Patent Publication Number: US-9427384-B2

Title: System for caries management by risk assessment

Description:
RELATED PATENT APPLICATIONS &amp; INCORPORATION BY REFERENCE 
     This application is a divisional application of U.S. application Ser. No. 11/337,435, entitled “System for Caries Management by Risk Assessment,” filed Jan. 23, 2006. This related application is incorporated herein by reference and made a part of this application. Moreover, any and all U.S. patents, U.S. patent applications, and other documents, hard copy or electronic, cited or referred to in this application are incorporated herein by reference and made a part of this application. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to the prevention and treatment of dental caries, including risk assessment, activity level, intervention and materials for the measuring said risk. Advanced clinical treatment procedures, methods and materials are presented and claimed herein. 
     2. Background and Related Art 
     Dentistry is usually considered to involve the restoration of natural teeth as they become carious. Cosmetic dentistry is another concept and an option with regard to tooth whitening and in some cases, orthodontia. In the July/August 2003 Dental Practice Report, Spaeth, in an article entitled “Not your father&#39;s dentistry” quotes Dr. G. V. Black who said, in 1896, that someday dentists would be “engaged in practicing preventive, rather than reparative, dentistry”. 
     These sentiments were echoed in 1997, when Dr. Harold Slavkin discussed biological solutions to oral health problems including biological approaches to restorative dentistry in the repair destroyed by infection from  Streptococcus mutans . There have been some patents that dealt with the idea of bacterial causes of dental decay and other problems. For example, Miehl in U.S. Pat. No. 5,213,615 uses active agents; said active agents are applied to the teeth as a dental varnish, cement, and the like. In RE 31,815 Alfano teaches a method for detecting the presence of caries in the teeth by the use of light beams of certain wavelengths and comparing the ratio of intensities of the lights in a plurality of carious and non-carious lesions in the mouth. 
     The prior art mentioned above dealt with advanced ways and means of the detection of carious areas of a patient&#39;s mouth. In U.S. Pat. No. 5,738,113 Connelly is concerned with the control and reduction of dental caries in people who are at risk of dental caries. Connelly discusses a method that applies fluoride and antimicrobial agents but does not provide a complete system for caries management by risk assessment. 
     In US patent application 20050191247, Drake et al discloses antimicrobial rinses and products based on chlorhexidine, alcohol free, xylitol and raspberry flavoring. Another US patent application 20050169852, to Roberge et al, discusses antimicrobial rinses all based on CPC, cetyl pyridium chloride. 
     US patent application 20050142074 to Pushpangadan et al is concerned with antimicrobial rinses based on herbs and herbal root extracts. US patent application number 20050100866 to Arnone et al shows an electronic DC probe used to determine if decay is in a tooth based on electric resistance. 
     In US patent application number 20050025720 Bailey shows a oral maintenance kit based on xylitol products with gum, candy, rinse, toothpaste and the like. US patent application number 20020114768 by Stoor et al discloses antimicrobial rinses based on essential oils. 
     U.S. Pat. No. 6,846,478 to Doyle et al discloses oral antimicrobial rinses based on chlorite ion. Applicants&#39; invention utilizes the hypochlorite ion as an antibacterial agent in various embodiments, not the chlorite ion. Applicants&#39; invention comprises various rinses as well as an important diagnostic component. 
     Dental caries recently has been considered as a complex, transmissible bacterial infection. There are multiple pathogenic, cariogenic, bacteria involved in the dental caries process. Dentistry has identified a couple of the specific bacterial pathogens, but many of the bacteria remain unidentified and not culturable in the laboratory. Consequently, this complex process is not completely understood. Current scientific research is focusing not so much on the specific bacterial pathogens, but on the cariogenic bacterial biofilm that causes the disease, and the activity potential of that biofilm. 
     In contrast to the previous inventions in the field, the current invention is looking for and detecting amounts and types of bacteria in the mouth. This invention includes a plurality of screening tests for the detection of  Mutans streptococci  and  Lactobacilli  in the patient&#39;s saliva and tooth surfaces. In addition to the levels of bacterial biofilm and the activity and activity potential of the bacterial biofilm it is seen as a diagnostic measure of the patient&#39;s presence of and risk for caries activity in their mouth. In this invention, one screening test is concerned with biofilm level in the mouth is determined by finding and measuring adenosine triphosphate (ATP), the energy molecule of living cells to measure the bioluminescence and to then correlate the amount of ATP present to the amount of bacterial load in the mouth. 
