Session forum offers practical ways to incorporate CAMBRA

By: Michele Flynn

Dr. Bruce Peltier, a professor of psychology and ethics at Dugoni School of Dentistry, addresses dental professionals during the CAMBRA course at the Fall Session. (Photo by Charr Crail)

Caries management by risk assessment, or CAMBRA, was a hot topic at the Fall Session in San Francisco as evidenced by the more than 400 people in attendance at a forum on the subject. In fact, several people were turned away at the door, according to the CDA Foundation, which offered the Thursday course.

Why the buzz?

“It’s a new practice philosophy,” said Rolande Loftus, program director for the CDA Foundation. “We’re trying to engineer a shift from the restorative model to more of a medical model of prevention.”

One attendee, David Tanner, DDS, who has worked to incorporate the CAMBRA strategies in his practice in Newhall, said CAMBRA takes a wellness approach and incorporates looking at the entire health and lifestyle of the patient to determine the caries risk level.

“An analogy that resonated with me and my staff at the forum was the flat tire analogy,” Tanner said. “Someone comes to you with a flat tire. You fix it, but you know that the problem is they have nails all over their driveway. Therefore, though you fix the problem, you are doing nothing to prevent the cause. With the CAMBRA protocol and products, we proactively prevent caries. You can fill a cavity, but if patient is at high risk of caries for a variety of reasons, they’re going to be back in your chair with another cavity to fill, or worse.  I will sleep better knowing that I am helping my patients to prevent future caries and invasive treatment.”

Tanner attended a seminar on CAMBRA a couple of years ago and ever since has been trying to get his staff on board. Upon hearing about the free forum at the Session, he decided to fly his staff up for the day to attend.

“We are very happy we attended. Even though I understood the principles and strategies prior to attending the forum, I, as well as my staff, feel more comfortable now with the chemistry and the products, and how they all fit together. Our patients are responding very favorably. We are all so excited. We are quickly running out of product,” Tanner said.

The CDA Foundation offered the CAMBRA forum with help from corporate sponsors Ultradent and 3M ESPE.

 “We feel this is a tremendous step in the direction of preventive care,” said Jon Roth, executive director of the Foundation. “In addition to regular dental checkups and cleanings, CAMBRA provides dentists with risk-based strategies for addressing the fundamental causes of why someone is at higher risk for caries and what can be done to prevent it.”

Putting CAMBRA to work in a practice, however, does take extra time. That’s why, the forum panel of experts noted, it’s vital that the whole staff is on board. To assess the risk level of a patient, the dental staff must do a little detective work to find out about diet, other medical conditions, lifestyle choices, etc. One example cited by panelist W. Stephen Eakle, DDS, of San Francisco was a patient who had no caries until he was prescribed a new medication that caused xerostomia. To compensate for the dryness, he had begun to suck on hard candies and drink Gatorade, and developed lesions as a result. Solutions include recommending the patient switch to trying candy containing xylitol and drinking water.

All the panelists agreed that several risk factors need to be analyzed including low saliva flow, smoking and a diet that includes frequent exposure to foods that feed caries-causing bacteria. In addition, careful scrutiny of the patient’s dental hygiene is needed.

V. Kim Kutsch, DMD, has a private practice in Albany, Ore., and is CEO of two dental companies. As a panel member, Kutsch told the attendees that he has patients drive up to four hours to his practice after being referred by other patients. Though advertising “I do CAMBRA” won’t ring a bell for very many patients, Kutsch noted, the term “minimally invasive” does mean something.

“I can’t think of anything that has changed my practice more, improved my patient care and treatment outcomes than CAMBRA. The whole concept of treating the cause of the disease rather than continually treating the effects of the disease is a huge change in thinking. The clinical success we have had with individuals who have suffered lifelong bouts with caries has created more word-of-mouth interest in my practice than anything we have ever done,” Kutsch noted. “Being able to truly stop the caries infection in a patient for maybe the first time in their life is a life-changing experience for them.  It’s given me the ability to predictably help people that have been suffering the chronic effects of this disease.”

CAMBRA, which started in California, is spreading to the rest of the country. Eastern and Central CAMBRA coalitions have recently formed, and an impressive list of caries experts signed a consensus statement supporting the concept, printed in the November 2007 CDA Journal.

Though the Journal devoted two entire issues last fall to laying out the principles of CAMBRA in detail, only five out of almost 400 people who attended the seminar say they practice CAMBRA.

The bottom line, agreed the panel, is that when caries is caught early enough, there are a number of non-invasive interventions a dentist can suggest that will arrest or reverse the disease process and keep the structure of the tooth intact.

The CAMBRA Forum will be offered again at the 2009 Anaheim meeting on Friday, May 15, from 9 a.m. to noon and continuing from 2 to 5 p.m. at the Anaheim Convention Center, Ballroom D.

The panel of experts for the CAMBRA forum was moderated by John D.B. Featherstone, MSc, PhD, dean of UCSF School of Dentistry. In addition to Featherstone, Eakle and Kutsch, forum members were Debra L. Gerger, RDH, MPH; Bruce Peltier, PhD, MBA; Francisco J. Ramos-Gomez, DDS, MS, MPH; and Vladimir W. Spolsky, DMD, MPH.

To read the October and November Journal issues dedicated to CAMBRA, visit the CDA Web site cda.org and click Publications or www.cdafoundation.org/journals. To request copies, please contact Jenifer Porter at 800.736.7071, ext. 4916.