Accessing and restoring root caries: a case report

Adequate access to root caries can be problematic. The inability to view, isolate, and access the entire lesion may result in residual caries, poor adaptation of the restoration, and defective margins. Minor periodontal procedures, ranging from a mini-flap involving only one tooth, to conventional flap surgery can provide increased visibility and access to these troublesome areas. Through utilization of this technique, excellent preparations and restorations can be achieved. Restorative materials with a high potential for fluoride release as well as uptake should be highly considered in cases of root caries. The selection of a conventional or resin-modified glass ionomer provides several advantages. Most notably are the ability of these restoratives to chemically bond to tooth structure, and to provide significant fluoride release and uptake. These properties are not present in amalgam, composites, or compomers. Additionally, the material itself is relatively easy to use and provides an effective zone of caries inhibition around the margins of the restoration. Glass ionomers are not as sensitive to moisture as conventional resin composites or compomers, and, as a result, may provide a better bond to tooth structure and margination in areas where moisture control is troublesome. Finally, the polymerization shrinkage of these materials is not as great as resin composites, which should also improve marginal integrity. Clinical studies have demonstrated longevity of ten years or greater as well as success in xerostomic patients. Management of xerostomic patients should be directed toward finding satisfactory methods to relieve dryness. Some prescription medications are available, but should only be recommended after consultation with the primary care physician. Oral moisturizers are also available as are saliva substitutes. Caution should be used when recommending saliva substitutes due to the fact that some commercial products have been demonstrated to have a pH below the demineralization point of enamel. Products of this nature should be avoided. In the last few decades, the age of the patient population has increased and individuals have a greater tendency to maintain their natural dentition throughout their entire life. Gingival recession and subsequent root exposure has become more prevalent in the adult population. Additionally, the use of prescription medications that impact the flow and consistency of saliva is widespread. As a result of these phenomena, it has been predicted that root caries will become more prevalent. When preventive measures prove to be ineffective and restorations must be placed, access, visibility, and appropriate material selection are paramount. A combined minor periodontal surgery and restorative procedure is relatively simple, and when done properly, can provide excellent and affordable dentistry in these problematic areas.