     The bacterial load in the mouth can also be measured with a second screening test, the protein detection screen; however, all teeth (even healthy teeth) are covered with a protective protein layer, the pellicle. The protein level as a determinant of the amount of bacterial biofilm present must account for the average pellicle protein baseline reading. In this invention, the presence of bacteria at high risk levels can be determined by a simple swab test looking for protein presence on the tooth surface. With a simple swab and reagent that results in a color change, bacteria on the tooth surface can be identified at high levels. The second swab test comprises a disposable protein sampler and identifying swab that changes color change indicator after swabbing. There is a color scale included with this swab test that helps to determine protein levels which are a direct result of levels of bacteria in the patient&#39;s mouth. A preferred commercially available color changing protein swab is the Biotrace Pro-Tect® system. This is a product of Biotrace Limited, located in Bridgend, in the UK. Details of the protein swab test and procedures will be described as part of the Detailed Description of the invention that follows. 
     The activity potential of the bacterial biofilm can be determined with the ATP bioluminescence. By taking a biofilm baseline reading of the ATP, then having the patient rinse with a specific concentration of a sugar in water solution for a specific time, then waiting a specific period of time and retesting. In a preferred embodiment, the sugar used is selected from the group consisting of sucrose and glucose, and the time period for retesting ranges from between 10 seconds and 10 minutes. The concentration of the sugar rinse used for this swab test is 0.1-40% by weight. Retesting for a second ATP level will provide a direct, calibrated, measure of the biofilm metabolic activity potential from which diagnostic decisions can be determined. 
     Yet another swab test that is part of this invention involves a rapid culture test for the detection of  Mutans streptococci  and  Lactobacilli  from the patient&#39;s tooth surface wherein the swab is removed from a sterile package; rubbed on a tooth surface, transferred to an agar tube selective for  Mutans streptococcus , incubated at body temperature (37 degrees C.) for 3-24 hours, and read for the number of colony forming units of  Mutans streptococci  and  Lactobacilli.    
     The system of the instant invention includes a diagnostic testing component, a diagnostic survey questionnaire, and a plurality of antimicrobial treatment components. Caries risk assessment and treatment procedures are now the standard of care in California and it may become standard in other locations. Details on the components, materials and methods of the invention will be detailed shortly. 
     SUMMARY OF THE INVENTION 
     This invention provides a complete turnkey system for caries risk assessment and treatment, including a protein test, an ATP test and a rapid bacterial culture test, and a plurality of rinses and educational and diagnostic materials. The system for the detection and treatment of the bacterial infection that causes dental caries in a patient comprises a disposable protein identifying swab with a color change indicator, a disposable ATP Bioluminescence sampler to swab areas of the patient&#39;s mouth, a bioluminescent light meter which measures the amount of ATP present in the patient&#39;s mouth, a rapid culture test for the detection of  Mutans streptococci  and  Lactobacilli , a diagnostic testing component that includes a caries risk assessment questionnaire, a treatment component that includes a therapeutic oral rinse comprising at least two components, a daily treatment component selected from the group comprising an oral rinse and an oral spray to be used by the patient independently, and a patient diagnostic survey questionnaire, which is assessed by a dental professional and that, with a decision tree, pinpoints any oral bacterial infection that exists in the patient that causes dental caries. 
     A preferred ATP Bioluminescence sampler to swab areas of the patient&#39;s mouth of this invention is the UltraSnap™ swab made by the Hygenia Company. UltraSnap is a simple and effective means for sampling which has a self-contained ATP device to measure ATP levels and the bacterial levels in a patient&#39;s mouth. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG. 1  depicts the Caries Risk Assessment Form of this invention 
         FIG. 2  depicts the CAMBRA Decision Tree of this invention 
         FIG. 3  depicts the components of a kit of this invention 
         FIGS. 4 and 4   a  shows the “SNAP-SWAB” of this invention:  FIG. 4A  shows the swab being rubbed on a tooth surface and  FIG. 4  shows the swab placed in the protective swab tube after swabbing has been done 
         FIG. 5  shows a user whose hand is breaking the “SNAP-VALVE” at the top of the swab by bending the bulb of the swab tube 
         FIG. 6  shows a user shaking the swab 
         FIG. 7  shows the swab being placed in the ATP bioluminescence light meter 
         FIG. 8  shows the ATP screen that shows the bioluminescence light meter test results for the swab placed therein 
         FIG. 9  is a view of a patient&#39;s dentition 
     
