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Clinical Implementations of CAMBRA

By saving their patients money and preventing or significantly easing a lifetime of oral health challenges, dentists and prosthodontists from around the world have begun to sustainably build their practices through the use of CAMBRA.

To implement CAMBRA, these clinicians:

  1. Take a dental and medical history and conduct a clinical exam to assess:
    a. Caries lesions early enough to reverse or halt progression
    b. An individual’s caries risk factors, which include acid-producing bacteria, frequent eating/drinking of fermentable carbohydrates, and abnormal saliva flow and function
  2. Manage caries risk factors by optimizing protective factors using both behavioral approaches and chemical treatments. The treatment plan might include:
    a. Remineralization through the use of fluoride and/or antibacterial therapies such as chlorhexidine and xylitol
    b. Minimally invasive restorative procedures to conserve tooth structure
    c. Regular patient follow-up

Studies have shown that at least one CAMBRA treatment — the application of 5,000-ppm fluoride twice daily — can reverse many root caries lesions – cavities on the root surface of teeth, usually below the gums and which occur more frequently in older patients.

Successful Provider Implementations

Anthony Fernandez, DDS
Anthony Fernandez is a third-generation San Francisco Bay Area native, who earned his DDS degree in 1986 at UCSF School of Dentistry. He’s been in private practice in Sonoma County for over 26 years, and is an active member of The California Dental Association (CDA), American Dental Association (ADA), Redwood Empire Dental Society (REDS), and UCSF Dental Alumni Association. Over the last few years, he has implemented CAMBRA for his patients.

I’ve always been active in continuing education, and when I saw Dean Featherstone give a CAMBRA presentation, a light bulb went on; it was as if I’d been given a set of glasses to see my profession differently. I’m not just a tooth repair guy; I’m treating individuals with disease and there are things that can we do to help them manage that disease.

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Pamela Alston, DDS
Pamela Alston, DDS, is the dental director at the Eastmont Wellness Center in Oakland and a UCSF School of Dentistry alumna. She has been providing dental services to the underserved and disadvantaged communities of Alameda County and beyond since 1983. Her experience includes more than 10 years of providing dental care at Santa Rita and North County jails and more than 20 years at the Central Health Center in Oakland.

About 10 years ago, I had a cathartic experience. Dean Featherstone was interim dean, and he was giving a CAMBRA course and I realized: I'm not doing this. This is not good. But I worried I didn’t have time to do it, that it might not fit my patient population.

I was wrong. Dentistry is experiencing a lull in visits among adults, so reaching patients when they are teenagers is very important and CAMBRA can play a big role. 

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Patient Profiles

Gayle Rebish is a patient at UCSF Dental Center’s Adult General Dentistry Faculty Clinic.

When I first met Dr. Brear, she took me under her wing, because I had chronic dry mouth. Up to that point — I was 52 years old — I had relatively good oral health, but I had started to get more cavities.

After doing a test for the percentage of bacteria in my mouth, Dr. Brear identified me as high risk and I took the necessary steps to maintain my dental health. She put a fluoride varnish on my teeth. I use the 5,000 parts per million fluoride toothpaste, medications and XyliMELTS that alleviate dry mouth and the chlorhexidine oral rinse for one week every month.

Using the toothpaste is no effort at all. Instead of going to the grocery store, I just order it and have it delivered by mail. The rinse, for me, if it helps prevent cavities, it’s worth it and I think it definitely has helped me.

I'm also more aware that not having enough saliva helps promote tooth decay and I've become much more educated about proper dental care. I was lucky enough to meet someone like Dr. Brear who sat down with me and explained the whole situation and what I needed to do to minimize my risk. It absolutely makes me a more loyal patient.

Jackie Thresh is a patient of Dr. Anthony Fernandez, DDS, in Santa Rosa, Calif.

I'm a Brit, and had British dentistry until my 40s. My dental care was very basic, very traditional, amalgam fillings only and no preventive dentistry at all — no cleaning, no polishing. Then my husband and I moved to Holland and it still was not preventive, just a little more attention to cosmetics. Through all of those years, I always had a checkup that required treatment; virtually every tooth I have is filled.

Ultimately, we came to California and started with one dentist who retired after a few years — and I was recommended to Dr. Fernandez. With him I had my first dental cleaning, and he also did a lot of work to deal with my dental discomfort and sensitivity. He stabilized the situation and then, about 2010, he put me on CAMBRA: a [chlorhexidine] rinse system, an intense fluoride toothpaste and a bicarbonate alkaline rinse for my dry mouth, which I use in in place of water.

Although at first this routine was a little unfamiliar, my concern about keeping my teeth persuaded me to spend the time, which soon became part of my daily dental care. I was rewarded by Dr. Fernandez’s encouragement and a completely clear examination. Now I am in my late 60s and do not need fillings. This has been so for more than two years. 

Now the routine is less intense. I’ve tapered off from daily to twice and now once a week. I'm so grateful that Dr. Fernandez put me on CAMBRA. I’m absolutely thrilled with the results and though it can be a challenge, I would do it again.