CARIES ACTIVITY TEST

BY :SIMRAN GILL

ROLL NO:25

IV/I

DENTAL CARIES: DENTAL CARIES IS infectious microbial

DISEASE OF CALCIFIED TISSUES OF THE TEETH ,CHARACTERIZED BY DEMINERALIZATION OF THE INORGANIC PORTION AND DISTRUCTION OF ORGANIC SUBSTANCE OF THE TOOTH,WHICH OFTEN LEADS TO CAVITATION

DENTAL CARIES IS A BIOSOCIAL DISEASE THAT CAN BE PREVENTED IF CERTAIN RISK FACTORS COULD BE IDENTIFIED IN SUSCEPTIBLE INDIVIDUALS OR COMMUNITY..

CARIES ACTIVITY: IT REFERS TO THE INCREMENT OF ACTIVE LESIONS [NEW AND RECURRENT LESIONS]OVER A STATED PERIOD OF TIME…

CARIES ACTIVITY IS A MEASURE OF THE SPEED OF PROGRESSION OF A CARIOUS LESION..

CARIES SUSCEPTIBILITY REFERS TO THE INHERENT TENDENCY OF THE HOST AND THE TARGET TISSUE,THE TOOTH TO BE AFFLICTED BY CARIES PROCESS…

THIS IS THE SUSCEPTIBILITY (OR RESISTANCE)OF A TOOTH TO A CARIES PRODUCING ENVIRONMENT..

CARIES ACTIVITY TEST MEASURES THE DEGREE TO WHICH THE LOCAL ENVIRONMENT CHALLENGE [EG.DIETARY EFFECT ON MICROBIAL GROWTH AND METABOLISM] FAVOURS THE PROBABILITY OF OCCURRENCE OF CARIOUS LESION…

THESE TESTS AID THE CLINICIAN IN EDUCATING THE PATIENTS REGARDING HIS OR HER CARIES ACTIVITY AND THEREBY HELP IN MOTIVATING THEM IN GOOD ORAL HYGINE PRACTICES..

CARIES ACTIVITY TEST HELPS TO: IDENTIFY HIGH RISK GROUPS AND INDIVIDUAL..

DETERMINE THE NEED FOR PERSONALIZED PREVENTIVE MEASURES AND MOTIVATE THE INDIVIDUAL..

MONITOR THE EFFECTIVENESS OF ORAL HEALTH EDUCATION PROGRAMS BY ESTABLISHING AN INTIAL BASELINE LEVELS OF CARIOGENIC PATHOGENS AS BASIS FOR FUTURE EDUCATION..

ENSURE LOW LEVELS OF CARIES ACTIVITY BEFORE STARTING ANY EXTENSIVE RESTORATION PROCEDURE..

TO MONITOR PATIENT BEHAVIOUR TOWARDS REDUCINGTHE NUMBER OF S.MUTANS AND LACTOBACILLUS AS A PART OF COUNSELLING TO CURTAIL SUCROSE INTAKE….

THE PROPOSED USES OF THESE TESTS FOR CLINICIAN ARE:

TO DETERMINE THE NEED FOR CARIES CONTROL MEASURES..

AS AN INDICATOR OF PATIENT CO-OPERATION.

TO ACT AS AN AID IN TIMING OF RECALL APPOINMENTS..

AS A GUIDE TO INSERTION OF EXPENSIVE RESTORATIONS..

TO AID IN THE DETERMINATION OF PROGNOSIS..

AS A PRECAUTIONARY SIGNAL TO THE ORTHODONTIST IN PLACING BANDS..

IDEAL REQUISITES OF CARIES ACTIVITY TEST: SHOULD HAVE MAXIMUM CORRELATION BETWENN

PREDICTED AND ACTUAL CARIES DEVELOPMENT..

SHOULD HAVE RELIABILITY AND VALIDITY IE: TEST MUST BE CONSISTENTLY ACCURATE AND REPRODUCIABLE..

SIMPLICITY WITH REGARDS TO TECHNICAL PROCEDURES AND SKILLS REQUIRED…

RESULTS OBTAINED RAPIDLY,WITHIN HOURS OR FEW DAYS..

