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Caries activity refers to the increment of active lesion(new and recurrent lesions) over a stated period of time.
Caries activity measures the speed of progression of a carious lesion.
It refers to the inherent tendency of the host and target tissue, the tooth to be afflicted by the carious process.
Caries activity measures the degree to which the local environmental challenge favors the
probability of occurrence of carious lesions.
Monitor the effectiveness of the oral health education programs. Determine the need for personalized preventive measures and motivate the individual.Uses of caries activity test Identify the high-risks groups and individuals. Aid in selection of patient for caries activity. . Ensure a low level of caries activity before any restoration.
Should be inexpensive and simple. .IDEAL REQUISITES Should have sound theoretical basis. Should have maximum correlation with clinical status. Easy to perform.
. Results should be accurate and reproducible. Should be adaptable for chair side. reliability and feasibility. Results should have good validity.
SALIVARY REDUCTASE TEST. . SNYDER TEST. ALBAN TEST. MICROBIAL TEST FOR LACTOBACILLI DETECTION.TYPES OF CARIES ACTIVITY TEST MICROBIAL TEST FOR MUTANS STREPTOCCOCI DETECTION.
DIP SLIDE METHOD. ORA TEST. SWAB TEST FOSDICK CALCIUM DISSOLUTION TEST. SALIVARY BUFFER CAPACITY TEST. .
. 5. plaque etc. 3. Types of methods are as follows: 1. Selective method.MICROBIAL TEST FOR MUTANS STREPTOCCOCI DETECTION Several methods are available to measure the level of Mutans Streptococci in saliva.Adherence method. Laboratory method. Chair-side method. 4. Survey method. 2.
2 U bacitracin/ml (MSB) which supresses the growth of non S.Mutans colonies. .Mutans colonies.LABORATORY METHOD Principle: Measures the number of forming unit (CFU)/unit volume of saliva by culturing the plaque samples from discrete sites(occlusal fissures/proximal areas)for detecting and quantitating S. Incubation is done on Mitis Salivarius Agar(MSA) selective streptococcal medium with addition of high concentration of sucrose (20%) and 0.
Samples are directly placed the selective agar plates The agar plates are incubated at 37˚C for 48hrs in 95% at 5% CO2 gas mixture. i. It is then mixed with proper transport medium and the sample is sent to a microbiological laboratory.LABORATORY METHOD Saliva or plaque sample is collected. .e(special petri dishes).
. The results are expressed as the number of colony forming units per ml of saliva. Mutans colonies on the plates are counted. Most common type of selective agar plates used is mitis-salivarius-bacitracin agar.
RESULTS FOR LABORATORY METHOD Caries Risk Or Activity 100.000 (105 to 5X105) cells/ml MEDIUM.000 to 500.000 (5X105) or above cells/ml HIGH . 100. 500.000 (105) S. mutans cells/ml of saliva LOW.
bacitracin discs. . use of the selective broth (High sucrose concentration in combination with bacitracin). test tubes with broth. The Dentocult SM-strip mutans kit is used for estimation of mutans streptoccoci in saliva containing test strips.CHAIR-SIDE METHOD Also known as “Strip mutans test” is based on the ability of streptococci to grow on hard surfaces. paraffin for chewing and a standard chart to evaluate the level of mutans after incubation.
equivalent to 106 mutans CFU per ml in saliva. The mutans sreptococci colonies as small blue dots but the color can vary from dark blue to pale blue. The level of mutans streptococci is given as “Class” after comparision with chart. . Indicating low to high .
DENTOCULT STRIP MUTANS KIT .
Plastic strip(test strip) is then taken in the mouth to become contaminated.PROCEDURES In case of dentocult SM Strip mutans test. Then. .bacitracin discs are added to the broth at least for 15 minutes before use. patient is asked to chew a piece of paraffin for 1 minute.
the strip with attached colonies is compared with the chart. The strip is then withdrawn through closed lips. The strip then incubated in the selective broth. After incubation for 48 hour at 35-37 degree centigrade. leaving a thin layer of saliva on the strip. .
RESULTS FOR CHAIR SIDE METHOD Strips for plaque (Squaretipped) Test strips for stimulated saliva (round-tipped) .
This test involves simple screening of diluted plaques sample streaked on the selective culture media. mitis-salivarius agar plates and incubator. sterile ringer solution. Equipments required are sterile toothpicks.mutans at the specific sites of oral cavity. platinum loops. This method is used for demonstration of S.SELECTIVE METHOD Described by Kristoffersson and Bratthall. .
