GC Back to your Roots MI Treatment solutions and Tips and Tricks for Root Caries

Back to your roots!

MI treatment solutions for root caries

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Root caries and the ageing population Challenges in dentate older adults Steady increases in both the absolute and relative numbers of older people – together with increased tooth retention into old age1 – pose particular challenges for the dental practice.

Aside from the repair and replacement of failed restorations, root caries will become a daily challenge within the ageing population. Once exposed to the oral environment, root surfaces are at greater risk of demineralisation, especially when patients have reduced saliva flow and diminished buffering capabilities.2,3 It is essential to approach root caries in a holistic way: identify the risk factors, prevent them from occurring and restore the already present cavities in a minimally invasive way.

Courtesy Wim Klüter, The Netherlands

Risk factors related to ageing • Reduced salivary flow and/or salivary pH: less buffering capacity to counteract acid attacks • General and oral health pathologies: risk of (co)morbidities • Medication intake and polypharmacy: risk of side effects, e.g. xerostomia • Reduction in fine motor skills: difficulties in maintaining oral hygiene

• Reduced abilities to cooperate because of cognitive or functional aspects: e.g. dementia, severe tremor, ...

• High dependency level: difficulties in finding dental care, e.g. not able to come to the dental office • Diet changes to increased sugar intake; increased preference for sweets

Identify GC TriPlaque ID Gel: identify new, old, and acid-producing plaque Using identification tools such as GC Tri Plaque ID Gel can help to identify cariogenic plaque, motivate patients and give them or their caretakers straightforward and objective feedback to optimise their brushing technique.

GC Tri Plaque ID Gel discloses the age and acidity of the biofilm Courtesy Dr Andrew Brostek, Australia

Pink/red Immature biofilm < 48h Blue/purple Complex biofilm > 48h Risk of gingivitis

Light blue Acidic plaque with pH < 4.5 This is a high-risk biofilm.

Saliva-Check BUFFER: how well does the saliva protect the teeth?

Chronic dry mouth and reduced salivary function due to various aetiologies occur in a substantial proportion of older people.

In 5 easy steps, Saliva-Check BUFFER helps to reveal underlying factors that disrupt the oral balance and cause demineralisation.3

HYDRATION

VISCOSITY

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ACIDITY

QUANTITY

QUALITY

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Root caries

Protect and prevent GC MI Paste Plus and MI Varnish: strengthen and desensitise The presence of fluoride and amorphous calcium phosphate in the saliva creates a favourable environment for tissue remineralisation.

Topical fluoride must be used at home and must be supplemented with regular professional application of fluoride varnish. Adjunctive use of bio-available calcium phosphates favours tooth repair and has shown impressive results in reducing hypersensitivity.4,5

GC MI Paste Plus contains RECALDENT (bio-available amorphous calcium phosphate; CPP-ACP) as well as fluoride (900 ppm).

It can be used overnight to enhance tooth repair and reduce hypersensitivity.

It is available in 5 delicious flavours that increase patient acceptance.

Patients with decreased salivary flow tend to show a preference for Vanilla flavour.

GC MI Paste Plus in 5 delicious flavours (left) and its fluoride-free alternative GC Tooth Mousse (right).

MI Varnish contains 22600 ppm fluoride as well as RECALDENT (CPP-ACP) and is intended for in office application. It adheres quickly to the teeth, without clumping and serves as a depot for minerals and fluoride, necessary to maintain or remedy the tooth integrity.

RECALDENT (CPP-ACP) and fluoride work in synergy: when RECALDENT (CPP-ACP) comes in contact with fluoride, it stabilises the fluoride ions to create the ideal source for building the more acid-resistant fluorapatite.

In office application of MI Varnish Courtesy Prof. Ian Meyers, Australia

RECALDENT™ is derived from milk casein. Do not use on persons with a milk allergy.

In case of allergic reaction: stop use, rinse mouth with water, and seek medical advice.

