However, it is not easy to make the diagnosis of an anaerobic infection in plaque samples as the research procedures described above are slow and expensive. Some clinicians, encouraged by the findings of Dr. Paul Keyes, have purchased phase-contrast microscopes and by coupling a video camera to the microscope, can examine with the patient the plaque samples on a TV monitor. Patients are usually surprised by the energy of the germs that they see swimming about under the microscope, and the presence of many white blood cells. Effective treatment results in fewer germs and a change in the types of germs that are present. As these events can be witnessed by the patients, the use of the microscope enhances patient compliance with the home treatments that are used.
Microscopes are expensive.
This has led us to seek alternate methods to capture the same information, i.e., that anaerobic germs are dominating in the plaque. We noted above that B. forsythus , P. gingivalis and T. denticola are the dominant anaerobes in plaque samples. We have used the BANA test to identify these germs in plaque samples and have confirmed that the BANA test is as reliable as the microscope, and even with DNA probes, in identifying these bacteria in plaque samples. When the BANA test reveals a positive reaction in at least three of the four plaque samples taken from teeth with the most inflamed clinical sites, the patient is diagnosed as having an anaerobic periodontal infection. Plaque samples are removed from four clinically-involved sites and applied to the lower reagent strip of the card.