MEASUREMENT OF MECHANISM INVOLVED IN THE CARIOUS PROCESS…

DENTAL CARIES ACTIVITY TEST CAN BE CLASSIFIED AS FOLLOWS: I: MICROBIAL TESTS: LACTOBACILLUS COUNT TEST SNYDER TEST ALBAN’S TEST DENTOCULT LACTOBACILLI TEST MUTANS GROUP OF STEEPTOCOCCI SCREENING TEST

:a: PLAQUE/TOOTH PICK METHOD

:b: SALIVA/TONGUE BLADE METHOD

:c: S.MUTANS ADHERENCE METHOD

:d: S.MUTANS REPLICATE TECHNIQUE

:e: S.MUTANS DIPSLIDE METHOD… SWAB TEST ORICULT TEST

SALIVARY REDUCTASE TEST. DENTOBUFF TEST. SALIVARY VISCOSITY. SALIVARY FLOW RATE TEST. FOSDICK CALCIUM DISOLUTION TEST. DEWAR TEST.

II: TESTS FOR EVALUATING SALIVARY DEFENCE:

LACTOBACILLI COLONY COUNT TEST: COUNTS OF LACTOBACILLI REPRESENTS ONE OF THE

EARLIEST AND MOST WIDELY USED TEST OF CARIES ACTIVITY..

IT WAS OBSERVED IN 1920’S THAT HIGH NUMBER OF LACTOBACILLI WERE FOUND IN SUBJECT WITH ABUNDANT CARIOUS LESION; AND IT WAS CONSEQUENTLY BELIVED THAT LACTOBACILLI ARE CAUSE OF CARIES..

THIS WAS INTRODUCED BY HADLEY IN 1933 SINCE LACTOBACILLI ARE NOT ESSENTIAL FOR INITIATION OF LESION,THERE LEVELS IN SALIVA REFLECT THE NUMBER OF EXISTING LESIONS AND ACIDURIC CONDITION IN MOUTH..

PROCEDURE: 5-10 ML STIMULATED WHOLE SALIVA BY CHEWING

PARAFFIN IS COLLECTED IN A STERILE BOTTLE

A 1:10 DILUTION IS PREPARED BY PIPPETING 1 ML SALIVA SAMPLE INTO 9ML TUBE OF STERILE SALIVA SOLUTION..

THIS IS SHAKEN AND A 1:100 DILUTION INTO ANOTHER 9ML TUBE OF STERILE SALT SOLUTION..

THE 1:100 DILUTION IS MIXED THROUGH AND 0.4ML OF EACH DILUTION IS SPREAD ON THE SURFACE OF AGAR PLATE WITH BLENT ON GLASS ROD..

THE PLACE ARE THEN INCUBATED AT 37 DEGREE CEL FOR 3-4 DAYS..

A COUNT OF THE NUMBER OF COLONIES IS THEN MADE WITH QUEBEC COUNTER..

THE NUMBER OF LACTOBACILLI PER ML SALIVA IS CALCULATED BY MULTIPLYING THE NUMBER OF COLONIES ON THE PLATE BY THE DILUTION FACTOR AND ITS INOCULUM.

NUMBER OF ORGANISM:

DEGREE OF CARIES ACTIVITY SUGGESTED:

0-1,000 NONE

LESS THAN 10,000 SLIGHT

LESS THAN 1,00,000 MODERATE

MORE THAN 1,000,000

MARKED

INDICATIONS FOR THE USE OF DENTOCULT-LB COUNT:• FOR PRE-SELECTION OF PATIENTS FOR YEARLY OR HALF

YEARLY CHECK-UPS IN COMMUNITIES.

• IT IS IMPORTANT EDUCATIONAL AID FOR MOTIVATION AND DIETRY COUNSELLING AMONG PATIENTS

• CONTROL THE EFFICACY OF DIETRY COUNSELLING

• SOMETIMES A HIGH ,STEADY LACTOBACILLUS COUNT INDICATES MEDICALLY COMPROMISED PATIENTS FOR EXAMPLE:DIABETIES MELLITUS PREDISPOSING THE SUBJECT TO LACTOBACILLUS GROWTH…

• AN UNCHANGED DENTOCULT-LB VALUE IS CONTRAINDICATON FOR EXPENSIVE BRIDGES ,ORAL IMPLANTS,OR ORTHODONTIC TREATMENT …THE TEST MAY BE CONSIDERED AN INSURANCE FOR THE DENTIST AGAINST ACCUSATIONS OF MALPRACTISE..

COUNTS FOR STREPTOCOCCI MUTANS:

NUMBER OF MUTANS STREPTOCOCCI HAVE BEEN ASSESSED IN SAMPLES OF PLAQUE AND SALIVA..

THE PRESENCE OF STREPTOCOCCUS MUTANS IN THE ORAL CAVITY IS AN INDICATION OF CARIOGENIC INFECTION..

