Root caries is a biofilm-mediated lesion on an exposed root surface. In older adults it often reflects the interaction of recession, previous caries, plaque stagnation, frequent sugars, reduced saliva, medications, dexterity limitations and dependence on caregivers. Management must combine patient-level risk control with site-level lesion assessment.
Contents
Why older adults are vulnerable
More teeth retained into later life means more root surfaces can become exposed. Hyposalivation, polypharmacy, carbohydrate-containing supplements, partial dentures, limited dexterity, cognitive impairment and difficulty accessing care can accelerate disease. Age alone is not the cause; risk is individual and changeable.
Assess the patient and the lesion
- Record recent lesions, restorations, plaque, diet, fluoride exposure and previous periodontal attachment loss.
- Review medications, dry-mouth symptoms, hydration and functional ability.
- Clean and dry the surface, then assess texture, colour, cavitation, cleansability and proximity to the gingival margin.
- Distinguish active soft or leathery lesions from hard, smooth lesions that may be arrested.
- Consider the patient’s goals, ability to cooperate, caregiver support and restorative feasibility.
- Document a recall and monitoring plan using the same clinical criteria.
Root-lesion decision table
| Finding | Interpretation | Management direction |
|---|---|---|
| Soft or leathery plaque-retentive lesion | Likely active | Intensify prevention and select nonrestorative or restorative care |
| Hard, smooth, cleansable surface | May be arrested | Maintain prevention and monitor |
| Non-cavitated accessible lesion | Potential for nonrestorative control | Fluoride-based and behaviour-focused strategy |
| Cavitated but cleansable lesion | Active disease with structural loss | Consider SDF or restoration according to goals and guidance |
| Deep, symptomatic or non-restorable lesion | Pulpal or structural complication | Full diagnostic and treatment planning pathway |
Personalised prevention and treatment
Support twice-daily fluoride toothpaste use at an appropriate concentration, improve plaque access and reduce the frequency of free sugars. Address dry mouth and involve caregivers where necessary. Professional fluoride and silver diamine fluoride may be appropriate under current guidance and informed consent. When restoration is needed, moisture control, margin location, lesion access and the patient’s ability to maintain the site affect material and design choices.
Related DentalReach reading
- caries risk assessment and prevention
- xerostomia and oral health
- silver diamine fluoride and caries arrest
Frequently asked questions
Is every dark root lesion active caries?
No. Colour alone is insufficient; assess texture, plaque stagnation, cavitation, cleansability and change over time.
Can root caries be managed without drilling?
Some accessible lesions can be arrested or controlled nonrestoratively, depending on activity, cavitation, cooperation and current guidance.
Should caregivers be included in the plan?
Yes, when the patient needs support. Daily plaque control, fluoride use and dietary routines may depend on caregiver participation.