We know that not everyone is at the same risk for cavities. Even if you brush, floss, and make your regular dental visits the same as someone else, you might develop twice as many cavities. So how do we know who is at an elevated risk and therefore more likely to benefit from additional preventive care?
Researchers have developed a system called caries management by risk assessment (CAMBRA) using various cavity risk assessments (CRA), but evidence for it has been limited. Now a new study shows that it has a strong predictive value and is therefore a useful approach to preventing and treating cavities.
What Is CAMBRA?
CAMBRA is an approach to dental care. It uses a CRA, a set of clinical factors that your dentist can use to assess your cavity risk. Once your risk level has been determined, your dentist will know how aggressively to respond to your tooth decay and what treatments to recommend. CRA generally include clinical indicators, biological indicators, and protective indicators.
Clinical indicators are considered to be the most serious risk factors. These are factors that your dentist can see during your regular checkups and exams. Depending on the individual CRA used, it might include items like visible decay, or cavities that show up on x-ray. White spots on teeth, and a need for fillings in the last three years.
Biological indicators of risk are less serious predictors of clinical risk. They can include both genetic (strictly biological) factors and cultural or behavioral factors, which are only partly biological. Some of these include saliva flow, visible plaque on teeth, pits and fissures in the tooth structure, frequent snacking, drug use, and wearing orthodontic appliances.
Protective indicators are those that can actually reduce your risk of developing cavities. In general, these are less strong than risk factors, but some of them do show the ability to significantly impact your cancer risk. Among the protective factors generally used are fluoridated community water, brushing with fluoride toothpaste, fluoride mouth rinse, antibacterial rinses containing chlorhexidine, and xylitol gum or lozenges.
New Studies Show Effectiveness of CAMBRA
Although there is much interest in CAMBRA techniques and they’re being applied across the country, as we said, evidence supporting them used to be limited. Now, though, two recently published studies have demonstrated that CRA can actually predict the development of cavities, which adds validity to the CAMBRA approach.
One study, published in Oral Health & Preventive Dentistry, showed that several of the indicators in CRAs were predictive of cavities risk. The strongest predictor was restorations in the previous three years, which was associated with a 7.31 times higher risk of cavities, while the presence of Streptococcus mutans was associated with a 7.15 times higher risk, and heavy visible plaque with a 5.54 times higher risk. Fluoride toothpaste was the strongest protective factor, cutting cavity risk in half.
Another study, just published in July and using a shorter CRA, showed that all the clinical and biological risk factors were associated with elevated risk for decay at the initial visit, except for salivary flow. However, when they ran a statistical analysis, they found that clinical indicators (visible decay, visible plaque, recent restoration) and the risk factor frequent snacking were associated with future decay. Baseline decay was the strongest predictor of future decay.
Your Dentist Has to Know You
What the CAMBRA and CRA approach essentially push is that a dentist has to do more than just look in your mouth to provide you with optimal dental care. Your dentist has to know you, have a sense of your lifestyle, including your family, to give you optimal treatment for dental decay–hopefully before it starts.