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''CAMBRA''''CAMBRA''

CARIES MANAGEMENTCARIES MANAGEMENT

BY RISK ASSESSMENTBY RISK ASSESSMENT


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CARIES MANAGEMENT BY RISKCARIES MANAGEMENT BY RISK

ASSESSMENTASSESSMENT

- A method of assessing caries (cavity) risk and

making dental treatment and restoration

recommendations based on a patients caries risk.


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ASSESSMENTASSESSMENT- A fact-based strategy for prevention and therapeutic

approaches for healing of early tooth decay.


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ASSESSMENTASSESSMENT

GOALS:

- To minimize caries experience while employing the

fewest possible interventions.

- Reduction of infectious bacteria, remineralization ofthe enamel and the reduction of the oral acid level.


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CAMBRA ASSESSMENT TOOLCAMBRA ASSESSMENT TOOL

This was developed in formats for use by dentalproviders 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.


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SECTIONS:

Caries disease indicators

Caries risk factors

Caries protective factors

Clinical examination


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Caries disease indicators low

SES (socioeconomic status);

development problems; and

presence of cavities, white spots,

and restorations placed in the

previous 3 years.


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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.


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Caries protective factors systemic and topical fluoride

sources; adequate saliva flow; and regular use of

chlorhexidine, xylitol, and calcium and phosphate paste.


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Clinical examination presence of white spots, decalcification,

restorations, and plaque; and bacterial culture and saliva flow

tests.


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The Caries Risk Assessment Toolto Continuing Care


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AfterAfter thethe cariescaries riskrisk assessmentassessment tooltool hashas beenbeen usedused

toto determinedetermine thethe patientspatients riskrisk level,level, thethe nextnext stepstep isis toto

developdevelop aa preventivepreventive andand therapeutictherapeutic treatmenttreatment planplan..


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CAMBRA Clinical Guidelines.

1. Caregiver/parent or patient answers the questions on the risk1. Caregiver/parent or patient answers the questions on the risk

assessment formassessment form

2. Determine the overall caries risk as low, moderate, high, or2. Determine the overall caries risk as low, moderate, high, or

extreme riskextreme risk

3. Perform bacteria and saliva testing as indicated by risk level3. Perform bacteria and saliva testing as indicated by risk level

4. Determine the plan for caries intervention and prevention4. Determine the plan for caries intervention and prevention

5. Discuss home care recommendations based on risk level5. Discuss home care recommendations based on risk level

6. Provide follow6. Provide follow--up care and reassess risk levelup care and reassess risk level


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1. CARE GIVER OR PARENT OR

PATIENT ANSWERS THE

QUESTIONS ON THE RISK

ASSESSMENT FORM


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2. DETERMINING THE OVERALL

CARIES RISK


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2. DETERMINING THE OVERALL2. DETERMINING THE OVERALL

CARIES RISKCARIES RISK

LowLow riskrisk

ModerateModerate riskrisk

HighHigh riskrisk

ExtremeExtreme riskrisk


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2. DETERMINE THE OVERALL2. DETERMINE THE OVERALL

CARIES RISK AS:CARIES RISK AS:

LowLow riskrisk

-- nono dentaldental lesions,lesions, nono visiblevisible plaque,plaque, optimaloptimal fluoride,fluoride, regularregular dentaldental

carecare..


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CARIES RISK AS:CARIES RISK AS:

deratederate riskrisk

entalental lesionlesion inin previousprevious 1212 months,months, visiblevisible plaque,plaque, suboptimalsuboptimal fluoride,fluoride,

gulargular dentaldental carecare..


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CARIES RISK AS:CARIES RISK AS:hh riskrisk

nene oror moremore cavitatedcavitated lesions,lesions, visiblevisible plaque,plaque, suboptimalsuboptimal fluoride,fluoride, nono

taltal care,care, highhigh bacterialbacterial challenge,challenge, impairedimpaired saliva,saliva, medications,medications,

uentuent snackingsnacking..


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CARIES RISK AS:CARIES RISK AS:ExtremeExtreme riskrisk

-- highhigh riskrisk patientpatient withwith specialspecial needsneeds oror severesevere hyposalivationhyposalivation..


