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The aim of this article is to present a practical caries risk assessment procedure and form for patients who are age 6 through adult. The content of the form and the procedures have been validated by outcomes research after several years of experience using the factors and indicators that are included.
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               
 
         



comes research based upon the use of the
procedures in a large cohort of patients at
the School of Dentistry at the University
of California, San Francisco, was recently
published, validating the form and proce-
dures.
2
e results from this study are the
basis for the current revisions to the caries
risk assessment form and procedures pre-
sented here. e successful components
of the previous version have been re-
grouped according to the outcomes results
and are presented in . e form can
be readily adapted for use in electronic
record systems, as has been done at UCSF.
e background, rationale, and step-by-
step procedures are described as follows.

Successful and accurate caries risk
assessments have been a dream for
decades. Numerous research papers
have been written on the topic, such
as the reviews by Anderson et al. and
Anusavice.
3,4
Several forms and pro-
cedures have been suggested, some
of which are summarized in a recent
review by Zero et al.
5
Individual contrib-










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














aries risk assessment is the
rst step in caries manage-
ment by risk assessment,
CAMBRA. e level of risk
should be used to determine
the need for therapeutic intervention and
is an integral part of treatment planning.
e management of caries following risk
assessment for 6-year-olds through adult
is described in this issue in detail in the
paper by Jenson et al. A separate form
and procedures for use for newborns
to 5-year-olds is presented in the paper
by Ramos-Gomez et al. in this issue.
A group of experts from across the
United States convened at a consensus
conference held in Sacramento, Calif., in
April 2002. is group produced a caries
risk assessment form and procedures
based upon literature available up to that
time. e results were published in 2003.
e consensus statement and supporting
review articles are available on the net:
www.cdafoundation.org/journal. is
form, or some variation of it, has been in
use in dental schools and private practices
for as long as four years. Recent out-
                 














       
               
 
                 
TABLE 1







  
 
 
 
 
 
 
 
 
 
 



 
 
 

 
 
 
 
 
 
 
 
 
 
 




   

               
 
         
to determine the level of risk that the
sum of these factors indicates.
7
Specific
pathologic and protective factors for
dental caries contribute to determin-
ing the balance between progression,
arrestment, or reversal of the disease.
For example, a young patient may have
poor oral hygiene but no other caries
risk factors. We would want to address
the oral hygiene issue, but this, in and
of itself, is not sufficient to put the
patient in a high-risk category. We know
that patients with high plaque levels
frequently demonstrate no evidence
of dental caries. On the other hand, a
patient with a cavitated caries lesion is
immediately put into the high-risk cat-
egory because this is a well-documented
predictor of future caries lesions.
anticipate that, with the updated form
presented here, the success will be even
higher as all of the contributing fac-
tors have been validated and ranked in
order of the odds ratios found they were
related to the formation of cavities.

Assigning a patient to a caries risk
level is the first step in managing the
disease process. A step-by-step guide
how to do this is laid out later in this
article. Before moving to the details
some overall discussion and definition
of terms are needed. is assessment
occurs in two phases: therst is to
determine specific disease indicators,
risk factors, and protective factors
each patient has. e second step is
uting factors to caries risk have been
identified over the last 30 years or so,
and a review of these was published in
two special issues of the Journal of the
California Dental Association, February
and March 2003 (www.cdafoundation.
org/journal), together with the consen-
sus statement referred to above.
6
Much
of the information has been available
for 0 to 20 years or more, but has not
been put into everyday clinical practice,
primarily because the information has
not been gathered together in a simple
form and procedure, and such combi-
nations have not been validated until
recently.
2
Utilization of risk assessment
to determine therapeutic modalities was
successful at a level of about 70 percent
in an adult population. e authors









