A research-based strategy for assessing risk factors and developing treatment plans for preventing and managing cavities early on
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.
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.'
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
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.