risk assesment cat

8/7/2019 risk assesment cat.

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Caries Risk Assessment and Caries

Activity Tests:

CONTENTS:

Definition

Caries indicators, Risk factors, Protective factors. Implementation of Caries Risk assessment in clinical

practice.

An introduction to CAMBRA: caries managementby risk assessment.

ICDAS criteria for caries detection.

Caries activity tests.


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Caries risk assessment:

A way to gather evidence in a most predictablefashion to diagnose current caries disease, help

predict the future disease, to determine whatfactors are out of balance so evidence basedclinical decisions can be made.

Caries risk changes with time and needs to bereassessed as time goes on.


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Caries Risk Assesment

Disease Indicators:White spots

Restorations


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Implementation of Caries Risk

Assessment in Clinical Practice:


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CAMBRA:AN EVIDENCE BASED

DENTISTRY APPROACH-

Caries management by risk assessment

involves Evidence-based dentistry which isthe practice of dentistry that integrates thebest available evidence with clinical

experience and patient preference in making

clinical decisions.


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ICDAS: The International Caries Detection and

Assessment System.

Status of tooth surface: unrestored, sealed, restored, crowned

First visual changesin enamel to

extensivecavitations.

In primary teeth ICDAS cannot distinguish accurately between thelesion related to the outer or inner half of the enamel ,as enamel in

primary teeth is much thinner as compared to permanent teeth.


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Scoring criteria :ICDAS

SCORE CRITERIA

0 No or slight change in enamel translucency after prolongedair drying. (5s)

1 First visual changes in enamel( seen only after prolonged airdrying or restricted to within the confines of a pit or fissure)

2 Distinct visual changes in enamel.

3 Localized enamel breakdown in opaque or discoloured

enamel ( without visual signs of dentinal involvement)4 Underlying dark shadow from dentin.

5 Distinct cavity with visible dentin.

6 Extensive distinct cavity with visible dentin.


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Caries risk assessment form(for 6yrs,

above) : Young and Featherstone.

Positive ornegative

Positive ornegative

Positive ornegative

Positive ornegative

Diseaseindicators

Risk factors

ProtectivefactorsBacteria/salivatest results


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Caries activity tests:

Caries activity tests measure the degrees to which thelocal environment challenge (eg: dietary effect on microbialgrowth and metabolism) favors the probability of cariouslesions.

IDEAL REQUISITESAccording 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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Kinds of Caries Activity Tests:

Lactobacillus colony count test.

Calorimetric Snyder test.

Swab test.

Streptococcus mutans levels in saliva. Dip slide method for Streptococcus mutans counts.

Salivary buffer capacity test.

Enamel solubility test.

Salivary reductase test. Alban test.

Fosdick calcium dissolution test.

Dewar test.


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Lactobacillus Colony Count Test

This test was first introduced by HADLEY in 1933.

principle-estimates the no. of acidogenic and aciduric bacteria in the patients salivaby counting the no. of colonies appearing. A selective media (Rogosa SL agar )

favouring the growth of aciduric lactobacilli is the basis of this test.

Advantages:

simple to carry out.

Useful as a screening test in large population groups.

Disadvantages :

Inaccurate for predicting onset of caries.

Doesnt completely exclude the growth of other aciduric organisms.

Colony counting is a tedious process.

Results are not available for several days.


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Lactobacillus colony counts in saliva as related

to caries susceptibility:

After incubating the culture media inoculated with saliva at 37C:


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Calorimetric Snyder test: Principle involved: measures the rapidity of acid formation when

a sample of stimulated saliva is inoculated into glucose agar withbromocresol green as color indicator which changes color in thepH range of 5.4-3.8.

The test is also a measure of acidogenic and aciduric bacteria.

Advantages- Test is simple and requires simple equipment.

Test takes only 24-48 hrs

Cost is moderate.

Disadvantage -of Snyder and lactobacillus count test-

Neither of the test can predict the extent of expectancy of carieswith any reliability for one individual.


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Color observations in Snyder Test


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Salivary Buffer capacity test

Principle - test measures the no. of milliliters of acid required 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.

There is an inverse relationship between buffering capacity of

saliva and caries activity.

Disadvantage :This test however does not correlate with

caries activity.


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Fosdick Calcium dissolution test

Principle - measures the milligrams of powdered enameldissolved in 4hrs by acid formed when the patients saliva ismixed with glucose and powdered enamel.

Advantage- Requires only 4 hrs.

Disadvantages-

Test is not simple Equipment is complex

Cost is high


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Dewar Test:

This test is similar to Fosdick calcium dissolution testexcept that the final pH after 4 hrs is measuredinstead of the amount of calcium dissolved.

This test has not been adequately tested for clinicalcorrelation.


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Mutans Group Of Streptococci Screening

Tests Plaque/toothpick method

Principle - involves simple screening of a diluted plaque samplestreaked on selective culture medium.

Saliva/tongue blade method

Principle -estimates the no. of S. mutans in mixed paraffin stimulated salivawhen cultured on mitis salivarius bacitracin(MSB) agar.

Advantages-

Simple and practical method for field studies

Requires no transport media/dilution stops


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Dip-Slide method for S.Mutans count:

Principle - these tests comprise of Dentocult SM, CariescreenSM.These tests classify salivary samples according to estimates of smutans colonies growing on modified mitis salivarius agar.

evaluated accordingto the CFU insideinhibition zone.

20mm

5mgbacitracin

5mgbacitracin

MSA agar+20% Sucrose + saliva

Incubated at 37c for 48 hrs

Zone of inhibition


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S mutans replicate technique

Principle- localizes s mutans colonies on tooth surfacesusing a solid impression matrix composed primarily ofsucrose and commercial gum base.

Matrices are placed in liquid broth and incubated at 37deg C overnight and examined directly for overgrowth of

s mutans colonies at specific sites.


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Prediction of future caries activity based on

previous caries experience

Koch grouped 9-10yr old children into a high caries active group and a low caries activegroup on the basis of restored:-

Proximal surfaces of incisors and first permanent molars.

Buccal surfaces of maxillary first permanent molars.

Lingual surfaces of mandibular first permanent molars.

Those who had a score of 4 or more were considered high caries active whereas thosewho had a 0 score were considered low caries active.

Drawbacks-

Caries will have already occurred in the population.

This method is not applicable to very young, when preventive intervention is desirable.


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CONCLUSION:

Dental caries is a multifactorial disease process.

We need to have a thorough knowledge of

several aspects of ever changing scenario ofthe oral cavity and the disease process in order

to prevent and treat it effectively.


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Bibliography:1.Cariology-third edition , Ernest Newbrun(1989)

2.Dental Clinics of North America; Implementing caries

Risk Assessment and Clinical Interventions:Young andFeatherstone, Detection Activity Assessment andDiagnosis of Dental Caries lesions: Mariana M. Bragaet al, July 2010 issue.

3.Dentistry for the Child and Adolescent-eighth edition,

McDonald, Avery, Dean.4. Textbook of oral pathology-Shafer, Hine, Levy.5. Essentials of preventive and community dentistry;Third edition, Soben Peter.


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