5.2 Treatment of Patterns of Caries
Root-Surface Caries
 Dental caries occurs on similar surfaces of corresponding teeth.
Although root-surface caries is a form of smooth-surface caries, the former requires different treatment. Because root surfaces have no covering of mineral-rich enamel, they decay more rapidly than enamel surfaces. This pattern most commonly develops in patients over age 55 only when root surfaces become exposed. Modifying factors that place a patient at risk for root-surface caries are age, periodontal disease, poor oral hygiene, poor health status, use of certain medications, and reduced cognitive function.
Root-surface caries is correlated with high counts of Lactobacillus species (Lactobacillus sp.) and frequently occurs in patients with decreased salivary flow. Prediction models have shown that high salivary levels of Lactobacilli and MS are primary indicators of root-caries development. Preventive strategies should include patient education, increased fluoride use, antimicrobials, short recall intervals, and consideration of artificial saliva supplements.
Under the risk classification model, root-surface caries are treated as smooth-surface decay, but patients with root-surface caries typically have different modifiers than patients with enamel caries. Therefore, patients with root-surface caries should be placed in the high-risk category.
Bilaterality
Bilaterality is the phenomenon whereby dental caries occurs on similar surfaces of paired teeth or tooth surfaces on the left and right sides of the mouth. For example, patients with interproximal lesions on the maxillary teeth on the left sides of their mouths often have similar lesions on the right sides.
The concept may also be useful in determining caries risk category and treatment because it can help the dentist predict the extent of unrestored bilateral lesions. For example, if the mesial carious lesion on tooth #3 is restored, and the dentist finds arrested caries, the mesial lesion diagnosed on tooth #14, which the dentist had originally planned to restore, may instead be watched. Conversely, if the same lesion on tooth #3 turns out to be more extensive than anticipated, the dentist would plan to restore the lesion on tooth #14.
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