This study reports on coronal and root caries incidence in elderly Iowans between 1987 and 1998. The sample consisted of 74 survivors of the Iowa 65+ Oral Health Study cohort who received oral examinations both in 1987 and between 1996-98. The study found that average untreated coronal and root increments were 0.96 and 0.69 surfaces, filled increments were 18.22 and 1.28 surfaces, and combined increments were 18.3 and 1.27 surfaces, respectively. Therefore, annualized untreated coronal and root increments were 0.10 and 0.07 surfaces, filled were 1.80 and 0.13 surfaces, and combined increments were 1.81 and 0.12 surfaces, respectively. The annualized attack rates were 2.13 for coronal and 0.80 for root caries. Approximately 93% of the subjects developed some new coronal and 43% some new root caries increment. Dental caries still constitute a significant problem since a large proportion of the elderly developed caries during this period. This suggests a need for improved preventive and treatment strategies for this aged population.