    
    
     DEFINITIONS USED IN THIS INVENTION 
     For purposes of this invention, a dental professional can be a dentist, a dental hygienist or a certified dental assistant. 
     In this invention, caries and periodontal disease are the oral health conditions that are being treated and improved by the system, methods and kit of the present invention 
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     The present invention deals with a biological approach to treatment of a patient&#39;s oral health problems. A large part of this approach involves the measurement of the types and amounts of bacteria present in the patient&#39;s mouth. It is known that while numerous different bacteria play major roles in dental caries and periodontal disease and many have yet to be identified. Two specific bacteria have been consistently identified with dental caries risk. These bacteria are  Mutans streptococci  and  Lactobacilli . Measurement of these bacteria in a patient&#39;s saliva enables the dental professional to treat the patient with a goal of long-term dental health. The instant invention provides a plurality screening tests, diagnostic guidelines, professional assessment forms, oral rinses and a daily treatment program to ensure and preserve the patient&#39;s long term oral health. 
     With reference to  FIG. 1 , a Caries Risk Assessment Form (CRAF) is completed by a dentist, or otherwise qualified dental professional while a patient visits a dental office. The patient is an adult or a child over the age of six years. Caries risk assessment can be performed on children under the age of six years, with additional considerations. 
     In general, patients with high risk of caries include: those with recurrent or residual decay, as shown by their treatment history; patients who are about to receive orthodontic care (as it is known that orthodontic appliances and/or brackets are natural sites for colonization of  Streptococcus Mutans ; patients with crown and bridge restorations; patients with limited salivary flow (xerostomia) due to systemic medications such as anti-hypertensive medicaments, anti-depressants, tranquilizers, antihistamines, and other drugs known to reduce saliva flow. Also factors are certain systemic diseases such as Sjogren&#39;s Syndrome, scleroderma, lupus, rheumatoid arthritis, or with neurological conditions such as Parkinson&#39;s Disease. Also at high risk are new patients exhibiting poor oral hygiene, poor dental knowledge and/or poor compliance with following instructions; and patients under periodontal care with exposed root surfaces. Age is a factor in that patients at peak periods for decay are often in their early teens, 20&#39;s and over 55 years of age. 
     The present invention uses the CRAF of  FIG. 1  to assess a patient&#39;s risk level. The CRAF has four columns labeled  1 ,  2 ,  3  and  4 . The CRAF can be a paper document and/or part of the patient&#39;s computerized dental record. As seen in  FIG. 1 , the CRAF column  1  lists seven factor categories in rows and a plurality of items under each category and three columns that classify the factors into rankings of HIGH, MODERATE, and LOW for each. The factors listed in column  1  of the CRAF are selected from the group consisting of local factors, dental conditions, medical history, dietary habits, environmental issues, protective factors and laboratory tests. 
     The first category of risk factors in column  1  or the CRAF is local factors. The local factors are the presence of dental plaque and/or calculus. The dental professional completing the form would indicate the presence of plaque and/or calculus by indicating if these factors are present or not present by using the columns headed high, moderate, and low. 
     The next category of column  1  is labeled ‘dental conditions’ and lists “visible cavitation”, “cavity in last three years”, “inadequate saliva flow” exposed roots”, “deep pits/fissures”, “radiographic lesions” and “white spot lesions”, and “appliances present” 
     The next category in column  1  is MEDICAL HISTORY. Factors that indicate a high caries risk in this category are listed in column  2  and include “Sjogren&#39;s syndrome”, “hyposalivary meds”, and “radiation therapy”. The next category in column  1  includes DIETARY HISTORY and indicates in column  2  that a high risk is present for “&gt;3 snacks between meals” and “regular (sugar-sweetened) soda”. The fifth category assigns a high risk factor to the use of “recreational drugs” under the category ENVIRONMENTAL. The sixth category of column  1  is PROTECTIVE FACTORS. In this category, high risk is assessed in column  2  when there is no “fluoridated water”, no “fluoridated toothpaste use”, and “inadequate saliva flow.” The seventh category, LABORATORY TESTS in column  2 , indicates the recommendation of both “saliva flow” and “Caricult rapid culture tests” for patients at high risk. 
     Column  2  of the CRAF of  FIG. 1  represents those patients at relatively high risk of caries. Typical responses that will fall into the high risk category are those patients having recent cavitation, inadequate saliva flow, dental appliances present, and who have at least one of the listed medical conditions, eat sugary snacks and/or beverages, use recreational drugs, and are low on protective factors such as fluoridated water and/or toothpaste. 
     Column  3  of the CRAF of  FIG. 1  contains the responses that categorize a patient at moderate risk. These responses include localized plaque/calculus, and “yes” responses in the areas under the DENTAL CONDITIONS of “exposed roots”, “deep pits/fissures”, “radiographic lesions” and “white spot lesions”. 
     Regarding the risk factors under “Dietary Habits”, moderate risk caries patients snack between meals 1-3 times and have infrequent use of regular soda. Patients at moderate caries risk likely use no fluoride mouth rinse, no xylitol gum or mints, no chlorhexidene rinse, and no povidone Iodine rinse. Depending upon the moderate risk patient&#39;s ATP bioluminescence Cariscreen score, they may be indicated for the Caricult rapid culture test. 
     Patients at low risk are addressed in Column  4  of the CRAF of  FIG. 1 . They have minimal or no plaque/calculus, no positive responses in the entire category of DENTAL CONDITIONS, no positive responses in the entire category of MEDICAL HISTORY, infrequent snacking between meals, no regular soda, no use of recreational drugs, and all positive responses in the PROTECTIVE FACTORS category. 
     Prior published studies of patients show that between 30% and 40% have  Streptococcus mutans  infections in their oral cavities at levels above 250,000 colony forming units per milliliter (cfu/ml). The level of 250,000 cfu/ml is an internationally recognized standard of caries risk (see I. Zickert et al, “Effect of Caries Preventive Measures in Children Highly infected with the Bacterium  Streptococcus mutans , in J. Oral Biol., 1982, pp. 861-868). 
     Typically, 10% of patients are high risk and 20% are medium risk as measured by the levels of  Streptococcus mutans  in their oral cavity. There are certain objective measures of  Streptococcus mutans  levels which are available to determine whether a patient is at high or medium risk of caries. Prior art testing procedures are available in the marketplace, including CARIESCREEN by APO Diagnostics Inc. or the CRT saliva test manufactured by Ivoclar-Vivadent. Categorization of patients into low risk, medium risk and high risk is essential to provide the optimal frequency of dental treatments to prevent future dental caries. This is a significant factor as those at medium risk and high risk that, if left untreated, will be at greater risk of developing symptoms (cavities) of the disease. 
     In addition to the necessity of objectively measuring  Streptococcus mutans  (MS) levels in the oral cavity, the CRAF of this invention provides insight into the dental and medical history of the patient, the oral hygiene habits of the patient, the age of the patient, and the type of medications the patient is taking. It is known that the presence of  Streptococcus mutans  is essential for the development of dental caries. It is also known that certain risk factors operate in determining caries risk. 
     While low risk is indicated by having less than about 250,000 cfu/ml  Streptococcus mutans , one could distinguish further between a lower risk group having 100,000 to 250,000 cfu and a very low risk group at less than 100,000 cfu. Objective measurements of levels of  Streptococcus mutans  can be used as an indicator of an individual&#39;s likelihood of developing dental caries in the future as well as control of existing dental caries. 
     The relationships between bacterial counts in the oral cavity and the development of dental decay and future prognosis in a patient are still being investigated. In fact, some studies are suggesting that the cut-off for high risk be lowered to 1000,000 cfu for MS. The system of the present invention are advantageous in that they provide both the dental treatment provider with a tool to control and reduce the incidence of dental caries and the patient do proactively play an important, preventative role in his or her dental and periodontal health. The system is particularly beneficial for reducing patient risk of dental caries in the population of patients with good nutritional habits and good habits of dental hygiene. 
