Caries Activity Test

Introduction
Dental caries is an irreversible progressive disease of multifactorial in nature affecting the calcified tissues of the teeth characterized by demineralization of inorganic portion & destruction of organic portion of the tooth. Terms like primary and secondary caries, initial and cavitated lesions, white spot lesions, arrested caries, and root caries are used to describe the activity and severity of caries.

Caries Risk and Caries Activity

Risk :the probability that a harmful (or unwanted) event will occur. Caries Risk :status of the whole patient. It can be defined as the likelihood of the patient getting a new cavitation Caries Activity :status of the caries process (demin/remin) on an individual tooth surface.

 Caries risk assessment: procedure to assessment: predict future caries development before the clinical onset of the disease. disease. Caries activity test preferably should estimate the actual state of disease activity (progression/regression)

Indication of Caries-Risk Test Caries New patients with signs of caries activity Pregnant patients Patients experiencing a sudden increase in the incidence of caries Individuals taking medications that may affect the flow of saliva Xerostomic patients Patients about to undergo chemotherapy Patients who frequently consume fermentable carbohydrates Patients suffering from diseases of the autoimmune system.

Individual Approach of Caries Activity

1. case history, 2. clinical and radiographic examinations, 3. diet history, 4. supplementary laboratory tests First, First, determine which particular factors are involved. Next, Next, find out why these factors are present. present. Finally, Finally, try to change the situation by targeted actions against identified factors. factors. Cariogram & Cariograph

Background Data for Caries Activity

General diseases Medication Social/family situation Dietary habits/feeding OralOral-hygiene routines fluoride support

Clinical Examination
1. It is important to collect data in a standardized & systematic way 2. (dmft/DMFT). 3. Why and when were the teeth extracted? (caries, periodontal disease, orthodontics), 4. Were the restorations placed long ago or recently? 5. Check number, extension & appearance of lesions, cavities, & fillings. fillings.

6. local aggravating factors (crowded arches, deep fissures, imperfect fillings & exposed root surfaces) are evaluated. 7. Texture & localization of lesions provide important hints for caries activity. 8. altered enamel development, such as increased porosity and decreased mineral content are directly linked to an increased caries risk.

Clinical Examination

 the estimation of the oral hygiene standard with a disclosing solution can be recommended. It should be emphasized that visible plaque on the labial surfaces of maxillary incisors of a young child is a serious sign of caries risk.

CariesCaries-Activity Tests for the Dental Office

The most common sources for sampling are saliva & plaque. Salivary tests are generally more practical Ideally, laboratory tests should accurately reflect the 4 overlapping circles presented by Keyes in 1962: 1962: 1. Bacterial challenge; determination of Streptococcus challenge; mutans as an indicator of relative risk. risk. 2. Diet; determination of lactobacilli as an indicator of sugar content in diet. 3. Remineralization potential; salivary flow rate and potential; buffer capacity as an indicator of potential biologic repair. repair. 4. Host suspectibility; caries experience as an indicator suspectibility; of past activity.

CariScreen
Caries Susceptibility Testing Meter and Swabs

Requirements of caries-risk test: caries1. reproducible & valid 2. good correlation between the caries activity scores & actual caries development 3. simple 4. Results should be obtained rapidly, within hours or few days 5. Should have measurement of mechanisms involved in caries process 6. inexpensive, non-invasive & applicable to nonany clinical setting

CARIES ACTIVITY TESTS

1. S.Mutans Count 2. S.Mutans screenig test 1_plaque/ tooth pick test 2_saliva / tongue blade method 3. lactobacilli Count 4. Salivary flow rate 5. Buffering capacity of saliva 6. Snyder Test

7. Swab test
8. Salivary Reductase Test(susceptibility test) 9. Plaque-forming Rate 10. Enamel Solubility Test (susceptibility test) 11. Fosdick calcium dissolution test 12. Dewer test

1. S.MUTANS COUNT:
This test measures the number of S.Mutans Colony forming units per units volume of saliva and culturing of the plaque samples from discete site with a selective media

2. LACTOBACILLI COUNT:
The number of lactobacilli can be estimated with the aid of the Dentocult-LB method, consisting of a plastic device covered with selective agar.

3. SALIVARY FLOW RATE

Salivary flow rate is considered as a "key" parameter in caries-risk assessment When measuring the flow rate, one can either sample unstimulated or stimulated whole saliva. The stimulation can be done by paraffin chewing or by adding droplets of a sour liquid (3% citric acid) on the back of the tongue.

4. BUFFERING CAPACITY OF SALIVA

Can be quantitated by using either a pH meter or color indicators this test measure the number of millimeters of acid require to lower the PH of saliva through an arbitrary PH interval, such as from PH 7.0 to 6.0, or the amount of acid or base necessary to bring color indicators to their end point.

5. SNYDER TEST
This test reflects the total number and the acidogenicity of the salivary bacteria and can be used as an alternative to the lactobacilli test.

ALBENS TEST
It is simplified substitute for synder test

SWAB TEST
Its advantage is no collection of saliva is necessary. The oral flora is sampled by swabbing the buccal surface of tooth with cotton. Its valuable in evaluating caries activity in very young children

6. Reductase Test:
This test measures the activity of reductase enzyme present in salivary bacteria.

7. Plaque-forming Rate
General Plaque has been suggested as a caries predictor. The speed of plaque development can be estimated by the plaque-forming-rate index

8. Enamel Solubility Test:

It is based on the fact that when glucose is added to saliva containing powdered enamel, organic acids are formed. Organic acid decalcifies the enamel, resulting in an increase in the amount of soluble calcium. The extend of increase of calcium is a direct measure of caries activity