GOOD MORNING

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Caries Activity Tests
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 Aim of the Lecture: Students should be able to describe in detail about
Caries Activity Tests

Objectives of the Lecture:

Students Should be able to describe;

1. Caries susceptibility and caries activity
2. Reasons for conducting caries activity tests

3. The methods of caries susceptibility testing

4. Interpretation of results

5. Application of caries activity tests in primary prevention of dental

caries
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 SOME IMPORTANT TERMS

Caries activity
Refers to the increment of active lesions(new and
recurrent) over a period of time. It is a measure of speed
of progression of disease.

Caries susceptibility
Refers to the inherent tendency of the host and target
tissue, the tooth to be afflicted by the caries process. It is
the susceptibility of the tooth to a caries producing
environment.
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 Reasons for conducting caries activity tests

• For the clinician-

 To determine the need for caries control measures.

 As an indicator of patient co-operation.

 To act as an aid in timing of recall appointments.

 As a guide to insertion of expensive restorations.

 To aid in determination of prognosis.

 As a precautionary signal to orthodontist in placing bands.

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 Reasons for conducting caries activity tests

• For the research worker-

 As an aid in selection of patients for caries study.

 To help in screening of potential therapeutic agents.

 To serve as an indicator of periods of exacerbation

and remission.

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 When should the tests be used?

• Clarify the reasons behind an ongoing disease and

formulate and motivate the preventive strategy to

the patient.

• Determine the effect of a causal treatment at follow

up visits.

• Predict caries development (ie; make a prognosis)

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at check up visits.
 IDEAL REQUISITES

According to Snyder:-
1. Have a sound theoretical basis.
2. Show maximum correlation with clinical status.

3. Should have validity, reliability and feasibility.

4. Be accurate with clinical status.
5. Be simple.

6. Be inexpensive.
7. Take little time.

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 Caries Activity Tests

• Caries activity tests measure the degrees to

which the local environment challenge favors

the probability of carious lesions.

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 Caries Activity Tests

1. Lacto bacillus Count Test

2. Snyder Test

3. Swab Test

4. Streptococcus mutans Level in Saliva

5. Salivary Buffer Capacity Test

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 Caries Activity Tests

6. Enamel Solubility Test

7. Salivary Reductase Test
8. Alban Test
9. Streptococcus mutans Screening Test
10.Fosdick Calcium Dilution Test.
11.Dewar Test
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 Lacto bacillus Count Test

• After rinsing the mouth the patient chews paraffin.

• The saliva accumulated in 3 minutes is collected in a sterile container.

• It is diluted to a factor of 1:1000 dilutions.

• The specimen is spread on Rogasa SL agar plate and incubated for 3 to 4

days.

• Counting of colonies is done under magnifying glass and number of colonies

obtained by multiplying with the dilution factor.

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 Lacto bacillus Count Test
Number of Organisms Degree of Caries
Activity Suggested
0-1,000 Little or None

1,000-5,000 Slight

5,000-10,000 Moderate

More Than 10,000 Marked

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 Snyder test

• 0.2 ml of stimulated saliva is collected and mixed with 10 ml of

melted agar and allowed to solidify.

• It is then incubated and change in pH detected at 24,48 and 72

hours.

• The change in color of bromocresol from green to yellow

suggests production of acid and thus higher caries activity.

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 Snyder test
24 Hours 48 Hours 72 Hours

If Yellow Marked Definite Limited

Caries Caries Caries
Activity Activity Activity
If Green Incubate Incubate Caries
and and Inactive
Observe at Observe at
48 Hours 72 Hours
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Early color change to light green   

Extreme color change after 24 hours

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 Swab Test

• Buccal surface of the teeth is swabbed with cotton

applicator.

• Sample is incubated in a medium for 48 hrs.

• The change in pH measured on pH meter or using

color comparator.
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 Swab Test
pH 4.1 or less Marked Caries Activity

pH 4.2 to 4.4 Moderate Caries Activity

pH 4.4 to 4.6 Slight Caries Activity

pH 4.7 and above Caries Inactive

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 Streptococcus mutans Level in Saliva

• Sample of organism is collected from plaque using tongue

blade.
• Incubation done on selective Mitis Salivarius Bacitracian
agar for 48hrs.
• The medium suppresses the growth of non S.Mutans
Colonies.

• Levels > 10 5 / ml indicates high caries activity

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Dentocult SM strip mutans test

Sample collection
using Screening
Strips

Sample application using Site Strips

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 Interpretation
Incubation (Screening
(48 hours)   Strips)

Interpretation
(Site Strips)

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 Salivary Buffer Capacity Test

• 10 ml of saliva is collected and the pH of this is adjusted to 7 by

addition of lactic acid or base.

• Now the pH is brought from 7.0 to 6.0 by adding a known

amount of lactic acid.

• The amount of lactic acid used is measured and thus the

buffering capacity of saliva can be calculated.

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 Salivary Buffer Capacity Test

• The more the lactic acid required to change the pH from 7.0 to

6.0, more is the buffering capacity.

• The buffering capacity of saliva is inversely proportional to caries

activity.

• If the buffering capacity is high the caries activity will be low

and vice versa.

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 SUMMARY
Test Principle underlying Method of quantitation Clinical significance/
test correlation
S mutans screening Known etiologic agent in No. of colony forming High count-suggestive
saliva or plaque units of high caries potential
Lactobacillus count Aciduric, acidogenic Colony count/ml in agar Useful in large samples
organisms in saliva plate
Snyder test Aciduric, acidogenic Agar tube culture, Useful for diet
organisms in saliva colorimetric measure of counselling,monitoring
pH effectiveness of
preventive procedures
Reductase test Total organisms in Qualitative, dye color Useful in large samples
saliva change
Oxidation reduction
potential
Buffer capacity Buffer capacity of Quantitative titration Correlation of extreme
saliva deviation
Fosdick calcium test Total organisms in Quantitative Ca Not established
saliva dissolved from enamel
powder
Dewar test Total organisms in Quantitative, modified unsatisfactory
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saliva fosdick
 Application of caries activity tests in primary prevention of dental caries

• To determine the need of personalized preventive

measures.
• To motivate and monitor the effectiveness of Health
education

programs.
• To manage the progress of restorative procedures.

• To identify high risk individuals

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 n k yo u
Th a

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