Root Decay in Older Adults: North Indian Study Identifies Key Risk Factors

Published 4 September 2026
Reviewed by Dr. Advaitha Anand, BDS MDS (Conservative Dentistry & Endodontics)

As healthcare and oral care improve, more people are keeping their natural teeth well into their senior years. However, retaining teeth into older age brings specific oral health challenges. One of the most notable is root surface caries—decay that develops directly on the exposed roots of teeth rather than on the enamel crowns.

A newly published cross-sectional study investigated how common root surface decay is among community-dwelling older adults in North India, identifying the primary clinical, social, and behavioural factors linked to the condition.

Investigating Root Decay in North India

The research was conducted in Ghaziabad District, Uttar Pradesh. The researchers evaluated 820 community-dwelling adults aged 65 to 74 years who still had some of their natural teeth. To ensure the findings represented the wider community, the researchers used a proportionate stratified random sampling method.

Each participant completed a pretested, structured questionnaire and underwent a standardized clinical dental examination following World Health Organization (WHO) criteria. The researchers evaluated the participants’ root decay experience using the Root Caries Index (RCI). In addition, they recorded sociodemographic details, oral hygiene habits, tobacco use, and periodontal (gum health) indicators, using multivariable logistic regression to isolate independent risk factors.

What the Study Discovered

The researchers observed that root surface caries represents a substantial health burden in this population:

Overall Prevalence: Root surface caries was diagnosed in 37.7% of the 820 participants examined.
Age and Sex Patterns: Decay was more common among male participants and among older individuals in the 70-to-74-year age bracket compared to younger participants in the cohort.
Gum Recession and Tooth Loss: The condition was more prevalent among individuals who had gingival recession—a condition where the gum tissue pulls back, leaving tooth roots exposed—as well as those who had fewer remaining natural teeth.
Social and Lifestyle Factors: Tobacco use and lower socioeconomic position were both linked to higher rates of root surface decay.
Independent Links: When the researchers ran a multivariable analysis to account for overlapping influences, gingival recession and selected behavioural factors remained independently associated with the presence of root surface caries.

Understanding the Biological Connection

Unlike the crown of a tooth, which is protected by a hard layer of enamel, tooth roots are covered by cementum and dentin, which are softer and more vulnerable to bacterial breakdown when exposed to the oral environment.

The study highlights that as gum attachment is lost—often due to periodontal disease or age-related tissue changes—the exposed root surfaces become susceptible to decay. When combined with behavioural factors such as tobacco use or suboptimal oral hygiene, the likelihood of developing root cavities increases significantly.

Genuine Limitations of the Study

While this study provides valuable public health data from North India, several limitations should be noted:

Study Design: Because this was a cross-sectional study, it captured a single snapshot in time. This type of research can identify statistical associations between risk indicators and root decay, but it cannot definitively prove direct cause-and-effect over time.
Geographic and Age Focus: The sample was drawn exclusively from adults aged 65 to 74 years in Ghaziabad District, Uttar Pradesh. The exact figures may vary in other age groups, regions, or healthcare settings.

What This Means for Patients

These findings underline that preserving natural teeth into older age requires close attention not just to the biting surfaces of teeth, but also to gum health.

Because root decay occurs primarily when gums recede and leave root surfaces vulnerable, maintaining good periodontal health and managing daily behavioural risks—such as tobacco use—are critical. Regular dental examinations can help detect early signs of gum recession and root surface changes before decay advances, supporting long-term oral health throughout later life.