Diagnostic Criteria for Detection of Root Caries and Assessing Root Lesion Activity

  • For the purpose of root caries detection, removal of calculus and plaque is recommended.
  • The characteristics of the base of the discolored area on the root surface can be used to determine whether or not the root caries lesion is active.
    • These characteristics include texture (smooth, rough), appearance (shiny or glossy, matte or non-glossy) and perception of texture on gentle probing (soft, leathery, hard).
    • Active root caries lesions are usually located within 2mm of the crest of the gingival margin
Evaluation criteria for assessing root caries are as follows:
Table 5. Assessing Root Caries Evaluation Criteria.
Code Evaluation Criteria
E If for any reason a root surface cannot be visualized directly, or with the assistance of gentle air drying, code E (excluded) can be recorded on the dental chart.
0 The root surface does not exhibit any unusual discoloration that distinguishes it from the surrounding or adjacent root areas nor does it exhibit a surface defect either at the cemento-enamel junction or wholly on the root surface. The root surface has a natural anatomical contour,
The root surface may exhibit a definite loss of surface continuity or anatomical contour that is not consistent with the dental caries process. This loss of surface integrity usually is associated with dietary influences or habits such as abrasion or erosion. These conditions usually occur on the facial (labial) surface. These areas typically are smooth, shiny and hard. Abrasion is characterized by a clearly defined outline with a sharp border, whereas erosion has a more diffuse border. Neither condition shows discoloration.
1 There is a clearly demarcated area on the root surface or at the cemento-enamel junction (CEJ) that is discolored (light/dark brown, black) but there is no cavitation (loss of anatomical contour).
2 There is a clearly demarcated area on the root surface or at the cemento-enamel junction (CEJ) that is discolored (light/dark brown, black) and there is cavitation (loss of anatomical contour ≥ 0.5 mm) present.

In addition to the use of these diagnostic criteria for evaluating both coronal and root caries, the ICCMS™ system calls for an assessment of surfaces surrounding restorations and sealants, to ensure that no surface is overlooked.  Another important diagnostic aspect of the ICCMS™ system is an evaluation of the biofilm, particularly with regard to its location and thickness.  The data indicate that dental caries infection occurs due to a shift in the microbial ecology within the oral cavity.  The data further suggest there is increased caries risk associated with plaque/biofilm accumulation.  Therefore, an ongoing evaluation of the biofilm is recommended to monitor for any significant changes that might be indicative of lesion activity.