CARIES ACTIVITY TEST

Practical goals : caries activity test

- To measure dental caries activity in a person.
- To help determine the development of caries in each
individual

These tests can help identify and determine the risk of caries
in patients so that it can help in the preventing and treating
teeth.

Being able to provide test results for patients at risk of caries,

can help patients to be cooperative in carrying out treatment.
Sugar
Bacteria : S. mutans,
Lactobacillus
Bacterial product :
acid

There are many tests for caries activity, but these test can not be used
as an indicator of dental caries with certainty. This is because the
etiology of dental caries is multifactorial and there are many variables
are involved

The measurement method only focuses on one major cause of caries. It

take several tests simultaneously so that the correlation is high → valid
indication for caries prediction.
Three (3) important indicators that must be owned in the caries activity
test kit, are :

1. Validity : The measurement method is easy to describe and

accurate.

2. Reliability : The test gives the same results on different

conditions and researchers.

3. Feasibility : The test is easy to do, to understand, and cheap,

ideally: non-invasive, inexpensive & easy to
implement.
Result should be obtained rapidly, within hours or few days
The basic of the caries susceptibility test :
correlation of bacteria in the oral cavity or metabolic products with the
indicator
Some types of test for caries activity :

1. LACTOBACILLUS COLONY COUNT:

- Taken from saliva was observed and incubated in
selective media of Lactobacillus bacteria (Rogosa,
Kulps Tomato Juice).
- The number of Lactobacillus colonies per milliliter of
saliva (Is the growth medium is broth  standard
optical density).
 Interpretation of the Results :
Number of Symbolic Degree of caries
Lactobacillus/ ml designation activity suggested
1 - 1000 + Little or non
1000 - 5000 + Slight
5000 – 10.000 ++ Moderate

More than 10.000 +++/++++ Marked

2. SALIVA FLOW TEST:

1. Flowrate is determined by collecting parafin stimulated saliva in
a test tube over 5 min
2. Severly decreased flow is related to caries suspectibility.
3. As salivary flow rate decreases viscocity increases
3. BUFFERING CAPACITY OF WHOLE SALIVA
This test calculates the ability of saliva to neutralize
standard acid fluids, based on the hypothesis that
acid production accumulated in dense dental plaque
leads to enamel demineralization or dental caries.

CORRELATION BETWEEN SALIVARY BUFFER

CAPACITY AND CARIES ACTIVITY.
If the salivary buffer capacity ↓, the risk of caries ↑.
Test result : valid but did not provide adequate correlation to
caries activity.
4. Streptococcus mutans colony count.

5.. Streptococcus mutans screening test.

Selective media were used :
- Tripton Yeast Cystein (TYC),
- Mitis Salivarius Agar (MSA) + ​Bacitracin + Sucrose
The S. mutans bacteria from px were put in a petri dish containing buffer
and bacitracin, after a few minutes, a thin layer of MSA was put in the
petri dish, and incubated. The calculation of the number of bacterial
colonies was determined by the density comparator chart. Each point on
the chart shows one colony and the number shows the number of
bacterial colonies per milliliter of saliva. Px free: low number of S. mutans
& L.acidophilus.
6. Cariostat: Colorimeter
Refinement of previous caries activity test theories. First introduced by
Shimono and Soube, 1974.
Material : Media: Semisynthetic ingredients: Sucrose (20%) as KH,
tryptose (2%) as a nitrogen source, sodium azide (0.02%) as
a drug to control Gram negative bacteria, and color indicators
of BCG (Bromo Cresol Green) and BCP (Bromo Cresol
Purple).
Sample: Dental plaque.
Method: Put dental plaque in cariostat media, incubation 37oC + 2oC
for 48 hours. The bacteria in the plaque ferment sucrose to
become acidic so that it occurs decrease in pH. Readings
the first 48 hours after incubation. The color change of the
cariostat can be read most accurately when indirect daylight
fluorescent light is used.
Cariostat color change: 4 grade
1. Bluish purple : pH 6.1 + 0.3. cariostat value 0. Px: inactive caries activity.

2. Green : pH 5.5 + 0.3, cariostat value 1. Px: mild active caries activity.

3. Yellowish green : pH 4.7 + 0.3 cariostat value 2. Px: active caries activity.
4. Yellow color : pH 4.0 + 0.3 cariostat value 3. Px: heavy caries activity.

Cariostat score
0 : OH px is very good, should be maintained.
1 : OH px is good, but sugar consumption is reduced and it is necessary to
clean teeth immediately after eating.
2 : Reduced frequency and consumption of foods containing sugar, to
prevent dental caries.
3 : Found some dental caries or dental caries in the near future, then the
frequency and consumption of foods containing sugar is reduced and
teeth cleaning should be done immediately after eating.
 7. Snyder Test.

Snyder Test:
Basic : Acid formation produced by acid-producing bacteria in
the oral cavity.
Method:
Measure the production of salivary acid for more than 3 days.

Bacteria are grown on Snyder medium, acid production, change in

color from green to yellow, due to the pH indicator.

There is a good relationship between the rate of color change and the
number of acid-producing bacteria in saliva.
The use of a color change indicator from pH determines the acid
production of bacteria.
 Snyder Test:
The results showed a strong association between clinical caries
activity and positive test results.

In patient with active caries, the number of acid-producing bacteria

is higher than px without caries or inactive caries.
 PROCEDUR OF SNYDER TEST

1. Take plaque or the saliva and put it in a beaker or test tube.

2. Put plaque or saliva into Snyder medium ( Solid or liquid
medium)
3. Incubation at 37oC for 3 X 24 hours
4. Observe the color change on days 1,2 and 3
Interpretation of Snyder Caries Test Result

Time (hr)

24 48 72

Color Yellow Yellow Yellow

Caries acivity High Definite Limited
Color Green Green Green
Caries activity Continue Continue Inactive
tes tes

From : Newbrun, Cariology, ed 2 William & Wilkins, p.259,1983,

with permission.