ONE DIAGNOSTIC PROBLEM IS THAT CARIES IS NOT A SPECIFIC INFECTION..THUS THERE ARE MANY PEOPLE WITH THE MUTANS INFECTION IN THE ORAL CAVITY WITHOUT THE SIGNS OF CARIES ATTACK ;WHILE ABUNDANCE CARIOUS LESION OCCURE IN PATIENT WITHOUT MUTANS INFECTION

THUS DIAGNOSTIC VALUE OF MUTANS IS ONLY RELATIVE….

STREPTOCOCCUS MUTANS TEST USEFUL IN FOLLOWING PURPOSE: FOR THE PRESELECTION OF PATIENTS FOR DENTAL

EXAMINATION .LIKE THE LACTOBACILLI TEST IT IS NOT ACCURATE ENOUGH FOR FINAL DIAGNOSIS..

FOR THE DEMONSTRATION OF CARIOGENIC INFECTION..

FOR THE EVALUATION OF THE EFFECTIVENESS OF ANY MOUTH-RINSE MEDICATION,PROVIDING AN OBJECTIVE MEASURE FOR TREATMENT..

FOR THE DIDACTIC PURPOSE IN HEALTH EDUCATION…

FOR DIAGNOSING MUTANS BEARING PARENTS IN A FAMILY BEFORE ERUPTION OF THE CHILD’S DECIDUOUS TEETH..

THE COMMERCIALLY AVAILABLE SYSTEMS ARE:

MSBB METHOD(MATSUKUBO ET AL[1981],SHOWA YAKUHIN CO.LTD TYOKO,JAPAN)

CARIES SCREEN SM (JORDAN ET AL[1987],APO DIAGNOSTICS,TORONTO,CANADA)

STRIP MUTANS TEST (JENSSEN AND BRATTHAL[1989],ORION DIAGNOSTICA ESPOO,FINLAND)

ALL THREE BASED ON THE FACT THAT BACITRACIN INHIBITS THE GROWTH OF ALL OTHER ORAL STREPTOCOCCI EXCEPT MUTANS ON THE MITIS SALIVARIS MEDIUM..

SNYDER TEST: THE SIMPLE CALORIMETRIC DEVISED BY SNYDER IN

1951 IS BASED UPON THE RATE OF ACID PRODUCTION WHEN A SAMPLE OF STIMULATED SALIVA IS INOCULATED INTO A GLUCOSE AND AGAR CONTAINING MEDIUM PH 4.7-5.0 CONTAINING COLOR INDICATOR BROMOCRESOL GREEN..

THIS TEST ESTIMATES THE NUMBER OF BOTH ACIDURIC AND ACIDOGENIC ORGANISM IN SALIVA BECAUSE IT RELIES ON THE PRODUCTION ADDITIONAL ACID UNDER ALREADY ACIDIC CULTURE CONDITIONS.LACTOBACILLI ARE BACTERIA CONTRIBUTING TO POSITIVE TEST…

TO EVALUATE VISUALLY THE RAPIDITY AND EXTENT OF ACID PRODUCTION,BROMOCRESOL GREEN INDICATES PH CHANGE…

AT THE END OF 24 HR,48HR,72HR COLOR MEDIUM IS RECORDED AS 1-4 ON THE BASIS OF WHETHER THE COLOR WITH AN UNINOCULATED TUBE AGAINST A

WHITE BACKGROUND….

SWAB TEST: THIS TEST WAS DEVELOPED BY GRAINGER

ET AL IN 1965 WHICH IS VALUABLE FOR EVALUATING CARIES ACTIVITY IN VERY YOUNG CHILDREN..

PRINCIPLE INVOLVED:

IT MEASURES THE ACIDURIC-ACIDOGENIC COMPONENT OF THE ORAL FLORA AFTER A SUITABLE INCUBATION PERIOD BY EMPLOYING A COLOR INDIACATOR IN THE TEST MEDIUM OR BY SWABBING THE BUCCAL SURFACE OF THE TEETH WITH COTTON APLICATOR..SUBSEQUENTLY INCUBATED IN THE MEDIUM..

THE CHANGE IN PH FOLLOWING A 48 HR INCUBATION IS READ ON A PH METER OR COLOR CHANGE IS READ ON COLOR COMPATOR….

INTERPRETATION:

PH 4.1 AND <4.1 MARKED CARIES ACTIVITY

PH 4.2- 4.6 ACTIVE

PH 4.5 -4.6 SLIGHTLY ACTIVE

PH > 4.6 CARIES ACTIVE

ADVANTAGES:

TESTS ARE OF VALUE IN PREDICTING CARIES INCREMENTS,PARTICULARLY IN CHILDREN..

