Root Caries From Prevalence to Therapy

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Root Caries:
From Prevalence to Therapy

Volume Editor

Marcela Rocha de Olivera Carrilho São Paulo

41 figures, 31 in color, and 16 tables, 2017

Basel · Freiburg · Paris · London · New York · Chennai · New Delhi ·

Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney
Marcela Rocha de Olivera Carrilho
Anhanguera University of São Paulo
Biomaterials and Biotechnology &
Innovation in Health Programs
Vila Madalena
Rua Girassol, 584, ap 301A
São Paulo, SP 05433-001 (Brazil)

Library of Congress Cataloging-in-Publication Data

Names: Carrilho, Marcela Rocha de Olivera, editor.

Title: Root caries : from prevalence to therapy / volume editor, Marcela
Rocha de Olivera Carrilho.
Other titles: Monographs in oral science ; v. 26. 0077-0892
Description: Basel ; New York : Karger, 2017. | Series: Monographs in oral
science, ISSN 0077-0892 ; Vol. 26 | Includes bibliographical references
and indexes.
Identifiers: LCCN 2017038123| ISBN 9783318061123 (hard cover : alk. paper) |
ISBN 9783318061130 (electronic version)
Subjects: | MESH: Root Caries
Classification: LCC RK331 | NLM WU 270 | DDC 617.6/7--dc23 LC record available at
https://lccn.loc.gov/2017038123

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Contents

VII List of Contributors

XI Foreword
Tjäderhane, L. (Helsinki/Oulu)

Epidemiology
1 Incidence, Prevalence and Global Distribution of Root Caries
Hayes, M.; Burke, F.; Allen, P.F. (Cork)
9 Etiology, Risk Factors and Groups of Risk
Hayes, M.; Burke, F.; Allen, P.F. (Cork)

Biological Determinants
15 Specificities of Caries on Root Surface
Damé-Teixeira, N. (Brasilia); Parolo, C.C.F.; Maltz, M. (Porto Alegre)
26 Root Surface Biofilms and Caries
Do, T. (Leeds); Damé-Teixeira, N. (Brasilia); Naginyte, M.; Marsh, P.D. (Leeds)
35 Endogenous Enzymes in Root Caries
Boukpessi, T.; Menashi, S.; Chaussain, C. (Paris)

Lesion Assessment and Features

43 Root Surface Caries – Rationale Behind Good Diagnostic Practice
Fejerskov, O.; Nyvad, B. (Aarhus)
55 Assessing the Risk of Developing Carious Lesions in Root Surfaces
Doméjean, S. (Clermont-Ferrand); Banerjee, A. (London)
63 Assessment of Root Caries Lesion Activity and Its Histopathological Features
Carvalho, T.S.; Lussi, A. (Bern)
70 Monitoring of Root Caries Lesions
Pretty, I.A. (Manchester)

Preventive and Operative Therapies

76 Biofilm Control and Oral Hygiene Practices
Maltz, M. (Porto Alegre); Alves, L.S.; Zenkner, J.E.A. (Santa Maria)

V
 83 Conventional Preventive Therapies (Fluoride) on Root Caries Lesions
Magalhães, A.C. (Bauru)
88 New Preventive Approaches Part I: Functional Peptides and Other Therapies to Prevent
Tooth Demineralization
Buzalaf, M.A.R. (Bauru); Pessan, J.P. (Araçatuba)
97 New Preventive Approaches Part II: Role of Dentin Biomodifiers in Caries Progression
Bedran-Russo, A.K.; Zamperini, C.A. (Chicago, IL)
106 Management of Cavitated Root Caries Lesions: Minimum Intervention and Alternatives
Burrow, M.F. (Melbourne, VIC/Hong Kong); Stacey, M.A. (Melbourne, VIC)
115 Clinical Performance of Root Surface Restorations
Reis, A. (Ponta Grossa); Soares, P.V. (Uberlândia); de Geus, J. (Fortaleza); Loguercio, A.D. (Ponta Grossa)

Epilogue
125 Concluding Remarks
Carrilho, M.R.O. (São Paulo)

