Caries Activity PDF

Universidad de Start zamboanga CARIES ACTIVITY Subject : CARIOLOGY Submit by : BUGAHOD, BAID  02 Dental Caries It is an irrever...

Universidad de Start zamboanga CARIES ACTIVITY Subject : CARIOLOGY Submit by : BUGAHOD, BAID  02 Dental Caries It is an irreversible progressive disease of multifactorial in nature affecting the calcified tissues of the teeth characterized by demineralization of inorganic portion and destruction of organic portion of the tooth.  02 Caries Activity Refers to the increment of active lesion (new and recurrent lesions) over a stated period of time. Caries activity is a measure of speed of progression of a carious lesion.  02 Caries Susceptibility Refers to the number of new lesions that may develop in an individual over a period of time while caries activity suggests the number of lesions that an individual has at the time of recording (new and old).  02 The Course of a Typical Prediction Study The outline of a typical study for evaluationg the predictive power of a risk marker of dental caries. Caries recordings at the end of the follow-up period make it possible to assess the caries increment during the period  02 The Course of a Typical Prediction Study Prediction studies deal with two dichotomies: 1. the dichotomy between the individuals for whom we believe that the risk is high and the individuals for whom we consider a low risk. 2. The dichotomy between the indiviuals for whom we observe a high true caries increment and the indiviuals among whome the observed true caries increment is low.  02 Principles of Risk Prediction 1. The higher the risk of developing caries for most of the population, the more significant the effects of one single preventive measure and the stronger the correlations between one single etiologic or modifying risk factor and the risk for caries development.  02 Principles of Risk Prediction 2. In populations in which only a minority of the people will develop new carious lesions, it is necessary to use accurate risk predictive measures to select at risk individuals and introduce needs-related combinations of caries preventive measures, in other words a “high-risk strategy”  02 Goals of Caries risk Prediction Screen out low risk patients (to allow safe recommendation of long recall intervals). Identify high risk patients before they become caries active. Monitor changes in disease status in caries active patients.  02 Risk Groups For Dental Caries Carious lesions are initiated more frequently at specific ages. Key Risk Age Group 1: Ages 1 to 2 Years Key Risk Age Group 2: Ages 5 to 7 Years Key Risk Age Group 3: Ages 11 to 14 Years Key risk age groups in young adults and adults: Ages 19 to 22 years.  02 Key-Risk Age Group 1: Ages 1 to 2 Years Studies by Kohler et al (1978,1982) showed that mothers with high salivary MS levels(mutans streptococci) frequently transmit MS to their babies. Studies by Wendt et al (1994) have shown that 1 year old babies with plaque and gingivitis develop several dental carious lesions during the following years. Wendt and Birkhed (1995) study ahs shown that the practice of giving infants sugar containing drinks in nursing bottles at night increases the development of caries.  02 Key-Risk Age Group 2: Ages 5 to 7 Years The enamel of erupting and newly erupted teeth is considerably more susceptible to caries until secondary maturation is completed, more than 2 years after eruption. However, the caries-reducing effect of fluoride is also about 50% greater in erupting and newly erupted teeth than it is in teeth that have undergone secondary maturation. The next high-risk age is, therefore from 5 to 7 years, during eruption of the first molars.  02 Key-Risk Age Group 3: Ages 11 to 14 Years Normally, the second molars start to erupt at the age of 11 to 11 1/2 years in girls and at around the age of 12 years in boys. The total eruption time is 16 to 18 months. During this period the approximal surfaces of the newly erupted posterior teeth are under going secondary maturation of the enamel and are also at their most caries susceptible.  02 Key-Risk Age Groups in Young Adults and Adults Most have erupting or newly erupted third molars without full chewing function but with highly caries-susceptible fissures and mesial surfaces until completion of secondary maturation of the enamel. In addition, many young adults leave home to study or work elsewhere, with ensuing changes not only in lifestyle but also in dietary and oral hygiene habits.  02 Other Risk Groups: Persons who work in occupations where frequent food sampling is required. Persons who are obese because of frequent eating. Persons who abuse recreational drugs. Persons who have systemic diseases and are taking regular medication. Persons who have Psychiatric disorders. Persons who have impaired salivary function or immune response.  