S 
A
F 
E 

B 
A
D 

W 
R 
E 
C 

       
               
 
e second phase of caries risk as-
sessment is by no means a mathematical
formula; it is better characterized as a
judgment based on the likely balance
between the indicators and factors
identified in the risk assessment form
() and illustrated visually in
. e risk assessment form ()
is comprised of a hierarchy of disease
indicators, risk factors, and protec-
tive factors that are based on the best
scientific evidence we have at this time.
As mentioned previously, the risk assess-
ment procedures published in 2003 have
been assessed over more than three years
and the outcomes led to the elimina-
tion of some items and to the validation
of those included here, together with
validation of the tool to assess caries
risk.
,2
e determination of high-risk
status is fairly clear. e decision to place
someone in the moderate-risk category
is sometimes not clear and different
practitioners may reasonably come to dif-
ferent conclusions. It is better to err on
the conservative side and place a patient
in the next higher category if there is
doubt. As we get more clinical data the
accuracy of these risk assessment forms
will no doubt increase even further.



e following section presents the
rationale and instructions for the use of
the form presented in : “Caries Risk
Assessment Form — Children Age 6 and
Over/Adults.

Caries disease indicators are clinical
observations that tell about the past car-
ies history and activity. ey are indica-
tors or clinical signs that there is disease
present or that there has been recent
with frank cavities has high levels of
cariogenic bacteria, and placing restora-
tions does not significantly lower the
overall bacterial challenge in the mouth.
8

Caries risk factors are biological fac-
tors that contribute to the level of risk for
the patient of having new carious lesions
in the future or having the existing lesions
progress. e risk factors are the biologi-
cal reasons or factors that have caused or
contributed to the disease, or will con-
tribute to its future manifestation on the
tooth. ese we can do something about.
ere are nine risk factors recently
identified in outcomes measures of car-
ies risk assessment
2
listed in : )
medium or high MS and LB counts; 2)
visible heavy plaque on teeth; 3) fre-
quent (> three times daily) snacking
between meals; 4) deep pits and fissures;
5) recreational drug use; 6) inadequate
saliva flow by observation or measure-
ment; 7) saliva reducing factors (medica-
tions/radiation/systemic); 8) exposed
roots; and 9) orthodontic appliances.
If there are no positive caries disease
indicators (see above), these nine fac-
tors in sum become the determinants
of caries activity, unless they are offset
by the protective factors listed below.

ese are biological or therapeutic factors
or measures that can collectively offset
the challenge presented by the previously
mentioned caries risk factors. e more
severe the risk factors, the higher must be
the protective factors to keep the patient
in balance or to reverse the caries process.
As industry responds to the need for more
and better products to treat dental caries,
the current list in  is sure to expand
in the future. Currently, the protective
factors listed in  are: ) lives/work/
disease. ese indicators say nothing
about what caused the disease or how to
treat it. ey simply describe a clinical
observation that indicates the presence
of disease. ese are not pathological
factors nor are they causative in any way.
ey are simply physical observations
(holes, white spots, radiolucencies). e
outcomes assessment described previ-
ously and prior literature, highlight
that these disease indicators are strong
indicators of the disease continuing un-
less therapeutic intervention follows.
e four caries disease indictors
outlined in  are: () frank cavita-
tions or lesions that radiographically
show penetration into dentin; (2) ap-
proximal radiographic lesions confined
to the enamel only; (3) visual white spots
on smooth surfaces; and (4) any restora-
tions placed in the last three years. ese
four categories are strong indicators for
future caries activity and unless there
is nonsurgical therapeutic intervention
the likelihood of future cavities or the pro-
gression of existing lesions is very high.
A positive response to any one of
these four indicators automatically places
the patient at high risk unless therapeu-
tic intervention is already in place and
progress has been arrested. A patient






                 
               
 
         
school located in a fluoridated community;
2) fluoride toothpaste at least once daily; 3)
fluoride toothpaste at least two times daily;
4) fluoride mouthrinse (0.05 percent NaF)
daily; 5) 5,000 ppm F fluoride toothpaste
daily; 6) fluoride varnish in last six months;
7) office fluoride topical in last six months;
8) chlorhexidine prescribed/used daily for
one week each of last six months; 9) xylitol
gum/lozenges four times daily in the last
six months; 0) calcium and phosphate
supplement paste during last six months;
and ) adequate saliva flow (>  ml/min
stimulated). Fluoride toothpaste frequency
is included since studies have shown that
brushing twice daily or more is significant-
ly more effective than once a day or less.
9
Any or all of these protective factors can
contribute to keep the patient “in balance”
or even better to enhance remineralization,
which is the natural repair process of the
early carious lesion.

