CARIES ACTIVITY/SUSCEPTIBILITY

TEST

SHAIK ISMAIL
 SOME IMPORTANT TERMS
CARIES:-According to KRAMMER, Dental caries is an irreversible
microbial disease of the calcified tissues of the teeth, characterized by
demineralization of the inorganic portion and destruction of the organic
substance of the tooth, which often leads to cavitations.

CARIES ACTIVITY :-Refers to the

increments of active lesions (new and recurrent lesions) over a stated
period of time.
• It is measure of speed of progression of disease.
CARIES SUSCEPTIBILITY:-Refers to the inherent tendency of the host
and target tissue, the tooth, to be afflicted by the caries process.
• It is the susceptibility of the tooth to a caries producing environment.
 PURPOSE
FOR THE CLINICIAN:-
• To determine the need for caries control measures.
• As an indicator of patient co-operation.
• To act as an aid in timing of recall appointments.
• As a guide to insertion of extensive restoration.
• To aid in determination of prognosis.
• As a precautionary signal to orthodontist in placing bands.
FOR THE RESEARCH WORKER:-
• As an aid in selection of patients for caries study.
• To help in screening of potential therapeutic agents.
• To serve as an indicator of periods of exacerbation and remission.
 IDEAL REQUISITES
According to SNYDER
• Have sound theoretical basis.
• Show maximum correlation with clinical status.
• Should have validity, reliability and feasibility.
• Be accurate with clinical status.
• Be simple.
• Be inexpensive.
• Take little time.
 FACTORS IN
EVALUATION OF CARIES RISK
 CARIES ACTIVITY TESTS
• LACTOBACILLUS COLONY COUNT TEST
• COLORIMETRIC SNYDER TEST
• THE SWAB TEST
• STREPTOCOCCUS MUTANS LEVEL IN SALIVA
• DIPSLIDE METHOD FOR S.MUTANS COUNT
• SALIVARY BUFFER CAPACITY TEST
• SALIVARY REDUCTASE TEST
• ALBAN TEST
• STREPTOCOCCUS MUTANS SCREENING TEST
• FOSDICK CALCIUM DISSOLUTION TEST
• ORA TEST
 LACTOBACILLUS COLONY COUNT TEST

• Introduced by HADLEY in 1933

PRINCIPLE:-Estimates the number of acidogenic and aciduric
bacteria

Saliva(5-10ml) 0.4ml 0f 1:100 dilution Quebec counter

incubated
 NUMBER OF CARIES ACTIVITY
LACTOBACILLI/ML
0-1000 LITTLE OR NO ACTIVITY
1000-5000 SLIGHT ACTIVITY
5000-10,000 MODERATE ACTIVITY
>10,000 MARKED ACTIVITY

• Disadvantages:
inaccurate in predicting
dose not completely exclude other organisms
time consuming
CALORIMETRIC SNYDER TEST
• Introduced by SNYDER in 1951
• PRINCIPLE: measures the ability of salivary
M O’s to form organic acids from a carbohydrate
medium
 24HOURS 48HOURS 72HOURS
COLOR YELLOW YELLOW YELLOW
CARIES ACTIVITY MARKED ACTIVITY DEFINITE ACTIVITY LIMITED ACTIVITY

COLOR GREEN GREEN GREEN

CARIES ACTIVITY CONTINUE TEST CONTINUE TEST INACTIVITY

Disadvantages: time consumed

color changes not clear
less predictive
ph of bromocresol used
 THE SWAB TEST
• Introduced by GRAINGER ET AL in 1965
• PRINCIPLE: SIMILAR TO SNYDER TEST
PH CARIES ACTIVITY
</=4 MARKED ACTIVTIY
4.2-4.4 ACTIVE
4.5-4.6 SLIGHTLY ACTIVE
>4.6 CARIES INACTIVE

ADVANTAGES: value in predicting caries increments

no collection of saliva
 STREPTOCOCCUS MUTANS LEVEL IN SALIVA
• PRINCIPLE: Measures the number of CFU/unit volume
of saliva by culturing the plaque from discrete sites

• INTERPRETATION: levels of s.mutans

• Colonization of new surface dose not occur readily
DIP-SLIDE METHOD FOR S.MUTANS COUNT
• PRINCIPLE: Estimation of s.mutans levels in saliva
SCORE CARIES ACTIVITY DESCRIPTION
1 LOW THE COLONIES ARE
DISCRETE AND COULD BE
READILY COUNTED AT 15 X
MAGNIFICATION WITH THE
TOTAL COUNT OF CFU
INSIDE THE INHIBITION
ZONES LESS THAN 200
2 MEDIUM THE COLONIES ARE
DISCRETE AND THE
NUMBER IN THE ZONES OF
INHIBITION IS MORE THAN
200 AT 32 X
MAGNIFICATION
3 HIGH THE COLONIES ARE TINY
AND ALMOST COMPLETELY
OR TOTALLY COVER THE
INHIBITION ZONE WITH THE
NUMBER OF COLONIES
UNCOUNTABLE EVEN WITH
32 X MAGNIFICATION
 SALIVARY BUFFER CAPACITY TEST
• PRINCIPLE: Measures the no. of ml of acid required to
lower the ph of saliva through arbitrary ph of 7 to 6

• EVALUATION: Inverse relationship between buffering

capacity of saliva and caries activity
 SALIVARY REDUCTASE TEST
principle :Measures the activity of reductase enzyme
present in salivary bacteria
COLOR TIME SCORE CARIES ACTIVITY
BLUE 15 MINUTES 1 NONCONDUCIVE
ORCHID 15 MINUTES 2 SLIGHTLY
CONDUCIVE
RED 15 MINUTES 3 MODERATELY
CONDUCIVE
RED IMMEDIATELY 4 HIGHLY CONDUCIVE
PINK/WHITE IMMEDIATELY 5 EXTREMELY
CONDUCIVE
 ALBAN TEST
• It’s a simplified substitute for snyder test
• A small scale to measure 60 grams
• Faster change or more pronounced colour
change is labelled ”worse”
Advantages
• Simple
• Low cost
• Diagnostic value when negative results are obtained
• Its motivational value
Disadvantages
• More armamentaria required
• Based on subjective evaluation of colour change that may not
be clear cut
NO COLOR CHANGE ¾

BEGINNING COLOR CHANGE +

(FROM TOP TO MEDIUM DOWN) ONE ++
HALF COLOR CHANGE
(FROM TOP DOWN)THREE FOURTHS +++
COLOR CHANGE
(FROM TOP DOWN)TOTAL COLOR ++++
CHANGE TO YELLOW
 STREPTOCOCCUS MUTANS
SCREENING TEST
Plaque /tooth pick method
Involves a simple screening of diluted plaque sample streaked on a selective
culture media
Saliva / tongue blade mehodi
Estimates the no of s.mutans in mixed paraffin stimulated saliva wen cultured
In mutans salivarius bacitracin agar.
 FOSDICK CALCIUM DISSOLUTION TEST
Principle: Measures the milligrams of powdered enamel
dissolved in 4 hrs by acid formed when pts saliva is mixed with
glucose and powdered enamel
 ORA TEST
This test was developed by rosenberg et al in 1989.
It is based on rate of oxygen depletion by MO’s in
expectorate milk samples.
THANK YOU