02 Risk Individuals For Dental Caries Caries Risk Assessment Of The Individual Background data (General diseases, Medications, Social/Family situation, Dietary/Oral hygiene habits) Clinical examination Caries activity tests  02 Key-Risk Teeth Molars are the key risk teeth for caries. The patter of dental caries in the dentition is refelcted in terms of missing teeth and DMFS (Decayed, Missing and Filled Surfaces). Risk for tooth loss can be predicted by measuring the bucco-lingual width of tooth crown and its distance posteriorly from the lips.  02 Key-Risk Surfaces The fissures of the molars. The approximal surfaces of the posterior teeth, from the mesial surfaces of second molars to the distal surfaces of the first premolars. The approximal surfaces of the maxillary incisors, the buccal surfaces of molars, lingual surfaces of mandibular molars. In elderly people, exposed root surfaces, particularly buccal and approximal surfaces.  02 Caries Activity Test It measures the degree to which the local environmental challenge (eg. Dietary effect on microbial growth and metabolism) factors the probability of occurrence of carious lesions.  02 Requirements of Caries Activity Tests Test should be reproducible and valid. There should be good correlation between the caries activity scores and actual caries development. Should be simple. Results should be obtained rapidly, within hours or a few days. Should have measurement of mechanisms involved in caries process. Should be inexpensive, non-invasive and applicable to any clinical setting  02 Lactobacillus Colony Count Test This test estimates the number of acidogenic and aciduric micro- organisms in a patient’s saliva by counting the number of colonies by culturing the bacteria on peptone agar plates after inoculation with a sample. Selective media favouring the growth of aciduric lactobacilli is the basis for the test.  02 Lactobacillus Colony Count Test Procedure: Saliva is collected by chewing paraffin before breakfast. The specimen is vigorously shaken and diluted after that 0.4ml of the sample is withdrawn. Dilute and undiluted samples are then spread evenly over a Rogosa SL agar plate. The plate is incubated for 4 days at 37 degrees Celsius and number of lactobacilly colonies that developed are counted  02 Lactobacillus Colony Count Test Degree of Caries Activity No. Of Organisms Symbolic Designation Suggested 1-1000 + Little or none 1000-5000 + Slight 5000-10,000 ++ Moderate More Than 10,000 +++/++++ Marked  02 Snyder Test This test measures the ability of salivary microorganisms to form organic acid from a carbohydrate medium. The classical formula of Snyder’s agar per litre of purified water is Pancreatic digest/casein -13.5gm Yeast extract -6.5gm Dextrose -20gm Sodium Chloride -5gm Agar -16gm Bromocresol green -0.029gm  02 Snyder Test Procedure: Saliva is collected by chewing paraffin. A tube of snyder glucose agar is melted and then cooled to 50 degrees Celcius. 0.2ml of saliva is added into the tube and mixed. The agar is solidified and incubated. Amount of acid produced by acidogenic organisms is detected by changes in the pH indicator and then compared to the uninoculated control tube against a white background after 24, 48 and 72 hours. The rate of colour change from green to yellow is indicative of degree of caries activity.  02 Snyder Test 24 Hrs ----------------> 48 Hrs ----------> 72 Hrs Color: Yellow Yellow Yellow Caries activity: Marked Definite Limited Color: Green Green Green Caries activity: Continue test Continue test Continue test  02 Alban’s Test It is a modified Snyder test. At the time of test 5 ml, tube of semisolid agar is removed from refrigerator but is not heated. The patient is asked to spit unstimulated saliva directly in to the tube. Tube is incubated for 4 days.  02 Swab Test It measures the ability of salivary micro-organism to form organic acids from a carbohydrate medium. The medium contains an indicator dye, bromocresol green which changes as the pH drops from 5.4 to 3.8 Procedure: The oral flora is sampled by swabbing the buccal surface of tooth with cotton and is subsequently incubated in the medium.  02 Reductase Test This test measures the activity of reductase enzyme present in salivary bacteria. Procedure: Saliva is collected in a plastic container The sample is then mixed with a dye. The caries conduciveness is measured by colour changes seen after 15 mins.  02 Reductase Test Color Time Score Caries Activity Blue 15min 1 Non conducive Orchid 15min 2 Slightly conducive Red 15min 3 Moderately conducive Red Immediately 4 Highly conducive Pink Immediately 5 Extremely conducive  02 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 if caries activity.  02 Saliva Flow Test Flow rate is determined by collecting paraffin stimulated saliva in a test tube over 5 min. Severely decreased flow is related to caries susceptibility. As salivary flow rate decreases viscosity increases.  Finish THANK YOU!