CAMBRA | School of Dentistry

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CAMBRA

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CAMBRA

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Proven method for preventing decay, protecting teeth<br/>A research-based strategy for assessing risk factors and developing treatment plans for preventing and managing cavities early on

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Overview

CAMBRA – caries management by risk assessment – is an evidence-based approach to preventing and managing cavities at the earliest stages.

Developed at UCSF in the early 2000s, CAMBRA takes into account a patient's health and lifestyle risk factors, such as the presence of harmful bacteria, low levels of saliva and poor diet, and weighs them against protective factors like living in a community with a fluoridated water supply, using fluoride toothpaste and antibacterial mouth rinses, and adequate saliva flow. Using this information, dentists rate a patient's risk for developing caries and determine a management strategy, which might include prescribing high-fluoride toothpastes and antibacterial mouthwash, encouraging lifestyle changes and monitoring.

Numerous studies have demonstrated that the CAMBRA approach can:

Prevent a lifetime of oral pain and discomfort
Save patients thousands of dollars in dental bills over their lifetimes
Be a powerful practice builder for dentists at a time when the U.S. health care system and the general public are increasingly focused on the concept of preventive care

The results of testing and validation aimed at replicating the results of university-based studies in community dental practices are expected in 2017.

Clinical Implications

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:

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

What Providers, Patients Say

Anthony Fernandez, DDS

'When I saw a CAMBRA presentation, a light bulb went on. 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.'

Pamela Alston, DDS

'I worried that [CAMBRA] might not fit my patient population: wrong. Dentistry is experiencing a lull in visits among adults; reaching patients when they are teens is very important and CAMBRA can play a big role.'

Gayle Rebish, Jackie Thresh

Patients share their experiences with improved oral health by following the CAMBRA method.

Patient profiles

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News, Publications & Current Research Initiatives

UCSF.edu: Cavity Prevention Approach Effectively Reduces Tooth Decay
The Evidence for Caries Management by Risk Assessment (CAMBRA®)
Journal of Dental Education: The Effects of Faculty Calibration on Caries Risk Assessment and Quality Assurance
Journal of the California Dental Association: Validation of the CDA CAMBRA Caries Risk Assessment: A Six-Year Retrospective Study

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CAMBRA Research

By the time the term “CAMBRA” emerged in 2002, there already were numerous peer-reviewed papers suggesting that dentists do caries risk assessment and understand the role of salivary dysfunction in caries. Those papers formed the underpinnings of the CAMBRA approach.

By 2006, initial validation of a CAMBRA risk assessment tool appeared. In less than a decade, researchers had further validated the assessment tool, as well as the CAMBRA therapeutic approach. Further testing and validation aimed at replicating the results of university-based clinical studies in community dental offices were published in 2018.

In brief: The science is in. CAMBRA works.

CAMBRA methodology is evidence-based and is provided as a guide to health care providers. The final decision as to caries risk level and caries management protocol for each individual patient remains the responsibility of the health care provider.

License, Copyright and Trademarks

In addition to CAMBRA, researchers and providers at UCSF have developed other clinical support tools since the early 2000’s which provide an evidence-based approach to preventing and managing cavities. These tools include:
PEMBRA Periodontal Disease Management by Risk Assessment
VERDICT Valid Electronic Health Record Caries Indices Calculator

CAMBRA, PEMBRA and VERDICT materials may be used free of charge for the purposes of patient care, education, academic works, research, health promotion, health policy and related activities. However, permission must be obtained before these materials are used for commercial purposes by contacting innovation@ucsf.edu.

Except where otherwise noted, CAMBRA, PEMBRA and VERDICT content is licensed under a Creative Commons 4.0 International license (CC BY-NC-ND 4.0). The full license text can be viewed here.
In summary, the terms of this license include:
(BY) Attribution: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use,
(NC) Non-Commercial: means not primarily intended for or directed towards commercial advantage or monetary compensation, and;
(ND) No Derivatives: If you remix, transform, or build upon the material, you may not distribute the modified material.

Attribution must include the relevant notice below:
CAMBRA: Copyright © 2003, 2010, 2011, 2019, 2020, 2021 The Regents of The University of California. CAMBRA® is a trademark of The Regents of the University of California.
PEMBRA: Copyright © 2013 The Regents of The University of California.
VERDICT: Copyright © 2017 The Regents of The University of California.

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