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ORIGINAL RESEARCH
Oratest: a simple chair side aid for caries risk assessment
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
|
2009 Volume 1 Issue 1
Ruchi Arora, Lahiri K Prathik, Masih Updesh
ABSTRACT
Background: A plethora of caries activity tests had been developed to predict susceptibility to caries. However, most of
these tests either require an extensive armamentarium or they are not completely reliable. A reliable, inexpensive caries
activity test for diagnosing high-risk patients, for patient motivation, and for preventive treatment planning is the need
of the hour. Rosenberg et al in 1989 developed oratest, a simple, economical, non-invasive and less time consuming test
for estimating the oral microbial level. Aims and Objectives: The present study relates plaque indices and DMFT counts
as indicators of caries activity to oratest scores. Materials and Method: Sixty volunteers participated in the study. The
children were asked to rinse their mouth vigorously for 30 seconds with 10 ml of ultra-high temperature sterilized cow’s
milk containing 3% of fat. The expectorate was collected in a sterile beaker, and 3 ml was immediately transferred with a
disposable syringe to a screw cap test tube, which contained 0.12 ml of 0.1% methylene blue. The expectorated milk and
methylene blue was thoroughly mixed, and the test tube was placed on a stand in a well- illuminated area. A mirror was
used to detect any color change [blue to white] in the bottom of the test tube every 5 minutes. The time taken for the initiation of the color change within 6mm ring was recorded. Results: The time taken for color change in control group, was
145-190 min and was 45 – 90 min for the test group. Conclusion: the study concludes that higher the level of infection,
lesser was the time taken for a change in color of expectorate, reflecting higher oral microbial levels.
Key words: Caries activity; Dental caries; Oratest
Introduction
The growing interest in the microbiological aspects of dental
caries has led to the development of a variety of diagnostic
procedures. A number of caries activity tests have been developed to detect the presence of oral conditions associated
with increased caries risk. For individual patients, currently no
single caries activity test can be relied upon to predict caries
with a high degree of confidence as many of these tests rely
on the samples of salivary bacteria. The reliability of such tests
is limited, because the bacteria that are free-floating in the
saliva may not necessarily represent the bacteria in plaque.
These tests also need extensive working time and expensive
armamentarium.1
Individual caries activity tests, despite their limitations, can
be useful adjuncts to the clinical practitioner, by guiding the
clinician in making decisions concerning the need for control
measures, the timing of recall appointments, the types of indicated restorative procedures, materials and the determination
of the prognosis. The test results can also be used to motivate
patients and to determine patient compliance with treatment
regimes. A simple, inexpensive technique, which does not demand sophisticated skills or consume less chair side time will
help to give the caries activity, tests the status they deserve in
routine clinical practice.
A large body of evidence supports the hypothesis that microorganisms present in dental plaque constitute the primary etiological factor in periodontal diseases.2-4 It has similarly been
established that dental plaque accumulation induces and promotes gingivitis.5 Prior to the 1970s, periodontal diseases were
ascribed to the overall increase in microorganisms, a concept
referred to as the “non-specific plaque hypothesis.”6 More recently, specific groups of bacteria were found to be associated with particular periodontal ailments, leading to a “specific
plaque hypothesis.”5 In 1985, Moore et al.7 reported that peri-
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odontal diseases are associated with elevated levels of at least
57 bacterial species. The observation that many suspected
periodontal pathogens require or prefer anaerobic growth
conditions has led to speculation that oxygen depletion by
aerobic plaque microorganisms is a prerequisite for the development and progression of periodontal diseases.8
Rosenberg and coworkers8 reported a simple, non-invasive
technique (the oratest) which estimates oral microbial levels,
based on the rate of oxygen depletion in expectorated milk
samples. The test is performed by rinsing the mouth with sterilized milk. A sample of expectorate is then added to a test
tube containing the redox indicator, methylene blue. The time
required for anaerobic conditions to be attained at the bottom
of the tube, as indicated by a blue-to-white color change, is
recorded. In a previous investigation, strong correlations were
observed between oratest scores and counts of aerobic and
aerotolerant microorganisms.9 The present study was undertaken to compare oratest scores with commonly used indices
for clinical evaluation of plaque levels and DMFT.
Materials and Method
Principle: Oratest is based on the rate of oxygen depletion by
microorganisms. Under aerobic conditions the bacterial enzyme; aerobic dehydrogenase transfers electrons or protons
to oxygen. Once oxygen gets utilized by the aerobic organisms and an anaerobic environment is attained, methylene
blue [redox indicator] acts as an electron acceptor and gets
reduced to leukomethylene blue. The metabolic activity of the
aerobic microorganism is reflected by the reduction of methylene blue to leukomethylene blue.
The test is based on rinsing the mouth with sterile milk that
dislodges the micro-organisms and also produces a substrate
for their further metabolism. The formation of leucomthylene
blue can be easily observed because of the white color of milk.
E-ISSN :0975-8437
P-ISSN: 2231-2285
Oratest: a simple chair side aid for caries risk assessment
Armammentarium
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Sterilized milk
0.1% aqueous solution of methylene blue.
Sterile beakers
Screw cap test tubes.
5ml disposable syringes
Sterile pipettes
Mirror
Test tube stand.
Water.