. Take the patient details, the patient
history (including medications) and
conduct the clinical examination. en
proceed with the caries risk assessment.
2. Circle or highlight each of the “YES
categories in the three columns on the
form (). One can make special
notations such as the number of carious
lesions present, the severity or the lack of
oral hygiene, the brand of fluorides used,
the type of snacks eaten, or the names of
medications/drugs causing dry mouth.
3. If the answer is “yes” to any one of
the four disease indicators in the first
panel, then a bacterial culture should
be taken using the Caries Risk Test
(CRT) marketed by Vivadent, (Amherst,
N.Y.). (*–See below or equivalent test.)
4. Make an overall judgment as to
whether the patient is at high-, moder-
ate- or low-risk dependent on the bal-
ance between the disease indicators/risk
tions in the form of a letter, based
on clinical observations and the
Caries Risk Assessment result.
8. Give the patient the sheet that
explains how caries happens ()
and the letter with your recommenda-
tions. Sample letters are given. More
details about these recommendations and
procedures are laid out in Jenson et al. in
this issue. Products that should be used
are described in detail in Spolsky et al.
9. Copy the recommendations and the
letter for the patient chart (or if you have
electronic records the various form letters
and recommendations can be generated to
be printed out custom for each patient).
0. Inform the patient of the results
of any tests. e.g., showing the patient
the bacteria grown from their mouth
(CRT test result*) can be a good motiva-
tor so have the culture tube or digital
photograph of the test slide handy at
the next visit (or schedule one for this
purpose — the culture keeps satisfacto-
rily for some weeks), or give/send them
a picture (digital camera and e-mail).
. After the patient has been follow-
ing your recommendations for three to six
months, have the patient back to reassess
how well they are doing. Ask them if they
are following your instructions, how often.
If the bacterial levels were moderate or
high initially, repeat the bacterial culture
to see if bacterial levels have been reduced.
Some clinicians report improved patient
motivation when a second bacterial test
is done initially immediately after the
first month of antibacterial treatment.
Documenting a “win in your column” early
on is a valuable tool to encourage patients.
Make changes in your recommendations
or reinforce protocol if results are not as
good as desired, or the patient is not com-
pliant. Refer to Jenson et al. this issue for
more detail on protocols and procedures.
factors and the protective factors using
the caries balance concept (see bottom
of  and ). Deter-
mining the caries risk for an individual
requires evaluating the number and
severity of the disease indicators/risk
factors. An individual with caries lesions
presently or in the recent past is at
high risk for future caries by default. A
patient with low bacterial levels would
need to have several other risk factors
present to be considered at moderate
risk. Some clinical judgment is needed
while also considering the protec-
tive factors in determining the risk.
5. If a patient is high risk and has
severe salivary gland hypofunction or
special needs, then they are at “extreme
risk” and require very intensive therapy
6. Complete the therapeutic recom-
mendations section as described in the
paper by Jenson et al. this issue, based
on the assessed level of risk for future
carious lesions and ongoing caries
activity. Use the therapeutic recom-
mendations as a starting point for the
treatment plan. e products that can
be used are described in detail in Jenson
et al. and Spolsky et al. in this issue.
7. Provide the patient with thera-
peutic and home care recommenda-








       
               
 