133 Author Index

134 Subject Index

VI Contents
List of Contributors

Patrick Finbarr Allen Michael Francis Burrow

Faculty of Dentistry, National University of Singapore Faculty of Dentistry
11 Lower Kent Ridge Road The University of Hong Kong
Singapore 119083 (Singapore) Prince Philip Dental Hospital
E-Mail [email protected] 34 Hospital Road
Sai Ying Pun, Hong Kong (SAR China)
Luana Severo Alves E-Mail [email protected]
Department of Restorative Dentistry, School of
Dentistry Marília Afonso Rabelo Buzalaf
Federal University of Santa Maria Department of Biological Sciences
Rua Floriano Peixoto, 1184 Bauru School of Dentistry, University of São Paulo
Santa Maria, RS 97015-372 (Brazil) Al. Octávio Pinheiro Brisolla, 9-75
E-Mail [email protected] Bauru, SP 17012-901 (Brazil)
E-Mail [email protected]
Avijit Banerjee
King’s College London Dental Institute Marcela Rocha de Olivera Carrilho
Floor 26, Tower Wing, Guy’s Dental Hospital Anhanguera University of São Paulo
Great Maze Pond Biomaterials and Biotechnology &
London SE1 9RT (UK) Innovation in Health Programs
E-Mail [email protected] Vila Madalena
Rua Girassol, 584, ap 301A
Ana K. Bedran-Russo São Paulo, SP 05433-001 (Brazil)
Department of Restorative Dentistry E-Mail [email protected]
University of Illinois at Chicago
College of Dentistry Thiago Saads Carvalho
801 S. Paulina Street, Room 531a Department of Preventive, Restorative and Pediatric
Chicago, IL 60612 (USA) Dentistry
E-Mail [email protected] University of Bern
Freiburgstrasse 7
Tchilalo Boukpessi CH–3010 Bern (Switzerland)
Dental School, University Paris Descartes E-Mail [email protected]
1, rue Maurice Arnoux
FR–92120 Montrouge (France) Catherine Chaussain
E-Mail [email protected] EA 2496, Orofacial Pathologies, Imaging and
Biotherapies, Dental School
Francis M. Burke University Paris Descartes
Restorative Dentistry, Cork University Dental School 1, rue Maurice Arnoux
and Hospital FR–92120 Montrouge (France)
University College Cork, Wilton E-Mail [email protected]
Cork T12 E8YV (Ireland)
E-Mail [email protected]

VII
Nailê Damé-Teixeira Ana Carolina Magalhães
Department of Dentistry, Faculty of Health Science, Department of Biological Sciences
University of Brasilia Bauru School of Dentistry, University of São Paulo
Campus Universitário Darcy Ribeiro Al. Octávio Pinheiro Brisolla, 9-75
Asa Norte, Brasilia, DF 70910-900 (Brazil) Bauru, SP 17012-901 (Brazil)
E-Mail [email protected] E-Mail [email protected]

Juliana de Geus Marisa Maltz

Paulo Picanço Faculty, Rua Joaquim Sa Department of Social and Preventive Dentistry
900 – Dionisio Torres Faculty of Odontology
Fortaleza, CE 60135-218 (Brazil) Federal University of Rio Grande do Sul
E-Mail [email protected] Rua Ramiro Barcelos, 2492
Porto Alegre, RS 90035-003 (Brazil)
Thuy Do E-Mail [email protected]
Division of Oral Biology, School of Dentistry
University of Leeds Philip D. Marsh
Wellcome Trust Brenner Building Division of Oral Biology, School of Dentistry
St. James University Hospital University of Leeds
Beckett Street Wellcome Trust Brenner Building
Leeds LS9 7TF (UK) St. James University Hospital
E-Mail [email protected] Beckett Street
Leeds LS9 7TF (UK)
Sophie Doméjean E-Mail [email protected]
UFR d’Odontologie
2, rue de Braga Suzanne Menashi
FR-63100 Clermont-Ferrand (France) EA 2496, Orofacial Pathologies, Imaging and
E-Mail [email protected] Biotherapies, Dental School
University Paris Descartes
Ole Fejerskov 1, rue Maurice Arnoux
Department of Biomedicine FR–92120 Montrouge (France)
Faculty of Health, Aarhus University E-Mail [email protected]
Wilhelm Meyers Allé 3
DK–8000 Aarhus (Denmark) Monika Naginyte
E-Mail [email protected] Division of Oral Biology, School of Dentistry
University of Leeds
Martina Hayes Wellcome Trust Brenner Building
Restorative Dentistry, Cork University Dental School St. James University Hospital
and Hospital Beckett Street
University College Cork, Wilton Leeds LS9 7TF (UK)
Cork T12 E8YV (Ireland) E-Mail [email protected]
E-Mail [email protected]
Bente Nyvad
Alessandro D. Loguercio Department of Dentistry and Oral Health
Department of Restorative Dentistry Faculty of Health, Aarhus University
State University of Ponta Grossa, Paraná Vennelyst Boulevard 9
Av. Carlos Cavalcanti, 4748 DK–8000 Aarhus (Denmark)
Ponta Grossa, PR 84030-900 (Brazil) E-Mail [email protected]
E-Mail [email protected]
Clarissa Cavalcanti Fatturi Parolo
Adrian Lussi Faculty of Odontology
Department of Preventive, Restorative and Federal University of Rio Grande do Sul
Pediatric Dentistry Rua Ramiro Barcelos, 2492
University of Bern Porto Alegre, RS 90035-003 (Brazil)
Freiburgstrasse 7 E-Mail [email protected]
CH–3010 Bern (Switzerland)
E-Mail [email protected]

