Caries and periodontitis are the primary non-communicable oral diseases among elderly individuals. The burden of the disease increases with ageing, particularly as the elderly are tending to retain more teeth due to improvement of oral health measures and increased life expectancy. Root caries represents itself as an overlapping pathology, but not necessarily a summation of the two diseases. This narrative commentary discusses the cross-boundary nature of root caries, a periodontal-cariological condition, taking into account the multi-morbidities of ageing. The evidence includes epidemiological and pathophysiological features of root caries, and specific influencing factors of ageing, such as xerostomia, polypharmacy, functional and cognitive impairment and oral ecological alterations. Active or previous history of periodontal disease poses a risk for root caries, whereas the systemic co-morbidities of ageing may also increase the susceptibility to this pathology. It is plausible that root caries is the net outcome of coexisting risk for these conditions. There exists no standardised system for risk assessment and diagnosis that takes into account the interactive effect of caries, periodontitis and the constellation of age-specific influencing factors. As restorative treatment is challenging, cost-effective prevention and diagnosis methods are needed for vulnerable elderly populations. These may include improved clinical registration methods and establishment of individualised prevention and treatment protocols.
Subscribe to Journal
Get full journal access for 1 year
only $4.96 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
World Health Organisation. Speed of population ageing. 2017.
Ronald L. The demographic transition: Three centuries of fundamental change. J Econ Perspect 2003; 17: 167-190.
World Health Organisation. Preventing chronic diseases: a vital investment. Geneva (Switzerland): WHO Publications, 2005. Report No.: 92 4 156300 1.
World Health Organisation. World report on Health and Aging. 2015. Geneva (Switzerland): WHO Publications, 2015
Government Offices of Sweden. Future Challenges for Sweden - Final Report of the Commission on the Future of Sweden. Available online at https://www.government.se/legal-documents/2013/03/ds-201319/ (accessed 31 October 2019).
Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010; 5: 207-216.
Joseph B K, Kullman L, Sharma P N. The oral-systemic disease connection: a retrospective study. Clin Oral Investig 2016; 20: 2267-2273.
Edman K, Ohrn K, Nordstrom B, Holmlund A. Prevalence of dental caries and influencing factors, time trends over a 30-year period in an adult population. Epidemiological studies between 1983 and 2013 in the county of Dalarna, Sweden. Acta Odontol Scand 2016; 74: 385-392.
Tonetti M S, Bottenberg P, Conrads G et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017; 44 (Suppl 18): S135-S44.
de Mata C, McKenna G, Burke F M. Caries and the older patient. Dent Update. 2011; 386: 376-378: 81.
Hujoel P P, Lingstrom P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol 2017; 44 (Suppl 18): S79-S84.
Shlisky J, Bloom D E, Beaudreault A R et al. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr 2017; 8: 17-26.
Elsig F, Schimmel M, Duvernay E et al. Tooth loss, chewing efficiency and cognitive impairment in geriatric patients. Gerodontology 2015; 32: 149-156.
Hayes M, Burke F, Allen P F. Incidence, prevalence and global distribution of root caries. Monogr Oral Sci 2017; 26: 1-8.
Hariyani N, Setyowati D, Spencer A J, Luzzi L, Do L G. Root caries incidence and increment in the population - A systematic review, meta-analysis and meta-regression of longitudinal studies. J Dent 2018; 77: 1-7.
Hsu H C. Trajectories of multimorbidity and impacts on successful aging. Exp Gerontol 2015; 66: 32-38.
Yang D C, Lee J D, Huang C C, Shih H I, Chang C M. Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan. Arch Gerontol Geriatr 2015; 60: 437-442.
Tucker K L, Buranapin S. Nutrition and aging in developing countries. J Nutr 2001; 131: 2417S2423S.
Frencken J E, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol 2017; 44 (Suppl 18): S94-S105.
Thorstensson H, Johansson B. Why do some people lose teeth across their lifespan whereas others retain a functional dentition into very old age? Gerodontology 2010; 27: 19-25.
Lopez R, Smith P C, Gostemeyer G, Schwendicke F. Ageing, dental caries and periodontal diseases. J Clin Periodontol 2017; 44 (Suppl 18): S145-S52.
Carvalho J C, Schiffner U. Dental caries in European adults and senior citizens 1996-2016: ORCA Saturday Afternoon Symposium in Greifswald, Germany - Part II. Caries Res 2018; 53: 242-252.
Gati D, Vieira A R. Elderly at greater risk for root caries: a look at the multifactorial risks with emphasis on genetics susceptibility. Int J Dent 2011; 2011: 647, 168.
Heasman P A, Ritchie M, Asuni A, Gavillet E, Simonsen J L, Nyvad B. Gingival recession and root caries in the ageing population: a critical evaluation of treatments. J Clin Periodontol 2017; 44 (Suppl 18): S178-S93.
Hayes M, Da Mata C, Cole M, McKenna G, Burke F, Allen P F. Risk indicators associated with root caries in independently living older adults. J Dent 2016; 51: 8-14.
Ritter A V, Shugars D A, Bader J D. Root caries risk indicators: a systematic review of risk models. Community Dent Oral Epidemiol 2010; 38: 383-397.
Zenthofer A, Schroder J, Cabrera T, Rammelsberg P, Hassel A J. Comparison of oral health among older people with and without dementia. Community Dent Health 2014; 31: 27-31.
