Prevention-Oriented Approach Helps Patients Avoid the Drill

What is CAMBRA?

A Benefit to Patients

Several years ago, Peter Rechmann, DMD, PhD, professor of Preventive & Restorative Dental Science at UC San Francisco’s School of Dentistry, saw a patient who was convinced that she needed a new set of dental crowns.

“That sounded good for my practice, but I didn’t do any crowns for her,” Rechmann said.

He was using what was then a new approach to dentistry known as Caries Management by Risk Assessment (CAMBRA), which emphasizes prevention and risk assessment rather than surgical procedures.

Rechmann forewent an easily billable procedure and instead, advised his patient to use a high-concentration fluoride toothpaste, anti-bacterial rinse, and xylitol chewing gum. When she returned a few months later, her teeth enamel had remineralized so much that she was no longer a candidate for crowns.

“I could show her in the mirror how hard the enamel was, and she was amazed,” Rechmann said.

Years after CAMBRA was developed at UCSF, it is starting to make inroads among dental professionals nationwide, and Rechmann is leading the first large study of the protocol in community dental practices. Researchers are hoping the study will validate the protocol’s effectiveness of catching early signs of caries, or cavities, and reversing them by addressing the underlying disease factors.

A New Approach

CAMBRA is a departure from the “drill and fill” approach to dentistry that is still dominant, said John Featherstone, PhD, dean of the School of Dentistry and one of the researchers at UCSF who helped to develop the CAMBRA approach in the early 2000s. Since then, Featherstone has been invited around the world to assist with CAMBRA implementation, including Japan, Argentina, Mexico, New Zealand, China, and Israel.

Assessing Caries Risk

CAMBRA weighs, in a standardized way, the many biological and lifestyle factors that determine caries risk. The most negative factors are disease indicators, such as visible cavities, enamel lesions, white spots and fillings within the last three years. Other contributors include the presence of harmful bacteria, inadequate saliva flow and frequent snacking. These risk factors are weighed against protective factors, such as living in a community with a fluoridated water supply, using fluoride toothpaste and antibacterial mouth rinses, and adequate saliva flow.

A Validated System

Several large-scale studies have validated CAMBRA’s accuracy in identifying who will likely develop caries. In one study, 69 percent of patients rated as high risk and 88 percent of those rated as extreme risk developed caries by the next visit, an average of 16 months later.  In children up to six years old, a study published earlier this year found that only 20 percent of low-risk patients had tooth decay at follow-up visits, compared to nearly 70 percent of those at high-risk.

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