The objective of this cross-sectional study was to clinically validate an
array of biochemical tests for oral acid/alkali generation as caries screening
instruments. 185 adult subjects (mean 33.6±10.6 years) were examined
clinically for dental caries using the ICDAS criteria. Bitewing radiographs were
used to confirm interproximal surfaces of posterior teeth. For the purposes of
this study, subjects were classified as “caries-active” if they
had at least one untreated caries lesion with ICDAS 4 or higher. Pooled
supragingival plaque and unstimulated saliva samples were collected and assayed
for pH changes from sucrose and urea metabolism using colorimetric tests. The
validity of each test to discriminate between “caries-inactive”
and “caries-active” subjects was assessed and compared to a
commercial bacteriological caries-screening test using roc regression and
logistic regression models.
The AUCs of the plaque-urea (PU: 0.59 (0.51, 0.67)), plaque-urea-glucose
(PUG: 0.59 (0.51, 0.67)) and saliva-urea-glucose (SUG: 0.59 (0.51, 0.67)) tests
did not differ significantly from the bacteriological tests (CRT-mutans: 0.62
(0.54, 0.70); CRT-lactobacillus: 0.63 (0.56, 0.71) (P>0.05), but the
plaque-glucose (SG), saliva-glucose (SG), saliva-urea (SU) and
saliva-plaque-glucose (SPG) tests had significantly smaller AUCs
(P<0.05). The AUCs for the PU, PUG, SUG, and the CRT-mutans tests were
higher in subjects who had no existing dental restorations (PU: 0.90 (0.77,
1.04); PUG: 0.90 (0.79, 1.01); SUG: 0.89 (0.69, 1.08); CRT-mutans: 0.90 (0.73,
1.08)). The incorporation of the biochemical tests into a multidimensional
bacteriological/psychosocial caries screening model significantly increased its
diagnostic values (Se+Sp: 160.6, AUC: 0.846).
In conclusion, as a proof of concept, the results of this study indicate
that measuring the ability of dental plaque and saliva to metabolize urea
together with the ability to generate acid from sugars may have a promising role
in caries screening either independently, or as part of a multidimensional
biological test.