PROCEDURES Plaques sample are collected from gingival 3rd of the tooth surface. Then it is placed in Ringer’s solution. Incubation is done at 37 degree centigrade for 72 hours. Contaminated slides are then pressed directly against selective agar plates. . Then sites with or without mutans sreptococci can be identified. It is then shaken homogeneously. Toothpicks are inserted into the approximal spaces.
incubator and MSB(mitis. rack to hold the culture tubes. disposable pipettes.salivarius bacitracin ) broth. . Equipment required are tube to collect saliva. mutans to adhere to glass surfaces when grown in sucrose containing broth.ADHERENCE METHOD It categorizes salivary samples based on ability of S.
. the supernatent medium is removed and the cells adhering to the glass surface are examined microscopically and scored. After the growth has been observed. Inoculated tubes are set at 60 degree angle and incubated aerobically at 37 degree centigrade for 24 hours.1 ml) is inoculated in MSB broth.PROCEDURES Unstimulated saliva(0.
RESULT OF ADHERENCE METHOD VALUE (-) (+) (++) (+++) INFERENCE No growth expressed A few deposits ranging from 1-10. Numerous minute deposits. . Scattered deposits of smaller size.
-Introduced by Hadley in 1933. .MICROBIAL TEST FOR LACTOBACILLI DETECTION Introduced by Hadley in 1933. Principle: Estimates the number of acidogenic and aciduric bacteria in patient’s saliva by counting the number of colonies appearing in tomato peptone agar plates(pH 5.0) after inoculation with sample of saliva.
PROCEDURES Before breakfast the patient is asked to chew a paraffin and the saliva accumulated is collected in a sterile container and shaken for 2 mins to mix it. It is again diluted to 1:100. . saliva sample is diluted to 1:10 dilution by pipetting 1 ml of saliva into a 9 ml of sterile saline solution.
The number of lactobacilli/ml saliva is calculated by multiplying the number of colonies by the dilution factor. 0. . Lactobacillus colonies are then counted using a colony counter or Quebec counter.4 ml of the diluted solution is spread on the agar plate and incubated at 37˚C for 3-4days.
The colony count as related to caries susceptibility is shown n the table: Number lactobacilli per ml saliva 0-1000 1000-5000 5000-10000 >10000 Caries activity Little or none Slight Moderate Marked .
Principle: The Snyder test measures the rapidity of acid formation when a sample of stimulated saliva is inoculated into glucose agar adjusted to pH 4. .7 to 5 with the help color indicator named bromocresol green.COLORIMETRIC SNYDER TEST It measures the ability of salivary micro-organisms to form organic acid from carbohydrate medium.
EQUIPMENTS Saliva collecting bottles Paraffin A tube of snyder glucose agar containing bromocresol green Pipettes Incubator .
. cooled at 50˚C. • A tube of Snyder glucose agar is melted. • Amount of acid produced is detected by pH indicator and compared to an uninoculated control tube after 24. • The agar is solidified and incubated at 37˚C.PROCEDURE: • Paraffin stimulated saliva is collected before breakfast. shaken and 0. 48 & 72 hrs of incubation.2 ml of saliva is pipetted in the tube.
RESULT OF SNYDER TEST Time Time Time 24 hours Color Caries activity Color Caries activity Yellow Marked activity Green Continue test 48 hours Yellow Definite activity Green Continue test 72 hours Yellow Limited activity Green inactive .
Softer medium are used that diffuse saliva and acids without the necessity of melting the medium. 2.ALBAN TEST Is a simplified version of the Snyder test. . Main features: 1. The patient simply has to spit directly into the tubes that contain the medium.
A 2 litre Pyrex glass to melt the medium 4. . Hundred 16mm test tubes with screw caps. Snyder agar 2. A funnel to dispense the medium into test tubes 5. A small scale to measure 60 grams 3.Materials required to prepare the Alban test medium: 1.
PROCEDURE • 60 gms of Snyder test agar is placed in 1 litre water and the suspension is boiled over a low flame. • The melted agar is then distributed among the tubes. • These tubes are autoclave for 15 mins. . cooled and stored in a refrigerator. About 5ml/tube.
