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.
Reaching Patients Early, Helping Them Follow Through
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. A significant number of my patients who enjoy going to the dentist when they’re younger begin to resist when they become teenagers, CAMBRA helps stem that tide. Most of my teens enjoy coming, see results and then continue to come when they become adults, with the frequency depending on their caries risk status.
Because so much of CAMBRA depends on patients following through at home, I work with patients in a motivational way. For me, it’s a gestalt feeling. A teenager will come in, ear buds in, eyes closed, thinking: “This too shall pass.” But they're here, so I might have the parent sit in the waiting room and I’ll start a conversation having nothing to do with dentistry, just to get on the teen’s wavelength, to find out what's important to them. We’ll wind up talking about the discipline of pro athletes like Kobe Bryant and Steph Curry and how it starts with small things, an easy discipline, like flossing. That opens the door to my educating them about caries disease progression.
I’ll use pictures to explain where they are in the process and how if the disease progresses — if they don’t brush and floss to remove food debris — they could wind up with a root canal, having the tooth pulled or even develop an infection that can make it’s way to the bones or even the brain. And then I might talk about how a filling is only a Band-Aid — and that we have to treat the underlying disease. About two years ago, I also began to use the CAMBRA app on my tablet so patients and families can do their own risk assessment, which helps them take ownership.
Deciding on patients’ initial set of goals depends on where they are in terms of their conviction that something needs to be done and their confidence that they can do it. The recovering drug addict, who needs the pleasure of eating candy, is different from a healthy, motivated teen.
I also try to start as early as possible. I used to begin to see patients at 6 years old; today I see them and do a CAMBRA assessment when they get their first tooth. First tooth, first visit and they are 100 percent caries-free, so it’s a perfect time to start.
Integrating Into the Existing Practice
But working with patients — and training my staff to work with patients — is only one part of making CAMBRA work. There’s integrating it into our existing practice.
We’ve changed our intake form so it now includes the first steps in the CARIES risk assessment and screening. We’ve worked with local pediatricians who will do some screening as part of their annual physicals.
It’s also important to remember that restorative dentistry is not the only billable service. A fluoride varnish takes about 30 seconds, but there is the oral evaluation and a prophy — and there are always many patients who have a backlog of treatment needs, including fillings, extractions, crowns and pulpotomies.
We’ve also decided to dispense the products here, even though this too takes a little more time. At first, we thought it would be helpful to give the products away, but we found people valued them less than when we sold them – they wanted their money’s worth. And when they realize that if they become low risk they don’t necessarily have to use the products the rest of their lives, they are encouraged.
All of this, especially at first, takes a little more time, but you get more efficient and it does bring in new patients. I’ve had babysitters bring children in and when they see what we’re doing, they ask to switch to us. CAMBRA is becoming the standard of care and the dentists who are doing it are the ones who will have the patients in the years ahead.