*. Saliva Flow Rate: Have the patient
chew a paraffin pellet (included with
the CRT test — see below) for three to
five minutes (timed) and spit all saliva
generated into a measuring cup. At the
end of the three to five minutes, mea-
sure the amount of saliva (in milliliters
= ml) and divide that amount by time to
determine the ml/minute of stimulated
salivary flow. A flow rate of  ml/min
and above is considered normal. A level
of 0.7 ml/min is low and anything at 0.5
ml/min or less is dry, indicating severe
salivary gland hypofunction. Investigation
of the reason for the low flow rate is an
important step in the patient treatment.
*2. Bacterial testing: An example (others
are currently available) of a currently avail-
able chairside test for cariogenic bacterial
challenge is the Caries Risk Test (CRT)
marketed by Vivadent. It is sufficiently
sensitive to provide a level of low, medi-
um, or high cariogenic bacterial challenge.
It can also be used as a motivational tool
for patient adherence with an antibacterial
regimen. Other bacterial test kits will likely
be available in the near future. e follow-
ing is the procedure for administering the
currently available CRT test. Results are
available after 72 hours (note: the manu-
facturers instruction states 48 hours, but
more reliable results are achieved if the
incubation time is 72 hours). e kit comes
with a two-sided selective media stick that
assess mutans streptococci on the blue
side and lactobacilli on the green side.
a) Remove the selective media stick
from the culture tube. Peel off the plastic
cover sheet from each side of the stick.
b) Pour (do not streak) the col-
lected saliva over the media on
each side until it is entirely wet.
c) Place one of the sodium bicar-
bonate tablets (included with the
kit) in the bottom of the tube.
d) Replace the media stick in the
culture tube, screw the lid on and label
the tube with the patient’s name, registra-
tion number, and date. Place the tube in
the incubator at 37-degrees Celsius for 72
hours. Incubators suitable for a dental
office are also sold by the company.
e) Collect the tube after 72 hours
and compare the densities of bacte-
rial colonies with the pictures provided
in the kit indicating relative bacterial
levels. e dark blue agar is selective for
mutans streptococci and the light green
agar is selective for lactobacilli. Record
the level of bacterial challenge in the
patient’s chart, as low, medium or high.
Some find it helpful for documentation
to number the pictures  through 4.



One of the following letters (
)including home care recommenda-
tions should go to each patient depend-
ing on the risk category and the overall
treatment plan (refer to Jenson et al.
this issue for treatment plan details).

                 
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
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










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
               
 
         
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





J Cal Dent
Assoc

J Dent Educ
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
J Am
Dent Assoc