VIII List of Contributors

Juliano Pelim Pessan Margaret A. Stacey
Department of Pediatric Dentistry and Public Health Melbourne Dental School
School of Dentistry, Araçatuba The University of Melbourne
São Paulo State University (Unesp) 720 Swanson Street
Rua José Bonifácio, 1193 Carlton, VIC 3010 (Australia)
Araçatuba, SP 16015-050 (Brazil) E-Mail [email protected]
E-Mail [email protected]
Leo Tjäderhane
Iain A. Pretty Department of Oral and Maxillofacial Diseases
Dental Health Unit University of Helsinki
The University of Manchester PO Box 41
Williams House, Manchester Science Park FIN-00014 University of Helsinki (Finland)
Manchester M16 6SE (UK) E-Mail [email protected]
E-Mail [email protected]
Camila A. Zamperini
Alessandra Reis University of Illinois at Chicago
Ponta Grossa State University College of Dentistry
Dentistry Department of Restorative Dentistry
Av. Carlos Cavalcanti, 4748 801 S. Paulina Street
Ponta Grossa, PR 84030-900 (Brazil) Chicago, IL 60612 (USA)
E-Mail [email protected] E-Mail [email protected]

Paulo Vinicius Soares Julio Eduardo do Amaral Zenkner

School of Dentistry, Federal University of Uberlândia Department of Stomatology, School of Dentistry
Av. Pará, 1720 – Umuarama Federal University of Santa Maria
Uberlândia, MG 38405-320 (Brazil) Rua Floriano Peixoto, 1184
E-Mail [email protected] Santa Maria, RS 97015-372 (Brazil)
E-Mail [email protected]

List of Contributors IX
Foreword

It is not very common in the academic life to have whether it occurs in enamel-covered crown or
the pleasure and opportunity to write a Foreword root surface, and the same preventative strate-
for such an important and timely publication as gies apply for fissure and root surface caries. I
“Root Caries: From Prevalence to Therapy.” Only personally do believe this is a false assumption:
yesterday, I was treating a lovely elderly lady with as a disease, root caries is definitely an entity of
severe root caries problem in and under her oth- its own. The population at risk, risk factors, mi-
erwise well-functioning bridgework. While try- crobiology, the critical pH for demineralization,
ing hard to save her functioning and esthetic oc- the role of endogenous preventive and destruc-
clusion, I could not help but think – again – how tive factors, the progression rate, etc. are signifi-
difficult and devastating the final outcome of the cantly different between coronal enamel and
root caries can be to the patient. root caries [2]. Therefore, our knowledge of the
Is this book really timely as I claimed above? pathogenesis, prevention, and operative treat-
Absolutely! For example, just a few months ago, ment of pit-and-fissure or smooth surface enam-
the President of the IADR, Professor Angus Walls el caries may not be enough to face the challenge
titled his IADR 2017 congress opening ceremony of root caries.
speech “Aging – A Call to Arms!” [1]. In his The volume title, as short and simple as it is,
speech, he addressed the challenges posed by the tells it all. This monograph takes the reader from
progressive global aging of society and not sur- the epidemiology of root caries through its bio-
prisingly, clearly pointed out that root caries is an logical determinants and lesion assessment and
important threat to the oral health, well-being, features to build up a comprehensive back-
and quality of life of the elderly. The accumula- ground for the last part of the book, preventive
tion of the predisposing factors, together with the and operative therapies. This volume has
increasing number of aged people with increasing brought together current knowledge and con-
number of their own teeth, is a growing concern cepts relating to root caries in a comprehensive
for the clinicians and policy makers alike. But age and lucid fashion. After all, only after under-
is not the only factor to consider. For example, standing the patients at risk and risk factors, and
patients with removable partial denture or fixed the pathological mechanisms and features of the
prosthodontic structures, orthodontic appliances disease, will the clinician be fully equipped to
or systematic diseases with or without medication successfully fight and win the battle. The signifi-
may be affected. cance of the text stems from the contributions of
Is this book important? Definitely, it is! It is a distinguished scientists and authorities in this
general assumption that dentin caries is the same field.

