When Jean Creasey, DDS, introduced the principles of CAMBRA into her Nevada City practice 13 years ago, she never envisioned the benefits reaped for her patients and the practice she shares with her husband, Craig Creasey, DDS.
CAMBRA, which stands for Caries Management by Risk Assessment, is a research-based, systematic approach to integrate caries risk assessment as a centerpiece of the dental practice. CAMBRA aims to diagnose and prevent caries through the process of assessing a patient’s risk for caries by examining various health and lifestyle factors as part of their regular dental checkup.
“The best part about implementing CAMBRA in your private practice is that it really makes the dentist’s life much easier. In fact, it makes the team’s job much easier,” said Creasey. “By having patients who recognize the benefits of prevention, your restorations are going to last a lot longer. Your patients will see the value of having a dentist who acts more in the role of an oral health coach instead of just a dental dictator.”
Creasey, who recently shared her CAMBRA experience in Anaheim during a CDA Presents lecture titled “Preventing Your Way to Success … Implementing CAMBRA in Private Practice,” said her patients appreciate the prevention aspect of their care and feel motivated to change oral health habits for the better.
“It’s very easy once you have the concepts down. Once you understand what the risk factors are, you’re able to look for these,” said Creasey. “You don’t need to buy any equipment — it’s something that you intuitively do and make simple notations in the chart, so that the next provider can look and see what risk they’re at and make sure they do the follow-up on patient motivation to ensure the patient is utilizing the best tools that you’ve been able to give them.”
Creasey said her practice has built a reputation on being prevention focused, with most patients coming in for cleanings rather than restorations. Her new patients, who are primarily generated by word of mouth, are interviewed about their oral health habits, diet and risk factors.
“I utilize motivational interviewing by listening first. I ask open-ended questions such as ‘What is your goal with your oral health? Where do you want your dental health to be in five years?’” said Creasey. “People only change behavior when they’re internally motivated. They will only change behaviors when they hear themselves talk about a need for change, and I guide patients toward making change statements.”
During a risk assessment, notations are made on the following:
- Existing restorations and their age;
- Wearing of a removable orthodontic appliance;
- Active caries or early lesions;
- Presence of plaque; and
- Saliva levels (check under tongue for small pool of saliva).
Creasey said based on the assessment, her patients are grouped into three categories:
- Low risk — brush twice a day with fluoride toothpaste, one-year recall.
- Moderate risk — prescription-strength fluoride gel, nutritional counseling, Xylitol chewing gum and chlorhexidine rinse.
- Extreme high risk — fluoride varnish, chlorhexidine rinse daily for six months, brush with 5000 PM toothpaste daily, recall every three to six months.
Creasey added that ongoing research at the University of California, San Francisco, School of Dentistry shows that prevention techniques can change the pathological aspects of dental disease. And to make compliance easier for her patients, she dispenses any needed products from her office, charging slightly above cost, so patients can use them right away.
“I’m grateful to be a part of a profession that places so much emphasis on prevention,” said Creasey.
The CDA Foundation has partnered with the UCSF School of Dentistry to educate dentists through forums and workshops about ways to implement CAMBRA into their practices. The October and November 2011 CDA Journal published evidence-based CAMBRA research that demonstrated caries could be prevented and managed through risk assessment. For more information, visit cda.org/journal.