Today I’ll be talking about a large concern for oral health in the population of dependant seniors, root caries (caries is another word for cavities). First and foremost, what are root caries? According to Darby & Walsh “Root caries is dental caries involving the tooth root, cementum, or cervical area of the tooth. Root caries is found most frequently in the elderly population, in whom root exposure is common because of gingival recession” (Darby & Walsh, 2014, p.263)
To better understand the significance of root caries/cavities you need the basic knowledge of what a cavity is and how they form. A cavity forms on a susceptible tooth when there are cavity causing bacteria called cariogenic bacteria present. The bacteria consumes carbohydrates from your diet and create acid. These acids as a result wear away and weaken the tooth creating a cavity (Darby & Walsh, 2014, p.261). Caries are a bacterial infection where the bacteria slowly wears away at the tooth structure and starting from the outermost layer called enamel into the second layer called dentin and eventually into pulp chamber if not treated in time (Darby & Walsh, 2014, p.261). Once the cavity progresses into the dentin some sensitivity to hot, cold or sweets may be felt (Darby & Walsh, 2014, p.267). If the cavity progresses to the pulp chamber pain may be experienced because this is where the nerves of the tooth are found (Darby & Walsh, 2014, p.267). Unfortunately, this disease is only reversible at the very first stage of progression and without regular dental visits for seniors the opportunity to stop the disease from progressing often gets missed.
The signs and symptoms of a cavity greatly depend on the location and extent of cavity progression. In the beginning stages of cavity formation symptoms may go unnoticed however as it further progresses some sign and symptoms may include:
- Toothache, spontaneous pain or pain that occurs without any apparent cause (Mayo Clinic, 2017).
- Tooth sensitivity (to hot or cold) (Mayo Clinic, 2017).
- Mild to sharp pain when eating or drinking something sweet (Mayo Clinic, 2017).
- Visible holes or pits in your teeth (Mayo Clinic, 2017).
- Brown, black or white staining on any surface of a tooth (Mayo Clinic, 2017).
- Pain when you bite down (Mayo Clinic, 2017).
You might be wondering to yourself why are root caries such a predominate issue in the dependant senior population? You may be surprised by many of the factors that make this population so at risk. Dependant seniors are particularly a high risk population for root caries due to several reasons including more frequent root exposure as a result of gingival recession, decreased salivary flow which is often a side effect of many common medications, compromised immune systems, dietary habits, knowledge deficit, socioeconomic status, lack of regular dental visits/funding, and limited dexterity resulting in inefficient oral hygiene technique and plaque removal (Darby & Walsh, 2014, p.263). One of the largest factors to take into consideration is that the current population of dependant seniors did not fully experience the benefits of water fluoridation “one of the 10 great public health achievements of the 20th century” (CDC, 2016) as it only began in 1945 and has been attributed to a 25% decrease in cavities in both children and adults. (CDC, 2016).
Unfortunately tooth structure cannot restore itself so it is important for us to try to preserve the tooth structure to the best of our ability and focus on a preventative approach. Root caries can be prevented through regular oral hygiene home care (proper brushing and flossing), regular dental visits, fluoridated water/products/treatments, avoiding frequent snacking (minimizing acid attacks), consuming a non-cariogenic diet and using antibacterial treatments such as mouth rinses (Darby & Walsh, 2014). It is important for us to preserve tooth structure for several reasons including aesthetic purposes which are often linked with self-esteem, freedom from pain that may arise with the progression of the cavity, saving time as practicing proper oral hygiene care daily can prevent the need for treatment of cavities and cost – preventative care such as regular oral hygiene practice can alleviate the need for restorative treatment.
Once the cavity has progressed past the initial stage, known as an incipient lesion, it becomes irreversible. The treatment for caries is having the dentist remove the decayed portion of the tooth and restore the void area with restorative dental material, most commonly known as a filling. The filling may be made of the following materials:
- Gold (Darby & Walsh, 2014, p.671)
- Porcelain (Darby & Walsh, 2014, p.671)
- Silver (Darby & Walsh, 2014, p.671)
- Amalgam (Darby & Walsh, 2014, p.671)
- Composites Resin fillings (Darby & Walsh, 2014, p.671)
- Glass ionomer (Darby & Walsh, 2014, p.671)
Another factor to take into consideration is the financial burden that comes along with restorative dental treatments. Regrettably, often dependant seniors do not have the means, funding or access to the dental care they may require and quite frankly it often is not a priority despite the many implications that arise as a result of cavities.
A few steps that can be taken by family members and nursing staff are: reminding seniors to practice proper oral hygiene care, providing seniors with the proper oral hygiene aids (taking manual dexterity and physical limitations into consideration), helping them perform oral hygiene, providing them with transportation to dental appointments and getting educated to know what to signs and symptoms to look for and when booking an appointment to the dentist is necessary.
