By: Sarah Kahil

Course: OPER511

1/1/2016

CAMBRA
CAMBRA: carries management by risk assessment.
PARADIGM SHIFT
- It represents a significant change in mindset, how we examine and prioritize
treating caries disease.
- The term prevention has become a common language term that has been
blanched and simplified to only mean brush and floss and dont eat sugar.
- Dental caries as an infectious disease model involves focusing on treatment of
entire disease process including prevention and curing not just surgically treating
cavities. Surgical-restorative approach minimal intervention.
PRINCIPLES
- Once clinicians have identified the patients caries risk (low, moderate, high or
extreme) a therapeutic and/or preventive plan should be implemented.
- Motivating patients to adhere to recommendations is an important aspect in caries
management.
- Along with fluoride, new products are available to assist clinicians with non invasive
management strategies.

THE CARIES PROCESS

- Depends upon the interaction of protective and pathologic factors in saliva and
plaque biofilm.
- The key of CAMBRA is to modify and correct the complex dental biofilm through
best-practices approach that decreases caries risk factors, increases protective
factors are increased.
- Non-cavitated caries lesions can be arrested if the caries challenge is reduced
sufficiently or eliminated, or if the protective factors are increased.

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By: Sarah Kahil

Course: OPER511

1/1/2016

CARIES BALANCE CONCEPT

-

The multifactorial nature of dental caries

The balance between pathological and protective factors
The dynamic nature that occur several times a day
If pathological factors outweigh protective factors, the caries disease process
progresses.

Pathological factors:
-

Acid producing bacteria

Subnormal saliva flow
Function
Frequency of eating/drinking of fermentable Carbohydrates.

Protective factors:
-

Saliva flow
Fluoride remineralization
Xylitol
Chlorhexidine mouthwash

Patients who are at risk with no apparent signs of disease are ones CAMBRA helps to
identify and benefit with caries risk reduction.
The earliest visible signs of enamel demineralization appear as white spots and later
brown spots in enamel. The enamel surface with white and brown spot lesions, although
discolored remain intact and are not cavitated.

CAMBRA IS THE CORNERSTONE OF MINIMALLY INVASIVE DENTISTRY (MID)

CAMBRA, MID and MI minimally invasive dentistry, minimal intervention and CAMBRA
are relatively new terms developed in response to scientific advances in the field. They
are used interchangeably by some, and by others a source of debate about which is the
most proper term. For example, CAMBRA does not stop at prevention and chemical
treatments; it includes evidence-based decisions on when and how to restore a tooth to
minimize structural loss.

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By: Sarah Kahil

Course: OPER511

1/1/2016

Surgical-restorative approach can lead to several replacement procedures, resulting in an

increased restoration size or more invasive procedures overtime. It is estimated that 71%
of all restorative treatments are performed on previously restored teeth, with recurrent
carious lesions as a predominant cause.
Minimally invasive dentistry and minimal intervention stand for much more conservative
cavity preparation. The traditional restorative model does not identify or address the
causative factors, nor does it alter the disease.
Restoring caries lesions places a tremendous economic burden on society and provides
no likelihood of preventing future disease.
Prevention resonates with patients because it leads to fewer restorative treatments and
maintains health, function and esthetics.
Studies show that children and adults at the highest risk tend to remain at that level and
develop further problem with traditional restorative treatment only.

CARIES RISK ASSESSMENT

- At the heart of the CAMBRA philosophy of care is the assessment of each patient
for his or her unique individual disease indicators, risk factors and protective factors
to determine current and future dental caries disease
- Extreme risk is designated when a patient at high risk from other factors also has
severe hyposalivation or other special needs.
- It was easy to accept that high-risk patients needed more care but it was not
acceptable that low-risk patients needed less care.
- The forms differ in disease indicators and protective factors, but they all agree that
the strongest predictor of future caries is the dental caries experience, such as
carious lesions within the last 3 years.
- The AAPD and CDA forms require saliva testing to determine cariogenic levels.

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By: Sarah Kahil

Course: OPER511

1/1/2016

At the heart of the CAMBRA philosophy of care is the assessment of each patient for his
or her unique individual disease indicators, risk factors and protective factors to
determine current and future dental caries disease.
The forms done are periodically updated based on:
- Opinion of experts who utilized the most up-to-date scientific information
available.
- Feedback regarding its usefulness
- Advances in science
Physical signs of present/past dental caries history and activity. Serve as strong prediction
of dental caries unless therapeutic intervention is implemented.
The biological reasons that cause or promote current/future caries (etiology of disease)
serve as an explanation of what could be corrected.

ANTIMICROBIALS OR ANTIBACTERIAL
- Chlorhexidine gluconate rinse 30 seconds rinse every day of the first week of every
month.
- The application of CHX varnish every three to four months 1% CHX diacetate and
1% thymol varnish.
- Families should be encouraged to drink fluoridated tap water and/or use
fluoridated toothpaste, which are very important aspects and measures of
preventive care.

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By: Sarah Kahil

Course: OPER511

1/1/2016

CARIOGRAM
Illustrates the interaction between caries related factors. This educational interactive
program has been developed for better understanding of the multifactorial aspects of
dental caries and to act as a guide in the attempts to estimate the caries risk. The main
purpose of the Cariogram is to demonstrate the caries risk graphically, expressed as the
Chance to avoid new caries in the near future. Cariogram Aims:
Illustrates the interaction of caries related factors.
Illustrates the chance to avoid caries.
Expresses caries risk graphically.
Recommends targeted preventive actions.
Can be used in the clinic.
CARIFREE
Well-documented, step by step process of amount and prevention techniques.
Questionnaire, examination and a quantitative measurement of bacterial activity using
cariscreen caries susceptibility test in one minutes at chairside will determine CR type of
the patient. Thus an individualized treatment plan is recommended.

CONCLUSIONS
- Caries, the most common chronic disease of our children and virtually universal
among adults, is both curable and preventable.
- A concept was born, the appropriate care for the appropriate patient at the
appropriate time.
- Scientifically and ethically, CAMBRA provides the best possible and the most
minimal dental care for your patient. This is the standard of our profession which
we must promote.

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