J Dental Education

J
Dent Educ

J Cal Dent Assoc

Oral Health Prev Dent


Caries Res
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Caries Res
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               
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... 9 Caries management has evolved from a traditional restorative, "drill-and-fill," surgical intervention to a multilevel approach with assessment and determination of caries risk levels divided into low, moderate, high, and extreme. 10,11 Caries risk assessment (CRA) is conducted during a clinical examination using a form inclusive of the information on disease indicators, biological, and protective factors to predict the likelihood of future caries development with a goal to determine a personalized caries management plan based on the risk status. 10,12 In the last 20 years, the dental community has embraced the philosophy of CRA and management, 13 but our understanding to which extent dental institutions, that is, academic, private, and group practices perform CRAs, and deliver appropriate risk-based caries treatments to patients is limited. ...
... 10,11 Caries risk assessment (CRA) is conducted during a clinical examination using a form inclusive of the information on disease indicators, biological, and protective factors to predict the likelihood of future caries development with a goal to determine a personalized caries management plan based on the risk status. 10,12 In the last 20 years, the dental community has embraced the philosophy of CRA and management, 13 but our understanding to which extent dental institutions, that is, academic, private, and group practices perform CRAs, and deliver appropriate risk-based caries treatments to patients is limited. With structured patient-level data in electronic health records (EHRs), rather than relying on administrative claims data, it is now possible to use clinical quality measures to evaluate our patients' oral health care. ...
... The consensus recommendation is prescription fluoride for patients at elevated risk levels, and antimicrobials treatments for high and extreme caries risk patients. 10 All participating institutions follow the evidence-based CAMBRA protocol for caries management and prevention which includes prescription 1.1% fluoride toothpaste, professionally applied fluoride (D1206 or D1208), and antimicrobials, or prescription chlorhexidine gluconate 0.12%. We also included the application of interim caries arresting medication (D1354) as fluoride therapy. ...
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Background Longitudinal patient level data available in the electronic health record (EHR) allows for the development, implementation, and validations of dental quality measures (eMeasures). Objective We report the feasibility and validity of implementing two eMeasures. The eMeasures determined the proportion of patients receiving a caries risk assessment (eCRA) and corresponding appropriate risk-based preventative treatments for patients at elevated risk of caries (appropriateness of care [eAoC]) in two academic institutions and one accountable care organization, in the 2019 reporting year. Methods Both eMeasures define the numerator and denominator beginning at the patient level, populations' specifications, and validated the automated queries. For eCRA, patients who completed a comprehensive or periodic oral evaluation formed the denominator, and patients of any age who received a CRA formed the numerator. The eAoC evaluated the proportion of patients at elevated caries risk who received the corresponding appropriate risk-based preventative treatments. Results EHR automated queries identified in three sites 269,536 patients who met the inclusion criteria for receiving a CRA. The overall proportion of patients who received a CRA was 94.4% (eCRA). In eAoC, patients at elevated caries risk levels (moderate, high, or extreme) received fluoride preventive treatment ranging from 56 to 93.8%. For patients at high and extreme risk, antimicrobials were prescribed more frequently site 3 (80.6%) than sites 2 (16.7%) and 1 (2.9%). Conclusion Patient-level data available in the EHRs can be used to implement process-of-care dental eCRA and AoC, eAoC measures identify gaps in clinical practice. EHR-based measures can be useful in improving delivery of evidence-based preventative treatments to reduce risk, prevent tooth decay, and improve oral health.
... CAMBRA 31 was developed in 2002 by Calif Dent Assoc, ref. 63 and ref. 64 further completed it in 2007 and updated since then. 65,66 CAMBRA is a qualitative model, but in the latest vision, quantitative components were added to better determine the caries-risk level. ...
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Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.
... Among them, CAMBRA system covers the largest number (#25) of factors related to caries for adults, followed by ADA (#19) and Cariogram (#14). [13][14][15][16][17] CAMBRA system also suggests the largest number (#20) of factors associated with dental caries for children, then followed by ADA (#14) and CAT (#13), and Cariogram (#9). Studies had revealed that Cariogram had a limited extent in predicting dental caries in preschool children, but more useful in identifying caries risk for the elderly. ...
