Prevention of dental decay (cavities) in children is our passion! Helping parents avoid cavities in their children along with all the challenges and consequences that come with them is our top priority. I have carefully designed my practice, developed programs, hand selected and trained my team members to educate children and parents on the importance and fundamentals of maintaining good oral health, a healthy smile and a positive self image through dentistry. Through education, experience, and following evidence based guidelines my staff and I will partner with you to help your child have a cavity free smile for a lifetime. We do this by supplying you the information, guidance, support and motivation needed to optimally care for your child’s oral health.
So what is CAMBRA anyway? CAMBRA stands for caries management by risk assessment. It is an evidenced based preventative program clinically tested and designed to help dentists prevent or control dental disease (dental cavities) in their patients.
CAMBRA History: In the early 2000’s, the disease model of dental caries (cavities) was adopted. A multi-state clinical study enlisting thousands of subjects was headed by Dr. John Featherstone from the University of California, San Francisco. The study tested a combination of known caries prevention strategies and treatment protocols. Once all the data was collected and analyzed it was clear that using the program was beneficial; a greater than 30% reduction in cavities was seen in High Cavity Risk individuals as compared to those receiving standard dental restorative and preventative care. By 2006 CAMBRA had become an accepted clinical tool for dentists and has been endorsed by every major dental organization both nationally and internationally. Further independent studies have validated CAMBRA and has become the premier evidence-based protocol for managing dental caries in both adults and children. Below you’ll find a detailed description and answers to frequently asked questions. For more information please visit https://dentistry.ucsf.edu/research/cambra
CAMBRA Protocol: The CAMBRA system starts with gathering important patient information such as the quality of oral hygiene practices, use of fluorides at home, dietary routines of the child, medical conditions, and medication usage and more. After necessary radiographs and dental examination has been completed, the risk assessment data is compiled, a risk level assigned and reviewed with the parent (and child if age appropriate). Detailed personalized recommendations and guidance is given and adjunctive preventative therapies offered depending on patient need and risk level. Oral health counseling and instruction is provided. Lastly, “Self management goals” are reviewed and chosen by the parent (or patient). All information gathered is documented and tracked until the next visit where the process will be repeated and assessment on improvements on goals will be reevaluated, reviewed and reinforced.
Why is there a fee for these services and why doesn’t my insurance cover it? Even though the CAMBRA model has been scientifically proven to significantly reduce cavity rates in children and adults, and has been adopted by all major dental organizations (ADA, CDA, AAPD, etc), unfortunately, to date no private dental insurances reimburse for these services. (NOTE: public programs such as Denti-CAL (Medi-Cal/Medicaid) have been paying for CAMBRA for > 5 years). A nominal fee is charged for our extra time, supplies and expertise involved in the delivery of this program. All children and their families benefit from the addition of CAMBRA preventative services, especially those who suffer from cavities or are at high cavity risk. With our main goal to minimize or eliminate cavities in all children, providing CAMBRA preventative services is the best method we have to help make this a reality. Because CAMBRA is the basis for all the preventative services we provide, there is no way to parcel, eliminate or “opt out” of select pieces of this program. If you have further questions about CAMBRA or the value of this service please speak with one of my team members or ask to speak with the office manager.
New Patient Visit
Until recently dentistry has been mostly a “reactive” health service. For centuries it has been accepted by dentists, medical doctors and scientists that cavities were unavoidable and “just a part of life.” Since recorded history, dentists were at the mercy of the cavity process and their main task was the repair or removal of broken down teeth. It was widely accepted that even “fixed” cavities would come back or new ones would form over time. Tooth destruction and the repair cycle continued until ultimate failure and tooth removal was necessary. Most dental patients followed the same trajectory; cavities, dental pain and infection, repair, failure, root canal treatments, crowns, loss of teeth and eventual need for partial or full dentures.
Dental quality of life for our recent ancestors was poor (read about George Washington). Death from dental infection was common until antibiotics were developed in the 1930’s. Eating was difficult or outright painful with a mouth full of infection, ulcers, missing or broken down teeth. Most people would have to endure years of uncomfortable or painful dental procedures throughout their lives until most or all teeth were removed. This cycle was the accepted “norm” which persisted until only a few decades ago when scientists began to fully understand the oral bacterial disease process of dental cavities and advancements in therapies for prevention and treatments for cavities became available.
