Salud Dental Para Todos


Root Caries Criteria  

D.D.S. Marcelo A. Iruretagoyena 

One score will be assigned per root surface. The facial, mesial, distal and lingual root surfaces of each tooth should be classified as follows:

Code E

If the root surface cannot be visualized directly as a result of gingival recession or by gentle air-drying, then it is excluded. Surfaces covered entirely by calculus can be excluded or, preferably, the calculus can be removed prior to determining the status of the surface. Removal of calculus is recommended for clinical trials and longitudinal studies.

Code 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, OR 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 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.




Code 1

There is a clearly demarcated area on the root surface or at the cemento-enamel junction (cej) that is discoloured (light/dark brown, black) but there is no cavitation (loss of anatomical contour < 0.5 mm) present.


Code 2

There is a clearly demarcated area on the root surface or at the cemento-enamel junction (cej) that is discoloured (light/dark brown, black) and there is cavitation (loss of anatomical contour = 0.5 mm) present.



Special considerations in the coding of root caries:

  • When the surface of the crown and root are affected by caries they must be identified independently. In case of doubt because the caries lesion is in the cement-enamel junction (UCE), it must be analyzed which surface is more affected or which extends at least 1 mm or beyond the limit of the cement enamel junction (UCE), In both cervico-incisal and cervical apical directions, it should be considered which is the most extensive applying the 50% rule, if there is equality the examiner must decide if the lesion is coded as root or crown, or in its defect can apply both . See right image.

  • When a carious lesion on a root surface extends beyond the angle of the root line but involves at least 1/3 of the distance across the adjacent surface, that adjacent surface must also qualify as caries. If it is smaller (<1/3) it will be coded as sound. See right image.
  • A root surface adjacent to a rim of the crown that is free of decay should be noted as sound.
  • If more than one lesion is present on the surface of the same root, the most serious injury will be noted.
  • All surfaces of the root remains should be coded as "06".
  • The non-vital teeth have the same score as the vital teeth.

The following diagram (Figure 1) will serve as a useful prompt for examiners in deciding on appropriate coding of root caries:

Figure 1: Decision tree for primary caries on thr root surface.

Caries associated with root restorations

When a root surface is filled and there is caries adjacent to the restoration, the surface is scored as caries. The criteria for caries associated with restorations on the roots of teeth are the same as those for caries on non-restored root surfaces. The following diagram (Figure 2) will assist the examiner in deciding on the appropriate coding of caries adjacent to restorations on root surfaces:

Figura 2: Decision treefor caries associated with root restorations

Root caries activity:

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 or not. These characteristics include texture (smooth, rough), appearance (shiny or glossy, matte or non-glossy) and perception on gentle probing (soft, leathery, hard). Active root caries lesions are usually located within 2mm. of the crest of the gingival margin

The following diagram (Figure 3) will be helpful in making a determination regarding the activity of root caries:

Figure 3: Decision tree for root caries activity

Salud Dental Para Todos

The information present on this website must be used for the purpose of promoting and protecting public dental health. It must not be used for commercial purposes.

E-mail: D.D.S. Marcelo Alberto Iruretagoyena

Wilde.  Provincia de Buenos Aires. Argentina

Revised: September 2018