Restorative treatment • The history of dental caries management

consisted of many restorations placed as well as many teeth removed and prosthetic replacements provided.

• Paradigm shift towards a “medical” strategy

approach that is risk based and implements appropriate therapeutic intervention.

• CAMBRA Approach

Widespread fluoride use has helped in the reduction of caries by 40 to 60% in the US since 1945. Community water supply Home care products (toothpaste and

mouthrinse) Professional application (topical solutions, gels, and varnishes)

Although the decline of caries is evident, it is still a continuing public health issue and major problem in the health of adults as well as children.

Objectives for caries management: The dental hygienist is challenged to select a management strategy to cover all of the individual patient’s needs.

Describe the CAMBRA Approach

Assess individualized needs

• Obvious lesions

• Dietary and personal oral care habits

• Remineralization potential

**The care plan will need to provide for treatment of existing nonreversible carious lesions but also will open up a changed pattern of personal care previously unrealized by the patient so that new lesions can be prevented.

Determine restorative needs: • Chart existing

restorations and sealants; present cavities; secondary lesions

Determine areas that require remineralization: • Chart white areas and

white cervical lines and outline appropriate strategies for the patient

Define steps for a remineralization program: • Explain needs and

corrective methods for patient understanding; prepare and explain risk assessment; provide treatment plan; plan for re-evaluation at re-care appointments

Risk factors: • Habits, behaviors, lifestyles, and conditions that

when present increase the probability of a disease occurring

• Caries management begins with risk factor assessment

Purpose of individual assessment

• Identification of specific needs • Provide scientific information for patient

education • Development of caries management plan

An individual can be in the “high-risk” or “low-risk” category for development of dental caries. All of the following factors are low-risk factors in the development of dental caries for adults except one. Which one of the following factors is not low risk?

A) Normal salivary flow B) Uses xylitol gum C) Sealants in pits and fissures D) Poor manual dexterity E) Regularly scheduled dental visits

D) Poor manual dexterity Poor manual dexterity will affect the patient’s

ability to control biofilm, which will increase caries susceptibility. All of the other answer choices are low risk.

Patient histories: medical, dental, and social; answers to these questions may be pertinent to a caries control program

• Perception of needs guided by past dental

experiences • Value placed on oral health: appearance, cost

implications, and personal time involved • Past dental experiences • Fluoride history: exposure and non-exposure • Success in changing habits • Direct questioning of patient: brief checklist to

show current daily oral care and fluoride use

• Protocol for prevention program to emphasize remineralization of early, non-cavitated lesions

• Patient participation in the activity helps the learning process

• Provide a checklist

– Personal and lifestyle habits

including oral health habits

– Actions to change risk to

prevent future cavities

The primary prevention objective is to provide the patient with positive care and education to maintain optimal oral health.

Determine if patients are low-risk category.

Identification of risky habits Supervision at re-care appointments is

necessary to prevent introduction of habit changes that can lead to caries infection.

Remove nidus of caries: acidogenic bacteria Placement of sealants to seal and close pits

and fissures and prevent the microorganisms to live.

Encourage family members in prevention Systemic disease factors: identify diseases and

medications that may lead to dry mouth.

Medically compromised risks: patients may need additional preventive recommendations.

Differentiate various agents used to arrest or reverse the demineralization process.

Identify the relationship between fluoride, antimicrobials, calcium phosphate products, and xylitol in the reduction of caries risk.

Personal fluoride use: fluoridated water; fluoride toothpaste, mouthrinse, and/or prescription fluorides

Dietary modifications: select non-carbohydrate foods; eliminate fermentable carbohydrate exposure between meals and bedtime

• Use of sugar-free products: sugar-free gum containing xylitol

*Xylitol reduces levels of Streptococcus mutans and promotes remineralization* • Professional applications –Chlorhexidine antimicrobial rinse 0.12%

(short term use) *Chlorhexidine is highly effective against Streptococcus mutans infections – Prescription fluoride dentifrice 1.1% – Fluoride varnish application during dental

appointments

Biofilm control Clinical detection of areas of

demineralization Continued remineralization program Short-term antimicrobial use