XI
 The problem has been recognized, it has been specifically on root caries failed to find any. This
under active research and a lot has been published volume of Monographs in Oral Science fills this
in dentistry literature, too. Simple PubMed search enormous gap, and I am fully confident that it will
with key words “root caries” and “review” result- be welcomed by the under- and postgraduate stu-
ed in over 300 hits. Therefore, it is surprising that dents, teachers, researchers, and practicing den-
even an extensive search for a textbook focusing tists alike.

Enjoy!
Leo Tjäderhane, DDS, PhD, Professor
Department of Oral and Maxillofacial Diseases, University of Helsinki, and
Helsinki University Hospital, Helsinki, Finland
Research Unit of Oral Health Sciences, and Medical Research Center Oulu
(MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland

References
1 Walls A: Aging – a call to arms! J Dent 2 Takahashi N, Nyvad B: Ecological hy-
Res 2017;96:721–722. pothesis of dentin and root caries. Car-
ies Res 2016;50:422–431.

XII Tjäderhane
Epidemiology
Carrilho MRO (ed): Root Caries: From Prevalence to Therapy.
Monogr Oral Sci. Basel, Karger, 2017, vol 26, pp 1–8 (DOI: 10.1159/000479301)

Incidence, Prevalence and Global Distribution of

Root Caries
Martina Hayes · Francis Burke · Patrick Finbarr Allen
Restorative Dentistry, Cork University Dental School and Hospital, Wilton, Cork, Ireland

