Caries activity test

CARIES ACTIVITY TEST

1. CARIES ACTIVITY TESTs Dr. Sucheta Prabhu Second year MDS 29/06/2017

2. Questions asked previously Short essays 1.Snyders test 2.Caries activity indicators 3.Caries succeptibility 4.Application of cariogenecity tests in prevention of dental caries

3. Questions asked previously Long Essays 1.Define caries activity and caries succeptibility tests.Critically evaluate various caries activity and succeptibility tests and their clinical implications.

4. CONTENTS INTRODUCTION DEFINITIONS NEED FOR CARIES ACTIVITY TESTS IDEAL REQUISITES CLASSIFICATION CARIES ACTIVITY TESTS LIMITATIONS OF CARIES ACTIVITY TESTS CONCLUSION REFERENCES

5. INTRODUCTION

6. DEFINITIONS

7. CARIES ACTIVITY TEST Are defined as tests that estimate the actual state of disease activity(progression/regression).

8. PURPOSE OF CARIES ACTIVITY TESTS 1.Identify high risk groups . 2.Determine the need for personalized preventive measures 3.Monitor the effectiveness of oral health education programs. 4 . Motivate the individual.

9. IDEAL REQUISITES OF A CARIES ACTIVITY TEST Snyder,1951 Should have a sound theoretical basis. Simple Easy to perform Inexpensive Time for test and result should be small. Should be adaptable to the chairside . Results should be accurate and reproducible. Tests should have maximum correlation with clinical status.

10. CLASSIFICATION

11. CLASSIFICATION

12. CLASSIFICATION

13. CLASSIFICATION

14. LACTOBACILLUS COLONY COUNT TEST Hadley (1933 ) BASIS Tomato peptone agar is the s elective medium favoring the growth of aciduric lactobacilli. PRINCIPLE: The number of acidogenic and aciduric bacteria in the patient’s saliva are estimated by counting the number of colonies appearing on tomato peptone agar after inoculation with a sample of saliva.

15. LACTOBACILLUS COLONY COUNT TEST EQUIPMENT : Saliva collecting bottles Paraffin Two 9ml tubes of saline Two agar plates Two bent glass rods Incubator Quebec counter Pipettes.

16. PROCEDURE

17. LACTOBACILLUS COLONY COUNT TEST

18. RESULTS: Number of lactobacilli per ml of saliva Caries activity 0-1000 Little or none 1000-5000 Slight 5000-10,000 Moderate >10,000 Marked

19. Dentoccult LB (Orion Diagnostica , Finland) Larmas (1975)   H ighly practical and greatly simplified method of estimating lactobacilli. Self-contained kit with a shelf life of at least 1 year .  

20. DENTOCULT ® LB A kit which includes Paraffin tablets. Dip-slide which on each side has a selective agar for lactobacilli . An evaluation chart which shows numbers of lactobacilli per ml saliva . A cup or tube A funnel An incubator  

21. PROCEDURE

22. PROCEDURE

23. RESULTS For assessment of the level of lactobacilli : Colony Forming Unit (CFU) per ml of saliva.

24. COLORIMETRIC SYNDER TEST Snyder 1951 PRINCIPLE It measures the ability of salivary microorganisms to form organic acids from a carbohydrate medium .

25. COLORIMETRIC SYNDER TEST The medium contains an indicator dye, Bromocresol green . This dye changes color from green to yellow in the range of pH 5.4 to 3.8 .

26. COLORIMETRIC SYNDER TEST EQUIPMENT : Saliva collecting bottles Paraffin Tube containing Snyder glucose agar+ Bromocresol green adjusted to a pH 4.7-5 Pipettes Incubator

27. PROCEDURE

28. RESULTS: 24 hours 48 hours 72 hours Color Yellow Yellow Yellow Caries Activity Marked Definite Limited Color Green Green Green Caries Activity Continue to incubate Continue to incubate Caries inactive

29. COLORIMETRIC SYNDER TEST ADVANTAGES : Simple Inexpensive DISADVANTAGES : Time consuming Color changes are not very clear

30. ALBAN TEST Simplified substitute for Snyder test. PRINCIPLE: Measures the ability of microorganisms to form acids from a medium. Alban’s method uses less agar in the media . Advantages are that it is simple , cost effective and can act as a motivational tool for patient. Color change from blue to yellow is indicative of caries activity.

31. PROCEDURE

32. RESULTS Color Change Score No color change 3/4 Beginning color change + One half color change ++ Three fourths color change +++ Total color change to yellow ++++

33. THE SWAB TEST Grainger et al 1965 PRINCIPLE : It measures the ability of salivary microorganisms to form organic acids from a carbohydrate medium PROCEDURE: Swab the buccal surface of the teeth with cotton applicator. And it is subsequently incubated in the medium for 48 hours.

