الرحمن الله بسمالرحيم

Caries Activity Test

IntroductionIntroduction

• Dental cariesDental caries is an irreversible progressive is an irreversible progressive disease of multifactorial in nature affecting the disease of multifactorial in nature affecting the calcified tissues of the teeth characterized by calcified tissues of the teeth characterized by demineralization of inorganic portion & demineralization of inorganic portion & destruction of organic portion of the tooth.destruction of organic portion of the tooth.

• Terms like primary and secondary caries, initial Terms like primary and secondary caries, initial and cavitated lesions, white spot lesions, and cavitated lesions, white spot lesions, arrested caries, and root caries are used to arrested caries, and root caries are used to describe the activity and severity of caries.describe the activity and severity of caries.

Caries Risk and Caries Caries Risk and Caries ActivityActivity

• Risk Risk ::the probability that a harmful the probability that a harmful (or unwanted) event will occur.(or unwanted) event will occur.

Caries RiskCaries Risk :status of the whole :status of the whole patient. It can be defined as the patient. It can be defined as the

likelihood of the patient getting a likelihood of the patient getting a new cavitationnew cavitation

Caries ActivityCaries Activity :status of the caries :status of the caries process (demin/remin) on an process (demin/remin) on an

individual tooth surface.individual tooth surface.

• Caries risk assessmentCaries risk assessment: procedure to : procedure to predict future caries development predict future caries development before the clinical onset of the diseasebefore the clinical onset of the disease..

• Caries activity testCaries activity test preferably should preferably should estimate the actual state of disease estimate the actual state of disease activity (progression/regression)activity (progression/regression)

Indication of Caries-Risk TestIndication of Caries-Risk Test• New patients with signs of caries activityNew patients with signs of caries activity• Pregnant patientsPregnant patients• Patients experiencing a sudden increase in the Patients experiencing a sudden increase in the

incidence of cariesincidence of caries• Individuals taking medications that may affect Individuals taking medications that may affect

the flow of salivathe flow of saliva• Xerostomic patientsXerostomic patients• Patients about to undergo chemotherapyPatients about to undergo chemotherapy• Patients who frequently consume fermentable Patients who frequently consume fermentable

carbohydratescarbohydrates• Patients suffering from diseases of the Patients suffering from diseases of the

autoimmune system.autoimmune system.

Individual Approach of Caries Individual Approach of Caries ActivityActivity

1. case history, 1. case history, 2. clinical and radiographic examinations, 2. clinical and radiographic examinations, 3. diet history, 3. diet history, 4. supplementary laboratory tests4. supplementary laboratory tests

• FirstFirst,, determine which particular factors are determine which particular factors are involved.involved.

• NextNext, find out why these factors are present, find out why these factors are present..• FinallyFinally,, try to change the situation by targeted try to change the situation by targeted

actions against identified factorsactions against identified factors. .

Cariogram & CariographCariogram & Cariograph

Background Data for Caries Background Data for Caries ActivityActivity

• General diseasesGeneral diseases• MedicationMedication• Social/family situationSocial/family situation• Dietary habits/feedingDietary habits/feeding• Oral-hygiene routinesOral-hygiene routines• fluoride supportfluoride support

Clinical ExaminationClinical Examination

1. It is important to collect data in a standardized & 1. It is important to collect data in a standardized & systematic waysystematic way

2. (dmft/DMFT).2. (dmft/DMFT).

3. Why and when were the teeth extracted? (caries, 3. Why and when were the teeth extracted? (caries, periodontal disease, orthodontics), periodontal disease, orthodontics),

4. Were the restorations placed long ago or recently?4. Were the restorations placed long ago or recently?

5. Check number, extension & appearance of lesions, 5. Check number, extension & appearance of lesions, cavities, & fillingscavities, & fillings..

6. local aggravating factors (crowded arches, 6. local aggravating factors (crowded arches, deep fissures, imperfect fillings & exposed deep fissures, imperfect fillings & exposed root surfaces) are evaluated.root surfaces) are evaluated.

7. Texture & localization of lesions provide 7. Texture & localization of lesions provide important hints for caries activity.important hints for caries activity.

8. altered enamel development, such as 8. altered enamel development, such as increased porosity and decreased mineral increased porosity and decreased mineral content are directly linked to an increased content are directly linked to an increased caries risk.caries risk.

Clinical ExaminationClinical Examination

• the estimation of the oral the estimation of the oral hygiene standard with ahygiene standard with a disclosing solution disclosing solution can can be recommended. be recommended.

• It should be emphasized It should be emphasized that visible plaque on the that visible plaque on the labial surfaces of labial surfaces of maxillary incisors of a maxillary incisors of a young child is a serious young child is a serious sign of caries risk.sign of caries risk.

Caries-Activity Tests for the Caries-Activity Tests for the Dental OfficeDental Office

• The most common sources for sampling are saliva & The most common sources for sampling are saliva & plaque. plaque.

• Salivary tests are generally more practicalSalivary tests are generally more practical• Ideally, laboratory tests should accurately reflect the 4 Ideally, laboratory tests should accurately reflect the 4

overlapping circles presented by Keyes in 1962overlapping circles presented by Keyes in 1962: :

1. Bacterial challenge1. Bacterial challenge; ; determination of Streptococcus determination of Streptococcus mutans as an indicator of relative riskmutans as an indicator of relative risk..2. Diet;2. Diet; determination of lactobacilli as an indicator of determination of lactobacilli as an indicator of sugar content in diet.sugar content in diet.3. Remineralization potential3. Remineralization potential; ; salivary flow rate and salivary flow rate and buffer capacity as an indicator of potential biologic repairbuffer capacity as an indicator of potential biologic repair..4. Host suspectibility4. Host suspectibility; caries experience as an indicator ; caries experience as an indicator of past activity.of past activity.

CariScreen

Caries Susceptibility Testing

Meter and Swabs

Requirements of caries-risk test:Requirements of caries-risk test:

1. reproducible & valid1. reproducible & valid2. good correlation between the caries activity 2. good correlation between the caries activity

scores & actual caries developmentscores & actual caries development3. simple3. simple4. Results should be obtained rapidly, within 4. Results should be obtained rapidly, within

hours or few dayshours or few days5. Should have measurement of mechanisms 5. Should have measurement of mechanisms

involved in caries processinvolved in caries process6. inexpensive, non-invasive & applicable to 6. inexpensive, non-invasive & applicable to

any clinical settingany clinical setting

Caries Activity Tests1. S.Mutans Count

2. S.Mutans screenig test 1_plaque/ tooth pick test

2_saliva / tongue blade method•3 .lactobacilli Count

4 .Salivary flow rate5. Buffering capacity of saliva

6. Snyder Test7. 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 TestThis test reflects the total number and the

acidogenicity of the salivary bacteria and can be used as an alternative to the lactobacilli test.

ALBEN’S TESTALBEN’S TEST

It is simplified substitute for synder testIt is simplified substitute for synder test

SWAB TESTSWAB TESTIts advantage is no collection of saliva is necessary. The oral flora is sampled by swabbing the buccal surface of tooth with cotton. It’s 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 It is based on the fact that when glucose is

added to saliva containing powdered enamel, added to saliva containing powdered enamel, organic acids are formed.organic acids are formed.

• Organic acid decalcifies the enamel, Organic acid decalcifies the enamel, resulting in an increase in the amount of resulting in an increase in the amount of soluble calcium.soluble calcium.

• The extend of increase of calcium is a direct The extend of increase of calcium is a direct measure of caries activitymeasure of caries activity

Thank You..