GC Dry Mouth Gel: alleviate xerostomia Dry Mouth Gel is a unique, sugar-free product to give long lasting comfort and to sooth symptoms of oral dryness. Uniquely, unlike most saliva substitutes, it has a neutral pH, preserving the oral pH within the safe range to prevent demineralization. It is colourless and comes in various pleasant flavours.

Use Dry Mouth Gel for relief during the day; for night-time prevention, MI Paste Plus is recommended to provide additional protection against caries, promote remineralisation and prevent and relieve hypersensitivity from exposed roots.

Dry Mouth gel does not interfere with the effectiveness of RECALDENT (CPP-ACP) or fluoride, so they can safely complement each other.

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Managing erosion, oral hygiene challenges and exposed roots with Fuji TRIAGE Fuji TRIAGE, a fluid glass ionomer, will help to protect the surface against caries formation and hypersensitivity • Fuji TRIAGE can bond chemically in a relatively moist environment6 • Root surfaces are fast and easily protected • The setting of the pink shade of Fuji TRIAGE can be accelerated with the dental curing light • Fuji TRIAGE can be coated with MI Varnish to boost the ion exchange

Restoration of root caries lesions with Fuji TRIAGE, followed by MI Varnish application.

Courtesy Prof Matteo Basso, Italy

Treat and control Minimally invasive restoration of root caries A restoration does not remove the cause of the lesion; hence, to avoid lesion progression, it should always be combined with preventive strategies • Sites of plaque retention are removed by restoring a smooth surface • The caries-affected dentine in the central part of the lesion does not need to be entirely removed; hence, the risk of pulp exposure/pulp infection is reduced, and the remaining tooth structure is weakened less • Glass ionomers, glass hybrids or composites can be used to restore root caries lesions. The best choice depends on the oral circumstances, preferences of the patient and practitioner as well as the ability of the patient to cooperate.

Control over speed with Fuji II LC Fuji II LC is indicated for any case where speed and ease of use are priorities. This might be the case in patients who cannot cooperate well, lacking the necessary cognitive or physical abilities to fully cooperate. These restorations show good survival rates.7

MI restorations of root caries lesions with Fuji II LC, one month after placement.

Courtesy Dr AmrEldeeb Core Team, Ain Shams University, Cairo, Egypt

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Root caries

Durable restorations placed fast and providing caries protection: EQUIA Forte HT EQUIA Forte HT, a glass hybrid restorative, has a pleasant consistency to pack and contour. The EQUIA Forte Coat gives it a nice, where resistant finish and gloss, and additionally adds to its strength by creating the right environment for the material to mature and strengthen. Its ease of placement is especially convenient when treating root caries because of the moisture tolerance and the speed of treatment; it can even be sculpted simply by using a finger. Moreover, through ion exchange, these restorations stimulate tooth remineralisation and prevent demineralisation and therefore the best option for active lesions.

Cervical restoration with EQUIA Forte HT Courtesy Dr Javier Tapia Guadix, Spain

The advantages of glass hybrids for restoring cervical lesions have been demonstrated in randomized controlled trials of a robust design.8 Even though this is not surprising, it should be highlighted that the cost-effectiveness in comparison with composites turned out beneficial, initially as well as in the long term.9

EQUIA Forte (the predecessor of EQUIA Forte HT) restorations before treatment (left), at baseline (middle) and after 6.5 years of function (right).

Courtesy Prof. Matteo Basso, Italy

Even though in many cases, Atraumatic Restorative Treatment (ART) won’t be the first option, this technique can be applied in case of highly dependent patients who do not manage to come to the dental practice or in any other situation where the use of rotary instruments is not an option.6,10 Powder/Liquid versions are available to work in absence of a capsule mixer. In the ART technique, only the infected dentine is removed but the affected/ leathery dentine close to the pulp is kept, which helps keeping pulp vitality and avoids sensitivity. Perfectly clean margins will ensure the success of the restoration. In most cases, anaesthesia is not necessary.

