CAMBRA is a very effective method because as we all know prevention is better than intervention.

Once you know the patien's risk (low, moderat, high), you will be able to start your prevention program for this specific patient.

The difficulties arise with unco-operative patients and sometimes it is difficult to change/modify the patient's lifestyle.

I had a student make the comment that "extension for prevention" is stupid.  As we build evidence for using CAMBRA and minimally invasive dentistry I think our world will change.

In our study group have not worked CAMBRA; use the proposal of Dr. Bratthall by Cariogram software

Hello:

I attended a seminar about the new  system called canary invented by Dr S  Abrams  from the university of Toronto..it is a very interesting soft ware program and according to the developer it  helps you detect caries  or no caries  to avoid  unnecessary treatment. also it is supposed  to take the guessing game out f the picture of treating caries.

up to now we all depend on the probe  to detect  caries s and e guesstimate what is the extension of caries ,this method   allows for minimal treatment .

let us not forget one thing about caries  ,in a a paper published some years  ago by my supervisor the world renowned enamel expert the late Professor dr: John Gwinnett (state Unive of Newyork),he  published a paper  on e detection of caries by micro-radiography  ,he was able to show that by the time you see very early caries by the naked  eye ,the caries  it has extended to a depth beneath the surface ,-(he co authored  this paper with Taylor in the 70"s in the Canadian Dental journal)-  ,a point one has to remember in treating caries using the risk assessment method techniquequuue

Prof .k.Galil

I have no vested interest in the canary system or No financial  relations  to both the developer or the sytem

Galil

Thank you for this piece of information. Is the canary system soft year available commercially in the market? I will appreciate if you can some more details.

Thank you dr Assad Mira

yes the canary system is for sale and here is their web

thecanarysystem.com

best wishes

prof galil

There was an online course by Dr Featherstone on CAMBRA. It was very useful. Managing caries after assessing the caries risk is the best way to handle existing disease and also to prevent future occurrence of the disease.

The Cariogram is a new concept, firstly made as an educative model,with a goal to simply represent the numerous factors which cause dental caries.The Cariogram as a model evolved over a long period of time to become a reality.

Caries experience-clinical examination of the dental health

Assessment of the type of diet(Lactobacillus in the saliva)

Assessment of the OHI-Oral Hygiene Index

Assessment of the frequency of eating

Assessment of the bacteria Streptococcus Mutans in the saliva

Assessment of the Fluorid program

Assessment of saliva secretion

Assessment of the salivary buffering capacity.

Clinical assessment from the examiner

A

Vesna Ambarkova given a good explanation.

In our university we teach caries risk assessment as a guideline for prevention as well as a help in decission making when to intervene operatively. In the Netherlands we have the luck of many patients comming in regularly for check-up, so we can decide not to intervene and intensify prevention and patient motivation without the danger of losing the patient, that's a big advantage.

One of the best predictors of future caries activity is the caries experience of the patient in the past. 

Moreover, I want to adress that according to nowadays guidelines, caries in the outer 1/3 of dentin on the radiograph should be monitored rather than treated operatively! The threshold: 'it's in dentin, then cut', is clearly outdated and will lead to gross overtreatment. 

We teach our students:

1. caries is a lifestyle disease, it's not a set of cavities

2. Treatment should be done by prevention

3. Operative treatment is necassary for cavitated lesions, active lesions reaching 1/2 of the distance between DEJ and pulp on the radiograph, but circumstances can make that this guideline is not followed.

4. When operative intervention is decided: don't expose the pulp! 

Hi

I agree with Dr Opdam.However, as he has clearly indicated they have the benefit of patients who regularly attend for check-ups.In South Africa, it is more common for patients to only visit when there is pain.This is due to a number of socioeconomic reasons.But I also feel that dentists should be practising more preventative dentistry and maybe this should be incentivised by third party funders.

Our first clinical risk management programme (in 2006) was for a South African medical insured population using a caries risk assessment software system (self-developed) to improve treatment outcomes of dental care.

It was for an insured population (under dental insurance benefits) and we showed that focusing care on the High and Medium at-risk-individuals, a 19% cost-savings could be achieved - or around 19% of treatment claims costs of the medical insurer could be re-directed and re-deployed to provide care to the at-risk individuals ...

Medical insurers should compensate dental practitioners for doing a caries risk assessment and should request that the risk assessment scores be used in patient wellnes and disease management programmes - our work shows that it is a win-win for the dental practitioner and the dental health plan (insurance)

We developed an online course on cariology, and used the cariogram program of Bratthall without counting bacterial colonies. we introduce the concept of CAMBRA and minimal intervention dentistry.

In the Netherlands  the NOCTP method has been adapted for 2 years now. It is widely promoted within dental hygiënist courses and it is a part of the curriculum on the universities. I strongly recommend to use intra-oral photo's and if possible also x-rays to follow the cariës progress. In my organisation (Hogeschool Utrecht) we are now implementing the ICDAS to score the cariës occlusal and approximal. Istrongly agree with Louis Rossouw that the medical insurers should compensate risk-assessments, because it's time consuming to motivate and follow the process. In the Netherlands though we are making progress. We can declare M01= instructions per 5 minutes. But it is only effective with children. Adults hate to pay for instructions. 

I think it is a very nice approach , especially when you have time and money (read sponsors) to invest in this. Also for children and anxious people it is great when you don't have to use the drill!

Hi

Marysol

thanks for the information about NOCTP. Can you tell me where can I get detailed information about it?

Hi Asaad,

Here is the link.

http://www.ivorenkruis.nl/userfiles/File/Proefschrift_Erik_Vermaire_final.pdf

The caries risk assessment gives the

dentist an excellent opportunity for preventive intervention

in order to avoid future decay.

Also see:

1. Oct 2007 California Dental Assoc. Journal- see Featherstone's articles and others on this. The whole issue id devoted to this.

Lance Kisby DMD, FASDC, FAAPD, MAGD

I agree with Dra. Ambarkova, and would be much more important if it can include risk analysis in health services. particularly I have not had experience with CAMBRA

We are working with caries risk assessment in diagnostic for children of primary school. We do the caries risk assessment and we give the instruction to the dentist for the requirements of this children, (based in the form of CAMBRA) for example this child needs sealers in 46 and 36. The parents and boys came back with a great response.

Is done with assessment of caries risk factors with risk indicator and develops the (Balancing Concept) by maximizing protective measuring factors and minimizing pathological risk factors.

Article It’s High Time to “Play Safe” with the Child