Results
Discussion
As the oratest, gives positive observations in cases of gingival
diseases, periodontal diseases, halitosis, etc., its limitation is
the lack of specificity, as it does not identify the source of microorganisms. The test can be easily learnt by the auxiliary personnel and hence can be used as a diagnostic tool in school
health programs. The positive results can easily be visualized
by the practitioner, child and the parent and thus can be used
to motivate.13 As it does not require any special instruments,
it can be used to monitor treatment progress. It can provide a
baseline with which subsequent changes in clinical status and
oral hygiene [i.e., following oral prophylaxis] can be monitored
in a chair side or even home environment.
DMFT
Time(minutes)
0 (Control Group)
145-190
1-3 (Group 1)
90-130
4-6 (Group 2)
110-60
Oratest, a simple chair side caries activity test provides a reliable estimate of oral microbial levels. Significant overall correlations were observed between oratest data and deft/DMFT
or plaque index.
>6 (Group 3)
45-80
Conclusion
Table 1: Relation between oratest scores and DMFT
Plaque index score
Time(minutes)
0-2
45-130
2.1-4
135-190
Table 2: Relation between Oratest scores and Plaque
Index Scores
A caries activity test facilitates the clinical management of
patients as they determine the need and extent of personalized preventive measures. It serves as an index for the success
of therapeutic measures and also help and to motivate and
monitor the effectiveness of educational programs relating to
dietary and oral hygiene procedures. It is of particular importance in identifying high-risk groups and individuals.
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2009 Volume 1 Issue 1
The present study, thus further proved the hypothesis that
higher the level of infection, lesser was the time taken for a
change in color of expectorate, reflecting higher oral microbial levels. Thus, the test can be used as one of the tools, to
estimate the activity of demineralization by the bacteria conducive to the suitable environment.
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In the present study, 60 children were randomly selected from
the Department of Pedodontics for the oratest. It was noted
that the correlations were slightly altered by drinking or eating prior to the test. Thus all subjects in the study were taken
only after a lapse of 90 minutes since the last intake of food or
drink. The test was based on whole mouth rinsing with sterile
milk, which is a suitable vehicle as it dislodges microorganisms
mildly yet effectively. It is nontoxic, provides an excellent medium for subsequent metabolism and also readily acceptable
by the children. Expectorate was then added with the methylene blue and the time taken for initiation of color change was
noted.
In the present study maximum time taken for color change
[90-130 min] was observed in children with 1-3 carious teeth
and the minimum time taken for the color change [45-80 min]
was in children with 6 or more carious lesions. Similar findings were reported by Patalay et al.10 and Anand et al.11 In the
present study, when all 60 subjects were grouped together,
significant co-relation was found between time required for
color change and plaque index. Tal Haim and Rosenberg Mel12
observed similar results when they compared oratest scores
with commonly used techniques for clinical evaluation of
plaque levels and gingival inflammation. They also reported
that higher the oratest scores, lower the value of plaque index
[γ =0.58, P=0.001].
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Procedure: Sixty volunteers (mean age 12 years) participated in the study. The plaque level and the number of decayed,
missing, filled teeth of each volunteer were scored using the
Loe and Silness (1967) and DMFT indices respectively. The children were asked to rinse their mouth vigorously for 30 seconds with 10 ml of ultra-high temperature sterilized cow’s milk
containing 3% of fat. The expectorate was collected in a sterile
beaker, and 3 ml was immediately transferred with a disposable syringe to a screw cap test tube, which contained 0.12 ml
of 0.1% methylene blue. (0.1% methylene blue was obtained
by mixing 100 mg of methylene blue in 100 ml of distilled
water) The expectorated milk and methylene blue was thoroughly mixed, and the test tube was placed on a stand in a
well- illuminated area. A mirror was used to detect any color
change [blue to white] in the bottom of the test tube every 5
minutes. The time taken for the initiation of the color change
within 6mm ring was recorded.
The time taken for color change of methylene blue was compared with the deft/DMFT values and plaque index scores. For
the control group, the time taken for color change was 145190 min and was 45 – 90 min for the test group. These findings
were in agreement with the findings of Patalay et al.,10 Anand
et al.11 who performed oratest on 50 children. They found the
mean time taken for the color change was 279.9 min ± 89.74
in the control group and 55.6 min ± 66.33 for the test group.
The difference between the two groups was highly significant.
E-ISSN :0975-8437
P-ISSN: 2231-2285
Arora et al
Authors Affiliations
1. Ruchi Arora, MDS, Professor, Department of Pedodontics and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India, 2. Lahiri Prathik K, BDS, Postgraduate Student, Department of Pedodontics and Preventive Dentistry, Pacific Dental College
and Hospital, Udaipur, Rajasthan, India, 3. Masih Updesh, MDS, Reader, Department of Pedodontics and Preventive Dentistry, Pacific Dental College and Hospital, Udaipur, Rajasthan, India.
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I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
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2009 Volume 1 Issue 1
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How cite this article
Arora R, Prathik LK, Updesh M. Oratest: A simple chairside aid for caries risk assessment. Int. J. Dent. Clinics. 2009;1(1):20-22.
Address for Correspondence
Dr. Ruchi Arora, MDS,
Department of Pedodontics and Preventive Dentistry,
Pacific Dental College and Hospital,
Udaipur, Rajasthan-313024, India.
Ph: +91.9929098915
Email: [email protected]
8. Rosenberg M, Barki M, Portnoy S. A simple method for estimating oral microbial levels. Journal of Microbiological Methods.
1989;9(4):253-6.
Source of Support: Nil
Conflict of Interest: None Declared
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