Abstract ways using different indices. There was great in-

High quality epidemiological data are essential for both terest in the epidemiology of root caries among
the development of national oral health policies and cost- the dental research community in the 1970s and
effective targeting of resources. Unfortunately, a high lev- 1980s. During this time, a number of epidemio-
el of clinical heterogeneity between studies in this area logical studies were published. Many of these
makes it difficult, and inappropriate, to try to produce any simply counted the number of carious and re-
definitive figures on the global prevalence or incidence of stored root surfaces and presented it as root de-
root caries. Published studies have reported wide ranges cayed and filled surfaces (RDFS). Some studies
for the prevalence of root caries (25–100%) and the mean felt that restorations on the root surface could not
Root Caries Index (9.7–38.7). The reported range for an- definitely be attributed to past caries experience
nual root caries incidence is also wide, from 10.1 to 40.6%. and felt it was more accurate to report root de-
While more research is needed in this area, most studies cayed surfaces. Others counted the number of
conclude that the burden of root caries is high in the old- teeth which had evidence of root caries or previ-
er age population. © 2017 S. Karger AG, Basel ously restored root caries and presented root de-
cayed and filled teeth.
Sumney et al. [1], in 1973, reported the per-
Introduction centage of the population with one or more root
surface caries lesions and also presented the aver-
Unfortunately, estimating the prevalence and in- age number of lesions per person per tooth avail-
cidence of root caries can be challenging as loss of able. In 1980, Banting et al. [2] reported the per-
teeth confounds the data and the diagnostic crite- centage of the population with at least one filled
ria for root caries differ between studies. In addi- or decayed root surface and also the mean num-
tion to the differences in diagnostic criteria ap- ber of decayed root lesions per patient alongside
plied to root caries, epidemiological studies of the mean number of restored root surfaces per
root caries report their findings in a variety of patient. As further studies were published during
this period, researchers began to highlight the in- causality. As the term “risk factor” implies cau-
consistent reporting methods and the difficulty in sality, it may be more accurate to describe any
comparing the results of studies [3, 4]. associations as “risk indicators” or “risk mark-
In 1980, Katz [5] proposed a new measure ers” for the disease.
which he named the Root Caries Index (RCI) for Examining epidemiologic studies of root car-
scoring and reporting root surface caries. From ies reveal numerous threats to their external and
the mid-1980s onwards, the RCI became one of internal validities. Very few studies of root caries
the 2 standard measures used for reporting root use a random sampling technique. Most studies
caries prevalence (the other being RDFS), with recruit volunteers according to pre-defined crite-
most studies reporting both in conjunction to ria. These criteria are unique to each study, which
give as rounded a picture as possible. While there impedes cross-study comparisons and limit gen-
is no doubt that the RCI is imperfect, it has yet to eralizability. The notable exceptions to this are
be superseded by a more useful measure. Given the national surveys [7, 8]. Studies recruiting vol-
the lack of consensus on a definition for root car- unteers should be interpreted with caution unless
ies and the considerable debate about how best to they can be proven to be representative or are a
measure it, it can be seen how complicated the subpopulation of interest in their own right, for
epidemiology of this disease is. Authors writing example, individuals with Alzheimer’s disease
about root caries have been calling for increased [9]. Studies on root caries prevalence have been
agreement in this area for over forty years [3, 6]. reported for institutionalized elderly [2], inde-
In light of the level of clinical heterogeneity be- pendently living elderly [10], those attending day
tween studies in this area, it is difficult, and inap- centers [11], adults in fluoridated areas [12],
propriate, to try to produce any definitive figures adults in non-fluoridated areas [13], urban dwell-
on the prevalence or incidence of root caries. ers, and rural dwellers [14], as well as the notable
However, it is interesting to look at the variety of Piedmont 65+ studies which looked at African-
populations in which root caries has been studied Americans and Caucasians in North Carolina
and the methods used to collect the data. [15]. Many of the studies reported baseline data
from large clinical trials [12, 16, 17]. Clinical trials
include selected populations, designed to maxi-
Prevalence of Root Caries mize the likelihood of finding differences be-
tween 2 therapies and are often not representative
Prevalence data from cross-sectional studies of a general population of interest.
serve a number of purposes. These data are used The studies involving some type of sampling
to monitor the amount of disease existing in a frame should provide estimates of prevalence,
population, to delineate the characteristics of with proper weighting for the sampling design
people who have the disease, to generate hypoth- and unbiased responses. Unfortunately, this lev-
eses regarding the etiology of the disease, and to el of reporting is rare in root caries epidemiolo-
plan public oral health services. The use of cross- gy. An exception to this is the study of Locker et
sectional studies to identify the association be- al. [18], which reported a 26% response rate for
tween risk factors and a disease are limited, how- individuals aged 50 and older. It was not possible
ever, the fact is that they are carried out at a sin- to identify any clinical studies which reported
gle time point and give no indication of the the characteristics of non-responders. This is ex-
sequence of events – whether exposure occurred pected as participation in any research is volun-
before, after or during the onset of the disease tary and it may not be possible to gather any
outcome. This being so, it is impossible to infer form of data on those who choose not to partici-

2 Hayes · Burke · Allen

Carrilho MRO (ed): Root Caries: From Prevalence to Therapy.

