''CAMBRA'' CARIES MANAGEMENT BY RISK ASSESSMENT

CARIES MANAGEMENT BY RISK ASSESSMENT

- A method of assessing caries (cavity) risk and making dental treatment and restoration recommendations based on a patients caries risk.

CARIES MANAGEMENT BY RISK ASSESSMENT

- A fact-based strategy for prevention and therapeutic approaches for healing of early tooth decay.

CARIES MANAGEMENT BY RISK ASSESSMENT

GOALS: - To minimize caries experience while employing the fewest possible interventions. - Reduction of infectious bacteria, remineralization of the enamel and the reduction of the oral acid level.

CAMBRA ASSESSMENT TOOL

CAMBRA ASSESSMENT TOOL

This was developed in formats for use by dental providers for patients age 0 to 5 and patients age 6 through adult. The assessment tool is a part of an overall approach to prevent and treat the caries infection.

CAMBRA ASSESSMENT TOOL

SECTIONS:

Caries disease indicators Caries risk factors Caries protective factors Clinical examination

CAMBRA ASSESSMENT TOOL

Caries disease indicators low SES (socioeconomic status); development problems; and presence of cavities, white spots, and restorations placed in the previous 3 years.

CAMBRA ASSESSMENT TOOL

CAMBRA ASSESSMENT TOOL

Caries risk factors type and quantity of Mutans streptococci (MS) and lactobacilli (LB); visible plaque; exposed roots; saliva reducing factors and inadequate saliva flow; frequent snacks; deep pits and fissures; and orthodontic appliances.

CAMBRA ASSESSMENT TOOL

Caries protective factors systemic and topical fluoride sources; adequate saliva flow; and regular use of chlorhexidine, xylitol, and calcium and phosphate paste.

CAMBRA ASSESSMENT TOOL

Clinical examination presence of white spots, decalcification, restorations, and plaque; and bacterial culture and saliva flow tests.

The Caries Risk Assessment Tool to Continuing Care

After the caries risk assessment tool has been used to determine the patients risk level, the next step is to develop a preventive and therapeutic treatment plan. plan.

CAMBRA Clinical Guidelines.

1. Caregiver/parent or patient answers the questions on the risk assessment form 2. Determine the overall caries risk as low, moderate, high, or extreme risk 3. Perform bacteria and saliva testing as indicated by risk level 4. Determine the plan for caries intervention and prevention 5. Discuss home care recommendations based on risk level 6. Provide follow-up care and reassess risk level follow-

1. CARE GIVER OR PARENT OR PATIENT ANSWERS THE QUESTIONS ON THE RISK ASSESSMENT FORM

2. DETERMINING THE OVERALL CARIES RISK

2. DETERMINING THE OVERALL CARIES RISK



Low risk Moderate risk High risk Extreme risk

2. DETERMINE THE OVERALL CARIES RISK AS:

Low risk - no dental lesions, no visible plaque, optimal fluoride, regular dental care. care.

2. DETERMINE THE OVERALL CARIES RISK AS:

Moderate risk dental lesion in previous 12 months, visible plaque, suboptimal fluoride,

rregular dental care. care.

2. DETERMINE THE OVERALL CARIES RISK AS:

one or more cavitated lesions, visible plaque, suboptimal fluoride, no

High risk

dental care, high bacterial challenge, impaired saliva, medications,

requent snacking. snacking.

2. DETERMINE THE OVERALL CARIES RISK AS:

Extreme risk - high risk patient with special needs or severe hyposalivation. hyposalivation.

3. PERFORM BACTERIA AND SALIVA TESTING AS INDICATED BY RISK LEVEL

4. DETERMINE THE PLAN FOR CARIES INTERVENTION AND PREVENTION

4. Determine the plan for caries intervention and prevention

Patients age 0 to 5

Patients age 6 through adult

4. Determine the plan for caries intervention and prevention

Patients age 0 to 5 consider the following for the caregiver and patient based on risk level: saliva and bacterial testing  antibacterials  fluoride consumption  professional application of fluoride varnish  frequency of radiographs  frequency of periodic examinations  oral hygiene instructions  xylitol and/or baking soda  sealants and existing lesions


4. Determine the plan for caries intervention and prevention

Patients age 6 through adult consider the following based on patient risk level: frequency of radiographs  frequency of caries recall examinations  oral hygiene instructions  saliva and bacterial testing  antibacterials such as chlorhexidine and xylitol  fluoride use and professional application of fluoride varnish  pH control; calcium and phosphate; and sealants. control; phosphate; sealants.


5. DISCUSS HOME CARE RECOMMENDATIONS BASED ON RISK LEVEL

6. PROVIDE FOLLOW-UP CARE AND FOLLOWRERE-ASSESS RISK LEVEL

THE DENTAL TEAM APPROACH

The Dental Team Approach

CAMBRA protocols are more likely to result in successful patient outcomes when the entire dental team including the office staff, dental assistants, dental hygienists, and dentists are involved and supportive. supportive.
 

5 Each team member is therefore required to have foundational knowledge and communication skills which take the evidence-basis for CAMBRA to patients of all evidencedemographics. demographics.

The following TEAM steps were developed to create a systematic approach to CAMBRA for the dental team:
Step 1 Topics to discuss Step 2 Essential CAMBRA supplies Step 3 A patient at a time Step 4 Monetary reimbursement

Step 1 Topics to discuss

The caries balance which focuses on the need to assess, manage, and treat the disease indicators, risk factors, and protective factors.

Step 1 Topics to discuss

Bacterial transmission vertical transmission from mother or caregiver to child and horizontal transmission from person to person.

Medicine issues specifically related to pH and sugar levels in oral suspensions and lozenges. Snack and beverage issues related to frequency and levels of pH and sugar.

Step 2 Essential CAMBRA supplies

Fluorides Sealants Saliva tests Bacteria tests Xylitol Buffering products Chlorhexidine gluconate Iodine Detection technology Palliative products for xerostomia Probiotics


Step 3 A patient at a time

Role play CAMBRA conversations with coworkers Work to implement CAMBRA one patient at a time Be clear on which steps of CAMBRA each team

member can legally provide

Step 4 Monetary reimbursement

Organizing for success Educate the entire dental team about CAMBRA Choose a coordinator for implementation Organize forms, codes, procedures, and billing

Conclusion

Scientifically and ethically, CAMBRA provides the best possible and the most minimally invasive dental care for your patients. This is the standard our profession must promote.