by Dr. V Kim Kutsch

This article outlines 10 Tips for CAMBRA Beginners, which is especially helpful if you are just starting out. Here are ten more things you should now in getting your CAMBRA program started!

1. You should include other fluoride products (on top of a varnish) in your treatment plan. I suggest adding fluoride tooth paste, rinse or gels as appropriate for your patient’s individual needs.
2. Antimicrobial agents provide a bacterial load reduction and give the commensal bacterial an opportunity to re-establish control of the biofilm. Chlorhexidine has been a standard anti-microbial agent, although it has little effect on Lactobacillus. Sodium hypochlorite in an oral rinse works as a rapid broad spectrum antimicrobial agent.
3. Xylitol, a 5-carbon naturally occurring sugar alcohol, is a proven anti-caries agent. The cariogenic bacteria ingest the xylitol but cannot metabolize it. This leads to expending energy to expel it from their cells. Xylitol is known to potentiate even small amounts of fluoride.
4. Frequently use products that neutralize the biofilm in order to correct the pH dysfunction. This drives remineralization and also selects for healthy commensal bacteria in the biofilm.
5. Frequent snacking results in periods of low pH, contributing to dental caries dysfunction of the biofilm. Counseling patients to eat larger meals can help lessen the pH dysfunction.
6. Many risk factors cannot be modified by counseling. Patients on multiple medications often experience medication induced xerostomia, and the low saliva flow reduces their ability to neutralize their mouth following eating, increasing their dental caries risk.
7. Saliva is already supersaturated with calcium phosphate in the form of nanoparticles of hydroxyapatite and fluorapatite (as well as some lower levels of tri-calcium phosphate, octa-calcium phosphate, and brushite), but the xerostomic patient doesn’t have enough saliva to begin with, so it makes sense to add a form of calcium phosphate supplement to their oral hygiene regimen.
8. The addition of probiotics is gaining popularity, however many of the probiotic bacteria being used are aciduric. But, this approach may have anti-caries potential in the future.
9. It is important to keep the treatment regimen simple for the patient. They need to be able to easily implement the behavioral changes and oral care products. A complicated regimen will result in confusion, overwhelming feelings and end in non-compliance and failure. Keep it simple.
10. For at risk caries patients, it is important to provide re-care appointments at 3 month intervals to re-evaluate them and provide ongoing counseling and supportive care to create a healthy smile, and keep them cavity free for life.