Root Cavities – Reasons And Risk Factors

root cavities
Roots of teeth exposed on an x-ray in an elderly patient

Root cavities affect middle to old-aged people whose roots of teeth are exposed in the mouth. The increase in life expectancy and a simultaneous reduction in tooth loss worldwide have placed older adults at risk of developing gum recession in teeth and the consequent root decay.

Approximately 15-27% of people above 75 years suffer from root decay in Australia and New Zealand.  The current generation of older adults has fewer root caries than the previous generation. The success lies in a combined effect of water fluoridation and the adoption of a healthy lifestyle.

Causes of root cavities

Enamel, a tough and highly mineral-dense layer, makes the outer layer of the crown of a tooth. The Crown of a tooth is the part of the tooth visible in the mouth and healthy gums start at the junction of the crown and the root of a tooth.

Enamel is designed by nature to resist the forces of biting and brushing applied to it throughout the day. However, the root of the tooth is enveloped by cementum that’s less hard and mineral-dense than the enamel. That’s why it is naturally covered by the gums in the mouth.

Several factors like aging, diseases like diabetes or heart disease, and aggressive tooth brushing over the years increase the chances of root exposure in the mouth. A condition is known as gum recession.  Once roots get exposed to the mouth, it is destroyed much faster by the mouth bacteria.

 Root surfaces are at risk of destruction by enzymes present in saliva and the protein breakdown products inside the dentin (layer next to cementum) provide nutrients for the invading bacteria. Root caries is less dependent on the sugars present in the diet. However, dental plaque and the consumption of refined foods and drinks accelerate the process of root decay.

the symptoms and Symptoms of root cavity?

Root caries affects people over 45 years and above. You may feel or experience on or more of the signs and symptoms:

  • A yellow to light brown discoloration along the gum line with a soft and leathery texture.
  • A dark brown to black discoloration along the gum line which is hard.
  • Sensitivity to heat, cold, sweet foods, and drinks.
  • A dull, constant toothache or more severe, sharp tooth pain in the affected area.
  • Pain when chewing.
  • Swelling or redness in the gum tissue around one tooth.
  • Tooth that feels loose.
  • Discoloration in tooth enamel.
  • Gum tissue recession.

 Risk factors for root cavities

Frequently observed factors that puts patients at risk of decay are:

  • Smoking: Smokers develop more gum recession and root decay than non-smokers. Smoking lowers the acid-neutralizing capability of saliva, and hence, increase the chance of decay. Smoking also raises the levels of tooth decay-causing bacteria for instance mutans streptococci and lactobacilli.
  • Male gender: Men report root cavities more than women because of the negligence of health and routine dental checkups. A routine check-up is an effective way of promoting good oral health and detecting disease at an early stage.
  • Bad oral (mouth) hygiene: Root cavities occur in people with poor oral hygiene and infrequent tooth brushing habit. Sugar availability and plaque buildup are well-known factors that trigger tooth decay or dental caries. Moreover, toothbrush bristles remove plaque and fluoridated toothpaste donates fluoride to the tooth and strengthens it, thus creating a preventive effect against root caries.
  • Social status: People of low socioeconomic status bear the most root caries burden. Because of the less healthy lifestyle and limited access to dental care, either preventive or treatment. A combination of these factors increases the risk of root caries.

Treatment of tooth cavities

Treatment strategies for root cavities rely on the size, depth, and location of the cavity, aesthetic requirements, and physical condition of the patient.

Fluoride treatment

Early cavities which are accessible and cleanable could be treated with fluoride varnish. Professionally applied high-fluoride varnish or gel and/or professionally recommended the use of high-fluoride toothpaste successfully controls root decay.

Deep root cavities may also benefit from the remineralizing effect of the fluoride treatment. This often requires less removal of tooth decay during the repair or even avoiding a filling altogether. Black hard decay shows arrested decay and can be left behind and a fluoride varnish placed.


Glass-ionomer cement or composite fillings are commonly used for repairing root cavities. However, most of the root fillings fail due to the poor visibility and access to the area of fillings, and the inability to keep the area dry as fillings bond best to the dry tooth with no moisture. Therefore, in the areas in the mouth where it is difficult to maintain a dry field, the soft decay is removed and the black, hard one is left and the tooth is treated with a fluoride-releasing material.

Prevention of root cavities

  • Good oral hygiene prevents root caries. Given that mouth bacteria acting on dietary sugars is the main cause for both coronal and root cavities.
  • Switching to a healthy diet, particularly a diet rich in fiber brushes away bacteria and plaque from teeth. Drinking fluoridated tap water and fluoride from other sources help keep cavities at bay.
  • Dentists advise specific measures like the use of electric toothbrushes and chemical plaque control measures for medically compromised people and those with impaired manual dexterity.
  • Prevention of root caries goes hand in hand with controlling the gum recession. The importance of explaining the correct brushing techniques to people and the use of soft toothbrushes cannot be overemphasized. However, the ability to carry out daily activities and intellectual functions diminishes with age and age-related diseases such as dementia, resulting in functional limitations among older adults. This disrupts the normal daily activities like oral hygiene practices etc. Dentist must guide their caregivers about the risk factors and preventive measures for root cavities. Regular dental checkups should not be missed in such patients.


  • Root cavities are common in middle to old-aged people and peak in people above 70 years.
  • A yellow to brown discoloration along the gum line is the sign that you have a root cavity.
  • Factors like old age, male gender, low socioeconomic status, brushing teeth infrequently, poor oral hygiene, missing regular dental visits, smoking, and dry mouth are associated with root cavities.
  • Early cavities are treated with fluoride varnishes and glass-ionomer cement, or composite fillings are commonly used for repairing root cavities.
  • Improved oral hygiene practices, locally applied preventive measures, good dietary habits, and regular dental check-ups are crucial approaches to prevent both gum disease progression and root caries.

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