Dr. Nicholas Tong is an Assistant Professor of Teaching at the UBC Faculty of Dentistry, Division of Dental Geriatrics. Managing Root Caries in Frail Older Adults Root caries in frail older adults present unique clinical challenges that demand more than routine care. This article offers practical, evidence-informed techniques to make care more manageable for both patients and clinicians. Root caries are increasingly prevalent and complex in aging populations, particularly among frail older adults with multiple medical, cognitive and functional challenges. This complexity requires clinicians to balance biological understanding with practical, patient-centred care. The root caries process is driven by biofilm activity on exposed root surfaces. Initially, microorganisms colonize tooth surfaces and create an acidic environment, which promotes demineralization and degradation of the organic matrix. Over time, the biofilm matures and becomes more pathogenic, producing enzymes that further break down hard tissue structures. In older adults, this process is often accelerated by factors such as multimorbidity, polypharmacy, and salivary gland hypofunction, all of which increase susceptibility to caries and complicate management. Treatment Planning Clinical decision-making in this population must extend beyond the lesion itself to include the patient’s overall condition and ability to tolerate treatment. Frail older adults, particularly those living with dementia, frequently present with compromised intra-operative cooperation. Moisture control may also be difficult, and dentists may need to mitigate contamination of prepared surfaces by gingival crevicular fluid, saliva, and/or blood. In many cases, these practical challenges become the primary determinants of a dentist’s treatment approach. Although non-cavitated or inactive lesions may be managed non-operatively with remineralization strategies, operative intervention becomes necessary when lesions are cavitated or when plaque control cannot be maintained. Considerations for Materials When operative care is indicated, material selection plays a critical role. Available options include composite resin, amalgam and glass ionomer–based materials, including conventional glass ionomer cements, resin-modified glass ionomer cements and newer glass hybrid materials. Evidence from people in long-term care (LTC) suggests that restoration survival rates between composite and glass ionomer materials are comparable over time. However, in frail populations, the ease of use and clinical practicality 28 | 2026 | Issue 4
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