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Dental Caries is a kind of chronic oral disease that greatly threaten human being’s health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.
... This cross-sectional study was conducted in the university dental clinics of the College of Dentistry, Jouf University, Sakaka, Saudi Arabia, using a Caries Risk Assessment (CAM-BRA) protocol, from 15 March 2021 to 15 June 2021 [11]. Patients and their attendees (e.g., patients' family members, relatives, and friends) visiting the outpatient departments of university dental clinics were selected. ...
Abstract: Background: Caries risk assessment is a useful tool in caries prevention and management. Using a tool such as CAMBRA, every individual can be assessed according to his or her disease indicators, risk factors, and protective factors for the current and future caries. Aim: This study aimed to assess caries risk among the general population of Sakaka, Saudi Arabia using the CAMBRA protocol. Methods: This cross-sectional study was conducted at university dental clinics using a questionnaire that was formulated using the CAMBRA caries risk assessment tool; afterwards, all 160 participants were intra-orally examined to assess oral hygiene status and presence of disease. Independent t-tests, ANOVAs, and chi-square tests were performed for analysis. Results: The majority of participants had one or more disease indicators, with white spots and visible cavities (71.3%), and the most commonly present risk factor was a visible heavy plaque on teeth (82.5%). The use of fluoridated toothpaste (92.5%) was the most common protective factor. The majority of participants (85%) were in the ‘High’ category of Caries risk assessment. The prevalence of high caries risk was significantly higher among the rural participants compared to the urban (p <0.05), and significantly fewer of those with a primary school education level or lower were in the high dental caries risk group compared to the other educational categories (p <0.001). Conclusion: The caries risk among the general population of Sakaka, Saudi Arabia, is high, with significant variation among age groups, education levels, and geographical locations.
... This cross-sectional study was conducted in the university dental clinics of the College of Dentistry, Jouf University, Sakaka, Saudi Arabia, using a Caries Risk Assessment (CAM-BRA) protocol, from 15 March 2021 to 15 June 2021 [11]. Patients and their attendees (e.g., patients' family members, relatives, and friends) visiting the outpatient departments of university dental clinics were selected. ...
Article
Full-text available
Background: Caries risk assessment is a useful tool in caries prevention and management. Using a tool such as CAMBRA, every individual can be assessed according to his or her disease indicators, risk factors, and protective factors for the current and future caries. Aim: This study aimed to assess caries risk among the general population of Sakaka, Saudi Arabia using the CAMBRA protocol. Methods: This cross-sectional study was conducted at university dental clinics using a questionnaire that was formulated using the CAMBRA caries risk assessment tool; afterwards, all 160 participants were intra-orally examined to assess oral hygiene status and presence of disease. Independent t-tests, ANOVAs, and chi-square tests were performed for analysis. Results: The majority of participants had one or more disease indicators, with white spots and visible cavities (71.3%), and the most commonly present risk factor was visible heavy plaque on teeth (82.5%). The use of fluoridated toothpaste (92.5%) was the most common protective factor. The majority of participants (85%) were in the ‘High’ category of Caries risk assessment. The prevalence of high caries risk was significantly higher among the rural participants compared to the urban (p <0.05), and significantly fewer of those with a primary school education level or lower were in the high dental caries risk group compared to the other educational categories (p <0.001). Conclusion: The caries risk among the general population of Sakaka, Saudi Arabia, is high, with significant variation among age groups, education levels, and geographical locations.
Article
The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.
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This research aims to provide updated information on caries experience and associated risk factors in children 6-12 years old. A cross-sectional and descriptive study design was carried out with a non-probabilistic, convenient sample of 209 children male and female. Clinical examinations were performed by calibrated dental students following WHO detection criteria. Caries indices dmft and DMFT were calculated. Caries Risk Assessment data was collected using an adapted CAMBRA instrument; following the International Caries Care guidelines. Descriptive statistics were performed to analyze the results and Chi-square test, Contingency Coefficient (C) and Corrected Typified Residues were calculated to determine the association between variables. 