34. THE SWAB TEST ADVANTAGES It predicts caries increments in children with low or no previous caries experience . No collection of saliva is required.

35. RESULTS pH Caries Activity ≤ 4.1 Marked caries activity 4.2 to 4.4 Active 4.5 to 4.6 Slightly active 4.6 and over Caries inactive

36. SALIVARY REDUCTASE TEST PRINCIPLE: Rapp claims, the test measures, ‘ the activity of the reductase enzyme ’ present in the salivary bacteria . The test measures the rate at which an indicator molecule , Diazo -resorcinol , changes from blue to red to colorless .

37. SALIVARY REDUCTASE TEST EQUIPMENT A kit is available under the trade name “ TREA TEX ” that includes: 1.Calibrated saliva collection tubes with the reagent on the inside of tube’s cap. 2.Flavored paraffin.  

38. PROCEDURE

39. RESULTS Color Time Score Caries Activity Blue 15 minutes 1 Non-conducive Orchid 15 minutes 2 Slightly conducive Red 15 minutes 3 Moderately conducive Red Immediate 4 Highly conducive White Immediate 5 Extremely conducive

40. SALIVARY REDUCTASE TEST

41. DENTOBUFF TEST OR SALIVARY BUFFER CAPACITY TEST PRINCIPLE The test measures the number of milliliters of acid required to lower the pH of saliva, from pH 7.0 to 6.0.

42. DENTOBUFF TEST OR SALIVARY BUFFER CAPACITY TEST EQUIPMENT pH meter Titration equipment 0.05N lactic acid 0.05N base Paraffin Sterile glass jars

43. PROCEDURE

44. EVALUATION There is an inverse relationship between the buffering capacity of saliva and caries activity. The saliva of individuals whose mouths contain a considerable number of carious lesions frequently have a lower acid buffering capacity than the saliva of those who are caries free . ADVANTAGE - Simple to carry out . DISADVANTAGE - Does not correlate adequately with caries activity.  

45. DENTOBUFF STRIP TEST

46. DENTOBUFF STRIP TEST

47. Scoring DEGREE 1, yellow - pH ≤ 4 DEGREE 2, green- pH 4.5-5.5 DEGREE 3, deep blue- pH ≥ 6.0 The higher the grade the stronger the saliva buffering capacity

48. FOSDICK CALCIUM DISSOLUTION TEST PRINCIPLE- T est measures the milligrams of powdered enamel dissolved in 4 hours by acid formed when the patient’s saliva is mixed with glucose and powdered enamel.

49. FOSDICK CALCIUM DISSOLUTION TEST EQUIPMENT- Powdered human enamel Saliva collection bottles Sterile test tubes Equipment for determining the calcium content of the saliva.

50. PROCEDURE

51. FOSDICK CALCIUM DISSOLUTION TEST

52. DEWAR TEST This test is similar to the Fosdick Calcium Dissolution test except that the final pH after 4 hours is measured instead of the amount of calcium dissolved. This procedure is not commonly used as it has not been adequately tested for clinical correlation.

53. STREPTOCOCCUS MUTANS SCREENING TEST PLAQUE/TOOTH PICK METHOD Kristofferson and Bratthall The test involves a simple screening of a diluted plaque sample streaked on a selective culture media.

54. STREPTOCOCCUS MUTANS SCREENING TEST EQUIPMENT Sterile toothpicks Sterile Ringer’s solution Platinum loop Mitis Salivarius Agar (MSA) plates containing sulphadimetine Incubator

55. PROCEDURE

56. STREPTOCOCCUS MUTANS SCREENING TEST 2. TONGUE BLADE METHOD The test estimates the numbers of S.mutans mixed in paraffin-stimulated saliva when cultured in Mitis Salivarius Bacitracin ( MSB) agar.

57. STREPTOCOCCUS MUTANS SCREENING TEST EQUIPMENT Paraffin wax Sterile tongue blades (wooden spatula) Disposable Contact Petri Dish (RODAC) containing MSB agar Incubator

58. PROCEDURE

59. EVALUATION Counts of more than 100 colony forming units by this method are proportional to greater than 10 colony forming units of S.Mutans per ml of saliva by conventional methods. ADVANTAGES Simple and practical for field studies. Requires no transport media/dilution steps.

60. STREPTOCOCCUS MUTANS SCREENING TEST 3. DIP-SLIDE METHOD This method is devised for S.mutans levels in saliva. EQUIPMENT Paraffin wax Plastic slides coated with Mitis Salivarius Agar Buffered diluent

61. PROCEDURE

62. EVALUATION Score 1 = Low. Colonies are discrete. CFU less than 200. Score 2 = Medium. Colonies are less discrete. CFU more than 200. Score 3 = High. Colonies are tiny & uncontrollable .

