Root Caries – Classification, Causes, Clinical Features and Treatment

Caries is derived from a Latin Word which means “Rot” or “Decay” and in Greek it means “Ker” for “Death”.

According to Ostrom (1980) has defined as a process of Enamel or Dentin dissolution which is caused by microbial action at the tooth surface and is mediated by physiochemical flow of water dissolved ions.

According to Hume (1993) Dental caries is essentially a progressive loss by acid dissolution of the apetite (mineral) component of the enamel then the dentin or of the cementum and then dentin.

Root Caries is a type of Dental caries which is seen apical to the cement enamel junction (CEJ), this type of lesions have a distinct outline in contrast to the sound tooth structure or the non carious portion of the tooth.

Causes or Aetiology of Toot Caries:

These are the most common associated factors which can be seen with Root caries which can be the primary factor playing a major role in leading to root caries or can be a contributing factor.

1. Gingival Recession which can be due to Periodontitis or with Age
2. Radiation Therapy
3. Xerostomia
4. Abrasion
5. Erosion
6. Abfraction
7. Primary toot caries
8. Recurrent Caries
9. Removable Partial Dentures or Over dentures
10. Malocclusion of teeth which are tipped and increases food lodgement and decreased accessibility for cleaning
11. Diabetes and in disabilities physical and psychological which decreases cleaning efficiency

The Micro organisms responsible for Root Caries are Streptococcus Mutans, Lactobacillus and Actinobacillus. The rate of progression or demineralization of tooth structure is much higher in Root caries compared to Enamel Caries because Root has less Mineral content when compared to Enamel.

Important Features of Root Caries:

Sex Predilection: Male > Females

Root caries is mostly seen in cases where there is periodontal attachment loss exposing the root surface to the oral environment which leads to initiation of caries.

Root caries appears as a white or discoloured soft irregular and progressive lesion which occurs at or apical to the CEJ.

Shape of Root caries is Round or Oval in shape and is highly demarcated from the surrounding non carious tooth.

But the Root caries progresses rapidly and may join adjoining Root carious lesions

Incidence of Root Caries in Maxilla and Mandibular Teeth:

Maxilla: More common in the following order Incissors > Canines > Pre Molars > Molars

Mandible: More common in Molars > Premolars > Canines  > Incissors

Root Caries Classification based on Extent of Lesion:

Grade 1 or Initial Root Caries:

1. Light Brown to Tan in color on visual inspection
2. No surface defect seen
3. Surface Texture is Soft and the surface of Caries can be disrupted with the pointed tip of Dental Explorer

Grade 2 or Shallow Root Caries:

1. Dark Brown to variable Tan in Color
2. Surface defect is seen which can be less than 0.5 mm in depth
3. Surface texture is Soft, irregular, rough which can be penetrated with the pointed tip of Dental Explorer

Grade 3 or Cavitation Root Caries:

1. Light Brown to Dark Brown in color which is variable
2. Surface texture is similar to Grade 1 which is soft and penetrated with a dental explorer
3. The lesion is penetrating and cavitation is more than 0.5mm without pulpal involvement

Grade 4 or Pulpal Root Caries:

1. It is similar in color to Grade 3 type root caries which is Dark Brown
2. The Surface of Lesion is cavitated and the lesion has pulpal involvement extending upto the Root canal.

Treatment of Root caries:

Treatment of Root Caries is similar to Dental Caries depending on the extent of the lesion into the tooth structure the mode of treatment is planned.

Excavation of the Infected tooth structure and replacement with the help of Restorations like Composite, GIC etc

In some cases where the caries is deep but not extending till Pulp can be treated with Indirect Pulp Capping and then Restoration

In case of Grade 4 types Root caries – Root canal Treatment is the ideal form of treatment indicated along with excavation and restoration of the structure.