58% of the total population had dental caries lesions in its more severe stages (cavitation) and 42% were apparently healthy (AHS) without any cavitated lesions. The mean dmft index was 1.34 ± 1.93, and the mean DMFT index was 0.63 ± 1.22. Lesion severity remained between 1-2 teeth affected on both dentitions. A statistically significant association (p = 0.035) between the health condition and toothbrushing was stablished with a degree of dependence of C = 0.144. A positive standardized residual of 2.1 was evident for schoolchildren that experience caries lesion that never brush their teeth and AHS that brushed their teeth more than once. No association (p = 0.081) was found between health condition and intake of sugary snacks and beverages. A severe dental caries experience with a statistically significant association between the health condition and toothbrushing with fluoridated toothpaste 1450 ppm > 1 a day and a positive correlation in schoolchildren that experience caries lesion that never brush their teeth.
Article
Objective To compare the mineral density (MD) of non-fluoridated-milk (non-F-milk), fluoridated-milk (F-milk), adjunctive to 1000-ppm-fluoride dentifrice (FD), and 1000-ppm-FD alone of proximal artificial enamel carious lesions (AECL) in high caries-risk patients. Materials and methods This double-blind, cross-over in situ study comprised seven high caries-risk volunteers. Orthodontic brackets with one slab of AECL were fixed randomly to each volunteer per phase. The study comprised three experimental periods with a 7-d wash-out period using FD between sessions; (1) A four-week tooth brushing with FD 2×/day by all subjects as a control. The participants were then randomly allocated to (2) drinking 2.5-ppm-F-milk 1×/day or (3) non-F-milk 1×/day, adjunctive to tooth-brushing with FD for 4-weeks. The subjects crossed over from each type of milk and continued the same protocol for another four weeks. After each phase, the MD of each specimen was analyzed using micro-computed tomography (Micro-CT). Results The baseline MD was not significantly differences (p = .653). When brushing with FD and drinking F-milk, the MD gain was significantly higher (11.68 ± 2.89%) compared with brushing with FD and drinking non-F-milk (4.59 ± 1.78%) (p = .003) or brushing with FD alone (5.30 ± 2.10%) (p = .003). Conclusions F-milk adjunctive to FD significantly increased MD gain compared with non-F-milk + FD or FD alone.
Article
Objective To determine effects of dental caries management using “CAMBRA-kids” mobile application for children under 5 years old for a period of a year. Methods This study was conducted on 119 preschoolers and parents. Parents downloaded “CAMBRA-kids” mobile application and entered risk factors and protective factors for children. Clinician entered disease indicators after clinical examination of children. Based on the input, the caries risk group was automatically determined by the “CAMBRA-kids” application. According to the caries risk level, caries management was conducted for 12 months according to guidelines. Results Children's caries risk level changed after conducting caries management for one year. In the change of CRA (Caries risk assessment) by factor, risk factors decreased in all risk groups, whereas protective factors increased in all risk groups. Disease indicators increased after 12 months in the extreme high-risk group and the high-risk group, but decreased in the low-risk group. Conclusion This study evaluated the effect of systematic dental caries management using “CAMBRA-kids” mobile application for preschool children. As a result, dental caries management had effects on children, especially for the extreme high-risk group and the high-risk group. Thus, it is expected to be used in a variety of areas for caries management of preschoolers.
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The aim of this review was to systematically assess clinical evidence in the literature to determine the predictive validity of currently available multivariate caries risk-assessment strategies (including environmental, sociodemographic, behavioral, microbiological, dietary/nutritional, and/or salivary risk factors) in: 1) primary teeth; 2) coronal surfaces of permanent teeth; and 3) root surfaces of permanent teeth. We identified 1,249 articles in the search, and selected 169 for full review. Inclusion and exclusion criteria were established prior to commencement of the literature search. Papers that conformed to these criteria were included (n = 15 for primary teeth; n = 22 for permanent teeth; and n = 6 for root surfaces), and 126 papers were excluded. Included articles were grouped by study design as: longitudinal, retrospective, and cross-sectional. The predictive validity of the models reviewed depended strongly on the caries prevalence and characteristics of the population for which they were designed. In many instances, the use of a single predictor gave equally good results as the use of a combination of predictors. Previous caries experience was an important predictor for all tooth types.
