Epidemiology, risk assessment, and treatment of root caries in older adults

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Hayes, Anne Martina
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University College Cork
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Objectives This research had four objectives; 1 To assess the prevalence of, and risk indicators associated with, root caries in a cohort of independently living older adults. 2 To determine the root caries incidence over a two-year period in a cohort of independently living older adults and identify associated risk factors. 3 To evaluate the Cariogram as a risk assessment tool for the prediction of root caries in an older adult population. 4 To clinically evaluate a calcium silicate cement (Biodentine™, Septodont, Saint Maur de Fosses, France) in the restoration of root caries lesions in older adults and to compare it to the clinical performance of a high viscosity glass ionomer cement (Fuji IX GP® Extra, GC Corporation, Tokyo, Japan) and a resin modified glass ionomer cement (Fuji II LC®, GC Corporation, Tokyo, Japan). Methods Three hundred and thirty four participants were recruited in this prospective cohort study. Each subject underwent an oral examination, performed by a single calibrated examiner, to determine the root caries index and other clinical variables (DMFT, BPE, plaque index). Stimulated saliva samples were collected to determine salivary variables at baseline. Questionnaires were used to collect data on oral hygiene habits, diet, smoking and alcohol habits and education level. The participants were recalled after 12 and 24 months for a repeat clinical examination. Data was entered into the Cariogram computer model to generate a risk assessment score. A nested randomised clinical trial recruited eighty-five participants. Each participant received at least two root surface restorations; one lesion was allocated to receive Biodentine™ and the other was allocated either Fuji IX GP Extra or Fuji II LC. One dentist placed all restorations. 303 were randomized with 151 lesions allocated to receive Biodentine™, 77 to Fuji IX GP® Extra and 77 to Fuji II LC®. Patients were reviewed by a calibrated dentist who was not involved in restoration placement and who was blinded to material allocation. Restorations were assessed according to a modified USPHS criterion. Results A total of 334 older dentate adults with a mean age of 69.1 years were examined at baseline. Of these, 53.3% had at least one filled or decayed root surface. The median root caries index was 3.13 (IQR 0.00, 13.92). 280 participants were examined at two-year follow up. One quarter (n=70) of participants had developed at least one new root caries lesion in this period. The mean root caries increment was 0.70 surfaces (Q3 0.75). The baseline variables xerostomia, coronal caries experience (≥2 teeth affected), root caries index (≥14) and number of exposed root surfaces (≥37) and low final education level were associated with new root caries development over a two-year period. New caries was observed in 55.6% of those categorised by the Cariogram in the highest risk group compared to 3.8% in the lowest risk group. The area under the ROC curve was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Restorations placed as part of the randomised clinical trial were assessed after one year. Restorations were clinically acceptable in 47.2% of the Biodentine™ group, 83.8% of the Fuji IX GP® Extra group and 84.9% of the Fuji II LC® group respectively. There was a significantly lower success rate in the Biodentine™ group compared to that of the other two materials Conclusions The prevalence and incidence of root caries was high in this cohort. The factors associated with new root caries development in this study should be examined in future studies. Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries. Biodentine™ cannot be recommended for the operative management of root caries. High viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option for the restoration of root caries.
Gerodontology , Dentistry , Caries , Older adults
Hayes, A. M. 2017. Epidemiology, risk assessment, and treatment of root caries in older adults. PhD Thesis, University College Cork.