ART subgingival restoration with EQUIA Forte HT Courtesy Prof. Gerry McKenna, United Kingdom

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Aesthetic restorations with G-ænial Universal Injectable When the lesion is non-carious or arrested and there is a possibility to isolate well with rubber dam, G-ænial Universal Injectable is an excellent restorative option for root caries lesions. It can easily be polished to high gloss, which reduces plaque retention, and it is wear resistant, which is important in these areas that are subjected to abrasion.

Apart from that, its bendable tip and thixotropic behaviour makes it easy to access even posterior cavities and to control the placement in difficult areas. It comes in many shades, making it possible to make a truly aesthetic and inconspicuous restoration - which is requested increasingly often by patients.

Highly aesthetic cervical restoration with G-ænial Universal Injectable Courtesy Dr Javier Tapia Guadix, Spain

Recall Follow-up regimen adjusted to response to treatment and caries risk Periodic risk assessment should be regarded as routine for all dental patients. Preventive measures for root caries might be considered to have a better long-term prognosis than restorative treatments.

However, cavitated root caries are less likely to reverse from active to inactive status compared to non-cavitated lesions, so restoration is required in this case.

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Root caries

Minimum Intervention Treatment Plan for root caries A framework for patient-centred treatment factors

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It is essential to adapt the treatment of older people to the individual patient’s conditions. The schedule below will make it easier to select the necessary interventions. It also shows which products from GC are especially suited for each individualised treatment plan.

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i

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EN

RE

Tr

TO

isk

RES

RECALL depending on susceptibility

a ll

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v a si

PR

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IDENTIFY Reduced salivary flow

Dry Mouth Gel

Relieve xerostomia

Test saliva quality

Tri Plaque ID Gel Identify oral hygiene issues

Plaque retentive sites

MI Paste Plus Strengthen/desensitise

Relieve xerostomia

Strengthen/desensitise

Fuji TRIAGE

Surface protection

In office

MI Varnish

At home

Saliva-Check BUFFER

PREVENT

RESTORE EQUIA Forte HT

Restore root surface caries

Active lesion

Fuji II LC

Restore root surface caries

Decreased ability to cooperate

G-ænial Universal Injectable Restore cervical erosion

Plaque-retentive cavitation

High aesthetic demand Isolation placement possible

RECALL

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Root caries treatment MI treatment solutions from GC SCAN FOR MORE INFORMATION

GC Tri Plaque ID Gel Three-tone plaque disclosing gel

Saliva-Check BUFFER In-office test to evaluate quality of saliva

GC MI Paste Plus Bio-available calcium and phosphate, with fluoride

MI Varnish Enhanced fluoride varnish treatment with bio-available calcium and phosphate

GC Fuji TRIAGE Radiopaque glass ionomer surface protection material

GC Fuji II LC Light cured glass ionomer restorative

EQUIA Forte HT Bulk-fill glass hybrid long-term restorative system

G-ænial Universal Injectable High-strength restorative composite

For ordering information, please check our online catalogue.

G-ænial Universal Injectable, GC Tri Plaque ID Gel, GC MI Paste Plus, MI Varnish, GC Fuji, GC Fuji TRIAGE and EQUIA Forte are trademarks from GC. RECALDENT and RECALDENT logo are trademarks of Mondelēz International group used under license.

GC EUROPE N.V. Head Office Researchpark, Haasrode-Leuven 1240 Interleuvenlaan 33, B-3001 Leuven Tel. +32 16 74 10 00 Fax.+32 16 40 48 32 info.gce@gc.dental https://www.gc.dental/europe

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GC UNITED KINGDOM Ltd. Coopers Court Newport Pagnell Buckinghamshire MK16 8JS United Kingdom Tel. +44 1908 218 999 Fax.+44 1908 218 900 info.uk@gc.dental https://www.gc.dental/europe/en-GB

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1. Berkey D, Berg R. Geriatric oral health issues in the United States. Int Dent J 2001; 51:254-264.

2. Baysan A. Consensus on root caries. 2022; https://orca-caries-research.org/ 3. Chalmers JM. Minimal Intervention Dentistry: Part 1. Strategies for addressing the new caries challenge in older patients. J Can Dent Assoc 2006;72(5):427-433.

