Root caries: what it is, causes, and how it is detected

Root caries is the destruction of hard tissues in an area that is normally covered by the gum. A dentist may refer to such a lesion at the neck of the tooth or under the gum, and it is useful for a patient to understand where it comes from and why it can be difficult to notice.

What root caries is

Caries in general is a chronic disease in which acids produced by bacteria destroy the hard tissues of the tooth, and over time a cavity forms in the dentin. Root caries is a special case: the lesion arises on the exposed surface of the root. In older people, gum recession and tooth wear increase the risk of caries on exposed root surfaces. Caries can present with white, brown, or black spots and a cavity.

Why caries appears near the gum and under the gum

The mechanism is the same as in any caries: bacteria in dental plaque ferment carbohydrates and release acids, and enamel loses minerals at a pH of 4.5. Natural fissures and the spaces between teeth provide conditions for plaque to remain fixed for a long time. A separate cause is gum recession: in older people the gum recedes, exposing the root, and the risk of destruction increases in these areas. Factors also include lack of fluoride, low saliva production due to medications, certain diseases or cancer treatment, and frequent sweet and starchy foods and drinks.

Symptoms of root caries

In the early stages there are usually no symptoms. As it progresses, tooth pain appears, sharp sensitivity to sweet, hot, or cold, and white, brown, or black spots. If infection sets in, an abscess may form — a collection of pus that causes pain, facial swelling, and fever.

• Tooth pain (toothache)
• Reaction to sweet, hot, cold
• White, brown, or black spots on the tooth

Who is at risk

The main risk factors are inadequate hygiene and excess sugar and starch in the diet. There is an increased risk in people with dry mouth, with fluoride deficiency, and in young children who are fed juice from a bottle or given one at night. In older people, due to gum recession and tooth wear, the exposed root surfaces are more often affected.

How root caries is diagnosed

The doctor examines the teeth and gums, probes suspicious areas with an instrument, and asks about symptoms. Sometimes an X-ray is needed — it helps to see a lesion under the gum and in the spaces between teeth. Additionally, the dentist may assess caries susceptibility using tests: enamel staining, plaque assessment, and tissue acid resistance.

Why it is dangerous and when to see a dentist

Without treatment, destruction reaches the pulp, causes inflammation, and may end in tooth extraction. You should see a dentist for tooth pain, a sharp reaction to food and drink, and also if the gums hurt, swell, or bleed when brushing. Regular check-ups are needed even without complaints: if there has been no check-up for two years, and under the age of 18 — for a year, it makes sense to book an appointment with a doctor.

On its own it is not a reason to call an ambulance; 103 or 112 — if, along with toothache, pronounced facial swelling and high fever appear (signs of an abscess).

This material is for reference: it explains what the doctor assesses but does not replace a dentist's consultation — the decision on diagnosis and management remains with you and your doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer