Caries Management by Risk Assessment (CAMBRA)

Dental Caries (tooth decay) is a bacterially based disease that progresses when acid produced by bacterial action on dietary fermentable carbohydrates travels into the tooth and dissolves the carbonated hydroxyapatite mineral.  This process is called demineralization.

Pathological factors, including acidogenic bacteria, salivary dysfunction, and dietary carbohydrates are related to caries progression.  Protective factors, which include antibacterials, salivary calcium, phosphate and proteins, salivary flow, and fluoride in saliva can balance, prevent or reverse dental caries through a process of remineralization.  Remineralization is a natural and reliable repair mechanism for non-cavitated carious lesions.

This course will provide the scientific basis behind the “caries balance” concept, which is the key to caries management by risk assessment in clinical practice.  If pathological factors prevail caries progresses.  If protective factors prevail the caries process is halted or reversed.

The course will present tools to implement  CAMBRA, “caries management by risk assessment,” in your clinical setting.  It can be in implemented medical and dental settings, and can benefit children and adults of all ages. Implementation in dental practice provides patients with genuine hope and success for the management of their oral health.  It is a practice builder for dentistry.

Week 1:

• Understand what dental caries is
• Understand the concept of the caries balance
• Know the three principal pathological factors of caries formation
• Understand that multiple bacterial species are responsible for dental caries
• Understand the role of frequent ingestion of fermentable carbohydrates in dental caries
• Recognize hyposalivation, how this occurs, and its importance in caries progression

Week 2:

• Refine the concept of the caries balance 
  
• Know and understand the multiple caries protective components in saliva
• Understand demineralization and the role of fluoride
• Understand remineralization and the role of fluoride 

Week 3:

• Understand remineralization and the role of fluoride 
  
• Understand how fluoride interacts with cariogenic bacteria 
  
• Know the three main mechanisms of action of fluoride 
  
• Know about fluoride toothpastes and fluoride mouthrinses

Week 4:

• Know about fluoride products for the dental office and for home use by prescription 
  
• Know why high concentration fluoride products are used for high caries risk individuals 
  
• Know the antibacterial products currently available for caries control 
  
• Understand the root caries process including similarities and differences with coronal caries

Week 5: 

• Understand the distinction among disease indicators, pathological (biological risk) factors, and protective factors
  
• Know that the CAMBRA risk assessment method is validated in clinical use in thousands of patients for 6 years through adult
• Know the bacterial assessment methods
• Understand the sequence for the entire CAMBRA method 

Week 6:

• Know how to assess caries risk for an individual as low, moderate, high, or extreme 
  
• Know the currently recommended chemical therapy for patients at low, moderate, high, or extreme risk 
  
• To study numerous examples of risk assessment and therapy and how to build this into the treatment plan 
  
• Understand the differences between risk assessment for young children, older children, and adults