4. Hay KD, Morton RP. The efficacy of casein phosphoprotein-calicum triphosphate complex (DC-CP) [Dentacal] as a mouth moisturizer in patients with severe xerostomia. N Z Dent J 2003; 99(2):46–8.

5. Reynolds EC, Walsh LJ. Additional aids to the remineralisation of tooth structure.In: Mount GJ, Hume WR, editors. Sandgate (Qld): Preservation and restoration of tooth structure. Knowledge Books and Software 2005; p. 111–118.

6. Chalmers JM. Minimal Intervention Dentistry: Part 2. Strategies for addressing restorative challenges in older patients. J Can Dent Assoc 2006;72(5):435-440.

7. Schwendicke F, Gostemeyer G, Blunck U, Paris S, Hsu LY, Tu YK. Directly Placed Restorative Materials: Review and Network Meta-analysis. J Dent Res. 2016;95(6):613-22.

8. Schwendicke F, Müller A, Seifert T, Jeggle-Engbert LM, Paris S, Göstemeyer G. Glass hybrid versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years. J Dent. 2021; 110:103689.

9. Schwendicke F, Gomez Rossi J, Krois J, Basso M, Peric T, Turkun LS, Miletić I. Cost-effectiveness of glass hybrid versus composite in a multi-country randomized trial. J Dent. 2021;107:103614.

10. da Mata C, McKenna G, Anweigi L, Hayes M, Cronin M, Woods N, O’Mahony D, Allen PF. An RCT of atraumatic restorative treatment for older adults: 5 year results. J Dent. 2019;83:95-99.

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Tips & tricks and FAQ

Back to your roots!

MI treatments for root caries

Are there any special considerations for treating root caries in elderly or medically compromised patients?

Every patient should be treated primarily as an individual* and the treatment plan should be tailored to his or her specific conditions and needs. The patients that fall into the older adult group and medically compromised patients do need some adjustments in their treatments. Firstly, a dentist should be familiar with the common conditions and medications of this patient group. Many of them can impact dental treatment or pose a contraindication for a certain procedure. Secondly, a dentist should also be aware of the patient’s social environment, frailty level and self-care skills and anticipate difficulties such as achieving adequate oral hygiene or visiting the dental office at regular intervals. Lastly, a dentist should keep in mind that older adults and medically compromised may present with a diminished capability for cooperation during dental visits. The general recommendation is to schedule this patient in the morning hours, after they had breakfast, and to keep dental appointments short. For this purpose, a dentist will have to choose appropriate materials to work with that will allow for fast and efficient procedures. * Pretty et al, Gerodontology. 2014 Feb;31 Suppl 1:77-87

What preventive measures can be recommended for patients at risk of root caries?

Older adults need comprehensive oral care with strong emphasis on prevention. Depending on the patients’ condition, different levels of prevention can be employed. The basic preventative measure for any patient is always education and help with adequate oral hygiene. The patient has to be instructed and if needed helped maintain their oral hygiene and the hygiene of any removable prosthesis by their caregivers. Furthermore, home care can be complimented with Mi Paste Plus for enhanced protection and promotion of favorable ionic balance. Due to Recaldent complex (CPP-ACP), calcium, phosphate and fluoride are delivered directly to tooth surface, and they strengthen the weakened tooth structure. Regular dentist visits are crucial for effective prevention. During the visit, a dentist will perform a complete check-up and asses current caries risk and required measures. A dentist can also apply MI Varnish with high fluoride content and Recaldent for further protection. Exposed and at-risk root surfaces can be covered and protected with Fuji Triage.

What is Recaldent and why is it useful in root caries treatment?

RECALDENT™ is derived from casein, the milk protein. Recent research has shown that milk’s protective effect lies in a part of the casein protein called casein phosphopeptide (CPP), which carries calcium and phosphate ions as Amorphous Calcium Phosphate (ACP). Calcium phosphate is usually insoluble; in other words, it forms a crystalline structure at neutral pH. However, the CPP keeps the calcium and phosphate in an amorphous, noncrystalline state, much like the saliva’s mineral components. This means that the CPP-ACP complex, or RECALDENT™, is the optimal way to deliver calcium and phosphate ions to the surface of the tooth and within dental plaque.

