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"Treatment Without Prevention is Simply Unsustainable"

Bill Gates

Caries Management by Risk Assessment (CAMBRA) is an evidence-based approach to prevent or treat caries at its' early stages. Caries is a multi-factorial disease and research has found common risk factors that help determine a person's liklihood of developing disease. By using those risk factors, an exam, and a CAMBRA form (ADA or CDA) the dental professional classifies the patient as low, moderate, or high risk.  After classification, a customized prevention plan can be implemented. The forms below will help put risk assessment to work in your practice.  Attending the webinars sited on the home page will be very helpful in understanding this complex yet rewarding topic. Read more by clicking on the CDA logo below. 

CAMBRA FORMS

DOWNLOAD FORMS

Use these forms in your operatory for a more complete assessment and education.

PUT RISK ASSESSMENT INTO PRACTICE

 

It is imperative to give patient-specific benefits of the fluoride varnish treatment upfront.  Focus on the ‘why’ but put it in their terms. If all they understand is the fee, you will almost never gain acceptance becasue they do not understand the health benefits. It is also important to let them know they are not alone in their risk.  Say things like ‘many of our patients’ or ‘like most people’ or even compare to yourself ‘like me, you have…’ This makes them feel more secure and helps them listen better because they don't feel alone.

SAMPLE DIALOG

Gingival Recession

Like many of our patients, your gums have receded and left softer, more vulnerable root surfaces exposed.  Roots decay faster because they are softer than enamel, more susceptible to acid attack, and don’t have the gums protecting them anymore. 

 

Medication (Prescription or OTC)

Your diabetes (HBP, acid reflux, etc.) medication has the side effect of reducing the amount of saliva you produce.  Like the majority of people, you probably don’t even notice, but I do see the change. Saliva is very important because it helps wash away food and restore a neutral pH after you eat or drink.  It also provides the minerals calcium, phosphate and fluoride to strengthen the tooth surface. Due to the side effects of your medications, you may not have enough saliva to perform these important functions so you are at risk of getting a cavity. Sometimes the first sign of dry mouth is decay.

 

Active or Recent Decay (24 months) 

Most people are unaware that a cavity is part of an active bacterial infection, a biofilm imbalance.  We can restore the tooth for you but you still have an ongoing infection. Reducing the number of cavity causing bacteria in your mouth is vital.  This will take two years of us working together including in-office and at-home fluoride, and a few strategies to alter the pH of your saliva.

Jenny, the questionnaire you completed in the waiting room, our discussion, and the exam today shows that you are at a moderate risk for developing cavities. Don’t be discouraged, many of our patients fall into that category, including me! Research shows that a simple fluoride varnish once a year will help you reduce that risk. While your insurance may not assist in paying for the varnish, the fee is only $23 and the preventive treatment may help you avoid more expensive dental work in the future.  I compare it to your medical insurance not paying for the gym; you do it anyway because it is good for you. It takes less than a minute and you can eat and drink immediately. As a preventive measure, would you like to go ahead with the fluoride varnish?

Jeff, thank you for filling out the questionnaire before I brought you back.  After completing your cleaning and the discussion we have had it appears that you are at risk due to your recession and side effects of your prescription medication.  Your blood pressure medication and your over-the-counter allergy pill both cause you to have less saliva than you should.  Your saliva is very important because it helps wash away food and reduces the acid levels in your mouth after you eat, drink or snack.  The recession has exposed the much softer dentin (cementum) of roots that are more susceptible to that acid attack; roots decay faster than enamel. I’m going to send you home with a few ways to reduce your risk but the most effective way to get started is with a preventive fluoride treatment.   I can apply the preventive varnish right now for you, it only takes a minute and you can eat and drink immediately.

 

Mark, you've been with our practice a long time and I know you can’t stand cavities; you have had several in the last few years. You are not alone; many adults are cavity prone.  Did you know that cavities are actually a bacterial infection?  Research shows when you have a cavity you are at high risk to get another one soon after because the destructive bacteria are still there even after the tooth is restored. Think of it like having a flat tire.  You have the nail removed, the tire patched and go on your way.  It doesn’t work if you still have nails in your driveway because you are likely to have another flat tire. There are things you can do between appointments; we will discuss those in a moment but a big part of your treatment plan is to have me apply fluoride varnish on your teeth every 3 months until you go two years without a cavity.  Like other prevention programs, insurance companies vary on assistance with this treatment. However, the fee is only $23 - and I know it would be worth it to you if it prevented you from having another cavity.  Plus, it takes less than a minute and you can eat and drink immediately. Would you like me to provide that protective treatment?  (YES)  Okay good.  I am also going to recommend a few preventive products to use at home to help further reduce your risk of infection. (Xylitol, fl rinse, 5000ppm fl toothpaste, etc.)

 

Jan, good news!  From the questionnaire and our discussion, it appears you are at low risk for developing a cavity.  Not too many people can say that, congratulations.  Once a year we will revisit your risk.  If any of your answers from the form change before your next appointment let me know and we can talk sooner. 

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