6˚F up to 4 days. • The tubes are observed daily for the colour change from blue to green to definite yellow with decrease in pH. • The tubes are labelled and incubated at 98.• 2 tubes of Alban medium are taken out and the patient is asked to expectorate saliva directly into the tubes. .
RESULT OF ALBAN TEST Color change Score No color change Beginning of color change One half color change Three fourths color change Total color change to yellow ¾ + ++ +++ ++++ .
SALIVARY REDUCTASE TEST This test measures the activity of the reductase enzyme present in the salivary bacteria. . Action: This test measures the rate at which the indicator molecule Diazoresorcinol changes from blue to red to colourless on reduction by the mixed salivary flora.
Change in colour after 30 seconds and after 15 mins is taken as a measure of caries activity. Then sample collected is mixed with a fixed amount of diazoresorcinol. .PROCEDURE The patient is asked to chew a paraffin and the saliva accumulated is collected directly into the collection tube(5ml).
RESULT OF SALIVARY REDUCTASE TEST COLOR BLUE ORCHID RED RED PINK OR WHITE TIME 15 minute 15 minute 15 Immediately Immediately SCORE 1 2 3 4 5 CARIES ACTIVITY Non conductive Slightly conductive Moderately conductive Highly conductive Extremely conductive .
• The sample collected is incubated in the medium.SWAB TEST • Grainger et al developed this test in 1965 • Principle is similar to that of Snyder test. Procedure: • Buccal surfaces of the teeth are swabbed with a cotton applicator. . • The change in the pH after 48 hrs incubation period is read on a pH meter or using a color comparator.
6 Over 4.5-4.2-4.6 Caries activity Marked caries activity Active Slightly active Caries active .RESULT OF SWAB TEST pH 4.1 4.4 4.
test tube agitation equipment. .FOSDICK CALCIUM DISSOLUTION TEST Principle: 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. saliva collection bottles. and equipment for determining the calcium content of the saliva. sterile host tubes. Equipment :powdered human enamel.
PROCEDURE • The patient is asked to chew paraffin wax and 25 ml of the saliva is collected and part of it is analysed for calcium content. The use of paraffin to stimulate saliva increases the concentration of the glucose by 5%. of powdered human enamel. • The remaining saliva is placed in an 8 inch sterile test tube with about 0. The amount of enamel dissolution increases as the caries activity increases. . after which it is again analysed for calcium content.1 gm. • The tube is sealed and shaken for 4 hours at body temperature.
.SALIVARY BUFFER CAPACITY TEST Principle: It measures the number of millimetres of acid required to lower the pH of saliva through an arbitrary pH interval.0 to 6. such as from pH 7.0 or the amount of acid or base necessary to bring colour indicators to their end point.
5. 2. 4.05 N lactic acid and 0. 1. 3.EQUIPMENT pH meter Titration equipment 0.05 base Paraffin Sterile glass jars containing oil. .
• pH of the saliva is adjusted to 7. .LABORATORY METHOD • 10 ml of stimulated saliva is collected under oil after 1 hour of eating.0 by addition of lactic acid or base using a pH meter in room temperature. • 5 ml is then measured in the beaker.
0 by adding lactic acid.• The level of lactic acid in graduated cylinder is rerecorded. . • pH of the sample is brought down to 6. • The amount (no of millimetres) of lactic acid needed to reduce the pH from 7 to 6 is the measure of buffer capacity.
This was developed by Ericson and Bratthall.CHAIRSIDE METHOD This system differentiates between buffer capacities. .
SALIVARY BUFFER KIT .
consists of a pH indicator paper that has been impregnated with acid. The colors have been chosen to indicate low. or good buffer capacity. medium. Dentobuff Strip.PROCEDURES A new and simplified method to estimate the salivary buffer capacity . A small volume of saliva is added to the strip and after 5 min the color of the strip is compared with a chart. .
RESULT OF BUFFER CAPACITY TEST BUFFER CAPACITY Low buffer capacity Intermediate buffer capacity Normal buffer capacity FINAL pH VALUE 4.0 or more COLOR CHANGE Yellow color Green color Blue color .5 to 5.0 or less 4.5 6.
. Principle: Based on the oxygen depletion by microorganisms in expectorated milk samples. aerobic dehydrogenase transfers electrons or protons to oxygen. In normal conditions the bacterial enzyme. This reflects the metabolic activity of the aerobic organisms. methylene blue acts as an electron acceptor and gets reduced to leucomethylene blue.ORA TEST Developed by Rosenberg et al in 1989 for estimating oral microbial level. Once oxygen gets utilized by the aerobic organisms.
