Caries of cement (K02.2) is localized in the cementum of root. It occurs in teeth with roots exposed as a result of gingival recession (fig. 22.1) or formation of periodontal pockets. This condition is usually found in patients with peri-odontal diseases, because professional hygiene with root polishing makes the cementum thinner. Prolonged use of a hard toothbrush affects the surface of the root and also leads to thinning of the cementum. Patients with periodontal diseases are a group of high risk for caries of cementum, because the critical depth of the periodontal pocket is 2-4 mm.
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Fig. 22.1. (left) Caries of cement, recession of the gum due to hard toothbrush, tooth 22. (right) Professional hygiene in patients with periodontal problems can cause cementum layer thinning
Another factor contributing to development of cemental caries is xerostomia, which can be caused by age or radiotherapy in the head and neck.
Caries of cementum can be caused by inadequate dentures, when the denture clammer presses on the root surface of the tooth, creating a place for adhesion of cariogenic microorganisms.
CLINICAL SIGNS
Carious lesions of the root, depending on the depth of damage, are divided into primary, superficial and deep caries of the root cementum. Primary (initial) root caries presents as a pigmented lesion of cementum, without involving the cementodentinal junction. Clinically it is a change in the color of the root surface from light to dark brown and even black. Superficial root caries is destruction of cementum and cementodentinal junction; there can be shallow-shaped defect with brown pigmentation of varying intensity. The depth of such lesions does not exceed 0.5 mm. Deep root caries leads to formation of a pigmented cavity whose floor is separated from the cavity by a thin layer of dentin. Carious lesion of the root with a depth of more than 0.5 mm is deep root caries requiring fillings, but viability of pulp should be established beforehand.