Monogr Oral Sci. Basel, Karger, 2017, vol 26, pp 1–8 (DOI: 10.1159/000479301)
pate. National surveys, however, should be able rely on self-reported income and level of educa-
to report on the age profile and gender of non- tion [11, 22].
responders as it is assumed that this knowledge As can be seen, there is substantial clinical het-
would be available prior to random sampling to erogeneity between studies reporting on root car-
ensure a representative sample is achieved. A pa- ies prevalence and so it would be misleading to
per was published reporting the findings of the attempt to synthesize this data to produce a glob-
First Uruguayan National Oral Health Survey al estimate of root caries prevalence. Table 1
[19], which indicated a 20% non-response rate briefly describes the settings of some studies re-
among the total population invited to partici- porting on root caries prevalence and Table 2 lists
pate. However, further information on the char- the estimated root caries prevalence to illustrate
acteristics of non-responders was reported in a the wide range reported.
separate document which was not available in
English [20].
While studies report good inter- and intra-ex- Incidence of Root Caries
aminer reproducibility, they each diagnose root
caries according to different field conditions, on For similar reasons outlined above, estimating
different populations, using differing criteria for the true incidence of root caries is extremely chal-
root caries. Some studies only refer to untreated lenging and fraught with inconsistencies. Also,
root caries when reporting root caries prevalence there can be confusion when authors refer to in-
[21], while others regard treated and untreated cidence and increment. The incidence of root car-
root caries equally or present them separately [2]. ies refers to the proportion of individuals in who
There is additional complexity when researchers any new root caries is observed over a given time
add in descriptors, such as quiescent, active, inac- period. Root caries increment refers to the num-
tive, or recurrent. It can then be difficult to deci- ber of root surfaces per person, which develop
pher whether they have included “inactive” le- new root caries over a given period of time.
sions in their calculations of RDFS or RCI. Longitudinal dental caries studies generally
Many of the exposures of interest in root caries take 2 forms: a cohort study that is observational
epidemiology are specific and reproducible, such and attempts to describe, model, or predict new
as age and gender. However, others such as xero- disease; and a clinical trial that is experimental in
stomia are more likely to vary between studies de- nature and attempts to report new disease inci-
pending on whether the investigators used a dence while concurrently testing a new interven-
questionnaire to determine self-reported oral tion. Clinical trials on interventions for root car-
dryness [17], or used a quantitative measure such ies tend to select populations who are at high risk
as stimulated saliva collection over a measured of developing new root caries within a relatively
time period [22]. Another example is one study short time, for example, patients who are xerosto-
which reported that root caries was correlated mic post-radiotherapy to the head and neck re-
with decayed-missing-filled-teeth but did not gions [24–26]. This is convenient from a research
specify if decayed-missing-filled-teeth was calcu- perspective as enough new cases of root caries can
lated from 28 or 32 teeth and whether coronal de- be observed to determine if there is any difference
cay was measured at cavitation level or not [12]. between groups within a relatively short period of
Many studies also investigate the relationship be- time. This data is only generalizable to a very spe-
tween socioeconomic status and root caries. A re- cific study population and should not be included
cent study categorized participants using Kup- in attempts to find the true population incidence
puswamy’s classification [23], while many others for root caries.

Incidence, Prevalence and Global Distribution of Root Caries 3

Carrilho MRO (ed): Root Caries: From Prevalence to Therapy.

Monogr Oral Sci. Basel, Karger, 2017, vol 26, pp 1–8 (DOI: 10.1159/000479301)
Table 1. Studies reporting root caries prevalence (continued over following pages)

Authors Country Population Number of Reported measures

participants

Banting et al. [2] Canada Institutionalized adults (mean age 67.9 years) 59 Root caries prevalence
Beck et al. [10] USA Independently living adults aged 65+ years 520 Root caries prevalence
Locker et al. [18] Canada Independently living adults aged 50+ years 138 Root caries prevalence,
(data presented separately for 65+) RDFS, exposed root
surfaces
Luan et al. [45] China Urban and rural adults aged 20–80 years 544 (238 M, 306 F) Root caries prevalence,
(data presented separately for 60+) exposed root surfaces
Fejerskov et al. Denmark Independently living adults aged 60–80 90 (46 M, 44 F) Sound root surfaces,
[46] years Active and inactive root
surface caries, RCI
Papas et al. [47] USA Adults aged 40+ years (data presented 180 (61 M, 119 F) RDFS
separately for 65+)
Slade and Australia Non-institutionalized aged 60+ 853 (497 M, 356 F) RDFS, exposed root
Spencer [48] surfaces, RCI
Närhi et al. [49] Finland Dentate elderly (mean age 79.3 years) 196 (56 M, 127 F) RDFS, exposed root
surfaces
Splieth et al. [50] Germany Adults aged 20–79 years (data presented 982 (545 M, 437 F) RDFS, exposed root
separately for 65+) surfaces, RCI
Kularatne and Sri Lanka Urban dwellers aged 60+ years 600 (281 M, 319 F) RDFS, exposed root
Ekanayake [51] surfaces, RCI
Islas-Granillo Mexico Institutionalized and non-institutionalized 85 (25 M, 60 F) Exposed root surfaces,
et al. [52] aged 60+ years RCI
Ellefsen et al. [9] Denmark Older adults with Alzheimer’s disease 61 (22 M, 39 F) Root caries prevalence,
RDFS
Mamai-Homata Greece Older adults in day centers aged 65+ years 749 (427 M, 322 F) Root caries prevalence,
et al. [11] RDFS, RCI
Chi et al. [22] USA Adult dental attenders aged 45+ years (data 368 (204 M, 164 F) Root caries prevalence
presented separately for 65+)
Silva et al. [33] Australia Institutionalized adults (mean age 83 years) 243 (80 M, 163 F) Root caries, prevalence,
RDFS, RCI
Christensen Denmark Adults aged 21–89 years (data presented 1,063 aged 65+ Root caries prevalence
et al. [53] separately for aged 65+)