Sterile beakers 2. Sterilized milk 3.EQUIPMENT 1. Mirror 8. 10 ml disposable syringes 6. Pipette 7. Stop watch and test tube .1% aqueous solution of methylene blue 5. Screw cap test tubes 4. 0.
0.12 ml of 0. . mixed and placed on a stand. • 3 ml of this is transfered to the screw cap tube with the help of a disposable syringe.1% methylene blue is added.PROCEDURES • Mouth is rinsed vigorously with 10 ml of sterile milk for 30 secs and the expectorate is collected. • To this.
• The tubes are observed every 10 mins for any color change at the bottom using a mirror. Higher the infection. lesser time taken for the color change reflecting higher oral microbial levels. • The time taken for the initiation of color change within 6 mm ring is recorded. .
mutans levels in saliva.MUTANS COUNT Devised for the estimation of S.DIP SLIDE METHOD FOR S. . Procedure: • Saliva stimulated with paraffin is poured on a special plastic slide that is coated with MSA (Mitis salivarious agar) containing 20% sucrose.
• The agar surface is moistened and excess saliva is allowed to drain. The slide is tightly screwed into a cover tube after inserting CO2 tablet and incubated at 37ºC for 48 hours in a sealed candle jar. • Two discs containing 5 µg of Bacitracin are placed on the agar plate 20 mm apart. .
EVALUATION FOR DIP SLIDE METHOD Score Caries Activity 1 Description The colonies are discrete and could be readily counted at 15X magnification with the total count of CFU inside the inhibition zone less than 200 The colonies are discrete and the number in the zone of inhibition is more than 200 at 32X magnification Low 2 Medium .
.Score 3 Caries Activity Description High The colonies are tiny and almost completely or totally cover the inhibition zone with the number of colonies uncountable even with 32X magnification.
. It expresses to what extent different etiological factors of caries affect caries risk.CARIOGRAM It is a computer program showing a graphical picture that illustrates a possible overall caries risk scenario. The cariogram identifies the caries risk factors for the individual and provides examples of preventive and treatment strategies to the clinician.
diet and susceptibilty related factors. .HOW IS A CARIOGRAM CREATED? The patient is examined and the data is collected for some factors of direct relevance for caries including bacteria. The program presents a pie diagram which represents a following sectors. The factors/variables are given score according to a predetermined scale and entered in a computer program.
1. The dark blue sector (DIET) is based on a combination of diet contents and diet frequency.
2. The red sector (BACTERIA) is based on the amount of plaque and mutans streptoccoci.
3. The light blue sector (SUSCEPTIBILITY) is based on a combination of fluoride program, saliva secretion and salivary buffer capacity.
4. The yellow sector (CIRCUMSTANCES) is based on a combination of caries experience and related diseases.
5. The green sector shows an estimation of (CHANCE OF AVOIDING CARIES). When the chance of avoiding caries is high, the caries risk is small and vice-versa.
caries activity tests measure a single parameter such as acid production.CONCLUSION Till date no single caries activity test is sufficiently accurate or reliable to serve as a predictor of potential caries activity for the individual patient. colony counts etc. Since. . the best predictors of caries activity would therefore result from the combined use of several selected tests.
‘ Essentials Of Preventive And Community Dentistry’ Internet sources .’Textbook Of Pedodontics’ Soben Peter 4th edition. ‘Textbook Of Pediatric Dentistry’ Shova Tandon 2nd edition.REFERENCE Nikhil Marwah 2nd edition.
WHAT ARE THE USES OF CARIES ACTIVITY TEST? .
Identify the high-risks groups and individuals. Monitor the effectiveness of the oral health education programs. . Aid in selection of patient for caries activity. Ensure a low level of caries activity before any restoration. Determine the need for personalized preventive measures and motivate the individual.
WHAT IS A CARIOGRAM? .
. It is a computer program showing a graphical picture that illustrates a possible overall caries risk scenario.
.IDENTIFY THE PICTURE.
WHAT IS THE MOST COMMAN TYPE OF AGAR USED FOR DETECTION OF MUTANS STREPTOCOCCI? .
mitis-salivarius-bacitracin agar(MSB) .
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