     Patients in a high risk group could be treated and monitored with the system and methods of the present invention to see if their risk grouping drops to medium risk. Similarly those in the medium risk could be monitored to see if they could move to a low risk group. The treatment guidelines for the new risk group would then apply for the patient. If a patient did not drop into a lower risk group then the dental treatment provider would know to continue with the current treatment for that risk group. This may also be a signal to the dentist that other factors, which were not at first appreciated or realized, may be at work. In the latter situation, the treatment methods of the present invention may act as an indictor of the overall oral health of the patient. 
     Each of the CRAF responses is assessed by the patient&#39;s dentist to determine the caries risk status of each individual patient. It is especially important to identify individuals with high  Streptococcus mutans  levels in their oral cavities. To measure the actual bacteria count, the dental professional uses a method of assessing the level and type of oral bacteria to determine the prognosis for the development of caries in a patient which includes the steps of 
     a) Swabbing an area of the patient&#39;s mouth with a disposable tool; 
     b) Performing a rapid culture test for the detection of  Mutans streptococcus  and  Lactobacilli;    
     c) Using a bioluminescent light meter to interpret the test results; 
     d) Diagnosing the likelihood for caries risk on the tested area of the mouth; 
     e) Combining these test results with the answers to patient survey forms, and using the decision tree shown in  FIGS. 1 and 2  and examination by dental professionals to produce a individualized caries risk assessment profile for the patient. The caries risk profile will then help the dentist to prescribe a series of specific treatments for said patient. The rapid culture test uses an agar medium that favors  Mutans streptococci , has a color change indicator, and is incubated at human body temperature, 37 C for a period of 3-24 hours before being read for the number of colony forming units. 
     The patient&#39;s risk assessment profile is done using the completed CRAF of  FIG. 1 , when combined with the decision tree of  FIG. 2 , pinpoints any oral bacterial infection that exists in the patient that causes dental caries. 
     To do this, the dental professional starts with component A of  FIG. 2 , the initial swabbing of the oral cavity followed by the performance of a rapid culture test. The swab used is shown and described in  FIGS. 4 and 4A  and is more fully described below. A bioluminescent light meter (shown in  FIGS. 7 and 8 ) is used to interpret the results of the ATP swab tests. The results of A can be either positive or negative; if they are negative the next point on the decision tree is component B, the caries risk assessment form, the CRAF of  FIG. 1 . The patient completes the CRAF: if the results of this are negative for caries risk, the patient is scheduled for a recall appointment. If the results of component B are positive, the patient moves on to step C which is a rapid culture test for the detection of  Mutans streptococci  from the patient&#39;s saliva. 
     Step C is another decision point on  FIG. 2 ; if the rapid culture test produces negative results, the patient is scheduled for a recall appointment. If the culture test is positive, the patient is now on step D of the decision tree. Step D is the application of a therapeutic rinse for a specified period of time determined by the dentist, usually from 1-3 weeks. After this time, the patient is placed on a daily maintenance rinse, to be used independently after completing the therapeutic rinse. 
     After repeated use of the daily maintenance (for a usual time period of about 3 weeks, the is retested at the dental office and the rapid culture test of step C to assess the effectiveness of the treatment and patient behavioral modification. This procedure is repeated until Step C gives a negative result for the detection of  Mutans streptococci.    
     This invention includes at least two rinses. The rinses include a treatment component that includes a short term therapeutic oral rinse and a long term maintenance treatment component that comprises a long term maintenance rinse and an oral spray to be used by the patient independently. 
