Dentists who account for their pediatric patients’ risk of developing dental caries can effectively tailor individual prevention and treatment efforts, reported researchers from the University of California San Francisco (UCSF) School of Dentistry.
Their work examined Caries Management by Risk Assessment (CAMBRA), a protocol developed at the school that combines risk assessment with personalized preventive care and regular monitoring, and how risk assessments affected courses of treatment and oral health.
The researchers assessed a baseline sample of 3,810 pediatric dentistry patients at UCSF using a 17-item form that records environmental and behavioral factors known to contribute to caries, including access to fluoridated water, frequency of snacking, and socioeconomic status.
Next, the predictive value of these risk assessments were evaluated in a follow-up group of 1,315 patients aged 6 months to 6 years old from a largely low-income, urban population. The risk assignments were found to be correlated with the risk of future decay, as 20% of low-risk patients and nearly 70% of high-risk patients presented with decay at the follow-up visits.
“Risk assessment is predictive. It tells you what kinds of outcomes are going to occur in a patient population,” said Benjamin Chaffee, DDS, MPH, PhD, assistant professor and director of the Global Oral Health Program at the UCSF School of Dentistry. “Together with other studies, our work has shown that providers are willing and able to use CAMBRA accurately, that it doesn’t take a lot of time to do it, and it’s effective.”
According to the researchers, caries risk assessments such as CAMBRA help providers account for factors known to influence oral health and to then design approaches to care according to the designated risk level. A patient labeled at high risk for dental caries, for instance, may require more frequent x-rays and checkups than a low-risk patient.
“Dental caries, like so many chronic diseases, follow a social gradient,” Chaffee said. “We want providers to recognize that our patients who come to us from a lower socioeconomic position are more likely to face a heavier burden of disease. It’s important to consider that what is going on beyond the dental chair is contributing to the health status of our patients.”
CAMBRA has the potential to fundamentally change dentistry, Chaffee said, but it won’t happen overnight.
“The traditional approach to dental caries for the last 100 years has been when a dentist sees a cavity to fill it and restore the tooth’s function,” Chaffee said. “But in and of itself, this approach doesn’t do anything to prevent the disease from occurring again. It treats the symptom, the consequences of disease, but it doesn’t get after the causes of the disease.”
“More than half of the schools and colleges of dentistry in the United States have adopted CAMBRA in one form or another as part of their standard curriculum,” said John Featherstone, PhD, dean of the UCSF School of Dentistry and professor of restorative and preventive dentistry.
“There are also increasing numbers of face-to-face and online courses that teach the CAMBRA methods,” Featherstone said. “I am encouraged by the accelerated adoption of CAMBRA in the field.”