CAMBRA

Caries Management By Risk Assessment

New Patient Visit | Return Appointments | Dental History

Preventing cavities in children is our passion! My practice, programs and team are built around teaching children and parents how to keep a healthy, cavity-free smile for life. We partner with you, giving you the information, guidance and motivation you need to care for your child’s teeth.

What is CAMBRA? CAMBRA stands for caries management by risk assessment: an evidence-based, clinically tested program that helps dentists prevent and control cavities.

CAMBRA History: In the early 2000s, a multi-state study of thousands of patients led by Dr. John Featherstone of the University of California, San Francisco, found that CAMBRA reduced cavities by more than 30% in high-risk patients compared with standard care. By 2006 it was endorsed by every major dental organization, and it is now the leading evidence-based approach to managing cavities in children and adults. Learn more at https://dentistry.ucsf.edu/research/cambra

How it works: We gather information about your child’s oral hygiene, fluoride use, diet, medical conditions and medications. After an exam and any needed x-rays, we assign a risk level and review it with you (and your child, if age appropriate). You receive personalized recommendations, preventive therapies suited to that risk level, and “self-management goals” you choose together with us. At each visit we track progress and update the plan.

Why is there a fee, and why doesn’t insurance cover it? Although CAMBRA is proven to reduce cavities and is endorsed by all major dental organizations (ADA, CDA, AAPD and others), no private dental insurance currently pays for it. (Public programs such as Denti-Cal, Medi-Cal’s dental program, have covered it for more than 5 years.) We charge a small fee for the extra time, supplies and expertise involved. CAMBRA is the foundation of all our preventive care, so it can’t be divided up or opted out of. If you have questions, please ask a team member or our office manager.

What to expect - CAMBRA services:


New Patient Visit

  • Review of your child’s health and dental history, looking for anything that raises cavity risk
  • Review of fluoride use, oral hygiene and diet at home
  • Hands-on brushing and flossing check with a disclosing agent and mirror, with personalized, positive coaching
  • Your child’s Caries Risk Assessment level, reviewed with you
  • The doctor’s exam and x-ray findings, including any early cavities, explained in detail
  • How bacteria, food and brushing habits cause or prevent cavities
  • Recommended treatment and preventive services, with options explained
  • Self-management goals: small, achievable improvements you choose, plus tips to keep your child motivated
  • You take home your child’s CAMBRA results and goals, tips on diet and hygiene, and a toothbrush, toothpaste and flossers (plus disclosing tablets and a brushing calendar as needed)


Return Appointments

  • The same health, home-care and hands-on brushing review as the first visit
  • The doctor’s exam and x-ray findings, CAMBRA findings and recommended treatment and preventive services
  • An updated Caries Risk Assessment level and new self-management goals
  • A look back at your previous visit: risk level, oral hygiene, goals and completed treatment
  • What has changed since last time, with encouragement that focuses on progress


Dental History


For centuries, cavities were considered an unavoidable part of life. Dentistry was mostly “reactive”: fixing or pulling broken-down teeth in a cycle of cavities, pain, infection, repairs, root canals, crowns and, eventually, dentures. Before antibiotics arrived in the 1930s, dental infections could even be fatal. Only in recent decades have scientists understood cavities as a bacterial disease, making real prevention possible.

What causes cavities? Are they genetic? Cavities are holes in teeth caused by acid from certain mouth bacteria, mainly Streptococcus mutans and lactobacilli. Whenever these bacteria get sugars or carbohydrates, they produce acid and sticky plaque that dissolve minerals from the teeth. Children acquire these bacteria after birth, and they stay for life. Cavities signal an imbalance between the body’s natural defenses and bacterial attack. A few rare inherited conditions raise cavity risk directly, and traits like crowded teeth can contribute, but the biggest family influences are the bacteria passed to children and the family’s hygiene and eating habits.

Do cavities in baby teeth really matter? Yes. Untreated cavities can cause pain and infection, require fillings, nerve treatments or crowns, and can lead to losing the tooth. The 2000 U.S. Surgeon General’s report found that cavities are the most common preventable disease in children ages 0–5, six times more common than asthma. Children with cavities in baby teeth get more cavities in their permanent teeth, miss more school, and can have trouble eating and need more orthodontic care, while parents lose time from work and pay more for treatment. Baby back teeth aren’t replaced until about ages 9–13, so they need to stay healthy for years.

Is there a cure for cavities yet? Not exactly. Fluoride’s benefits were recognized in the 1950s and cut cavity rates dramatically by the 1970s. Today, researchers are exploring anti-cavity vaccines and ways to change or crowd out harmful bacteria, but there is still no simple cure.

Until there is, programs like CAMBRA are the best tool we have. They combine evaluation, education and behavior guidance with therapies such as xylitol, silver diamine fluoride (SDF), calcium phosphates, hydroxyapatite and chlorhexidine. The most effective way to deal with cavities is to prevent them in the first place, and with CAMBRA, your child has a real chance of never having a cavity.

If you have questions about anything on this page, please ask any of our team members during your visit.