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3. PERFORM BACTERIA AND3. PERFORM BACTERIA AND

SALIVA TESTING AS INDICATED BYSALIVA TESTING AS INDICATED BYRISK LEVELRISK LEVEL


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4. DETERMINE THE PLAN FOR4. DETERMINE THE PLAN FOR

CARIES INTERVENTION ANDCARIES INTERVENTION AND

PREVENTIONPREVENTION


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4. Determine the plan for caries4. Determine the plan for caries

intervention and preventionintervention and prevention

Patients age 0 to 5Patients age 0 to 5

Patients age 6 through adultPatients age 6 through adult


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Patients age 0 to 5Patients age 0 to 5 consider the following for the caregiver andconsider the following for the caregiver and

patient based on risk level:patient based on risk level:

salivasaliva andand bacterialbacterial testingtesting antibacterialsantibacterials

fluoridefluoride consumptionconsumption

professionalprofessional applicationapplication ofof fluoridefluoride varnishvarnish

frequencyfrequency ofof radiographsradiographs frequencyfrequency ofof periodicperiodic examinationsexaminations

oraloral hygienehygiene instructionsinstructions

xylitolxylitol and/orand/or bakingbaking sodasoda

sealantssealants andand existingexisting lesionslesions


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Patients age 6 through adultPatients age 6 through adult consider the following based onconsider the following based on

patient risk level:patient risk level:

frequencyfrequency ofof radiographsradiographs

frequencyfrequency ofof cariescaries recallrecall examinationsexaminations

oraloral hygienehygiene instructionsinstructions

salivasaliva andand bacterialbacterial testingtesting antibacterialsantibacterials suchsuch asas chlorhexidinechlorhexidine andand xylitolxylitol

fluoridefluoride useuse andand professionalprofessional applicationapplication ofof fluoridefluoride varnishvarnish

pHpH controlcontrol;; calciumcalcium andand phosphatephosphate;; andand sealantssealants..


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5. DISCUSS HOME CARE5. DISCUSS HOME CARE

RECOMMENDATIONS BASED ONRECOMMENDATIONS BASED ONRISK LEVELRISK LEVEL


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THE DENTAL TEAM APPROACHTHE DENTAL TEAM APPROACH


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The following TEAM steps were

developed to create a systematic

approach to CAMBRA for the dentalteam:

Step 1 Topics to discuss

Step 2 Essential CAMBRA supplies

Step 3 A patient at a time

Step 4 Monetary reimbursement


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Step 1Step 1 Topics to discussTopics to discuss

Bacterial transmission vertical transmission frommother 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.


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Step 2Step 2 Essential CAMBRA suppliesEssential CAMBRA supplies

FluoridesFluoridesSealantsSealants

SalivaSaliva teststests

BacteriaBacteria teststests

XylitolXylitol

BufferingBuffering productsproducts

ChlorhexidineChlorhexidine gluconategluconate

IodineIodine

DetectionDetection technologytechnology

PalliativePalliative productsproducts forfor xerostomiaxerostomia

ProbioticsProbiotics


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Step 3Step 3 A patient at a timeA patient at a time

Role play CAMBRA conversations with coworkersRole play CAMBRA conversations with coworkers

Work to implement CAMBRA one patient at a timeWork to implement CAMBRA one patient at a time

Be clear on which steps ofCAMBRA each teamBe clear on which steps ofCAMBRA each team

member can legally providemember can legally provide


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Step 4Step 4 Monetary reimbursementMonetary reimbursement

OrganizingOrganizing forfor successsuccess

EducateEducate thethe entireentire dentaldental teamteam aboutabout CAMBRACAMBRA

ChooseChoose aa coordinatorcoordinator forfor implementationimplementation

OrganizeOrganize forms,forms, codes,codes, procedures,procedures, andand billingbilling


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ConclusionConclusion

Scientifically and ethically, C AMBRA provides thebest possible and the most minimally invasive dental

care for your patients. This is the standard our

profession must promote.

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