UCSF Study Demonstrates CAMBRA Predicts Future Patient Outcomes

A study published this month in JDR by researchers from UCSF demonstrates the importance of CAMBRA and Caries Risk Assessment protocols for predicting the future of tooth decay in patients. In a recent press release about the findings, researcher B.W. Chaffee stated:

“Risk assessment is predictive – it tells you what kinds of outcomes are going to occur in a patient population… Together with other studies, our work has shown that providers are willing and able to use CAMBRA accurately, that it doesn’t take a lot of time to do it, and that it is effective.”

 

The findings of the study reinforce the importance of implementing CAMBRA protocols in office. Chaffee goes on: “CAMBRA has the potential to fundamentally change dentistry, but it won’t happen overnight, Chaffee said. “The traditional approach to dental caries for the last 100 years has been when a dentist sees a cavity to fill it and restore the tooth’s function, and that’s a critical aspect of what dentists should be doing,” Chaffee explained. “But in and of itself, this approach doesn’t do anything to prevent the disease from occurring again. It treats the symptom – the consequences of disease – but it doesn’t get after the causes of the disease.”

 

For further information we have included the study abstract below. Find the full study here.

 

Caries Risk Assessment Item Importance- Risk Designation and Caries Status in Children under Age 6, B.W. Chaffee, J.D.B. Featherstone, S.A. Gansky, J. Cheng, L. Zhan

1. Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA

2. Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA

B.W. Chaffee, Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California St., Suite 495, Box 1361, San Francisco, CA 94143, USA. Email: benjamin.chaffee@ucsf.edu

Abstract

Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children younger than 6 y. The objective of this study was to assess the relative importance of pediatric CRA items in dental providers’ decision making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally. CRA information was abstracted retrospectively from electronic patient records of children initially aged 6 to 72 mo at a university pediatric dentistry clinic (n = 3,810 baseline; n = 1,315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay. Thirteen individual CRA items, including all clinical indicators and all but 1 risk indicator, were independently and statistically significantly associated with student/resident providers’ caries risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%) to moderate (30.6%) to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment, 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and 1 risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor. In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers’ risk determination than with future caries status. These university dental providers considered many items in decision making regarding patient risk, suggesting that, in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management.

 

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