Dental caries: an updated medical model of risk assessment.

Dental caries is a transmissible, complex biofilm disease that creates prolonged periods of low pH in the mouth, resulting in a net mineral loss from the teeth. Historically, the disease model for dental caries consisted of mutans streptococci and Lactobacillus species, and the dental profession focused on restoring the lesions/damage from the disease by using a surgical model. The current recommendation is to implement a risk-assessment-based medical model called CAMBRA (caries management by risk assessment) to diagnose and treat dental caries. Unfortunately, many of the suggestions of CAMBRA have been overly complicated and confusing for clinicians. The risk of caries, however, is usually related to just a few common factors, and these factors result in common patterns of disease. This article examines the biofilm model of dental caries, identifies the common disease patterns, and discusses their targeted therapeutic strategies to make CAMBRA more easily adaptable for the privately practicing professional.

Reconsidering remineralization strategies to include nanoparticle hydroxyapatite.

Dental caries is a transmissible biofilm-mediated disease of the teeth that is defined by prolonged periods of low pH resulting in net mineral loss from the teeth. Hydroxyapatite, fluorapatite, and the carbonated forms of calcium phosphate form the main mineral content of dental hard tissues: enamel, dentin, and cementum. Active dental caries results when the biofilm pH on the tooth surface drops below the dissolution threshold for hydroxyapatite and fluorapatite. The clinical evidence of this net mineral loss is porosity, whitespot lesions, caries lesions, and/or cavitation. The potential to reverse this mineral loss through remineralization has been well documented, although previous remineralization strategies for dental hard tissues have focused on the use of fluorides and forms of calcium phosphate. This in-vitro study documented the deposition of nanoparticle hydroxyapatite on demineralized enamel surfaces after treatment with an experimental remineralization gel. This finding supports consideration of an additional approach to remineralization that includes pH neutralization strategies and nanoparticle hydroxyapatite crystals.

New directions in the etiology of dental caries disease.

This review explores the multifactorial etiology of dental caries disease. Current theories suggest that a singular focus on mutans streptococci and lactobacillus as the sole causative microbiological agents is no longer a viable strategy in treatment of this prevalent disease. Dental caries is an infectious transmissible disease process where a cariogenic biofilm in the presence of an oral status that is more pathological than protective leads to the demineralization of dental hard tissue.

Changing the face and practice of dentistry: a 10-year plan.

Jan. 7 through 9, 2011, the California Dental Association Foundation hosted a symposium on caries management by risk assessment in which a diverse range of stakeholders from across the nation gathered to discuss current and future status of CAMBRA. The consensus of the group was to develop a national strategic plan for CAMBRA implementation which will chart the course to improve the standard in caries disease management within the next decade. This paper represents the initial start of this living document.

A clinician's guide to CAMBRA: a simple approach.

Caries risk assessment identifies those factors that are pathologic and suggests ways an astute clinician can implement protective strategies that can prevent progression and/or return the patient to health. Caries management by risk assessment (CAMBRA) focuses on treating and preventing the cause of the disease at an early stage, rather than waiting until it causes damage to tooth structure. This article summarizes and simplifies information previously published about CAMBRA implementation from the perspective of today's practicing clinician. The most recent science on prevention, remineralization, antimicrobials, and pH, as well as the use of fluoride, xylitol, and casein phosphopeptide-amorphous calcium phosphate (CCP-ACP) is also discussed.

How to integrate CAMBRA into private practice.

The traditional dentistry approach treated the disease with a limited surgical strategy aimed at removing carious lesions on teeth. Today, the dental profession is refocusing its efforts to include risk assessment with evidence-based diagnosis while also treating the biofilm component of the disease. While there is compelling science to support CAMBRA, there are fewer articles with practical direction regarding how to integrate CAMBRA diagnostics and treatment into clinical practice, which this article addresses.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.