Management of Cavitated Root Caries Lesions: Minimum Intervention and Alternatives

Abstract

The prevalence of root caries among the elderly is increasing. The lesion shape can vary considerably from a broad shallow saucer-shape to a deeper defined cavity. The variety of shapes poses a series of complications when considering restorative management. This is accompanied with a paucity of clinical evidence on treatment techniques and clinical outcomes. The current philosophy centered on conservative management of root caries will most likely provide patients with the greatest chance of maintaining their teeth. When a lesion can be effectively cleaned in conjunction with a high fluoride content toothpaste and other remineralizing agents, this should be the treatment of choice. For lesions that are cavitated and cannot be effectively cleaned, the initial management should be to apply remineralizing agents for a period to "harden" lesion margins thus potentially reducing the prepared cavity and restoration size, as well as providing a better-defined tooth-restoration margin for finishing. Material selection is either a glass ionomer cement (conventional or resin-modified) or resin-based material. Frequently, the restoration site is easily contaminated; hence, glass ionomer cement is an ideal material. However, for saliva-deficient patients, resin composite or a combination of resin composite and resin-modified glass ionomer adhesive allows for a highly polished, easily cleansable restoration surface that may reduce the potential for further caries initiation. The current evidence base for the restoration of root caries is poor.