Caries activity test

Prof. Dr. Fadil Abdullah Kareem

Caries:
Caries is a multifactorial disease, the many contributing factors can be grouped into three categories:

(1) Those microorganisms that constitute a challenge to the integrity of the tooth,

(2) tooth and host resistance to the challenge, challenge

(3) remineralization capacity (repair).

• The objective of caries activity testing is to identify some parameters related

relatedto to
the the
triadtriad
of of
defence repair
challenge, defense, and repair that will indicate impending or existent caries activity or inactivity.
Such information can be used to help estimate the probability of caries but more importantly to

formulate strategies for the prevention of disease

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Criteria of Caries Activity Test:

1. The test should be reproducible.

2. The test should be valid.
3. The test should be simple and inexpensive to perform.
4. The test should be noninvasive, easy to evaluate, and applicable to any
clinical setting.
5. There should be a minimal occurrence of false response

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Advantages of Caries Activity Tests:

1. Permits the identification of individuals with a higher probability of developing caries.

2. Institutes intensive effective primary-preventive measures designed to arrest and to

reverse the disease process before the irreversible point of caries has been reached.

3. Provides a patient with an individual preventive program to be implemented before

extensive dental restorative procedures are accomplished.

4. Helps to screen large segments of the population such as schoolchildren.

5. To understand the caries process better.

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A caries activity test
It facilitates the clinical management of patients for the following
reasons:
1. To determine the need and the extent of personalized preventive
measures.
2. To serve as an index of the success of the therapeutic measures
3. To motivate and monitor the effectiveness of educational programs
relating to dietary and oral hygiene procedures.
4. To manage the progress of restorative procedures.
5. To identify high risk groups and individuals.

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Caries Activity Tests:
1. Lactobacilli Colony Count Test:
The first microbiologic caries activity test that was used by practitioners was the lactobacilli colony
count. The lactobacilli counts were performed by using serial dilutions of saliva that was collected
by chewing 1 gm paraffin wafer. A 1 ml aliquot from each dilution was then placed in a series of
petri dishes, to which was added approximately 10 ml of Ragosa’s lactobacilli selective medium.
After incubating 4 days the number of colonies was counted. Counts were often scored 1 to 4,
depending on whether they fell with in the ranges of 0 to 1000, 1000 to10,000, 10,000 to 100,000
or 100,000 and up. When the score increased for a group of individuals, so did the caries score
increase.

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Caries Activity Tests:
2. Snyder’s Test:
Colorimetric

This calorimetric test is much easier for the private practitioner to use than the
preceding lactobacilli counts. It is based on the assumption that the amount of acid
produced in a medium is proportionate to the number of lactobacilli in the
inoculum. The selective medium used for the test has a pH of approximately 5.0 which is
optimum for lactobacilli growth. To evaluate visually the rapidity and extent of acid production,
bromocresol green is incorporated into the medium to indicate pH change. The medium is blue at
pH 5.0, green at 4.6, yellowish at 4.2, and yellow at 3.8. A standardized color chart is used as an
aid in determining the colour changes

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2. Snyder’s Test:

The medium is initially prepared by adding 1 liter of boiling water to 61

g of the powdered Snyder’s medium and adjusting pH with glacial acetic
acid. Approximately 5 ml of medium is placed in sterile test tubes that
are stored in a refrigerator.

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2. Snyder’s Test:
•To perform the test a specimen of saliva is secured with paraffin stimulation. One tube from refrigerator is
heated to 100 degree celsius to liquefy the agar. It is then cooled to 45 degree celsius before 0.1 ml of the
saliva specimen is added and the tube shaken before being placed in the incubator for 72 hours at 37 degree
celsius. At the end of 24 hours and again at 48 and 72 hours, the color of the medium is recorded as 1 to 4 on
the basis of whether the color remains the same or changes to light green, a light yellow, or a definite yellow in
24 hours.

•In-between scores are less informative but can be used along with clinical judgement as an aid in evaluating
caries status. Snyder’s test has the advantage of requiring only one tube of medium and no serial dilutions. Yet
because of the need to use a controlled temperature to melt the agar before adding the saliva specimen, the
test is still best accomplished in a laboratory environment. This discourages office use of the test. The classical
formula of Synder’s agar per litre of purified water is, Pancreatic digest of casein 13.5 g Yeast extract 6.5 g
Dextrose 20.0 g Sodium chloride 5.0 g Agar 16.0 g Bromocresol green 0.029 g

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Caries Activity Tests:
3. Alban’s Test (Modified Snyder Test):
•Arthur L. Alban modified the basic Snyder test to accomplish easily the caries
activity test for routine dental office use. This modified Snyder test uses the same
formula as Snyder’s media, with the exception that less agar is added. This
modification permits an easier permeation of bacterial metabolic end products
throughout the agar column.

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3. Alban’s Test (Modified Snyder Test):

• At the time of the test, a 5 ml tube of semisolid agar is removed from

the refrigerator but it is not heated. The patient is asked to spit
unstimulated saliva directly into the tube until there is thin layer of
saliva covering the surface of green agar. The tube is then incubated
for 4 days, with daily recordings is made to observe color changes
produced by the acidogenic organisms in the salivary specimen. The
color changes are scored from 0 to 4, with the score being based on
the amount of color changes occuring from top to bottom in the
tube. A zero score indicates no color change.

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•A 1 + score indicates color change to yellow in the top ¼ of tube.
•A 2+ score indicates color change to yellow in the ½ mark of tube.
•A 3+ score indicates color change to yellow in the ¾ mark of tube.
•A 4+ score indicates entire length of agar column has changed to
yellow.
•The Alban test is ideal for patient education. Favourable changes in
diet intake and plaque control procedures are reflected within a few
weeks by corresponding changes in the Alban test score

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Caries Activity Tests:
Other tests include the following:
4. Salivary Buffer Capacity Test
5. Enamel Solubility Test (Susceptibility Test)
6. Salivary Reductase Test
7. Streptococcus mutans Level in Saliva

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Limitation of caries activity tests

1. None of the tests are highly reliable as indicators of expected caries increments. Since caries
activity tests measure a single parameter such as acid produced or colony count of bacterial species,
dental caries is a multifactorial disease, and caries predictive tests do not encompass those factors.
This is a reason why the best predictor of expected caries activity has resulted from the combined use
of several selected tests.
2. It is significant that the media in some of these tests are adjusted to a pH of 5.2 or less thus
selectively eliminating growth of organisms that are not aciduric.

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 THANK
YOU

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