CAMBRA Flashcards
what is risk assessment?
Risk assessment is the first
step; this is the estimation of the likelihood that an event will occur in the future
What is cambra aimed at?
prevention
(risk factors, caries disease indicators, protective factors)
what is created as a result?
evidence-based care plan
what is the highest inidicator for risk factor
no saliva
dental caries is
- A transmissible
bacterial infection - Preventable
- Sometimes
reversible - Not self-limiting
- Not amenable to a
course of antibiotics
demineralization equation
cariogenic bacteria + fermentable carbohydrates
= organic acids
dental mineral + organic acids = demineralization
what can help stop caries besides fillings?
SDF or spf?
remineralization equation
calcium in saliva + phosphate in saliva = remineralization
(saliva ~ “tooth water”)
saliva’s beneficial actions
- Provides calcium and phosphate for remineralization
- Carries topical fluoride around the mouth for
remineralization - Neutralizes organic acids produced in plaque biofilm
- Discourages the growth of bacteria, inhibiting infection
- Recycles ingested fluoride into the mouth
- Protects hard and soft tissues from drying
- Facilitates chewing and swallowing
- Speeds oral clearance of food
what does the caries balance include?
pathological factors and protective factors
Caries Risk Assessment
First step in CAMBRA
* Manages the disease process
* For ages 6 years or older
2 phases of caries risk assessment
Phase 1: assess caries indicators, risk factors and protective factors
Phase 2: determine level of caries risk (low, mod, high/extreme)
Four Caries Disease Indicators for Caries Risk
Assessment
- Teeth with frank cavitations or lesions that
radiographically show penetration into dentin - Approximal radiographic lesions confined to the enamel
only - Visual white spots on smooth surface
- Any restorations placed in the last 3 years
caries risk factors
- Medium or high S. mutans
and lactobacilli counts - Visible heavy plaque
biofilm on teeth - Frequent snacking
between meals - Deep pits and fissures
- Recreational drug use
- Inadequate salivary flow
- Saliva-reducing factors
- Exposed roots
- Orthodontic appliances
caries protective factors
Lives, works, and attends school in fluoridated community
Uses fluoride toothpaste at least once daily
Uses fluoride toothpaste at least twice daily(additional +)
Uses fluoride mouthrinse daily (0.05% NaF)
Uses 5000 ppm fluoride toothpaste daily
Had fluoride varnish applied in the last 6 months
Had an office fluoride topical application in the last 6 months
Used prescribed chlorhexidine daily for 1 week during each of
the last 6 months
Used xylitol gum or lozenges four to five times daily for the last
6 months
Used calcium and phosphate supplement paste during last 6
months
Has adequate salivary flow
Criteria for High Caries Risk: Ages 6 Years and Older to
Adult
One or more disease indicators:
* Cavities
* Radiographic lesions to dentin
* Recent restorations
* White spots
And/or
Multiple risk factors:
* Heavy plaque on teeth
* Frequent (greater than three times per day) between meal
snacks of sugars or cooked starch
* Appliances present (e.g. orthodontic brackets)
Coupled with little or no protective factors
when should salivary flow rate test be conducted?
should be conducted if inadequate salivary flow is noticed or if the patient reports having a dry mouth
if any one of the four disease indicators is present,
a bacterial culture should be taken
results from bacterial culture can be used for what?
used to motivate
patient compliance with
recommended antibacterial
regimens
comprehensive CAMBRA assessment for kids 0-5 yrs
- Parent interview
- Examination of the child
- Assignment of caries risk level
- Individualized treatment based
on risk level - If indicated, bacterial culture
on parent or caregiver and
child - Sharing of bacterial results
with parent or caregiver as the
basis for treatment
recommendations and to
enhance motivation - Individualized homecare
recommendations - Motivational interview of parent
or caregiver for caries control - Setting of self-management
goals with parent and child - Anticipatory guidance according
to a specific age category - Determination of the interval for
periodic oral examination - Collaboration with other
healthcare professionals
FACTORS FOR HIGH CARIES RISK FOR AGES
BIRTH TO 5 YEARS
- Mother or primary caregiver with active dental decay in the last 12
months - Sleeps with bottle or nurses on ad lib basis
- Bottle contains fluids other than milk or water
- Visible cavities, white spots, or obvious decalcification
- Recent dental restorations (<2 years)
- Bleeding gums or heavy plaque on teeth
- Frequent (more than three times) between-meal snacks of sugars or
cooked starch - Appliances present (e.g., space maintainers, obturators)Visually
inadequate salivary flow - Visually inadequate salivary flow
- Presence of saliva-reducing factors, as follows:
- Medications, such as for asthma or hyperactivity
- Medical reasons (cancer treatment) or genetic predisposition
PROTECTIVE FACTORS FOR
AGES BIRTH TO 5 YEARS
- residence includes community fluoridated water
- mother/caregiver cleans child’s teeth 2x daily with fluoride toothpaste (small amount)
- dental exam for child combined with oral hygiene instruction for parent/caregiver
- visible adequate saliva flow
- caregiver uses xylitol gum/mints four to five times daily
- caregiver who has no caries activity
