Root Caries

As individuals age, gingival recession often occurs, exposing root surfaces composed of dentin and cementum. These tissues are significantly more susceptible to acid dissolution than enamel due to their lower mineral content. As a result, root caries lesions are more prevalent in older adults, especially those with periodontal attachment loss. In this population, several risk factors contribute to the development and progression of root caries. Decreased salivary flow, commonly due to polypharmacy and age-related changes in salivary gland function, compromises the natural protective mechanisms of the oral cavity. Many medications—particularly antihypertensives, antidepressants, and anticholinergics—are known to induce xerostomia, which reduces oral clearance and buffering capacity. Additionally, dietary changes such as increased consumption of soft, carbohydrate-rich foods, along with challenges in maintaining adequate oral hygiene due to cognitive or physical limitations, further exacerbate the risk.

Recent evidence also suggests that root caries is associated with frailty, cognitive decline, and institutionalization in older populations, and managing these lesions requires tailored preventive and restorative strategies. Non-invasive interventions such as high-fluoride toothpaste, silver diamine fluoride application, and regular professional cleanings have shown efficacy in arresting root caries and should be part of individualized care plans for older adults.