Root caries is decay that develops on the exposed root surfaces of teeth, occurring when gingival recession uncovers the cementum and dentin apical to the cementoenamel junction (CEJ). Because cementum and dentin are significantly less mineralized than enamel, root lesions can advance toward the pulp with considerable speed if left unaddressed.

Why Root Caries Is a Growing Concern

Root caries disproportionately affects older adults whose years of cumulative gingival recession leave increasing lengths of root surface vulnerable to bacterial attack. As more people retain their natural teeth into later decades, prevalence has risen sharply. Many older patients also take medications that cause xerostomia (dry mouth), reducing saliva’s buffering and remineralizing capacity and dramatically accelerating lesion formation. A prior history of periodontal disease compounds risk by increasing the extent of attachment and root exposure.

Common Risk Factors

• Gingival recession exposing cementum and dentin at or apical to the CEJ
• Xerostomia from systemic medications, radiation therapy, or systemic conditions
• A history of periodontal disease with significant attachment loss
• Poor oral hygiene and plaque accumulation at the gingival margin
• Frequent consumption of fermentable carbohydrates or acidic foods and beverages

Clinical Presentation and Detection

Root caries typically presents as a discolored lesion — tan, brown, or black — at or just below the cementoenamel junction. On probing, an explorer tip catches or penetrates softened tissue. Active lesions feel leathery or soft; arrested lesions are usually darker and hard. Early root lesions can be radiographically subtle, making careful tactile and visual examination essential during routine clinical assessment.

Treatment and Prevention

Management is guided by lesion activity and severity. Non-cavitated active lesions may be addressed non-operatively with:

• High-concentration fluoride varnish or prescription-strength fluoride dentifrice
• Silver diamine fluoride (SDF) for rapid arrest, particularly in high-risk or medically complex patients
• Remineralizing agents containing calcium phosphate to support cementum rehardening

Cavitated lesions require restorative care. Glass ionomer cement is frequently preferred over composite resin for root-surface restorations because of its fluoride-releasing properties and tolerance of a moist operative field. Deeply progressed lesions involving the pulp may necessitate endodontic treatment or extraction.

Routine clinical surveillance combined with targeted preventive measures — especially topical fluoride and proactive management of xerostomia — offers the most effective means of detecting and arresting root caries before advanced intervention becomes unavoidable.