     The short term therapeutic rinse of this invention is a two component product. The first of the two components of the short term therapeutic rinse is comprises at least one sugar-free taste enhancing agent, at least one solvent, at least one carrier, at least one preservative and a flavoring. More specifically, the first of the two components of the therapeutic rinse comprises xylitol as the sweetener, water as the carrier, Poloxamer 407 as the surfactant, flavor enhancers selected from the group consisting of menthol, peppermint, cranberry, cinnamon, citrus, mint oil and lemon, sodium benzoate as the preservative, and sodium fluoride for anti-cavity protection and remineralization. 
     Poloxaers are a non-ionic surfactants which are polyoxyethylene polyxypropylene block copolymers. In the present invention, the poloxamer 407 is bought from Voigt Global Distribution of Kansas City, Mo. 
     The second of the two components of the short term therapeutic rinse comprises at least one antimicrobial agent, a carrier, and sufficient pH adjusters to bring the pH to a basic value higher than 7.0. More specifically, the second of the two components of the therapeutic rinse comprises sodium hypochlorite as the antimicrobial agent, water as the carrier, and sodium hydroxide as the pH adjuster. 
     Another rinse of this invention is the long term maintenance rinse. It is used by the patient independently and comprises at least one antimicrobial agent, a solvent, at least one flavoring, a preservative, at least one pH adjuster, and at least one remineralization agent. The remineralization agent is selected from the group consisting of fluoride, calcium and phosphate ions in the form of water soluble salts. 
     More specifically, a preferred long term maintenance rinse flavoring is xylitol, the solvent is water, the antimicrobial agents are selected from the group consisting of polyphenols of white tea extract and anthocyanidins of cranberry extract, the preservative is sodium benzoate, the remineralization agent is sodium fluoride, and the pH adjuster is sodium bicarbonate. The pH adjuster is present to insure that the pH of the long term maintenance rinse is higher than 7 
     The long term maintenance treatment of this invention may also include a spray that is used for antimicrobial treatment, acid buffering, and remineralization. A preferred oral spray comprises the flavoring of xylitol, the solvent is water, the antimicrobial agents are selected from the group consisting of polyphenols of white tea extract and anthocyanidins of cranberry extract, the preservative is sodium benzoate, the remineralization agents are calcium and phosphate ions, and the pH adjuster is sodium bicarbonate. 
     Additional products included in the system of this invention include oral chewing substances made of natural leaf products selected from the group consisting of mint leaves, tea leaves, herbal leaves, tobacco leaves, the flavoring is xylitol, the solvent is water, the antimicrobial agents are selected from the group consisting of polyphenols of white tea extract and anthocyanidins of cranberry extract, the preservative is sodium benzoate, the remineralization agent is selected from the group consisting of calcium and phosphate ions, and the pH adjuster is sodium bicarbonate. 
     The instant invention includes a kit for patients use in conjunction with professional dental treatment in the control of oral bacterial infection to prevent the occurrence of dental decay in patients. As depicted in  FIG. 3 , the kit includes 
     i) a first rinse that is a two-part short term therapeutic rinse  20  that reduces  Mutans streptococci  and  Lactobacilli  levels and whose components are listed supra. 
     ii) a second long term maintenance rinse  22   
     iii) an oral spray that is packaged in a plastic spray bottle and that comprises a flavoring, a solvent, an antimicrobial agent, a preservative, a remineralization agent, and a ph adjuster. 
     The rinses of this invention are a large part of the uniqueness and utility of the present invention. The two-component short term therapeutic rinse can be made using the following formula 
     Component One: 
     CAMBRA CariStat™ Treatment Oral Rinse 
                                             Component Rinse A   % Wt                                                    Water   72.70           Xylitol   22.0           Mint Oil   1.0           Sodium Benzoate   2.0           Poloxamer 407   1.25           Menthol   1.0           Sodium Fluoride   0.05           Total Rinse   100                        
In the above formulation, xylitol is a sweetener, sodium benzoate is a preservative, sodium fluoride is a decay-preventive and remineralization agent, sodium bicarbonate is a pH buffer, menthol is a flavoring and water is the solvent.
 