63. STREPTOCOCCUS MUTANS SCREENING TEST 4 .ADHERENCE METHOD Categorizes salivary samples based on ability of S.mutans to adhere to glass surfaces when grown in sucrose-containing broth. EQUIPMENT Tube to collect saliva Rack to hold culture tubes Disposable pipettes Incubator MSB broth

64. PROCEDURE

65. CARIOSTAT TEST It was formulated by Prof. Tsutomu Shimono (1974 ) PRINCIPLE Designed to measure the pH decrease caused by Streptococcus mutans in the plaque sample.

66. PROCEDURE

67. SCORING IN CARIOSTAT TEST pH COLOR CARIES ACTIVITY 0 6.1 ± 0.3 BLUE CARIES INACTIVE 1 .54 ± 0.3 GREEN SLIGHT CARIES 2 .47 ± 0.3 YELLOW GREEN MODERATE CARIES 3. 4 ± 0.3 YELLOW MARKED CARIES

68. CARIES RISK TEST Recently caries reactivity tests have been advocated as new, quick & effective. Caries reactivity tests has 2 components

69. PROCEDURE :

70. ORA TEST Rosenberg et al 1989 PRINCIPLE: Is based on the rate of oxygen depletion by microorganisms in expectorated milk. In normal conditions , bacterial enzyme , aerobic dehydrogenase transfers electrons and protons to oxygen. Once oxygen gets utilized by aerobic organisms, methylene blue acts as an electron acceptor and gets reduced to leucomethylene blue. This reflects the metabolic activity of aerobic organisms.

71. ORA TEST Estimates oral microbial levels. EQUIPMENT: Sterile beakers Sterilised milk 0.1% aqueous solution methylene blue 10ml disposable syringes Pipette Stopwatch Mirror

72. PROCEDURE:

73. ORA TEST EVALUATION: Higher the infection , lesser was time taken for color change of expectorate reflecting higher oral microbial levels. ADVANTAGE: Less time consuming Economic Non-toxic vehicle DISADVANTAGE: Lack of speciality

74. CARISCREEN ATP METER / CARIES SUSCEPTIBILITY TESTING METER It is a new device which shows the result on the Cari Screen meter within 1 minute . The test suggests risk of caries caused by cariogenic biofilm, & can be explained to the patient regarding the consequences of a biofilm infection .

75. CARISCREEN ATP METER / CARIES SUSCEPTIBILITY TESTING METER The test is quick and painless . Swab sample of the plaque from patients , combined with special bioluminescence reagents within the swab, will create a reaction which is then measured with the meter.

76. CARISCREEN ATP METER / CARIES SUSCEPTIBILITY TESTING METER SCORING The Cari Screen will give a score between 0 and 9,999 . A score under 1,500 is considering relatively healthy , while above that shows considerable risk for decay.

77. Oratest : A Simple Chairside Aid for Caries Risk Assessment ; Arora Ruchia , Lahiri Prathik , Masih Updeshc ; INTERNATIONAL JOURNAL OF DENTAL CLINICS 2009:1(1): 26-30 The study relates Plaque indices and DMFT counts as indicators of caries activity to Oratest scores. Despite its drawbacks this test may be used as an indicator of caries activity. This study aimed at establishing Oratest as a reliable and convenient chair side procedure for routine dental practice.

78. LIMITATIONS OF CARIES ACTIVITY TESTS NONE of these tests are highly reliable as indicators of expected caries increments . Single parameters are usually read (such as acid produced or colony counts of bacterial species) but, dental caries is a multifactorial disease. They do not determine factors involved in caries resistance such as fluoride exposure, maturation of enamel or immune protection.

79. LIMITATIONS OF CARIES ACTIVITY TESTS Tests for microbial activity ( lactobacillus count, S.mutans colony count, synder test, swab test) have media adjusted to a pH of 5.2 or less, thus selectively eliminating growth of organisms that are not aciduric . Combined use of several selected tests may give a better picture of the caries activity of an individual.

80. CONCLUSION Caries activity tests are a valuable adjunct for patient motivation in a plaque control program. ‘ To run a caries preventive program without using microbiological methods is like running a weight control program without a scale .’ But, there are no ideal tests in existence at the present time. Further research is still necessary…

81. REFERENCES 1.Marwah N. Textbook of pediatric dentistry.3 rd edn . 2.Tandon S. Textbook of Pedodontics . 2 nd edn . Paras medical publishers 2009 3.Peter S. Essentials of Community Dentistry . 4 th edn . 4.Studervant CM, Roberson TM, Heymann HO, Studervant JR. The Art and science of operative dentistry. 3rd ed. Mosby Co: 1995.p. 62-3. 5 . Michiko Nishimura et al. Using a caries activity test to predict caries risk in early childhood. JADA. 2008; 139: 63 – 71.