Treatment of Root Caries in an Ageing Population

The aim of this study was to assess treatment of primary root carious lesions (PRCLs) in a non-invasive treatment protocol. The data is taken from a wider study of single surface caries reversal with the use of ozone (O3) in a general dental practice over the last 2 years. Previous studies have shown that ozone can predictably reverse carious lesions without the need to drill and fill. Other studies have show that prior to the investigation of ozone, remineralisation can take place, but there were no predictable methods of achieving this. Studies have shown the anti-microbial effects of ozone on PRCLs with a significant reduction in total colony forming units (tcfus) being observed in the ozone-treated groups and a significant reduction in tcfus was observed in ozone-treated samples for Streptococcus mutans and Streptococcus sobrinus. A further in vivo study demonstrated a significant reduction in tcfus. Other studies have assessed the safety of the ozone delivery system during treatment, and the maximum ozone detectable levels (ppm) adjacent to the point of the application were measured in vivo and in vitro. These investigations revealed that the mean maximal detectable levels of ozone were all within EU and FDA guidelines. A further longitudinal study assessed the safety and efficacy of ozone either with or without a root sealant, for the management of PRCLs. In this longitudinal study, the ECM, DIAGNOdent and clinical detection criteria were used and there were four experimental groups involved: 89 patients with PRCLs were examined in a general dental practice for patients over the age of 60. The mean age was 70.85 years, the mode 65, and a standard deviation of 7 years. The entry criteria for this study were that each patient had two PRCL’s lesions on a single surface. One lesion was treated with ozone for 40 seconds, the other kept untreated as a control. Oral hygiene instructions and a remineralising paste and rinse were prescribed, and the manner of application demonstrated. Patients were instructed to apply the paste and mineral wash to all areas of their mouth. At recall, each lesion was re-assessed, and then the ozone treatment was repeated for 40 seconds. At baseline (T0 ), after 8 (T1 ) and 16 (T2 ) weeks, clinical assessments and DIAGNOdent readings were obtained for each PRCL. This study showed that 100% of the treated lesions had progressed from leathery to hard in the ozone treated group at the 16 week recall based on clinical criteria, compared to the control group, where 19% became worse over the same time period, 80% stayed the same, and one lesion showed reversal to a hard lesion. In general, this study showed that the DIAGNOdent readings showed little improvement in either group. Current recommendations are showing that the DIAGNOdent is very useful in establishing the entry-level treatment criteria, but as a tool to assess carious lesions, it is not so useful. This study has shown that oral hygiene and the use of a remineralising paste and wash are ineffective in caries control and reversal. Longer treatment times (compared to previous research) with ozone is a very effective and predictable treatment modality when combined with oral hygiene and remineralising products, and offers an alternative to the traditional amputation, or ‘drill and fill’ therapy often practiced all over the world. Dr Julian Holmes, September 2003.