NO COLLECTION OF SALIVA IS REQUIRED..

SALIVARY DEFENCE FACTORS:

SALIVA FLOW RATE,QUALITY AND SALIVA CONSTITUENTS HAVE BEEN STUDIED ALONG WITH OTHER SYSTEMIC AND ORAL PARAMETERS THAT ARE RELATED TO CARIES.

SALIVARY FOLW RATE: COLLECTION OF UNSTIMULATED SALIVA: THE

PATIENTS SITS UPRIGHT ITH THE HEAD BENT FORWARD AND LESS SALIVA DRIP INTO GRADUATED TUBE WITHOUT CHEWING..THE RESTING FLOW RATE FOR WHOLE SALIVA AVERAGES ABOUT 0.3-0.4 ML/MIN IN ADULTS,WHILE THE FOLW RATE STIMULATED BY PARAFFIN WAX AVERAGES 1-2/MIN. LESS THAN 0.1 ML/ML IS CONSIDERED HIGH CARIES RISK..

COLLECTION OF STIMULATED SALIVA: PATIENT IS IN THE UPRIGHT POSITION WITH THE HEAD BENT FORWARD,FLOW RATE IS DETERMINED BY COLLECTING PARAFFIN STIMULATED SALIVA IN A CALIBERATED CYLINDER OR TEST TUBE OVER A 5 MIN PERIOD OF TIM..APPROXIMATELY 10.1ML/5 MIN IN MALES AND 8.6 ML/MIN IN FEMALES CAN BE COLLECTED

VALUES LESS THAN 0.7 ML/MIN IS CONSIDERED HIGH CARIES RISK..

BECAUSE OF THE VAST RANGE OF FLOW RATES,IT IS DIFFICULT TO ASSES THE STATUS OF A PATIENT’S SALIVARY GLAND FUNCTION FROM A SINGLE FLOW RATE DETERMINATION AND REPEATED MEASUREMENT IS REQUIRED TO ESTABLISH A PATIENT’S NORMAL FLOW RATE….

A SEVERELY DECREASED FLOW IS RELATED TO CARIES SUSCEPTIBILITY.FOLLOWING RADIATION THERPY THERE IS DRASTIC DECREASE IN SALIVA:0.05ML/MIN,3 YEARS AFTER THERPY,HENCE,THE INCIDENCE OF RADITION CARIES INCREASES..

VISCOCITY OF SALIVA: AS SALIVARY FLOW RATE DECREASES,VISCOCITY INCREASE..THIS INVERSE RELATIONSHIP IS IMPORTANT ,SINCE SALIVA THAT IS MORE VISCID IS LESS EFFECTIVE IN CLEARIN THE MOUTH….

VISCOCITY IS DETERMINED BY COMPARING IT WITH WATER..

A SPECIAL OSTWALD PIPETTE WITH A CALIBERATED BORE IS USED..

RELATIVE VISCOCITY=TIME REQUIRED FOR THE SALIVA/TIME REQUIRED FOR WATER,WHICH IS ABOUT 1.5 .

SALIVARY BUFFER CAPACITY TEST: ALSO CALLED AS DENTOBUFF STRIP TEST.

A RECENT MORE SIMPLIFIED MODIFICATION OF DENTOBUFF SYSTEM IS SUGGESTED BY ERISCON AND BRATTHAL .

ONE DROP OF STIMULATED SALIVA IS PLACED ON THE TEST STRIP CONTAINING AN A ACID AND A PH INDICATOR

AFTER 5 MINIUTES WHEN THE REACTION BETWEEN SALIVA AND ACID HAS TAKEN PLACE,THE COLOR OF THE TEST PAD IN COMPARED TO THE COLOR CHART OF PH INDICATOR .

THIS SYSTEM IDENTIFIES SALIVA WITH LOW INTERMIDIATE AND HIGH BUFFER CAPACITY..

INTERPRETATION: PATIENTS WITH HIGH BUFFER CAPACITY ARE QUITE RESISTANT TO CARIOUS PROCESS AND THOSE WITH LOW ARE SUSCEPTIBLE TO CARIES.THESE RELATIONSHIPS ARE STRONGER IF ONE TAKES INTO ACCOUNT THE SALIVARY BY MIXED SALIVARY FLORA.

SALIVARY REDUCTASE TEST: THIS TEST MEASURES THE RATE AT WHICH AN

INDICATOR ,DIAZORESORCINOL CHANGES FROM BLUE TO RED TO COLOURLESS OR LEUKOFORM ON REDUCTION BY THE MIXED SALIVARY FLOW..