Component Two:
 
                             Component Rinse B                                                6% Sodium Hypochlorite Solution   2.84 gal           Water   42.6 gal                       18% Sodium Hydroxide Solution, added to achieve a solution pH of 11.9            
In the above formulation, sodium hypochlorite is the antimicrobial agent, sodium hydroxide is present to keep the pH of the formula at or above a pH value of 7 and water is the solvent.
 
The CariStat™ maintenance rinse with Fluoride has the following formula Single Component Long Term Maintenance Rinse
 
     
       
         
           
               
               
               
             
               
                   
                   
               
               
                   
                 Weight (lbs) 
                 Weight percent 
               
               
                   
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Xylitol 
                 114.4 
                 25% 
               
               
                   
                 Water 
                 333.9 
                 72.95%   
               
               
                   
                 40 gal 
               
               
                   
                 Sodium Benzoate 
                 9.15 
                  2% 
               
               
                   
                 Sodium Fluoride 
                 .228 
                 .05%  
               
            
           
           
               
               
               
               
            
               
                   
                 Sodium Bicarbonate 
                 to pH of 7+ 
                   
               
               
                   
                 Natural Flavoring (lemon) 
                 ¾ cup 
               
               
                   
                 Color (Red, Yellow) 
               
               
                   
                   
               
            
           
         
       
     
     The ingredients listed above are present as a sweetener (xylitol), a preservative (sodium benzoate), anti-cavity/remineralization agent (sodium fluoride), pH buffer (sodium bicarbonate), solvent (water) and flavor (lemon) and color (red). 
     EXPERIMENTAL DATA 
     All patients who are treated for the prevention and treatment of dental caries, including risk assessment, activity level, and intervention begin their treatment by being swabbed and categorized for caries risk based on the following procedure: 
     The CariScreen™ Swab sampling device shown in  FIG. 4  is a self-contained ATP device for use with the CariScreen Meter used for Caries Susceptibility Testing. This system is used as a screening test for the presence of high dental caries risk. The CariScreen Meter in conjunction with the CariScreen Swab measures adenosine tri-phosphate (ATP), the universal energy molecule found in all animal, plant, bacterial, yeast, and mold cells. 
     When collecting a sample, the dental professional must make sure to use aseptic techniques; care must be taken to not touch the swab or the inside of the sampling device with fingers. The patient&#39;s mouth should be at rest, which in general terms means no mechanical activity, brushing, flossing, swishing, coughing, chewing, eating and the like for a period of 15-30 minutes prior to the test. 
     The first step of swab sampling is to remove the swab which ends in a tip  32  from the swab tube  41 . The swab tip  32  is rubbed on a tooth surface  40  as depicted in  FIG. 4A . After swabbing, the swab  32  is put back into the swab tube  41 . 
     Condensation may be visible on the inside of the swab tube, which is normal. The buccal surface of a maxillary molar in the gingival third without touching the gingiva is swabbed carefully with the swab tip. The swab tip is moved across the tooth surface three times from mesial to distal. Use the maxillary right first molar if it is present; if not present select the second molar or premolar to swab instead. Using the same swab, carefully swab a maxillary incisor in the gingival third with the same protocol: swab three times across the surface from mesial to distal being sure not to contact the gingiva. Use the maxillary right central incisor if it is present; if not present select another incisor and swab it with the same protocol. A patient&#39;s dentition is shown in  FIG. 9 , which diagrams a mouth. The mesial, distal, buccal, lingual, and facial areas of the mouth are shown along with some further explanatory notes. 
     After swabbing the desired test area, place swab  32  back in swab tube  41 . The sample can be left for up to 4 hours on the cotton ball-end of the swab before activating the device, however once activated the sample must be read in the CariScreen Meter within 60 seconds. 
     ATP is brought into contact with a sample of the swab tip  32  when a user snaps the snap valve  36  between the bulb  34  and the swab shaft  36  as seen in  FIG. 5 . The unique liquid-stable luciferase/luciferin reagent contained in the bulb  34  of CariScreen Swab sampling device  14 , light is emitted in direct proportion to the amount of ATP present. 
       FIG. 5  depicts the activation of the device. It is activated by holding the swab tube  41  firmly, and using the thumb and forefinger to break the snap valve  35  by bending the bulb  34  forward and backward. Squeeze the bulb twice expelling all liquid down the swab shaft  36 . Bathe the swab bud in liquid by gently shaking for 5-10 seconds as shown in  FIG. 6 . 
       FIGS. 7 and 8  display the reading and interpretation of the results of the swab test. The swab  14  is inserted into a ATP bioluminescence light meter such as the CariScreen Swab bioluminescent light meter  12 . The lid is closed and read the results by pressing “OK”. A 15-second sequence will then commence. Results should be read within one minute of activation of the ATP light meter  12 . 
     The reading will appear on the screen  38  of the ATP light meter  12  as a number of RLUs (1-9999). This number is recorded for the patient on the CRAF form  10  Values correspond to level of risk as follows:
         0-1500=low risk   1501-3500=moderate risk   3501-9999=high risk   There will also be an icon in the lower portion of the screen  12  indicating low, moderate, or high risk. The ATP bioluminescence instrument manual will contain further user information and details.
 