Recaldent can be very useful in prevention and treatment of root caries, as it protects the root surfaces, reduces hypersensitivity and reverses early carious lesions.

Use of Recaldent products counters the effects of acid onto the teeth surface by delivering calcium and phosphate ions.

What are the treatment options for root caries?

Simply removing the carious tissue and filling the cavity with a restorative material is not enough in cases of root caries. In order to effectively stop the disease, the treatment of root caries has to be holistic and focused on prevention. Due to the population that is most affected being older adults, the treatment has to take in account the socio-economic factors, the general health of the patient and always include planning for the future. GC’s MI approach to root caries offers a truly holistic and long-term treatment planning. The approach includes prevention of the disease, identification of risk factors and restoration of irreversible lesions. Following the three steps, combined with recall appointments, helps clinicians draft and execute a holistic and individually tailored treatment plan.

When is restoration of root caries necessary?

Not all root caries lesions need to be restored. MI approach strives for minimum interventions, depending on the type of lesion. Inactive lesions don’t require restorations. Active but noncavitated lesions can be managed with non-invasive and micro invasive interventions such as protection and restoration of ionic balance with MI Varnish and Mi Paste Plus or arresting the lesion with silver diamine fluoride. More aggressive lesions (active and cavitated) require a more invasive restoration, but with products such as Equia Forte HT and Fuji II LC, and use of selective carious removal technique, the invasiveness of the preparation can be kept to minimum.

Caries management decision tree is based on: Schwendicke, Falk et al.. (2019). When to intervene in the caries process? An expert Delphi consensus statement. Clinical Oral Investigations. 23. 10.1007/s00784-019-03058-w.

What should I do if I cannot isolate the lesion?

Root caries lesions often pose a challenge of effective isolation, due to their proximity to gum tissues. Furthermore, the patients that are most often affected – older adults – may present with physical and mental challenges which minimize their tolerance for rubber dam isolation. The difficult isolation is further potentiated by very common inflammation of gingiva that is prone to bleeding. In these cases, a choice of restorative material becomes very important. A clinician must choose a moisture tolerant, easy to handle material, that will be able to withstand the difficult conditions of placement. Glass ionomers and glass hybrids, such as Fuji II LC and EQUIA Forte HT, are an excellent option as they offer unparalleled moisture tolerance, fast and easy handling and placement, and good physical properties. These materials are cited as the materials of choice for treatment of root caries by numerous geriatric dentist and specialists.

How can I best manage treatment of uncooperative patients?

Due to possible comorbidities on older patients, it can be expected that some patients will have a hard time cooperating with the dentist during their appointment. For these patients, prevention is absolutely essential in maintaining their oral health.

Use of MI Varnish and Mi Paste Plus can support an oral environment in which the presence of fluoride ions can create a favorable situation for hard tissue remineralization. MI Varnish can be applied during the visits in the dental office, and MI Paste Plus can be easily and effectively applied at home by the patient or caregivers. In light of preventative principles, the exposed root surfaces can be protected with Fuji Triage.

The dental procedures should be fast and atraumatic for the patient. EQUIA Forte HT and Fuji II LC offer fast bulk placement.

Furthermore, Fuji II LC can be light-cured and therefore the placement time can be made even shorter, which makes it ideal for patients that cannot effectively cooperate or keep their mouth open for a longer time.

What is the best treatment for patients with several root caries lesions at once?

Several root caries lesions can be treated in one appointment, with considerations to patient’s general status and cooperation ability. The time is usually a critical component, so materials that allow for fast placement should be used. EQUIA Forte HT and Fuji II LC offer fast bulk placement. Furthermore, Fuji II LC can be light-cured and therefore the placement time can be made even shorter. When the material of choice is composite, G-aenial Universal Injectable offers fast and easy placement and definitely saves the time. Any restorative intervention has to be combined with preventative measures.

