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.