CAMBRA & Cariology Flashcards
What is CAMBRA?
A balance between:
- Disease indicators
- Risk factors
- Protective factors
-Goal is to re-mineralize decalcified areas to reduce the use of surgical interventions
-Risk levels: Low Moderate High Extreme
- Difference between high and extreme risk is presence of xerostomia
- If you cannot distinguish between low or high risk patient should be considered moderate
Low risk patient interventions?
- Periodic exams every 12 months
- BWX 18-24 months
- OTC fluoridated toothpaste (1100 ppm) brush bid
- Continue existing dietary and oral hygiene habits
- Colgate toothpaste
- Contains triclosan
- Broad spectrum antibacterial
- Bacterial reduction for 12 hours
Moderate risk patient interventions
- Periodic exam every 12 months
- BWX 18-24 months
- Apply sealants to deep pits and fissures
- Xylitol gum or mints 2 pieces bid
- OTC toothpaste (1100 ppm) brush bid
- Sodium (NaF 224 ppm) rinse 0.05% 1-2 X day
High risk patient interventions?
- CariFree bacterial testing
- Initial visit
- 6mo recall
- Saliva flow measurment
- BWX 6-12 months
- Periodic exam 6-12 months
- Prophy every 6 months
- Restorative treatment as indicated
- Apply sealants to deep pits and fissures
- Fluoride varnish 5% NaF
- Initial visit
- 6mo recall
- Antimicrobial mouth rinse 0.12% CHX 10ml for 1 minute 1 X daily (PM) for 1 week
- Prescription fluoride 1.1% NaF 5000 ppm (Prevident) brush bid
- Xylitol gum or mints 2 pieces bid
Extreme risk?
- CariFree bacterial testing
- Initial visit (3mo recall)
- Saliva flow measurement
- BWX 6 months
- Periodic exam 3-6 months
- Prophy every 3 months
- Restorative treatment as indicated
- Apply sealants to deep pits and fissures
- Fluoride varnish 5% NaF
- Initial visit
- 3mo recall
- Antimicrobial mouth rinse 0.12% CHX 10ml for 1 minute 1 X daily (PM) for 1 week
- OTC toothpaste 1100 ppm brush bid
- Prescription fluoride 1.1% NaF 5000 ppm (Prevident) in custom tray 5min
Describe Neutral sodium fluoride 5% 22,500 ppm?
- Fluoride varnish, professional application only
- High to extreme caries risk
- Pediatric patients(ECC)
- Geriatric patients (root caries, xerostomia)
- 2-4 applications per year
- Can drink or eat after use
- Avoid brushing for the first hour
- Avoid hot or crunchy food and drink
- Reduces hypersensitivity and prevents caries
0.12% Chlorhexidine Gluconate?
- High substantively
- 8-12 hours
-Currently most effective anti-plaque & anti-gingivitis adjunct
- Not an anti-caries rinse
- Prevents plaque build up that can harbor caries causing microorganisms
- Active against gram + and gram – microorganism
- Prevents pellicle formation by binding hydroxyapatitie & glycoprotein
-Interferes w/ cell attachment by binding to bacterial cell surface
-Only extends 2mm into sulcus, not effective against subgingival oral microflora
-Interferes with cell attachment by binding to bacterial cell surface
-Available by prescription
-Peridex (brand name)
-Apply using a tooth brush
-Prevents extrinsic staining of plaque
Prevents taste alteration
Describe Xylitol?
- 5 carbon sugar
- Non-fermentable by cariogenic bacteria
- Extracted from a birch tree
- Mints and gum products
- Can not be used in baking with yeast
- 5-10 grams per day
- 5-10 min for each exposure
Describe MI paste?
- Custom tray
- Extreme caries risk
- Replaces calcium and phosphorus lost due to decalcification
- Application
- 5 minute 1 X per day for 3 weeks using custom tray or finger
- Use as prophy paste
- Do not use with chlorhexidine, molecules in products will bind together
- Contains casein do not use with patients who have a milk allergy
- MI plus contains fluoride
Describe Sealants?
- Incidence of caries can be reduced 17% to 54% by applying sealants to the occlusal surfaces of posterior teeth with deep pits and fissures
- Use with any patient at risk for caries that has pits and fissures regardless of age
Advantage & Disadvantage of Baking soda?
-Sodium bicarbonate
Advantages: 1) Neutralizes acids produced by acidogenic bacteria 2) Antibacterial properties 3 )Removes stain 4) Many enhance plaque removal
Disadvantage:
1) Slightly abrasive
Note: Biotene for xerostomia