Cases:
 
Case 1) Patient 1 was a 48-year-old Caucasian male who does blue collar work. He presented for oral examination and was examined and tested for caries risk assessment. Upon screening, an ATP Bioluminescence swab  14  was swabbed over the buccal surface of the maxillary first molar in the gingival third three times. After this was done, also swabbed on the labial surface of the maxillary central incisor in the gingival third three times, after which the swab was placed into the ATP Bioluminescence light meter  12 . The reading in relative light units (RLU) after 15 seconds was 4242 indicating this patient was potentially high risk for dental caries. As a next step in the system, the patient was both cultured with a rapid culture for  Mutans Streptococci  and surveyed with the CRAF form  10  of  FIG. 1 . The results of the culture demonstrated CFU&#39;s colony forming units greater than 10 5 , indicating high risk. The completed CRAF form  10  also demonstrated a high risk for caries.
       

     A diagnosis of the bacterial infection that is responsible for dental caries was confirmed. The patient was treated with the short term therapeutic two-component oral rinse  20  once per day for two weeks. This was followed by treatment with the long term maintenance oral rinse  22  on an ongoing basis. The patient was subsequently cultured at the end of one month and the bacterial rapid culture demonstrated fewer than 10 5  colony forming units of  Mutans streptococci , indicating that the infection had been controlled and the patient was now at low risk for the bacterial infection responsible for dental caries. The patient was placed back into a normal re-care appointment schedule for regular dental check-ups, which will include routine ATP Bioluminescence swab  14  screening. 
     2) Patient 2 was a 56-year-old Caucasian female patient who is a white collar professional. She presented for a routine dental re-care appointment and caries risk assessment. Upon screening with the ATP Bioluminescence swab  14 , which was swabbed over the buccal surface of the maxillary first molar in the gingival third three times, and then also swabbed on the labial surface of the maxillary central incisor in the gingival third three times. The swab  14  was then placed into the ATP Bioluminescence light meter  12 . The reading in RLU&#39;s after 15 seconds was 321 indicating this patient was low risk for dental caries. As a next step in the system, the patient was surveyed with the CRAF Risk Assessment form  10 . The results of the questionnaire indicated the patient was low risk for dental caries. A diagnosis was confirmed that the patient was low risk for the bacterial infection responsible for dental caries, and the patient was placed back into the normal re-care scheduling for dental check-ups. 
     SCOPE OF THE INVENTION 
     The above presents a description of the best mode contemplated of carrying out the present invention, and of the manner and process of using it, in such full, clear, concise, and exact terms as to enable any person skilled in the art to which it pertains to make and use this invention. This invention is, however, susceptible to modifications and alternate constructions from that discussed above which are fully equivalent. Consequently, it is not the intention to limit this invention to the particular embodiments disclosed. On the contrary, the intention is to cover all modifications and alternate constructions coming within the spirit and scope of the invention as generally expressed by the following claims, which particularly point out and distinctly claim the subject matter of the invention.