2023 National Love Teeth Day Core Message (IV) Topical fluoride application, proper diet, and prevention of root caries

Author: Liu Chang and Tai Baojun, School of Stomatology, Wuhan University

As they age, the elderly often experience gum atrophy and exposed tooth roots. Due to reduced saliva secretion, inadequate cleaning, and local plaque accumulation, the tooth neck and root surface are prone to caries, namely root caries, which is one of the common oral diseases in the elderly (Figure 1).

The fourth national oral health epidemiological survey found that 62% of the elderly in my country have root caries, and on average each elderly person has two teeth with root caries in their mouth.

In the early stages of root caries, the tooth will be sensitive to cold, hot, sour and sweet stimuli, which will lead to tooth defects and affect the appearance. Severe root caries will develop into pulpitis and apical periodontitis, causing tooth pain and even swelling of the gums and face. In addition, the affected teeth are prone to fracture when the force is uneven, forming residual roots, which hinders pronunciation. The integrity of the dentition is also destroyed, resulting in difficulty in chewing, which greatly affects the quality of life and overall health of the elderly.

Figure 1 Root caries (the above picture is from "Oral Health, Start with Me")

Compared with the caries on the crown, the root caries that occurs on the adjacent surface of the tooth near the gums is hidden and not easy to be found, and it is not conducive to the entry of treatment instruments. In addition, because the protective layer of the root surface (cementum) is thinner and less hard than the protective layer of the crown (enamel), the root surface is more susceptible to caries under the action of the acid produced by the plaque. Once the root caries occurs, it progresses very quickly. These characteristics of root caries increase the difficulty of treatment. Therefore, the prevention of root caries is very important.

To prevent root caries, topical fluoride can be used. Fluoride can reduce the dissolution of enamel, inhibit the demineralization of enamel, that is, the loss of calcium, phosphorus and other components, and promote the remineralization of demineralized areas on the enamel, thereby terminating and preventing the occurrence of caries.

You can use fluoride toothpaste to brush your teeth every day. Fluoride toothpaste refers to toothpaste containing fluoride. The concentration of fluoride toothpaste used by the elderly is generally above 1000mg/kg.

Using fluoride mouthwash can also enhance the teeth's ability to resist acid. Mouthwash containing 0.2% sodium fluoride should be used once a week, and mouthwash containing 0.05% sodium fluoride should be used once a day. Fluoride mouthwash should be gargled in the mouth for one minute and then spitted out. Do not eat or rinse your mouth with water within half an hour.

You can also use fluoride dental floss and fluoride interdental brushes to clean the adjacent surfaces of teeth and the root surfaces in the interproximal spaces.

For the elderly with exposed root surfaces, they should also go to dental medical institutions regularly to receive professional root fluoride application to prevent the occurrence of root caries (Figure 2).

Figure 2 Fluoride application on the root surface

In order to prevent root caries, the elderly should also eat a balanced diet, control the total amount and frequency of sweets and beverages, eat more fresh vegetables and fruits, eat more high-protein foods such as soy products, eggs, and milk, and foods that are easy to chew and digest. Avoid eating foods that are too cold, too hot, or too hard or sharp.

When root caries occurs, timely treatment should be given to prevent the progression of caries. The more severe the root caries, the more complicated the treatment method and the lower the success rate of treatment. Therefore, it is recommended that the elderly undergo regular oral health examinations to detect root caries early and take appropriate treatment measures in time to maintain the integrity of the dentition, effectively exercise the chewing function, maintain clear pronunciation and beautiful facial shape.