THE NEXTDDS Blog

Understanding the CAMBRA Approach for Caries Management

Posted by THE NEXTDDS on Thu, Nov 10, 2016 @ 05:04 PM

Murphree3.jpgIt’s interesting to see how far dentistry has come in such a short amount of time. As the industry grows, dentists are constantly adapting to new technology and methodologies for restoring their patient's teeth to ideal form and function. Despite how common dental caries and periodontitis are in the modern patient population, new understandings are still being applied to the risks of the disease, improving patient education, and assessing the preventive measures that must be enforced to combat these risks.

The acronym CAMBRA stands for Caries Management By Risk Assessment. It encompasses a methodology of identifying the cause of caries disease through the assessment of risk factors for each individual patient and then managing those risk factors through behavioral, chemical, and minimally invasive restorative procedures.1 In an effort to forego the dependence on operative procedures (the so called “drill and fill”) for dental caries, a CAMBRA Approach can be more cost-effective for the patient, and be less invasive over time.

Given these benefits, it’s easy to see why CAMBRA has become the new standard of care for many practices due to the growing body of research and experts to confirm its efficacy. Since dental caries is a multifactorial process, using CAMBRA can support dentists in managing the disease by three main ways: 1) determining the contributory factors, 2) assessing the risk level for the patient, and 3) ultimately helping the patient find a clear treatment regimen. Risk factors can include visible cavities, enamel lesions, white spots, three-year-old fillings, harmful bacteria, inadequate saliva flow, and frequent snacking.2

The University of California San Francisco (UCSF) School of Dentistry is just one of the many schools that advocate this relatively new, but wholistic technique to dental caries treatment. In a recent article, Dr. Peter Rechmann, Professor of Preventive & Restorative Dental Science, and Dr. John Featherstone, Dean of UCSF School of Dentistry and leading researcher for the school’s new CAMBRA Approach, discussed how the school has adapted to this new curriculum.

Murphree5.jpgThe CAMBRA Approach can be a way to create a long-term goal for the patient and practitioner instead of a short-term solution. Instead of more invasive operative procedures, utilizing a series of chemotherapeutic agents or fluoride-based solutions in the CAMBRA Approach can create a conservative option for the dentist and encourage additional self-care by the patient. In a couple years’ time, CAMBRA began to take a hold nationwide, and Dr. Rechmann is leading a team to study and confirm the approach’s effectiveness.

With many professionals looking to avoid irreversible cavity preparations to manage dental caries, CAMBRA is a very contemporary topic in today's dental schools. Dental students at the UCSF School of Dentistry, for example, learn about dental caries and the CAMBRA approach during their first year of training. Despite this emphasis both at UCSF and many dental schools across the country, operative procedures continue to be the standard response to dental caries for many private practices, and the challenge lies in instilling CAMBRA after graduation. The biggest barrier, besides a change in practice philosophy and patient compliance, is that most insurance companies do not yet reimburse preventive therapies for adults, meaning patients face higher costs and dentists make less profit from incorporating CAMBRA. But as insurance companies see proof of the long-term cost savings of prevention, they may be more likely to expand coverage to these measures.2

While implementing CAMBRA can involve a small learning curve for the practice, it is ultimately in the best interest of the patient and the professional looking for a diagnostic-based, minimally invasive approach to the management of dental caries. On behalf of THE NEXTDDS user community, we'll continue to monitor the progress of the UCSF research team and share their findings.
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References

[1] Bernie KM. CAMBRA: Caries management by risk assessment. DentistryIQ. http://www.dentistryiq.com/articles/2011/03/cambra.html. Published March 1, 2011. Accessed October 27, 2016.

[2] Bai N. Prevention-oriented approach to dentistry helps patients avoid the drill. University of California San Francisco. http://www.ucsf.edu/news/2016/10/404626/prevention-oriented-approach-dentistry-helps-patients-avoid-drill. Published October 20, 2016. Accessed November 4, 2016.

Tags: caries, CAMBRA, dental caries, caries management

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