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Scottish children have one of the highest levels of caries experience in Europe. Only 33% of 5-year-old children in Dundee who developed caries in their first permanent molars by 7 brushed their teeth twice a day. High-caries-risk children should benefit if they brush more often with fluoridated toothpaste. The aim of this clinical trial was to determine the reduction in 2-year caries increment that can be achieved by daily supervised toothbrushing on school-days with a toothpaste containing 1,000 ppm fluoride (as sodium monofluorophosphate) and 0.13% calcium glycerophosphate, combined with recommended daily home use, compared to a control group involving no intervention other than 6-monthly clinical examinations. Five hundred and thirty-four children, mean age 5.3, in schools in deprived areas of Tayside were recruited. Each school had two parallel classes, one randomly selected to be the brushing class and the other, the control. Local mothers were trained as toothbrushing supervisors. Children brushed on school-days and received home supplies. A single examiner undertook 6-monthly examinations recording plaque, caries (D(1) level), and used FOTI to supplement the visual caries examination. For children in the brushing classes, the 2-year mean caries increment on first permanent molars was 0.81 at D(1) and 0.21 at D(3) compared to 1.19 and 0.48 for children in the control classes (significant reductions of 32% at D(1) and 56% at D(3)). In conclusion, high-caries-risk children have been shown to have significantly less caries after participating in a supervised toothbrushing programme with a fluoridated toothpaste.
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This study was designed to assess, retrospectively using dental records, the impact on the management of dental caries of new caries risk assessment (CRA) forms and procedures introduced into a predoctoral dental school clinic. Of 3,659 patients with a new patient visit (NPV) and baseline exam (BE) in the two-year period of July 2003 through June 2005, 69 percent (n= 2,516) had a baseline CRA. "Visible cavitation or caries into dentin by radiograph" was significantly correlated to most items included in the CRA form, for example, "frequent between meal snack of sugars/cooked starch" (p<0.001), "inadequate saliva flow" (p=0.03), and "deep pits and fissures or developmental defects" (p<0.001). Fluoride toothpaste use (odds ratio, OR=0.7) was negatively related to cavitation risk while "readily visible heavy plaque on teeth" (OR=2.0), "frequent between meal snack of sugars/cooked starch" (OR=1.6), "interproximal enamel lesions or radiolucencies" (OR=11.8), and "white spots or occlusal discoloration" (OR=1.50) were positively related. CRA use at follow-up, the use of bacterial tests, antibacterial therapy, and specific patient recommendations were all very low. While the content and usefulness of the CRA procedures were validated, the study highlighted the difficulties of implementing such programs in educational establishments even with an extensive student didactic program and faculty training.
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Treating the disease, not the symptoms, is the change in managing dental caries. As researchers supply the tools, dentists can apply more efficient and realistic methods for better patient care.
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The aim of this article is to present a brief overview of the dental caries process, in particular, the management of dental caries and the role of early detection methods in the clinical management of caries.
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Dental caries progression or reversal depends upon the balance between demineralization and remineralization. The 'Caries Balance' is determined by the relative weight of the sums of pathological factors and protective factors. Minimally invasive dentistry aims at the least possible removal of enamel or dentin, including reducing pathological factors and enhancing remineralization to avoid any removal of hard tissues. A structured caries risk assessment should be carried out based upon the concept of the caries balance. Following the risk assessment a treatment plan is devised which leads to the control of dental caries for the patient. The balance between pathological and preventive factors can be swung in the direction of caries intervention and prevention by the active role of the dentist and his/her auxiliary staff. Much is now understood about the mechanism of dental caries. We have known for a long time that demineralization of enamel, dentin or cementum is caused by organic acids that are generated by so-called acidogenic bacteria in the plaque when these bacteria feed upon fermentable carbohydrates (Silverstone, 1973; Featherstone, 2000; Loesche, 1986). The natural repair process is remineralization, which occurs when the pH rises again and calcium and phosphate from saliva together with fluoride enter the subsurface region of the lesion and form a new veneer on the existing crystal remnants in the lesion (Ten Cate and Featherstone, 1991). This veneer is less soluble than the original mineral and resists further acid attacks. The key to improved dental health for all is now for the dental profession to embrace this knowledge and put it into practice in the real world, to inhibit caries formation and progression, and to enhance the natural repair process.
A randomized clinical trial of caries management by risk assessment
  • Jd Featherstone
  • Gansky
  • Sa
Featherstone JD, Gansky SA, et al, A randomized clinical trial of caries management by risk assessment. Caries Res 39(4):295, 2005.