CARIES ACTIVITY

TESTS
Chapter Four
 OBJECTIVES OF CARIES ACTIVITY TESTS

 These tests measure the degree to which the local environmental challenge
favors the possibility of carious lesions.

 Caries activity tests are essential to:

a. Establish an initial base-line level of cariogenic pathogens as a basis for
future evaluation and preventive dentistry counseling.

b. Ensure a low level of caries activity before starting any extensive restorative
procedure.

c. To monitor patients behavior towards reducing the number of streptococcus

mutans and lactobacilli as a part of counseling to restrict sucrose intake.
ADVANTAGES OF CARIES ACTIVITY
TESTS

i. Permits public-health dental personnel to screen

large segments of the population for example
school children.

ii. Permits the identification of individuals with a

higher probability of developing caries and
institute intensive and effective primary-
preventive measures designed to arrest and to
reverse the caries process.
iii. Permits the researchers to understand the caries
process better and to develop better caries control
measures by testing new preventive agents.

iv. These provide a patient with an objective

evaluation of caries risk and an individual
preventive program to be implemented before
extensive restorative procedures are started.
CRITERIA OF AN IDEAL CARIES ACTIVITY
TESTS

i. It should be reproducible: this means that repeated

results of any chemical or bacteriological tests
should be in the same order of magnitude if taken
from same specimen or from different specimens
collected at different times under standardized
conditions.
ii. The test should be valid.
iii. There should be minimal occurrence of false
responses.
iv. There should be a high correlation between the
caries activity scores and the DMFS incidence or
prevalence scores for an individual.
v. The test should be simple and inexpensive to
perform.
vi. The test should not require special equipment or
training.
vii. Should be non-invasive, easy to evaluate and
applicable to any clinical setting.
CARIES ACTIVITY AND CARIES
SUSCEPTIBILITY

 Caries activity refers to the increment of active

lesions (new recurrent lesions) over a stated period
of time. It is a measure of the speed of progression
of a carious lesion. Retrospectively it can be
determined as caries incidence, that is, new carious
lesions over time of an individual or population.
 Caries susceptibility: This is the susceptibility (or
resistance) of a tooth to a caries-producing
environment. It refers to the inherent tendency of
the host and target tissue (tooth) to be afflicted by
caries process. The risk of developing a lesion,
however, is individual and varies, depending on the
tooth, its localization, surfaces, previous fluoride
exposure etc.
Tests Which Measure Caries Activity

1. Lactobacillus colony count.

2. Streptococcus mutans level in saliva.
3. Dip slide method for s.mutans count.
4. S.mutans screening tests.
5. Alban test.
6. Dewar test.
7. Swab test.
8. Salivary buffer capacity.
Tests Which Measure Caries Susceptibility

1. Snyder’s colorimetric test.

2. Enamel Solubility test.
3. Dewar test.
4. Fosdick calcium dissolution test.
5. Salivary reductase test.
VARIOUS CARIES ACTIVITY
TESTS
1. Lactobacillus colony count test.
2. Colorimetric Snyder’s test.
3. Alban test.
4. Reductase test.
5. Fosdick calcium dissolution test.
6. Dewar test.
7. Ora test.
8. Swab test.
9. Buffer capacity test.
Lactobacilli Counts

 This test was first described by Hadley in 1933.

 Procedure
1. Serial dilutions of saliva, collected by chewing a 1
gm paraffin wafer.
2. 1 ml aliquot from each dilution is then placed in a
series of Petri dishes.
3. Approximately 10 ml [45°C] Ragosa’s lactobacilli
selective medium is added.
4. After incubation for 4 days, the number of colonies
are counted (Fig. 29.1).

5. Caries activity is described from little or none to

marked depending upon the number of colonies
(Table 29.1). Counts are scored 1–4 depending
upon whether they fall within the following ranges
With the increase in score, there was an increase in
caries score for a group of individual.
Snyder’s Test
 Colorimetric method of measuring production of
acid (Snyder’s Test) was developed by Snyder in
1951 as a simple method for estimating the reactive
numbers of lactobacilli in the saliva.

 It is based on the fact that acid is produced by

lactobacilli and the amount of acid produced in a
medium is proportionate to the number of
lactobacilli in the inoculum.
 Procedure
i. Saliva is collected before breakfast by chewing paraffin.
ii. A tube of Snyder glucose agar is melted and then cooled
to 45°C.
iii. Saliva is shaken vigorously and 0.2 ml of saliva is added
to agar tube and immediately mixed by rotating the tube.
iv. The tube is then incubated for 72 hours at 37°C.
v. The color change from green to yellow of the indicator is
observed after 24, 48 and 72 hours of incubation (Fig.
29.2).
Tube 1: Uninoculated Synder tube.

Tube 2: No color change indicates little or

no susceptibility to forming dental caries.

Tube 3: Sight color change indicates mild

susceptibility to forming dental caries.

Tube 4: Significant color change indicates

moderate susceptibility to forming dental
caries.

Tube 5: Complete color change indicates

high susceptibility to forming dental caries.
Results

Interpretation
 Interpretation is based upon the color change seen

after 24 to 48 and 72 hours (Table 29.2).

Advantages
1. It is a simple test and needs only one tube of medium
and no serial dilutions.
2. Has a moderate cost.
Disadvantage
 Needs controlled temperature, best accomplished in a

 laboratory environment.