What are cavities? What causes them? Can they be avoided? Is there a genetic cause? Dental cavities are simply “holes” in a tooth. These holes are caused by acids produced from certain bacteria found in our mouths. These acids leach minerals from the teeth, ultimately breaking down the tooth structure causing cavities. These particular bacteria produce acids and a sticky film (plaque) any time they get access to sugars or carbohydrates from our diet. The main (bad) bacteria are streptococcus mutans & lactobacilli. They are acquired after birth and become part of a stable oral bacterial ecosystem for life. Cavities are a symptom of an imbalance between our natural defenses and bacterial attack. We call this imbalance a disease state.
There are a few direct genetic dental conditions that are known to be passed from parent to child which directly increase caries risk. These are rare occurrences and are usually connected with some type of syndrome or heritable condition. However, many physical characteristics are passed from one or both of their parents. Parental traits such as dental crowding, teeth size, jaw size, or other dental or skeletal conditions may be passed from parent to child and can increase caries risk. However, by far the most common parental influence on cavities is the inoculation or passing of oral bacteria (which is unavoidable) and family oral hygiene and dietary behaviors.
So what is the big deal with getting a cavity in baby teeth? They lose them right? The dental decay (caries) process causes mineral loss and tooth destruction over time. Loss of tooth structure can lead to pain or infection in the nerve and blood supply of the tooth (pulp) or jaw. Large cavities necessitate the need for invasive dental treatment (fillings/pulpotomies/crowns) or if left unchecked, complete loss of tooth (extractions) if the tooth is no longer restorable. Cavities, loss of teeth and dental function is a big problem in both the primary (baby teeth) and the permanent dentition. Tooth destruction and loss can significantly decrease quality of life for those individuals which include pain, discomfort, chronic infection, financial burden, aesthetic concerns and lowered self esteem.
The 2000 U.S. Surgeon General's report found in children aged 0-5 years dental caries is the most common preventable disease, six times more common than asthma. Studies have shown that children who have cavities in the primary dentition (baby teeth) develop more cavities in their permanent dentition as compared to their cavity free peers. These same children missed more days of school due to pain, infection, and need for dental treatment. Chronic dental pain in children was found to show a correlation with learning delays and lower academic achievement. Early loss of primary teeth due to cavities led to eating difficulties as well as dental developmental issues requiring more use of orthodontics. Parents of children with cavities were also found to experience extra financial burden stemming from lost time from work, travel expenses and added costs for the dental care itself.
It is important to realize that all eight primary back teeth do not “fall out” or get replaced until around the age of 9 to 13 years, or later in some individuals. The ages 6-12 years old are called the “mixed dentition” stage because there are both permanent and primary teeth in the mouth. Those children who develop cavities in their primary teeth also develop cavities in their permanent teeth during this stage (see above).
Hasn’t anyone developed a “cure” for cavities yet? Well…. Not exactly. It wasn’t until the early 1950’s that the true preventative benefits of fluorides were fully realized. Dramatic decreases in cavity rates were seen by the 1960’s and 1970’s due its wide promotion and adoption. By the 1990’s the infectious bacterial disease model of dental cavities was established which has helped researchers and dentists to develop new protocols, therapies and strategies to help patients avoid developing cavities over the next decades.
As of 2023 we do not have a simple “cure” for cavities. However, we do have a good handle on how the caries process works, what biological factors play the biggest role, information and therapies which can greatly reduce cavity incidence. Scientists are currently looking into topics such as development of an anti-cavity vaccine, altering DNA of select bad bacteria causing a change in their metabolism, and manipulating good bacteria that will out compete the bad bacteria. Only time will tell if we can totally eradicate cavities through science but, as our knowledge of the complex oral biologic cavity process increases, research and technology continues moving forward, the chances of finding a simple and absolute cure for cavities in teeth soon is promising.
Until then, implementation of programs such as CAMBRA, which utilizes evaluation, education, behavioral guidance along with adjective chemotherapeutic therapies such as Xylitol, Silver Diamine Fluoride (SDF), Calcium Phosphates, Hydroxyapatite, Chlorhexidine and other therapeutics are the best options we have at preventing cavity development and/or progression.
In conclusion, the most effective option we have for dealing with dental cavities is to avoid them from forming in the first place. Luckily, current dentistry has the scientifically backed information and therapies needed to aid parents in attaining this goal. With the application of CAMBRA protocols; the reduction or elimination of cavities through assessment, education, motivation and through evidence-based therapies can put your child on a trajectory of possibly never experiencing a cavity in their lifetime.
If you would like more information about any of the topics discussed, please feel free to ask any one of my staff members for clarification or guidance during your visit.