Random sampling is preferred when esti- ease such as root caries, which is more prevalent
mating the incidence of any disease as it pro- in older age groups, it can be logical to focus
vides a group from which to generalize the re- resources on the population of interest. For ex-
sults or conclusions of the study. Quite often, ample, the most recent oral health survey in Ire-
however, random sampling is not practical due land examined 1,196 people aged between 16
to the cost and time constraints. Also, in a dis- and 24 years of age. The mean number of ex-

4 Hayes · Burke · Allen

Carrilho MRO (ed): Root Caries: From Prevalence to Therapy.

Monogr Oral Sci. Basel, Karger, 2017, vol 26, pp 1–8 (DOI: 10.1159/000479301)
 Table 2. Reported root caries prevalence across studies (nr = not reported)

Study Prevalence of root Mean RDFS Mean RCI

caries experience, %

Banting et al. [2], 1980 83 nr nr

Beck et al. [10], 1985 63 nr nr
Locker et al. [18], 1989 57 2.6 10.2
Luan et al. [45], 1989 66 nr nr
Fejerskov et al. [46], 1991 100 7.4 nr
Papas et al. [47], 1992 nr 5.6 nr
Slade and Spencer [48], 1997 nr 3.1 11.9
Närhi et al. [49], 1997 37 5.2 nr
Splieth et al. [50], 2004 53 8.6 10.3
Kularatne and Ekanayake [51], 2007 90 3.8 25.0
Islas-Granillo et al. [52], 2012 96 nr 37.7
Ellefsen et al. [9], 2012 75 10.3 ns
Mamai-Homata et al. [11], 2012 38 2.7 9.7
Chi et al. [22], 2013 25 nr nr
Silva et al. [33], 2013 77 6.5 38.7
Christensen et al. [53], 2015 45 nr nr

posed roots was 1.2 and the mean root decayed not necessarily synonymous. Older adults can be
and filled teeth was 0 [7]. From the point of subdivided into the 3rd age and the 4th age [27],
view of a governmental agency or funding body, or the young-old, old-old, and oldest-old [28, 29].
it would not be justifiable to spend limited re- They can also be categorized according to frailty
sources to determine the incidence of root car- using a measure, such as the Canadian Study of
ies in this population. The sample size should be Health and Ageing frailty scores [30]. This system
large and the follow-up longer, and it would be of categorization was advocated in the Seattle
difficult to see the benefit of this data for a wid- Care Pathway for securing oral health in older pa-
er society. tients [31].
As root caries is a disease seen predominantly Frail or institutionalized older adults have a
in older adults, it is justifiable to limit a study pop- higher prevalence of root caries than other older
ulation to this group. Unfortunately, this group is populations, and so it may be clinically useful to
not easily defined. Most developed countries have study the root caries incidence of this population
accepted the chronological age of 65 years as a separately compared to that among independent-
definition of ‘elderly’ or older person. While this ly living older adults [32, 33]. However, caution
definition is somewhat arbitrary, it is associated should be exercised with definitions in this area;
with the age at which one can begin to receive many authors use the terms frail and dependent
pension benefits. Although there are commonly to describe those in nursing homes, yet one study
used definitions of old age (such as 65 years and specifically recruited non-frail individuals living
older), there is no general agreement on the age at in nursing homes [34]. This indicates that living
which a person becomes old. The common use of in a nursing home is not synonymous with frailty.
a calendar age to mark the threshold of old age as- And so it can be difficult to examine the literature
sumes equivalence with biological age, yet at the and separate out data for frail older adults and
same time, it is generally accepted that these 2 are non-frail older adults.

Incidence, Prevalence and Global Distribution of Root Caries 5

Carrilho MRO (ed): Root Caries: From Prevalence to Therapy.

Monogr Oral Sci. Basel, Karger, 2017, vol 26, pp 1–8 (DOI: 10.1159/000479301)