Like so many oral diseases, root decay can form quickly and often without warning. Root decay occurs near the gumline, along the exposed root surface of a tooth. It can develop on the outside of the teeth – where it is usually visible – or in between teeth, where it often cannot be detected by anyone other than oral healthcare providers using x-rays. When it takes form, root decay is indicated by notches in the teeth along the gumline, or discoloration of the root along the gumline. There may not be sensitivity associated with root decay. Because roots are porous, with no hard outer shell for added protection, they are much more susceptible than teeth to decay…a decay that can be extremely aggressive and damaging if not cared for promptly.
Aging Increases Susceptibility
People over 60 years old are at the greatest risk for developing root decay. The aging process – which for teeth, begins as early as 20 – causes gums to shrink. And as gums shrink, the roots of the teeth become exposed, resulting in a greater susceptibility to decay. As this occurs between teeth, food can collect and stick to the roots. It breaks down into sugar and causes decay. Prevention, however, must begin early – long before gums appear to shrink.
Check-Ups + Proper At-Home Care = Prevention
Root decay can be prevented by regular visits – at least every six months – to our office. Each visit should include thorough root cleanings, as well as more frequent radiographic evaluation with cavity-detecting x-rays. In addition, at-home flossing and proper brushing is essential for maintaining healthy roots. Part of at-home care must include cleaning between teeth and along the gumline. To help accomplish this task, we recommend using the Prox-A-Brush – a special toothbrush especially for cleaning between teeth, with a head that looks like a short pipe cleaner.
Caring For Root Decay
When root decay strikes, we apply a treatment process that restores current lesions and prevents future decay. First, lesions that are accessible on the outer surface of the teeth are filled with tooth-colored material that bonds to the healthy root structure and releases fluoride. We accomplish this during a single office visit. However, if a lesion is between teeth, a metallic onlay or a crown with a metal finish line may be necessary since direct access to the lesion is not available. Clinically it has been found that a metal finish line along the root surface is far superior to control root decay when compared to bonded restorations.
The second step in the process is to provide fluoride to prevent future decay. Fluoride can be administered three different ways – and selection of the method is based on the number of lesions you’ve had as well as your future risk.
1. In-office fluoride treatment
We use this method if we detect more than two areas of root decay. While this is similar to what is used for children to help strengthen their teeth as they develop, the formula helps strengthen and protect adults’ root surfaces as well. Once the fluoride is administered, there is no eating, drinking, smoking, or rinsing for 30 minutes. Inoffice fluoride is applied at each cleaning visit. Research shows that three fluoride treatments per year are successful in reducing the chance of decay. Unfortunately, two annual fluoride treatments were unsuccessful in controlling decay risk.
2. At-home fluoride use
We prescribe a rinse or toothpaste if we detect more than three areas of root decay. Patients must use the rinse or prescription strength toothpaste after breakfast and before going to bed. The prescription strength toothpaste has 5000 PPM (parts per million) fluoride – much stronger than over the counter toothpastes. We can provide this toothpaste for you in the office or write a prescription to be filled at your pharmacy. The fluoride rinse is prepared in a vial according to the directions; half of the rinse is taken into the mouth and swished for 30 seconds, then expectorated – followed by the other half of the rinse with the same routine. This prescription is typically filled in our office as neighborhood pharmacies do not typically stock this particular item and charge a premium for ordering it.
3. At-home fluoride trays
When your diagnosis calls for the highest level of protection available, we prescribe custom trays, usually when there are more than four areas of root decay. The fluoride used with this method is the same as what is used in our office. Patients who receive this fluoride treatment option are at the highest risk for root decay. They may have three or more root cavities, dry mouth (xerostomia) from medicine or systemic disease, or they may be undergoing radiation therapy of the head and/or neck or certain chemotherapies.
Soft custom fitting trays are made to fit teeth – one for the upper arch and the other for the lower. Patients use these trays every evening, just before going to bed. And before using the trays, patients must thoroughly floss and brush to eliminate food and plaque between teeth. To use the trays, patients simply fill the trays with the fluoride as instructed and seat them in the mouth. If excess fluoride seeps out – it should be expectorated, not rinsed. The trays must remain in the mouth for four minutes. After four minutes, the trays are removed and excess fluoride is expectorated, not rinsed. There is no eating, drinking, smoking, or rinsing for 30 minutes following at-home fluoride treatment. Trays should be cleaned with a toothbrush, rinsed with water, and left to air dry in a drawer or cabinet.