Root Caries in Older Adults: Clinical Management Guide

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

1. Risk
2. Assessment
3. Decision table
4. Management
5. FAQs
6. References

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

1. Record recent lesions, restorations, plaque, diet, fluoride exposure and previous periodontal attachment loss.
2. Review medications, dry-mouth symptoms, hydration and functional ability.
3. Clean and dry the surface, then assess texture, colour, cavitation, cleansability and proximity to the gingival margin.
4. Distinguish active soft or leathery lesions from hard, smooth lesions that may be arrested.
5. Consider the patient’s goals, ability to cooperate, caregiver support and restorative feasibility.
6. Document a recall and monitoring plan using the same clinical criteria.

Root-lesion decision table

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.