Elsevier

Dental Abstracts

Volume 59, Issue 6, November–December 2014, Pages 309-312
Dental Abstracts

Hands On
Caries risk assessment

https://doi.org/10.1016/j.denabs.2014.07.034Get rights and content

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Background

The traditional view of dental caries is a disease model resulting from mutans streptococci and Lactobacillus species. More recent scientific evidence, however, indicates greater complexity and traits often seen in other biofilm diseases. Further biofilm research using next-generation sequencing technologies may add to the number of species that participate. A surgical model of treatment has been the historical approach to dental caries, with the aim of restoring lesions or correcting damage

Characteristics

CAMBRA is an attempt to explain the underlying risks and causes of dental caries in individuals. Once the risks are identified, an individualized, targeted treatment plan can be formulated. CAMBRA uses known, validated common risk factors and disease indicators for caries. Risk factors include noticeable plaque buildup on the teeth, frequent snacking, hyposalivation, exposed roots, deep pits and fissures, and recreational drug use. Among the disease indicators are visible cavitation and

Management

Management strategies can be reparative, therapeutic, and behavioral. Reparative strategies include remineralization and restoration. Fluoride is the most effective remineralization agent and includes fluoridated water and professionally applied fluoride varnish. Patients with a high risk of caries should have fluoride varnish applied every 3 months. Calcium phosphate, specifically nanoparticle hydroxyapatite, is a biomimetic for the natural building blocks of enamel and reduces biofilm

Discussion

Designing an appropriate, effective treatment strategy for an individual patient should be fairly straightforward because the causes of disease dictate the treatment strategy. For someone at high risk for dental caries who has a bacterial issue, antimicrobials, pH modification, and home care instructions are an appropriate intervention (Fig 2). For a high-risk patient whose issue is dietary, modifying sugar consumption or snacking habits should be the target. Patients who have difficulty with

Discussion

Clinicians need to be able to appreciate and understand the complexity of the dental caries biofilm disease model. Seeing common disease patterns and tailoring associated therapies may improve the usefulness of the CAMBRA approach.

Clinical Significance

A challenge to implementing CAMBRA in clinical practice is the lack of time to perform the assessment, since it is usually assigned to be done during the hygiene appointment. A possible aid to using CAMBRA is the new CRA form, which begins with

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Kutsch VK: Dental caries: An updated medical model of risk assessment. J Prosthet Dent 111:280-285, 2014

Reprints available from VK Kutsch, 2200 14th St SE, Albany, OR 97322; e-mail: [email protected]

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