Stronger together. Diverse dentists weigh in on racism and its impact on oral health in our communities.

OBJECTIVES: 1) To detail how racism and its intersection with the social determinants of health affect the oral health of Blacks or African Americans (B/AA), Hispanics or LatinX (H/L), and American Indians and Alaska Natives (AI/AN) as well as their ability to thrive and succeed in dental academic and professional settings; 2) to describe how the Diverse Dental Society is addressing the oral health of these ethnic/racial populations METHODS: The processes in which 1) structural (systemic) and cultural racism operate in the living and working environments of B/AA, H//L, and AI/AN to impact oral health outcomes and 2) B/AA, HL, and AI/AN oral health organizational leaders are collectively addressing the oral health effects of racism are examined RESULTS: Structural racism and cultural racism and their intersection with the social determinants of health adversely affect the oral health of B/AA, H/L, and AI/AN as well as their ability to thrive and succeed in dental academic and professional settings. CONCLUSIONS: The leaders of the Hispanic Dental Association, National Dental Association, and the Society of American Indian Dentists realize that it will take collective action under the auspices of the Diverse Dental Society to synergize their organizations' individual efforts to create systemic change to address racial and health inequities and improve oral health outcomes.

A Comparison of Four Caries Risk Assessment Methods.

Introduction: Caries risk assessment (CRA) is essential as the basis for successful management of dental caries. Of the many published CRA tools, four well-known ones are CAMBRA, Cariogram, American Dental Association (ADA), and American Academy of Pediatric Dentistry (AAPD) CRAs. The predictive accuracy of CAMBRA and Cariogram CRA tools have been examined in clinical outcomes studies in thousands of patients and the tools are widely used all over the world. The purpose of the present paper is three-fold, namely (1) to briefly review, compare and contrast these four CRA methods, (2) to provide a concise method for CRA introducing a quantitative component to the CAMBRA forms (CAMBRA 123), and (3) to guide the choice of CRA methods that will support caries management decisions. Comparison of Caries Risk Assessment Methods: In the present evaluation, the above-mentioned four CRA methods for ages 0-6 years and 6 years-adult were compared using 26 hypothetical patients (13 per age group). Comparison results show that Cariogram and CAMBRA categorized patients into identical risk categories. Each of the ADA and AAPD tools gave different results than CAMBRA and Cariogram in several comparison examples. CAMBRA 123 gave the same caries risk level results as the Cariogram and the CAMBRA methods for all hypothetical patients for both age groups. Conclusions: Both the Cariogram and the CAMBRA CRA methods are equally useful for identifying the future risk of dental caries. CAMBRA 123 shows promise as an easy-to-use quantitative method for CRA in clinical practice. The health care providers will be the ones to decide which CRA method will allow them to establish individualized, successful caries management therapies and how to combine these for the best care of their patients.

Evidence-Based Caries Management for All Ages-Practical Guidelines.

Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0-6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level. Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0-6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals. Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.

Who will tend the dental safety net?

The dental safety net relates to the sites, providers, programs and payer sources that are available to low-income people in households with incomes less than three times the federal poverty level. Thirty percent of the population of California depends upon the health care safety net. Proposed solutions to meeting the safety net's dental needs challenge conventional thinking about who is responsible for providing oral health care and what safety net groups gain improved access.