SALIVA IS COLLECTED BY CHEWING A SPECIAL FLAVOURED PARAFFIN AND EXPECTORATED DIRECTLY INTO THE COLLECTION TUBE .

THE REAGENT CAP IS REPLACED ONCE SALIVA REACHES THE 5 ML CALIBERATION MARK..

THE SAMPLE IS MIXED WITH THE FIXED AMOUNT OF DIAZORESORCIONAL,THE REAGENT UPON WHICH THE REDUCTASE ENZYME IS TO REACT. COLOR CHANGE AFTER 30 SEC AND AFTA 15 MIN IS TAKEN.

RESULTS: THE COLOR AND CARIES CONDUCIVENESS IS READ AS:

SCORE

TIME COLOR CARIES ACTIVITY

1 15 MIN BLUE NON CONDUCIVE

2 15 MIN ORCHID SLIGHT CONDUCIVE

3 15 MIN RED MODERATELY CONDUCIVE

4 IMMEDIATELY

RED HIGHLY CONDUCIVE

5 IMMEDIATELY

PINK EXTREMLY CONDUCIVE

DIP SLIDE METHOD FOR S.MUTANS COUNT: THIS METHOD WAS DEVISED FOR THE ESTIMATION OF

STREPTOCCOUS MUTANS LEVELS IN SALIVA

PROCEDURE: UNDILUTED PARAFFIN STIMULATED SALIVA IS POURED

ON SPECIAL PLASTIC SLIDE THAT IS COATED WITH MSA(MITIS SALIVARINE AGAR) CONTAINING 20% SUCROSE..

THE AGAR SURFACE IS THROUGHLY MOISTENED AND EXCESS SALIVA IS ALLOWED TO DRAIN OFF

TWO DISCS CONTAINING 5MICROGRAM OF BACITRACIN ARE PLACED ON AGAR 20mm APART

THE SLIDE IS TIGHTLY SCREWED INTO COVER TUBE AFTER INSERTING A CO2 TABLET AND INCUBATED AT 37 DEGREE CEL FOR 48 HR IN SEALED CANDLE JAR..

EVALUATION FOR DIP SLIDE METHOD:

SCORE CARIES ACTIVITY

DESCRIPTION

1 LOW THE CALORIES ARE DISCREATE AND COULD BE READLY COUNTED AT 13*MAGNIFICATION WITH TOTAL COUNT CFU INSIDE INHIBITION ZONE LESS THAN200

2 MEDIUM THE CALORIES ARE DISCRETE AND THE NUMBER IN THE ZONE OF INHIBITION IS MORE THAN 200AT 32* MAGNIFICATION

3 HIGH THE CALORIES ARE TINY AND ALMOST COMPLETE OR TOTALLY COVER INHIBITION ZONE NUMBER OF COLONIES UNCOUNTABLE EVEN 32*MAGNIFICATION

ALBAN TEST IT IS A SIMPLIFIED SUBSTITUTE FOR SYNDER TEST

MAIN FEATURE: USE OF A SOMEWHAT SOFTER MEDIUM THAT PERMITS

THEDIFFUSSION OF SALIVA AND ACIDS WITHOUT THE

NECESSITY OF MELTING THE MEDIUM. USE OF A SIMPLIFIER SAMPLING PROCEDURE IN WHICH

THE PATIENT EXPECTORATES DIRECTLY INTO THE TUBES THAT CONTAIN THE MEDIUM

TO PREPARE THE ALBAN TEST MEDIUM ,THE FOLLOWING

MATERAILS ARE REQUIRED: SYNDER TEST AGAR A SMALL SCALE TO MEASURE 60 GRAM A2 LITRE PYREX GLASS TO MELT THE MEDIUM A FUNNEL TO DISPENSE THE MEDIUM INTO TEST TUBES HUNDRED 16mm TEST TUBE WITH SCREW CAPS

PROCEDURE: 60 GRAMS OF SNYDER TEST AGAR IS PLACED IN 1

LITER OF WATER AND THE SUSPENSIONIS BROUGHT TO A BOIL OVER A LOW FLAME.

WHEN THOROUGHLY MELTED,THE AGAR IS DISTRIBUTED USING ABOUT 5ML PER TUBE.

THESE TUBES SHOULD BE AUTOCLAVED FOR 15 MIN ALLOWED TO COOL AND STORED IN REFRIGERATOR .

2 TUBES OF ALBAN MEDIUM ARE TAKEN FROM REFRIGERATOR AND THE PATIENT IS ASKED TO EXPECTORATE A SMALL AMOUNT OF SALIVA DIRECTLY INTO TUBES.