Multiple MI restorations of root caries lesions with Fuji II LC, one month after placement.

Courtesy Dr AmrEldeeb Core Team, Ain Shams University, Cairo, Egypt

Which is the most cost-effective treatment for patients with limited means?

The most cost-effective treatment for patient with limited means is preventative measures, combined with restorations of glass ionomers or glass hybrid materials, such as Fuji II LC and EQUIA Forte HT.

What is EQUIA Forte HT? EQUIA Forte HT is a strong, cost effective, biocompatible longterm bulk fill restorative system (Fil & Coat) with enhanced mechanical properties, excellent handling and improved translucency. The unique glass hybrid technology with intelligent particle size distribution and synergistic coat make EQUIA Forte HT restorative system a versatile and durable restorative solution, ideal for patients of all ages, including pediatric, geriatric, high caries risk and special care patients.

Additionally, glass hybrid materials show good adhesive potential to sclerotic dentine, commonly found in older adults. * The abovementioned qualities make EQUIA Forte HT an excellent material of choice for root caries restorations, where speed, strength and moisture tolerance are of high importance.

Discover more at: https://campaigns-gceurope.com/equia-forteht/ * Schwendicke F, Müller A, Seifert T, Jeggle-Engbert L-M, SebastianParis S, Göstemeyer G. Glass hybrid versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years. J Dent 2021, Vol. 110:103689

Is the use of coating obligatory when restoring with EQUIA Forte HT? Yes, use of EQUIA Forte coat is obligatory. EQUIA Forte Coat nano-fillers increases surface hardness, flexural strength and wear resistance for long-lasting restorations. Only by using both EQUIA Forte HT and EQUIA Forte Coat, can the system be indicated for long-term restorations.

How long will the restoration of Equia Forte HT last for the indication of root caries? Is there any data available?

There is a lot of research available on effectiveness and longevity of glass hybrid restorative materials. A longitudinal clinical study* beginning in 2018 is aiming to compare EQUIA Forte HT with composite restorations. The study concluded that there was no significant difference in clinical performance between EQUIA Forte HT and composite restorative materials over the period of 60 months. This conclusion suggests that EQUIA Forte HT performs well over a long period of time, even comparable to composite restorations.

* Gurgan S,Koc U, Meral E, Ergin E.: Sixty-Month Follow-up of a Glass Hybrid in NCCLs.2022. Dent Res Vol 101 (Spec Iss C): P319

Multiple root caries restorations with Equia FORTE HT immediately after placement

6,5 years recall

How can we manage pain and discomfort associated with root caries and its treatment?

Exposed root surfaces and root caries cause hypersensitivity and pain. Aggressive lesions can even lead to pulpitis, pulp necrosis and abscesses if not treated. The burden of the disease is high for the patients; therefore prevention is of extreme importance.

Once root caries has developed, a dentist can alleviate the pain caused by it by preventing hypersensitivity and promoting favorable ionic balance of incipient lesions with fluoride rich products (such as MI Past Plus and MI Varnish). Incipient carious lesions and exposed root surfaces can also be protected with Fuji Triage. During the restoration procedure, application of local anesthesia is an option for preventing any pain associated with the procedure. When selective caries removal technique is used, often there is not even a need for a local anesthesia and therefore the patient’s discomfort is truly minimized.

Infected dentin removed

Affected dentin preserved

When should I use a composite material for root caries restoration?

Composite materials can be used when restoring root caries lesions, in cases where the size of the lesion is limited, and the carious tissue can be removed in its entirety. Another important factor is the possibility of complete isolation of the working area – rubber dam use is required for composite restorations. A dentist must consider the described factors and take into account also the patient’s capability for cooperation, tolerance for rubber-dam isolation, and good abilities of maintain excellent oral hygiene. If all the criteria are met, a composite material can be a highly esthetic long-term solution for a root caries lesion. G-aenial Universal Injectable can be an excellent material of choice in this case, as it enables fast, ergonomic and efficient placement, highly aesthetic outcome and wear resistant surface. Furthermore, the high polishability of G-aenial Universal Injectable acts protectively as the smooth surface prevents the retention of plaque, which is a big benefit in elderly patients that often cannot keep up efficient oral hygiene.

