPubMed, Pubmed Clinical Queries, EMBASE, the American Dental Associations Evidence-Based Dentistry Website, Cochrane Library, Web of Science, repository of the Journal of the American Dental Association and Google Scholar.Study selectionFour authors independently assessed the abstracts of studies resulting from the above searches which compared treatment of root caries in an older population with SDF versus other preventive agents or placebos.Data extraction and synthesisTitles and abstracts of all reports identified through the electronic searches were assessed independently by four authors based on agreed upon inclusion and exclusion criteria. Of the selected studies for final inclusion in the systematic review, study quality was assessed using the critical appraisal worksheet for randomised controlled trials from the Oxford Centre for Evidence-Based Medicine (CEBM 2005). Prevented fraction (PF), number needed to treat (NNT) and relative risk (RR) were calculated as outcome measures in each study. In addition, the published evidence on SDF was reviewed in order to formulate clinical recommendations on safety and effectiveness when treating root or coronal caries in an adult population with SDF, as well as treatment of dental hypersensitivity.ResultsThree randomised controlled trials were identified that addressed the effectiveness of SDF on root caries in older adults, but none addressed coronal caries. Root caries prevented fraction and arrest rate for SDF were significantly higher than placebo. The prevented fraction for caries prevention for SDF compared to placebo was 71% in a three-year study and 25% in a two-year study. The prevented fraction for caries arrest for SDF was 725% greater in a 24-month study and 100% greater than placebo in a 30-month study. No severe adverse effects were observed.ConclusionsExisting reports of SDF trials support effectiveness in root caries prevention and arrest, remineralisation of deep occlusal lesions and treatment of hypersensitive dentine.

A systematic review of silver diamine fluoride: Effectiveness and application in older adults.

This systematic review examines the effectiveness of silver diamine fluoride (SDF) in the management of caries in older adults. Silver diamine fluoride has been extensively researched and proven effective for caries prevention and arrest in children. Limited studies support its effectiveness in adult and older adult populations. Multiple databases were searched according to specified inclusion-exclusion criteria. Quality assessment used modified Centre for Evidence-Based Medicine worksheets. Three randomised controlled trials were identified that addressed the effectiveness of SDF on root caries in older adults, but none addressed coronal caries. Root caries prevented fraction and arrest rate for SDF were significantly higher than placebo. The prevented fraction for caries prevention for SDF compared to placebo was 71% in a 3-year study and 25% in a 2-year study. The prevented fraction for caries arrest for SDF was 725% greater in a 24-month study and 100% greater than placebo in a 30-month study. No severe adverse effects were observed. This systematic review evaluates the use of SDF for both root caries prevention and arrest in older adults. Existing reports of SDF trials support effectiveness in root caries prevention and arrest, remineralization of deep occlusal lesions and treatment of hypersensitive dentin.