Managing caries and motivating change part 1: Caries risk assessments

Caries classification and assessment systems

Implementing a caries classification and assessment system in your office
has more benefits than simply helping categorize lesion progression.
These systems are evidence-based, preventive care models that help
identify individual patient medical, behavioral, environmental, and
societal risk factors that may cause decay, as well as classify and monitor
existing or potential lesions along a structured scale. From there, this
information can be used to recommend preventive and restorative
treatment to reduce the risk of future decay.
Plus, caries risk assessments are inherently designed to help preserve
tooth structure, which aligns with minimally invasive strategies. They
encourage treating the disease process rather than the outcome. And
while the assessments are standardized, they actually help individualize
preventive treatment planning.

Open up! Assessments and patient communication
Beyond classifying existing risks, caries risk assessments can be
helpful in determining oral health literacy – to see what
patients already know and where you may need to educate
them further.

Depending on how the clinician presents and implements the
assessment, it can be very personal, which can help the patient
identify goals they want to work on – and help the clinician
identify any barriers that are getting in the way of the patient
achieving their best oral health. These assessments can help
identify things we can’t otherwise sift out in the medical history
or hygiene instructions. It can also be a way for patients to
open up and give you a lot of valuable information that you can
then use in a standardized way to tailor your treatment and
home care recommendations.

Dental professionals know that moderate to high-risk patients
can benefit from regular applications of in-office fluoride or athome prescription toothpaste, but not all risks are obvious.
CAMBRA covers saliva and hyposalivary medications, diet, OTC
fluoride use, and existing disease indicators to help guide
treatment recommendations. For example, a patient with
reduced salivary flow has an increased risk of caries. If they are
also low on their essential salivary buffers like calcium and
phosphate, you may want to recommend a product that has
those minerals in addition to fluoride. Some offices offer
bacterial testing, out of which you might recommend
antimicrobial therapy. CAMBRA can also help us identify and
treat patients with medical conditions (chemo or radiation,
Sjögren’s syndrome, etc.) who would benefit from more
frequent fluoride applications. CAMBRA reminds us to take a
holistic approach to caries prevention and management—
looking at the whole person and their unique circumstances.
Through these assessments, you can recommend over-thecounter products for lower-risk patients or identify whether
prescription products are better suited.

Risk assessments in practice
Thankfully, a team interested in implementing one of these
protocols wouldn’t have to start from scratch – there are
existing tools rooted in scientific literature that have already
proven effective with patients.

Existing assessments with accompanying recommendations –
to be used with our own clinical judgment on a case-by-case
basis – can be used as a guide for treatment recommendations
for all patients. For example, Caries Management by Risk
Assessment (CAMBRA), developed by the California Dental
Association over 20 years ago, is still widely used,
straightforward, and easy to implement. Questions are worded
in a way that you can work them into a conversation rather
than reading from a checklist. Keep in mind that many of these
systems are categorized by age, so depending on who you
service, you may need more than one to cover all your
clientele. In addition, these assessments are designed to be
regularly updated with patients – so that we are routinely
checking their risk at set time intervals for progress or changes
– as well as refreshed with new scientific evidence, so you and
your practice can stay up to date.

Assessments like CAMBRA can be implemented as is or used as
a template/guideline to develop your own system – whatever
works best for you and your practice. You don’t have to
abandon what you already use; bringing CAMBRA or something
like it into your day could help keep you at the top of your
game: making sure each patient gets the treatment they need.


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