THE TUBES ARE LABELLED AND INCUBATED AT 98.6 DEG FOR UPTO 4 DAYS..

THESE TUBES ARE OBSERVED DAILY FOR:1.CHANGE OF COLOR FROM BLUISH GREEN (PH5)TO

DEFINATE YELLOW (PH 4 OR BELOW).

2.THE DEPTH IN THE MEDIUM TO WHICH THE CHANGE HAS OCCURRED..

3.THE DAILY RESULTS COLLECTED FOR A 4 DAY PERIOD SHOULD BE RECORDED ON THE PATIENT’S CHART..

** THE FOLLOWING METHOD IS USED FOR FINAL RECORDING AFTER 72 HRS OR 96 HOURS OF

INCUBATION.1.READINGS NEGATIVE FOR THE ENTIRE INCUBATION

PERIOD ARE LABLED “NEGATIVE”

2.ALL OTHER READINGS ARE LABBLED “POSITIVE”WHETHER +,++,+++, OR ++++

3.SLOWER CHANGE OR LESS COLOR CHANGE (COMPARED TO PREVIOUS TEST) IS LABELED “WORSE”

5.WHEN CONSECUTIVE READINGS ARE NEARLY IDENTICAL THEN THEY A RE LABELED AS “NOCHANGE”

SCALE FOR SCORING:

NO COLOR CHANGE 3/4

BEGINNING COLOR CHANGE +

ONE HALF COLOR CHANGE ++

THREE FOURTH COLOR CHANGE +++

TOTAL COLOR CHANGE TO YELLOW ++++

ADVANTAGES SIMPLE LOW COST DIAGNOSTIC VALUE WHEN NEGATIVE

RESULT ARE OBTAINED ITS MOTIVATIONAL VALUE(IDEAL FOR

EDUCATION) DISADVANTAGE: MORE ARMAMENTARIA REQUIRED BASED ON SUBJECTIVE EVALUATION OF

A COLOR CHANGED THAT MAY NOT BE CLEAR CUT

COMPOSITATION OF MEDIA USED FOR SNYDER AND ALBAN TEST BACTO PEPTONE 20GMS

DEXTROSE 20GMS

SODIUM CHLORIDE 5GMS

AGAR 16GMS

BROMOCRESOL 0.02GMS

GREEN

STREPTOCOCCUS MUTAN SCREEENING TEST

A.PLAQUE/TOOTH PICK METHOD : ACTIONS: THE TEST INVOLVES A SIMPLE

SCREENING OF DILUTED PLAQUE SAMPLE STREAKED ON A SELECTIVE CULTURE MEDIA

EQUIPMENT: STERILE TOOTH PICKS, STERILE RINGER’S SOLUTION, (5ML)PLATINUM LOOP,MITIS SALIVARIUS AGAR PLATES (MSA) CONTANING SULPHADIMETINE INCUBATOR.

PROCEDURE:

PLAQUE SAMPLES ARE COLLECTED FROM THE GINGIVAL THIRDS OF BUCCAL TOOTH SURFACE ONE FROM EACH QUADRANT AND PLACED IN RINGER’S SOLUTION

THE SAMPLE IS SHAKEN UNTILL HOMOGENIZED

THE PLAQUE SUSPENSION IS STREACHED ACROSS MSA PLATES

AFTER AEROBIC INCUBATION AT 37 DEGREE CEL FOR 72 HOURS CULTURES ARE EXAMINED AND TOTAL COLONIES IN 10 FIELDS ARE RECORDED.

THIS TEST IS ATTEMPT TO SEMI-QUANTITATIVELY SCREEN THE DENTAL PLAQUE FOR SPECIFIC GROUP OF CARIES INDUCING STREPTOCOCCUS MUTANS

SALIVA/TONGUE BLADE METHOD: ACTION: THIS TEST ESTIMATES THE NUMBER OF S.MUTANS IN

MIXED PARAFFIN-STIMULATED SALIVA WHEN CULTURED IN MUTANS SALIVARIUS BACITRACIN (MSB) AGAR. THIS WAS DEVELOPED FOR USE IN LARGE NUMBER OF SCHOOL CHILDREN.

EQUIPMENT: PARAFFIN WAX,STERILE TONGUE

BLADES,DISPOSABLE CONTACT PETRI DISH CONTANING (MSB) AGAR, INCUBATOR

PROCEDURE: THE SUBJECTS CHEW A PIECE OF PARAFFIN WAX FOR ONE MINIUTE TO DISPLACE PLAQUE MICROORGANISM,THEREBY INCREASING THE PROPORTIONS OF PLAQUE MICROORGANISM IN SALIVA.

