CAMBRA: Caries Management by Risk Assessment

By Kristy Menage Bernie, RDH, BS, RYT

Caries management by risk assessment (CAMBRA) encompasses a methodology of identifying the cause of disease through the assessment of risk factors for each individual patient and then managing those risk factors through behavioral, chemical and minimally invasive procedures.

As this approach has been qualified through various experts, researchers and advocated by numerous professional organizations, it has now become a new standard of care which should be incorporated into the dental hygiene process of care.

The World Congress of Minimally Invasive Dentistry states Caries Management by Risk Assessment (CaMBRA): The latest research shows that caries is a pathogenic bacterial infection of the tooth’s natural biofilm and is a multifactorial disease. Measuring the bacterial load, learning the various contributory factors for each patient and assigning a risk level for each patient allows the practitioner to effectively help patients fight caries and the subsequent cavitations.” (1)

Minimally invasive, evidence-based processes of care have been identified as key strategies to prevent disease life-long and include the following aspects: Assessment; Determination of Risk; and Formation of Treatment/Prevention Strategies.

To simplify this process, the California Dental Association--in collaboration with leading experts and researchers-- developed assessment forms for 0-5 years(2) of age and 5 to adult(3). The 0-5 assessment form published was adopted by the American Academy of Pediatric Dentistry in 2010. The American Dental Association has also developed assessment forms(4) and once implemented these will assist clinicians in determining if a patient is low, moderate, high, or extreme risk. Additionally, the AAPD process further defines moderate; non compliant and high; non compliant.

Along with assessment forms, suggested management protocols and clinical guidelines for each category of caries risk were developed (see resources) and include the following:

0-5 years of age: (REFERENCE #2)
• Frequency of periodic examination
• Frequency of radiographs
• Saliva testing
• Fluoride Utilization (in-office, daily use and care giver)
• Xylitol products
• Sealants
• Antibacterials
• Anticipatory guidance/counseling
• Self management goals
• White spot precavitated lesion management
• Restoration/Existing lesions

5 through Adult(5):
• Frequency of radiographs
• Frequency of caries recall exams
• Saliva test (saliva flow & bacterial culture)
• Antibacterials, chlorhexidine & xylitol
• Fluoride (in-office & daily use)
• pH control
• Calcium phosphate topical supplements
• Sealants

These evidence-based resources will provide clinicians the foundation needed to develop and implement CAMBRA as well as formulate clinical protocols. The philosophy behind CAMBRA matches that of dental hygiene--prevention goes a long way in achieving optimal oral health. Take the lead in your practice. Access and utilize these resources to further your role as the preventive expert and maximize your value to patients!

Resources
CAMBRA Assessment Forms:

0-5 year of age:
California Dental Association Journal
– October, 2010, page 750.
cda.org/library/cda_member/pubs/journal/journal_1010.pdf

American Dental Association – Resources – Caries Form (Patients 0-6 Years)
www.ada.org/5157.aspx

5 – Adult:
California Dental Association Journal
October, 2007, page 704.
www.cda.org/library/cda_member/pubs/journal/jour1007/featherstone.pdf

American Dental Association – Resources – Caries Form (Patients Over 6 Years)
www.ada.org/5157.aspx

CAMBRA Management Protocols:
0-5 years: California Dental Association Journal – October, 2010, pages 754 & 755.
cda.org/library/cda_member/pubs/journal/journal_1010.pdf 

5 through Adult: California Dental Association Journal – October, 2007 – page 716.
www.cda.org/library/cda_member/pubs/journal/jour1007/jenson.pdf

References
1. World Congress of Minimally Invasive Dentistry: www.wcmidentistry.com/index.php – accessed 2/22/11

2. Ramos-Gomez, F.J., Crystal, Y.O., Ng, M.W., Crall, J.J. & Featherstone, J.D.B. (2010). Pediatric Dental Care:
Prevention and Management Protocols Based on Caries Risk Assessment. Journal of the California Dental Association, 38 (10), 748-761. cda.org/library/cda_member/pubs/journal/journal_1010.pdf – accessed 2/22/11

3. Featherstone, J.D.B., Domejean-Orliaguet, S., Jenson, L., Wolff, M., & Young, D.A. (2007). Caries risk assessment in practice for age 6 through adult. Journal of the California Dental Association, 35(10), 703-713. www.cda.org/library/cda_member/pubs/journal/jour1007/featherstone.pdf  – accessed 2/22/11

4. American Dental Association Caries Risk Assessment Forms www.ada.org/5157.aspx – accessed 2/22/11

5. Jenson, L., Budenz, A.W., Featherstone, J.D.B., Ramos-Gomez, F.J., Spolsky, V.W., & Young, D.A. (2007). Clinical protocol for caries management by risk assessment. Journal of the California Dental Association, 35(11), 714-723. www.cda.org/library/cda_member/pubs/journal/jour1007/jenson.pdf – accessed 2/22/11

Additional Reading
www.cdafoundation.org/library/docs/jour1007/ramos.pdf

Kristy Menage Bernie is the owner and Director of Educational Designs, an international speaker, author and registered yoga teacher. She can be reached at info@EducationalDesigns.com.

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