How to ensure a solid adhesion of the composite material in this area?

Due to the lack of enamel on the root surfaces, the adhesion of composite materials can be very challenging. The first prerequisite for efficient adhesion is to ensure truly sound dentin margins of the preparation. If this cannot be achieved, glass hybrids and glass ionomers might be a better choice. When sound margins can be achieved and all other criteria for composite placement is satisfied, an adhesive with good bonding ability do dentin must be used. GC offers an adhesive solution that shows very high bond strengths to dentin and enamel and minimizes the risk of hypersensitivity: G-Premio BOND.

How often should the recall of older adult patients be?

It's essential for older adults and their caregivers to have an open and ongoing conversation with their dentist to develop a personalized dental care plan that takes into account their unique needs and circumstances. Regular dental check-ups are crucial for maintaining oral health and preventing dental issues, and they become even more important as people age to ensure that any problems are detected and addressed promptly. The recall interval varies a lot among the dental professionals. Some recommend all adults to see a dentist every 6 months, but older adults with high caries risk might need even more frequent visits: even every 3 to 4 months.

Keep in mind these questions when assessing the recall needs of your patients: • Is the bacterial environment under control?

• Do the plaque test, bacterial tests or the salivary tests.

• Does the home care seem to be efficient?

• Evaluate the efficiency of at-home treatment • Look out for the signs of demineralization • Check if there is remineralization or not • Check if the dental restorations are stable • Evaluate if the diet risks are still present • Check the evolution of the lesion(s) on the X-rays For more information visit: https://www.gc.dental/europe/sites/europe.gc.dental/files/produ cts/downloads/mivarnish/leaflet/LFL_MI_Dentistry_Handbook_en. pdf

What are the long-term outcomes and prognosis for patients with root caries?

Long term prognosis of patients with root caries can be improved, if the disease is treated holistically.

Restorative treatments for root caries lesions have poor prognosis due to the close proximity of the gingival margin, the difficulties of isolation and problems associated with bonding to dentine.

Lesions tend to spread laterally making them shallow but extensive, and proximally, difficult to access. When necessary, resin modified glass ionomer cements are the restorative materials of choice. Composite resins and calcium silicate cements have lower survival rates. Noninvasive and preventive strategies are preferable. * Literature shows that the best long-term prognosis can be attributed to restorations made of glass ionomer cements and modified glass ionomer cements. **

* AlQranei M S, Balhaddad A A, Melo M A S. The burden of root caries: Updated perspectives and advances on management strategies. Gerodontology 2021; 38: 136-153 ** Carilho MRO: Root Caries: From Prevalence to Therapy.

Karger.2017. ** Ghilotti, J.; Mayorga, P.; Sanz, J.L.; Forner, L.; Llena, C. Remineralizing Ability of Resin Modified Glass Ionomers (RMGICs): A Systematic Review. J. Funct. Biomater. 2023, 14, 421. ** Cheng, L., Zhang, L., Yue, L. et al. Expert consensus on dental caries management. Int J Oral Sci 14, 17 (2022).

How can we educate patients about the importance of root caries prevention and early intervention?

As with any disease, patient education is of big importance for long-term success of the treatment. In the fast-paced everyday work environment, it could be difficult to adequately explain to the patients, and the patient might not successfully retain a large amount of information. For this reason, GC wants to make it as simple and as informative as possible – introducing GC’s new patient leaflet that presents the risks and solutions in an efficient and understandable way. Let this leaflet be your helper in raising awareness among the patients and helping improve overall oral health of our older adults’ population! https://www.gc.dental/europe/sites/europe.gc.dental/files/produ cts/downloads/equiaforteht/leaflet/LFL_Root_Caries_Campaign.p df