STERILE TONGUE BLADES ARE THEN ROTATED IN THE PATIENTS MOUTH 10 TIMES SO THAT BOTH THE SLIDES ARE THOROUGHLY INOCULATED BY THE ORAL FLORA.

IT IS THEN PRESSED ONTO MSB AGAR IN A DIAPOSABLE AGAR PETRI DISH..

INCUBATION IS DONE AT 37 DEGREE CEL. FOR FIELD STUDIES ,THE PLATES CAN BE PLASTIC BAGS CONTAINING EXPIRED AIR,WHICH ARE THEN SEALED AND INCUBATED AT 37 DEGREE CELCIUS..

COUNTS OF MORE THAN 100 COLONIES FORMING UNITS BY THIS METHOD ARE PROPORTIONAL TO GREATER THAN 10 COLONY FORMING UNITS OF S.MUTANS PER ML OF SALIVA BY CONVENTIONAL METHODS..

ADVANTAGES: THIS IS A SIMPLIFIED AND PRACTICAL METHOD FOR

FIELD STUDIES AVOIDS THE NECESSITY OF COLLECTING SALIVA IT REQUIRES NO TRANSPORT MEDIA/DILUTION

STEPS…

FOSDICK CALCIUM DISSOLUTION TEST:

PRINCIPLE: THIS TEST MEASURES THE MILLIGRAMS OF POWDERED ENAMEL DISSOLVED IN 4 HRS BY ACID FORMED WHEN THE PATIENTS SALIVA

IS MIXED WITH GLUCOSE AND POWDERED ENAMEL.. PROCEDURE: SALIVA IS STIMULATED BY HAVING

THE PATIENT CHEW GUM OR PARAFFIN 25ML OF THIS SALIVA IS COLLECTED AND PART OF IT IS ANALYZED FOR CALCIUM CONTENT

THE REMAINING SALIVA IS PLACED IN AN 8 INCH STERILE TEST TUBE WITH ABOUT 0.1 GRM OF POWDERED ENAMEL.

THE TUBE IS SEALED AND SHAKEN FOR 4HRS AT BODY TEMPERATURE ,AFTER WHICH IT IS AGAIN ANALYZED FOR CALCIUM CONTENT.

ADVANTAGES: IN LIMITED STUDIES,THE CORELATION REPORTED IS

GOOD..

DISADVANTAGE: THE TEST IS NOT SIMPLE AND REQUIRES COMPLEX

EQUIPMENT. THE TEST IS EXPENSIVE AND REQUIRES TRAINNED

PERSONNEL

ORA TEST: THIS TEST WAS DEVELOPED BY ROSENBERG ET AL

IN 1989 FOR ESTIMATING ORAL MICROBIAL LEVELS. PRINCIPLE: IT IS BASED ON RATE OF OXYGEN DEPLITION BY

MICROORGANISM IN EXPECTORATED MILK SAMPLES. IN NORMAL CONDITIONS THE BACTERIAL

ENZYME,AEROBIC DEHYDROGENASE TRANSFER ELECTRONS OR PROTONS TO OXYGEN…

ONCE OXYGEN GETS UTILIZED BY THE AEROBIC ORGANISMS..METHYLENE BLUE ACTS AS ELECTRON ACCEPTOR AND GETS REDUCED TO LEUCOMETHYLENE BLUE.

THIS REFLECTS THE METABOLIC ACTIVITY OF THE AEROBIC ORGANISM..

EQUIPMENT: STERILE BEAKERS,STERLIZED MILK,SCREW CAP TEST TUBES,0.1%AQUEOUS SOLUTION OF METHYLENE BLUE,10 ML DISPOSABLE SYRINGE,PIPETTE,MIRROR,STOPWATCH AND TEST TUBE STAND.

PROCEDURE: MOUTH IS RAINSED VIGOROUSLY WITH 10 ML OF STERILE MILK FOR 30 SECONDS AND THE EXPECTORATE IS COLLECTED...

3 ML OF THIS IS TRANSFERRED TO THE SCREW CAP TUBE WITH THE HELP OF DISPOSABLE SYRINGE.

TO THIS,0.12 ML OF 0.1% METHYLENE BLUE IS ADDED,THOROUGHLY MIXED AND PLACED ON A STAND IN A WELL ILLUMINATED AREA

THE TUBES ARE OBSERVED EVERY 10 MIBIUTES FOR ANY COLOR CHANGE AT THE BOTTOM USING MIRROR.

