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Simple but important steps for hygienists
Much of our time as dental hygienists is focused on caring for patients' periodontal health, with an emphasis on calculus removal and prevention of periodontal disease. However, there is a growing push for the hygiene community to become more actively involved with caries prevention, beyond the typical practices of home-care instruction and evaluation. Several years ago, dental professionals began organizing the outlines of what would become known as Caries Management by Risk Assessment (CAMBRA). The CAMBRA protocols represent a shift for the dental profession, from simply treating caries to actively working to prevent it by addressing its bacterial cause. Through learning about CAMBRA and implementing its recommendations in their offices, dental hygienists have a valuable opportunity to help patients take charge of both their caries control and periodontal health.
CAMBRA began taking shape in 2003 after the publication of two special issues of the Journal of the California Dental Association, calling for dental professionals to adapt their caries strategies to address bacterial causes as well as "remineralization and repair of early lesions."1 An updated consensus statement was issued in 2007, renewing the call for dental professionals to focus on "modification of the oral flora, patient education, remineralization, and minimal operative intervention."2 By refraining caries as a "curable and preventable" disease, CAMBRA encourages the dental team to expand its practice beyond simply detecting and filling cavities.3
How risk assessment works
The "risk assessment" in CAMBRA is grounded in the use of a Caries Risk Assessment Form, which practitioners are instructed to use to evaluate each patient's disease indicators, risk factors, and protective factors to determine their level of caries risk. Several incarnations of this form exist, but the California Dental Association's (CDA) is likely the most well known. The form lists 24 factors that dental professionals can use to evaluate patients' level of risk, from disease indicators such as white spots on smooth surfaces to protective factors such as living in a fluoridated community. The form organizes the questions in a way that makes scores easy to visualize and tabulate. A separate form for pediatric patients adapts these items into a format for parental questioning and clinical examination.
Based on the results of the assessment form, the dental...