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Updated on August 18, 2022

Root Decay: Causes, Risks, Symptoms & Treatment

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What is Root Decay?

Root decay may also be called root cavities or root caries. It is when a lesion develops on the root surface of your tooth.

These lesions typically develop close to the gingival (gum) margin. Older adults are more prone to developing root decay. This is because people are living longer and keeping their teeth longer nowadays.

Tooth roots can only develop cavities if exposed due to periodontal disease or gum recession.

Root decay also spreads faster than normal cavities because the cementum covering tooth roots is thinner and softer than enamel.

According to Dr. Nandita Lilly,

"Oral health issues are often insidious, which means that without appropriate treatment, they are likely to become much more serious with time. Early detection leads to a more successful treatment."

Dr. Nandita Lilly

Causes & Risk Factors of Root Decay

Poor oral hygiene is the leading cause of all oral diseases and infections.

Poor oral hygiene results from not:

  • Brushing with a fluoride toothpaste at least twice a day
  • Flossing at least once a day
  • Using mouthwash regularly
  • Going to the dentist every six months

Other factors that result in poor oral health include tobacco use (smoking cigarettes or cigars, chewing tobacco, dipping, etc.) and marijuana use.

Other causes of root decay and gum recession include:

  • Aggressive brushing
  • Age
  • Diabetes
  • Misaligned/crooked teeth
  • Trauma

These factors can lead to the development of:

  • Cavities (due to plaque build-up)
  • Dry mouth
  • Gum disease
  • Root cavities

Root decay forms when your teeth roots become exposed due to long-term neglected dental care.

Common conditions that may lead to root decay include:

Advanced Periodontal Disease

The primary cause of root decay is due to periodontal attachment loss. Periodontal disease (PD) is a severe form of gum disease that permanently damages the gums, tissues, and surrounding bone.

Patients with PD commonly develop gum recession. This is when the gums begin to pull away from the teeth, which eventually causes periodontal attachment loss.

Gum recession separates the teeth from the gums. Over time, your teeth roots become exposed, making them more susceptible to decay.

gum disease NewMouth

Poorly Fitted Removable Partial Dentures

If you have partial dentures that do not fit properly, gum recession may develop over time.

This is because partial dentures only replace the visible part of your teeth rather than the entire dental arch.

removable partial denture NewMouth

Partial dentures are attached to a metal plate secured in the mouth using clasps and hooks that attach to your real teeth. These hooks and clasps commonly irritate the gums, leading to inflammation and gum recession.

As a result, your teeth roots become exposed, leading to decay over time.

If your gums are receding due to poorly fitted partial dentures, your dentist can adjust or remake them for you.

Medications & Xerostomia

Many prescription and over-the-counter medications list dry mouth (xerostomia) as a side effect.

Xerostomia is a common oral condition when the salivary glands in the mouth do not make enough saliva. Saliva is necessary for cavity protection because it helps repair tooth enamel and rinses plaque.

If your mouth produces inadequate saliva, you are more prone to tooth decay. If you have dry mouth and periodontal disease or gum recession, you are more prone to developing root decay.

Medications that may cause dry mouth include antidepressants, muscle relaxants, and decongestants.

Other risk factors associated with root caries in older adults include:

  • Chronic medical conditions, such as diabetes, a previous stroke, Parkinson’s disease, Sjögren's syndrome (an autoimmune disease), and arthritis
  • Cognitive limitations that develop due to mental illnesses. This includes chronic depression and Alzheimer’s disease
  • Radiation treatment for neck and head cancers
  • Previous root caries

Symptoms & Complications of Root Decay

Signs and symptoms of root decay include:

  • Continuous pain near the affected area that interferes with your daily life
  • Toothache that doesn't go away
  • Difficulties eating, chewing, and swallowing
  • A dental abscess
  • Pus and swelling around the tooth
  • Loose teeth
  • Tooth loss
  • Broken or cracked teeth

If root decay is left untreated, you may develop a severe oral infection.

Diagnosis & Treatment of Root Decay

A general dentist uses a visual exam and an x-ray to diagnose root cavities during a regular dental exam.

The root cavity is visible to the naked eye when gum recession is present.

Microbiological tests can also detect the presence of decay-causing bacteria on tooth roots.

Root cavities are more difficult to treat than normal cavities because they are deeper and can travel under the gum line.

Depending on the severity of root decay, your dentist may recommend the following treatments:

Restorative Treatment

If the root decay is severe or develops between your teeth, your dentist may recommend a dental crown instead of a dental filling.

A tooth extraction followed by a dental implant or dental bridge may be necessary in more severe cases.

Root Canal Treatment

If you have root decay, root canal treatment may be necessary to prevent the spread of decay and save your tooth.

Root cavities are closer to the dental pulp in teeth. This means there is a higher chance bacteria will spread to the pulp.

The infected dental pulp must be extracted via root canal to prevent further infection, pain, and tooth loss.

Periodontal Therapy

If gum recession is caused by periodontal disease, the root cause must be eliminated. This can be done via scaling and root planing procedures.

By removing the tarter and smoothing the root surfaces, this periodontal treatment can help gum tissues heal and reattach to the tooth surface.

Root Surface Remineralization (Fluoride Treatment)

If the lesion hasn’t progressed too deep, your dentist may recommend remineralization. This treatment involves the use of fluoride mouth rinse and toothpaste.

Fluoride is essential for cavity prevention because it holds onto the calcium and phosphate in your mouth, which encourages remineralization.

Root Surface Recontouring

The earliest treatment for root decay involves the removal of softened tissue around the affected tooth. Then your dentist recontours the decayed root structure, which creates a smooth and cleanable surface.

Surgical Gum Grafting

A gum graft may help protect the root surface from sensitivity and further decay.

Glass Ionomer with Fluoride Release

For severe root decay, the treatment of choice is a glass ionomer restoration with fluoride release. This type of restoration is used on any tooth in a patient with a high risk for cavities. It also releases fluoride to help prevent future cavities.

Benefits include:

  • It does not cause pulpal irritation
  • It contains 20 percent fluoride
  • The procedure is relatively simple and aesthetically pleasing
  • It is anti-cariogenic, antibacterial, and adhesive to root surfaces

Preventing Cavities and Root Decay

Practicing excellent oral care and eating a healthy diet (low in sugar) helps prevent the development of cavities and root decay.

Other root cavity prevention techniques include:

  • Brushing your teeth with fluoride toothpaste
  • Brushing your teeth twice a day with an electric toothbrush
  • Flossing every night
  • Getting professional teeth cleanings, dental exams, and checkups every six months
5 Sources Cited
Last updated on August 18, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. “Cavities/Tooth Decay.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 July 2017, https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892.
  2. Fejerskov, Ole, et al. Dental Caries: the Disease and Its Clinical Management. Wiley Blackwell, 2015.
  3. Garg, Nisha, et al. Textbook of Operative Dentistry. Boydell & Brewer Ltd, 2010.
  4. “Root Caries: An Aging Problem.” The Internet Journal of Dental Science, vol. 5, no. 1, 2007, doi:10.5580/a32. http://ispub.com/IJDS/5/1/5636#
  5. American Dental Association. Cannabis Oral Health Effects. Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC., www.ada.org/resources/research/science-and-research-institute/oral-health-topics/cannabis-oral-health-effects.
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