How to identify a
patient at risk

In order to identify if a patient is at risk for cavities, the dental practitioner must identify if the patient has any risk factors for the disease dental caries. A risk factor is simply something that increases your risk for a disease. For example, smoking is a risk factor for lung cancer. Likewise, many risk factors have been identified for cavities.

The most common methods of identifying risk factors is to have a patient fill out a risk assessment form or have a dental practitioner interview a patient to assess their risk factors. This process of identifying a patient’s risk for dental caries (the bacterial imbalance that causes cavities) is called CAMBRA.

The acronym CAMBRA stands for “CAries Management By Risk Assessment.” CAMBRA is a method used by preventive dental practitioners for assessing caries risk and making dental treatment and restoration recommendations based on a patient’s caries risk.

A simple comparison used to understand CAMBRA methodology is to compare it to a risk assessment for heart disease your physician may perform during a physical examination (See Figure 3).

When assessing risk for heart disease, a physician will perform tests for blood pressure and cholesterol count. Then they will examine and interview for other risk factors such as heredity, age, sex, tobacco usage, alcohol consumption, weight, dietary habits, physical activity level, stress level, and other present disease conditions.

The physician will then make recommendations based on the above risk factors. For example, patients with a low-level risk for heart disease may be good candidates for running a marathon or having any elective cosmetic surgery. On the contrary, patients with a high-level risk for heart disease may not be good candidates for running a marathon or having elective surgery and may require medical intervention such as prescription medications or diet and exercise counseling.

Dental professionals who perform CAMBRA are performing a similar function. Based on risk factors for caries disease, dental professionals will perform tests for oral bacteria levels as well as take x-rays and perform a thorough oral examination. They will then examine disease indicators and risk factors such as current decay condition, current bacterial challenge, decay history, dietary habits, current daily medications, saliva flow, medical conditions, presence of oral appliances or braces, and oral hygiene habits.

Patients at high risk may require medical intervention in the form of prescription/professional oral rinses, gels, gums and sprays.

The dental professional can then make recommendations based on the above risk factors. Patients at high risk may require medical intervention in the form of prescription/professional oral rinses, gels, gums, and sprays. They will also require restoration of any existing tooth decay. High-risk patients may also receive recommendations to put off elective cosmetic dental procedures, whitening, or orthodontics until risk levels can be decreased. Patients at low risk may receive recommendations for home care preventive oral products, like CTx3 Rinse and CTx3 Gel, to keep risk levels low and will be better candidates for elective cosmetic dental procedures.

Patients who are assessed as high risk are more likely to have failures in expensive dental work due to recurrent decay. The challenge for dental professionals is that the patients who have the highest need for restorative care also come with the highest risk for restoration failure. Studies have shown that high/extreme-risk patients have an 88% chance of new decay within the next 12 months.[1] The dental professional performing CAMBRA will include treating the cavity-causing bacterial infection/imbalance and risk factor recommendations in addition to the restoration treatment plan based on the patient’s specific risk factors to reduce the risk of restoration or cosmetic failure due to recurrent decay.

Many dental journals have been dedicated to the subject of CAMBRA, and CAMBRA methodologies, like heart disease risk assessment, have proven to reduce decay rates in all age groups. The Journal of the California Dental Association dedicated their February and March 2003, October and November 2007, and October and November 2011 journals to CAMBRA.

It is extremely important to mention that having risk factors identified does not mean an individual has current cavities, or that an individual is guaranteed to have cavities in the future. Just as a physician may identify a risk factor for heart disease, it does not mean that a patient is guaranteed to have a heart attack; simply there is a greater risk. Risk factors are identified in order to get a clear picture of what the likelihood is patients may experience dental disease in the future, and to provide practitioners with evidence-based information and the ability to target therapeutic recommendations to each individual patient and decrease their risk of future disease signs and symptoms.


  1. Sophie Domejean, Joel M White, and John D. B. Featherstone, “Validation of the CDA CAMBRA Caries Risk Assessment —A Six-Year Retrospective Study,” J Calif Dent Assoc 39, no. 10 (2011): 709–15.