Caries Activity Tests PDF

Caries Activity Tests ➢ Tağmaç Özberk PhD, DDS ➢ Department of Restorative Dentistry Learning Outcomes: At the end of this lecture; ✓ Students will be able to define the mechanisms measured at caries activity tests. ✓ Students will be able to define streptococcus mutans and lactobacillus tests....

Caries Activity Tests ➢ Tağmaç Özberk PhD, DDS ➢ Department of Restorative Dentistry Learning Outcomes: At the end of this lecture; ✓ Students will be able to define the mechanisms measured at caries activity tests. ✓ Students will be able to define streptococcus mutans and lactobacillus tests. ⚫ CARIES ACTIVITY TESTS Analysis made by dental indices can give information about the past experiences of the patient related with dental caries. To find out a way to explain the recorded and analysed information, to analyse the changed parameters in time and to assess the possible future experiences related with dental caries risk, it is important to use caries activity tests. 1- Test should be repeatable and valid. 2- here should be a high correlation between caries activity scores and real caries progression. 3- Application should be simple and easy. 4- Results should be obtained as soon as possible. 5- It should really analyse the mechanisms related with the dental caries progression. 6- It should be non-invasive. 7- It should not be expensive, and it should be easy to achieve. THE MECHANISMS MEASURED AT CARIES ACTIVITY TESTS Parameters related with the habits like diet and oral hygiene. Parameters related with Saliva Parameters related with Oral Microflora PARAMETERS RELATED WITH THE HABITS LİKE DİET AND ORAL HYGIENE ⚫ ⚫ For the analysis of oral hygiene, dental plaque indices or dental oral hygiene indices can be preferred to be used. The forms developed by ADA, can be used to search for the history of the patient according to the systemical diseases, diet, treatment made before, current caries formations etc. and to make a decision about the caries risk. Diet Analysis If it is thought that the patient has a high caries risk especially related with the diet, to confirm this, diet analysis can be used and the patients can be informed in a more synergistic way. Diet analysis can be the record of 24 hours or 3-4 days. Assesment of diet analysis: Are the consumpted food and beverages at main meals and are they, especially the snacks, cariogenic? Does the patient use any medicament including sucrose or causing xerostomia? What is the type and frequency of consumpted Beverages? Does the patient consumpting food, chewing gum etc. including sugar especially sucrose? Does the patient consumpting food at late night especially so often? PARAMETERS RELATED WITH SALIVA PH, Buffering Capacity ⚫ Amount ⚫ Consistency ⚫ Flow Rate ⚫ Content ⚫ Saliva Analysis ⚫ ⚫ ⚫ ⚫ Saliva can buffer the acids produced by microorganisms. As the pH of saliva increase, the protective ability increase too. It consists of molecules related with immune system. It can wash and clean the hard and soft tissues, so the hydration capacity and flow rate of saliva are important. The minerals found at its content can remineralise the demineralised dental tissues. Lubricating Capacity of Saliva It can be measured by the hydration and the consistency of the saliva. ⚫ Testing the level of hydration shows the time for visible productions of saliva of the lower lip labial gland secretion. ⚫ Values higher than 60 seconds indicates a low resting flow. Saliva consistency ⚫ Increased viscosity is represented by sticky frothy saliva residues, normal viscosity means clear and watery saliva which has a higher lubricating efficacy. ⚫ ⚫ Resting Saliva; For adults, the patient sits in a vertical position and stoops his head. For babies and kids, saliva can be collected by cotton or pipet. The adult patient expectorate for 5-10 min into a sterile cup. ⚫ Stimulated Saliva; The patient chews a sugar-free chewing gum or paraffin for a few seconds. Patient swallows the firstly produced saliva. Then he continue to chewing for 5 min. The produced saliva is collected in a sterile cup. The amount of collected stimulated saliva for 5 min. is expected to be higher than 5 ml for a protective characteristics. If it is less than 3,5 ml, the amount of the saliva is not Efficient. Flow rate can be obtained by the division of the amount to the time. PH and Buffering Capacity The critical pH for the caries formation is aproximately 5.5. After the food consumption, by the fermentation occured by the microorganisms, the pH decreases too fast and demineralisation of dental tissues occurs leading to the formation of dental caries. The most important mechanisms which can prevent this changes at pH are the pH and buffering capacity of saliva. Measurement of pH is made by placing the test strip into the expectorated saliva, the color indicated will show the value, 5-5.8 is highly acidic, 6-6.6 is moderately acidic and between 6.8-7.8 is healthy saliva. Content ⚫ Saliva includes lots of antimicrobial peptides and glycoproteins like immunoglobulins,lactoferrin, lysozyme, statherin, histatin and mucin. Although in clinical routine it is not possible to check these contents for now, the saliva content severely affects its protective characteristics. PARAMETERS RELATED WITH ORAL MICROFLORA ⚫ Although oral microflora is composed of a lot of species of microorganisms, the most important ones related with dental caries are Streptoccocus and Lactobacillus species. The increase at the numbers of these microorganisms will increase the dental caries risk. ⚫ STREPTOCOCCUS MUTANS TESTS Generally it is analysed by the incubation of collected samples at MSB (Mitis,salivarius bacitracin) agar for 48 hours at 37°C with a %5 concentration of carbondioxide. For the more specific analysis related with the species of microorganisms, PCR method is preferred to be used which analyses the genetic code. Nowadays, there are kits which gives results too fast and can be used at clinics. ⚫ LACTOBACİLLUS TESTS ⚫ Lactobacillus Colony Counting Test For this analysis, there are need of 2 of 9 ml test tubes, saliva collecting bottles, paraffine, pipette, 2 LSB agars and equipment for incubation. This test is not too specific, because other aciduric microorganisms can also be produced at LSB agar with lactobacillus. ⚫ Snyder Test It is counting both the aciduric and acidogenic microorganisms in an indirect way. It is calculating the acid formation by the microorganisms obtained from stimulated saliva,There is an indicating die of green "Bromocresol" which changes into yellow at the change of pH from 5,4 to 3,8. The color is controlled at 24, 48 and 72 hours. If it is still green after 72 hours, the person is caries inactive.,If it is yellow after 24 hours high caries risk, after 48h moderate and after 72h low caries activity. ⚫ Reductase Test It is observing the reductase enzyme found at saliva microoganisms related with caries by using an indicator named ‘diazoresorcinol’ . The color change from Blue to Red in 15 min. shows the reductase appearence. The correlation of this test with the reality of caries dignosis is not well. ⚫ Fordisk Calcium Dissolution Test and Dewar Test FCDT, is measuring the dissolution amount of calcium from the human enamel (powder form) mixed with collected saliva and glucose in 4 hours. Increase at calcium concentration indicates high caries risk. Dewar test is a test using the same technique but analysing the pH at the end of 4 hours. These tests are expensive, difficult to apply and needs special equipments and specialists. ⚫ LB meauserement need specially educated people for the analysis, special equipments and were time consuming. Nowadays to eliminate these disadvantages, there are several kits which can be used more easily at clinics both to analyse SM and LB. One example is CRT bacteria, where the colony numbers can be examined more easily. The other examples are Dentocult SM strip and Dentocult LB kits. The main disadvantage of CRT and Dentocult kits is that, there is still need of 48 incubation time. On the other hand for SM, Saliva Mutans Check system is giving information in 15 min.