CAMBRA Clinical Applications (Test I)

Question 1

Examination findings high risk

Answer 1

-High Risk: signals a bacteria test for step. mutans (SM) and lactobacillus (LB)
-Disease indicators: indicate presence of disease via clinical observations, visible caries present. & restoration in last 3 years, inter proximal caries lesions/radiolucencies (that reaches the DEJ) = most important risk factor
white spots on enamel surfaces w/ or w/o pitting, possible fluorosis

Question 2

Examination findings moderate risk?

Answer 2

• Medium or high levels of S. mutans or lactobacilli in culture
• Visible heavy plaque on teeth
• Frequent (greater than 3 times) between meal/snacks of sugars/cooked starch
• Deep pits and fissures
• Recreational drug use
• Inadequate saliva flow (less than 0.5 ml/min)

Saliva reducing factors:
-Medications
Radiation to head and neck
Systemic disease

-Exposed tooth roots
-Orthodontic appliances present
-Presence of any one of the above factors places patient into moderate risk category
Bacterial test is optional

Question 3

Examination findings low risk?

Answer 3

• Lives in fluoridated area (zip code)
• Fluoride toothpastes at least once daily
• Fluoride toothpaste at least 2x daily
• Fluoride mouth rinse (0.05% NaF) daily
• 5000 ppm F fluoride toothpaste daily
• Fluoride varnish in last 6 months
• Office F topical in last 6 months
• Chlorhexidine prescribed/used one week each of last 6 months
• Xylitol gum/lozenges 4x daily last 6 months
• MI paste during last 6 months
• Adequate saliva flow (> 1 ml/min stimulated)
• Protective factors in the absence of disease indicators or risk factors automatically placed in a low risk category
• Bacterial Test is unnecessary

Question 4

Risk assessment procedures (Diet Analysis)

Answer 4

• Take a weekly diet log
• Analyze fermentable sugars and carbohydrates
• Find ‘hidden sugars’
• Frequency of snack time exposures (most important)
• Duration of each sugar exposure (contact time)
• Discuss with patient and make recommendations

-Dietary survey measures exposure to
Liquid (x1)
Solid or sticky (x2)
Slowly dissolving (x3)
-Calculate dietary risk (different than caries risk)

Question 5

Plaque pH measurements?

Answer 5

• Get toothpicks and collect plaque from teeth
• Place it on pH litmus paper and record the pH every minute for at least 20 minutes
• Create a graph of pH (0-8) on the vertical axis and minutes on the horizontal axis
• *******5.5 is considered critical pH

Question 6

Saliva Flow Test?

Answer 6

• Get a small piece of Paraffin wax or 2 sticks of sugarless gum and have patient chew at least 3 minutes
• Patient will spit into measuring cup

-Measure saliva and calculate ml/minute:
-Paraffin wax
1-3 ml/min for adults - normal
< 0.7 ml/min - low
0.5 ml/min - xerostomia

Two sticks sugarless gum:
***Salivary Flow Rate (adults) ***
 Sugarless gum - 2 sticks
≥ 1.4 ml/min = normal
≤ 0.7 ml/min = xerostomia

Question 7

Causes of xerostomia?

Answer 7

• Medications
• Radiation therapy to head & neck
• Salivary gland disease
• Diabetes
• Decreased function with aging

Question 8

What is the Bacterial test?

Answer 8

Types:
1) CariScreen
2) CariFree
- ATP bioluminescence activity
- ATP activity is highly correlated with Strep mutans bacteria levels
This reaction is swift – so once test has begun bioluminescent reading must occur within 1 minute

Question 9

What is CariScreen (Bacteria Test)?

Answer 9

• Must be done before Saliva Flow Test! (so not to wash away bacteria)
• Swabs must be at room temperature
• Hold swab close to tip and use firm pressure against the teeth
• Swab the incisal 2/3rds of the lower anteriors #22-27, with –ONE FIRM SWIPE, do not touch gingival or soft tissue, only go one direction and do not re-swab
• After sampling place swab back into the tube
• Immediately snap the reagents and make sure they go down the tube
• Shake very vigorously for 10 seconds and insert into the meter

-After 15 seconds a beep will indicate a reading is ready
0-1500 = Low Risk
1501-9999 = At Risk

Question 10

Decreased salivary flow can do what?

Answer 10

1) Slow clearance of food particles
2) Decrease buffering of acids
3) Encourage growth of bacteria
4) Inhibit remineralization because calcium and phosphate ions are reduced

Question 11

Xylitol sources

Answer 11

1) Epic
http://www.epicdental.com/departments.asp
You can buy gums and mints from this company, including dispensers.

2) Omnii Oral Pharmaceuticals
http: //www.omniipharma.com/

3) Spry
Markets gum and mints to dental offices
http://www.homesteadmarket.com/xylitol_mints.html