Tugnait A, Clerehugh V. Gingival recession - its significance and management. J Dent 2001; 29: 381-394.
Pitts N B, Ekstrand K R, Foundation I. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol 2013; 41: e41-52.
Ismail A I, Pitts N B, Tellez M et al. The International Caries Classification and Management System (ICCMS) An Example of a Caries Management Pathway. BMC Oral Health 2015; 15 (Suppl 1): S9.
Kamppi A, Tanner T, Pakkila J, Patinen P, Tjaderhane L, Anttonen V. Comparison of simple screening criteria with the International Caries Detection and Assessment System classification in determining restorative treatment need. Int Dent J 2016; 66: 63-70.
Ismail A I, Tellez M, Pitts N B et al. Caries management pathways preserve dental tissues and promote oral health. Community Dent Oral Epidemiol 2013; 41: e12-40.
Tellez M, Gomez J, Pretty I, Ellwood R, Ismail A I. Evidence on existing caries risk assessment systems: are they predictive of future caries? Community Dent Oral Epidemiol 2013; 41: 67-78.
Hayes M, Da Mata C, McKenna G, Burke F M, Allen P F. Evaluation of the Cariogram for root caries prediction. J Dent 2017; 62: 25-30.
Schwendicke F, Gostemeyer G. Cost-effectiveness of root caries preventive treatments. J Dent 2017; 56: 58-64.
Featherstone J D B, Chaffee B W. The Evidence for Caries Management by Risk Assessment (CAMBRA). Adv Dent Res 2018; 29: 9-14.
Chi D L, Berg J H, Kim A S et al. Correlates of root caries experience in middle-aged and older adults in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network. J Am Dent Assoc 2013; 144: 507-516.
Ekstrand K R, Poulsen J E, Hede B, Twetman S, Qvist V, Ellwood R P. A randomized clinical trial of the anti-caries efficacy of 5000 compared to 1450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents. Caries Res 2013; 47: 391-398.
Heijnsbroek M, Paraskevas S, Van der Weijden G A. Fluoride interventions for root caries: a review. Oral Health Prev Dent 2007; 5: 145-152.
Lynch E, Baysan A, Ellwood R, Davies R, Petersson L, Borsboom P. Effectiveness of two fluoride dentifrices to arrest root carious lesions. Am J Dent 2000; 13: 218-220.
Marsh P D. In Sickness and in health what does the oral microbiome mean to us? An ecological perspective. Adv Dent Res 2018; 29: 60-65.
Takahashi N, Nyvad B. Ecological hypothesis of dentin and root caries. Caries Res 2016; 50: 422-431.
Do T, Dame-Teixeira N, Naginyte M, Marsh P D. Root surface biofilms and caries. Monogr Oral Sci 2017; 26: 26-34.
Belibasakis G N. Microbiological changes of the ageing oral cavity. Arch Oral Biol 2018; 96: 230-232.
Schupbach P, Osterwalder V, Guggenheim B. Human root caries: microbiota in plaque covering sound, carious and arrested carious root surfaces. Caries Res 1995; 29: 382-395.
Schupbach P, Osterwalder V, Guggenheim B. Human root caries: microbiota of a limited number of root caries lesions. Caries Res 1996; 30: 52-64.
Sanchez-Garcia S, Reyes-Morales H, Juarez-Cedillo T, Espinel-Bermudez C, Solorzano-Santos F, Garcia-Pena C. A prediction model for root caries in an elderly population. Community Dent Oral Epidemiol 2011; 39: 44-52.
Mira A, Simon-Soro A, Curtis M A. Role of microbial communities in the pathogenesis of periodontal diseases and caries. J Clin Periodontol 2017; 44 (Suppl 18): S23-S38.
Ekstrand K, Martignon S, Holm-Paedersen P. Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years. Gerodontology 2008; 25: 67-75.
Wu B, Fillenbaum G G, Plassman B L, Guo L. Association Between Oral Health and Cognitive Status: A Systematic Review. J Am Geriatr Soc 2016; 64: 739-751.
Bischoff S C, Boirie Y, Cederholm T et al. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr 2017; 36: 917-938.
Gronbeck-Linden I, Hagglin C, Petersson A, Linander P O, Gahnberg L. Discontinued dental attendance among elderly people in Sweden. J Int Soc Prev Community Dent 2016; 6: 224-229.
Naka O, Anastassiadou V, Pissiotis A. Association between functional tooth units and chewing ability in older adults: a systematic review. Gerodontology 2014; 31: 166-177.
Nakanishi N, Hino Y, Ida O, Fukuda H, Shinsho F, Tatara K. Associations between self-assessed masticatory disability and health of community-residing elderly people. Community Dent Oral Epidemiol 1999; 27: 366-371.
Bertl K, Loidl S, Kotowski U et al. Oral health status and dental care behaviours of head and neck cancer patients: a cross-sectional study in an Austrian tertiary hospital. Clin Oral Investig 2016; 20: 1317-1327.
Belibasakis G N, Bostanci N, Marsh P D, Zaura E. Applications of the oral microbiome in personalized dentistry. Arch Oral Biol 2019; 104: 7-12.
This work was supported by Institutional funds.
About this article
Cite this article
Gavriilidou, N., Belibasakis, G. Root caries: the intersection between periodontal disease and dental caries in the course of ageing. Br Dent J 227, 1063–1067 (2019). https://doi.org/10.1038/s41415-019-0973-4
British Dental Journal (2020)