MH
REFERENCES
CDC. (2016, October 4). Community Water Fluoridation | Division of Oral Health | CDC. Retrieved from https://www.cdc.gov/fluoridation/index.html
Darby, & Walsh (2014). Dental Hygiene: Theory and Practice 4th Edition. St. Louis: Elsevier Canada
Mayo Clinic. (2017, July 19). Cavities/tooth decay. Retrieved from https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892
Rabb-Waytowich, D. (2009). Water Fluoridation in Canada: Past and Present. JCDA, 75(6), 451-454. Retrieved from https://www.cda-adc.ca/jcda/vol-75/issue-6/451.pdf.
Bringing Life to Your Smile 
Hello,
I’ve had an experience before where a client was not financially able to restore his root caries. I was empathetic to him and I wished that I could just pay for him.
Unfortunately, the population that root caries typically affect is not well-off financially, as you pointed out in this post. As the senior population grows, I truly hope that any healthcare provider is knowledgable in interventions and management of seniors’ oral health. In addition to financial troubles, you mentioned that common medications put them in a higher risk for root caries due to xerostomia and other common side effects in the oral mucosa. As this is unavoidable, educating seniors or their caregivers/family on how to manage this changing environment of the mouth.
I found this resourceful link of a fact sheet where family/caregivers and seniors themselves can gain knowledge on maintaining or improving the senior’s/their oral health. Also it touched base on root caries as one of the more prevalent types of decay in this age group. I hope you can check it out as it informs on other risks in terms of oral health for seniors.
Click to access ODHA-Facts-seniors.v2.pdf
– The A-team (Bianca)
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Hello Bianca,
Thank you for such a thoughtful response! You’ve raised some great points regarding root caries in the dependant senior population.
Unfortunately, I can relate regarding having a client who was not financially equipped to have a restoration placed and that is always heartbreaking to see. I think the factsheet you’ve included will be a great resources for clients, family and caregivers within this population that I’ll be seeing in the future!
With so many risk factors for the development of caries in this population and the financial burden that comes along with treatment we believe that advocacy for adequate dental care in this population is beyond necessary!
Stay tuned for future blog posts related to advocacy and lack of funding/ dental programs for the dependant senior population!
Regards
MH
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Hello MH,
Very informative post on an issue that, I believe, is not very well known. According to the ADA (2019) “approximately 50% of persons older than 75 years of age have root caries affecting at least one tooth” (Center for Scientific Information, ADA Science Institute, 2019). Your article has made me think about what could be done to reduce the prevalence of root caries in the senior population. Although root caries is clearly such a prevalent issue in older adults, I think it is hard to determine an exact method to prevent this issue since there is so many contributory factors.
Like you said some of the factors contributing to root cares are: gingival recession, medication, lack of regular dental visits, and inefficient oral hygiene technique. In order to effectively prevent root caries in seniors it would involve a thorough knowledge of each individual’s specific oral health, contributory factors, their ability to perform oral hygiene at home, as well as other factors. This is unfortunately not an option for many seniors due to lack of coverage for professional oral care under the current health care in Canada. However, recently the Canadian Press released an article claiming “Ontario will be announcing free dental care for low-income seniors” (The Canadian Press, 2019) and this would mean “Anyone 65 and over in the province making under $19,300 — or $32,300 for couples — would qualify” (The Canadian Press, 2019). This budget change could be a step in the right direction in allowing seniors access to the dental care they need to avoid preventable diseases like root caries.
Focusing specifically on dependant seniors with cognitive impairment, they are at an increased risk for caries due to the decreased ability to perform oral hygiene care at home (Center for Scientific Information, ADA Science Institute, 2019). I believe an important intervention required to help serve the needs of this population would be to have interprofessional care between dental professionals and the caregivers who are providing daily care to these individuals. With collaboration between both health professionals, the daily caregivers could receive the proper knowledge on how to care for the oral hygiene needs of this population.
Courtney C
References
Center for Scientific Information, ADA Science Institute. (2019, March). Oral Health Topics- Aging and Dental Health. Retrieved from American Dental Association: https://www.ada.org/en/member-center/oral-health-topics/aging-and-dental-health
The Canadian Press. (2019, April). Free dental care for low-income seniors to be announced in budget. Retrieved from CBC News: https://www.cbc.ca/news/canada/toronto/ontario-budget-health-politics-free-dental-care-1.5090396
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Hello Courtney,
Thank you for your insightful comment. You’ve raised some great points regarding how multifactorial of an issue this truly is. One of the reasons that I’m so passionate about the needs of this population is that I feel they are often overlooked. I believe that this population is already at such a disadvantage for optimal oral health with the number of risk factors they encounter on a day to day basis, many of which are beyond their control. The statistic you provided from the Center for Scientific Information, ADA Science Institute is truly eye opening to how in need this population is and why I am such a big advocate for necessary changes.
As previously mentioned, I agree that unfortunately this problem doesn’t have an easy fix however there are so many we can do to help improve the oral health of this population. I do believe that one of the most important roles of caregivers would be providing interprofessional care because as we know not only does oral health affect our systemic health but also self-esteem and quality of life.
I’m so happy you brought up the recent announcement of “free dental care for low-income seniors” as cost is one of the many different barriers that play a role in prevent dependant seniors from receiving regular dental visits. Stay tuned as we will discussing the financial aspect of care for this population in blog posts to come!
Regards,
MH
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