THE TIME TAKEN FOR THE INITIATION OF COLOR CHANGE WITHIN 6mm RING IS RECORDED

ADVANTAGES:-1. SIMPLE, INEXPENSIVE, NONINVASIVE, LESS

TIME CONSUMING.2. USED TO MONITOR THE MOUTH RINSE REGIME,

GINGIVAL INFLAMMATION.3. ANTICIPATE THE ONSET OF CARIES

DISADVANTAGES1. IT DOES NOT IDENTIFY A SPECIFIC GROUP OF

ORGANISMS IN A SPECIFIC DISEASE.

2. IT CANNOT DIFFERENTIATE BETWEEN THE HEALTHY STATE AND BETWEEN THE INITIAL AND PROGRESSIVE CARIOUS LESIONS.

CARIOGRAM: THE ORIGINAL CARIOGRAM WAS INTRODUCED BY

BRATHALL IN 1944 AS CIRCLE DIVIDED INTO THREE SECTORS,EACH REPRESENTING FACTORS STRONGLY INFLUCING CARIOUS ACTIVITY: DIET,BACTERIA AND SUSCEPTIBILITY..

THE DEVELPOMENT OF THE MODEL WAS BASED ON A NEED TO EXPLAIN WHY,IN CERTAIN INDIVIDUALS,CARIOUS ACTIVITY COULD BE LOW INSPITE OF,FOR EXAMPLE,HIGH SUCROSE INTAKE,POOR ORAL HYGINE ,OR NON USE OF FLOURIDE..

RECENTLY A NEW METHOD OF ILLUSTRATING THE INTERACTIONOF FACTORS CONTRIBUTING TO DEVELOPMENT OF CARIES HAS BEEN RE-INTRODUCED BY BRATTHAL ET AL (1999) KNOWN AS “INTERACTIVE CARIOGRAM PROGRAMME”

IN THIS SOFTWARE PROGRAMME ,A PIE CIRCLE DIAGRAM IS DIVIDED INTO 5 SECTORS,IN FOLLOWING COLORS:

GREEN: SHOWS AN ESTIMATION OF THE “CHANCE TO AVOID CARIES”

DARK BLUE:”DIET” IS BASED ON COMBINATIONOF DIET CONLENTS AND DIET FREQUENCY..

RED: “BACTERIA” IS BASED ON A COMBINATION OF AMOUNT OF PLAQUE AND MUTANS STREPTOCOCCI.

LIGHT BLUE SECTOR: “SUSCEPTIBILITY” IS BASED ON COMBINATION OF FLOURIDE PROGRAMME ,SALIVA SECREATING AND SALIVA BUFFER CAPACITY..

YELLOW: “CIRCUMSTANCES” IS BASED ON A COMBINATION OF POST CARIES EXPERIENCES AND RELATED DISEASE..

CONCLUSION: NONE OF THESE TEST ARE HIGHLY RELIABLE AS

INDICATORS OF EXPECTED CARIES INCREMENTS. THIS IS NOT UNEXPECTED AS CARIES ACTIVITY

TESTS MEASURES A SINGLE PARAMETER SUCH AS ACID PRODUCED OR COLONY COUNTS OF BACTERIAL SPEICES.

HOWEVER,DENTAL CARIES IS A MULTIFACTORIAL DISEASE AND CARIES PREDICITIVE TESTS DO NOT EMCOMPASS ALL THOSE FACTORS INVOLVED IN DETERMINING CARIES RESISTANCE SUCH AS FLOURIDE EXPOSURE,MATURATION OF ENAMEL OR IMMUNE PROTECTION.

THE LIMITATION INHERENT IN A SINGLE FUNCTIONS CARIES ACTIVITY TEST ARE CLEAR.THIS IS THE REASON WHY THE BEST PREDICTOR OF EXPECTED CARIES ACTIVITY HAS RESULTED FROM THE COMBINED USE OF SEVERAL SELECTED TEETH.

REFERENCE:

TEXTBOOK OF PEDODONTIC : SHOBHA TONDON,EDITION{2ND

EDITION}2008.. PREVENTIVE AND COMMUNITY

DENTISTRY..SOBHEN PETER,EDITION{4TH EDITION}2009..

DENTISTRY FOR THE CHILD AND ADOLOCENT,RALPH E. MC DONALD, DAVID R EVERY, {8TH EDITION 2004}…

ORAL PATHOLOGY ,SHAFER’S. HINE .LEVY,{6th edition 2009) …

THANK YOU…