Operative Dentistry - Best Practices
(last modified August 8, 2014)
Patient centered disease prevention and management can occur before there is irreversible damage done to the teeth and can be accomplished via a medical model of disease control called ‘Caries Management by Risk Assessment’ (CAMBRA). The balance between pathologic risk factors, disease indicators (contributing factors) and protective factors can be obtained by the evaluation and management of individual caries risk assessment. These strategies lead to evidence based questionnaires or caries risk assessment forms that help determine individualized caries risk and suggest effective medical non-surgical and minimally invasive surgical treatment options based on that risk. Based on this protocol it is possible to arrest dental caries and remineralize or reverse the caries disease.
In 2001 the NIH Consensus Development of Diagnosis and Management of Dental Caries Throughout Life identified the need to use the following new strategies to: (1) provide more access for those who suffer from the disease; (2) provide improved detection, risk assessment and diagnosis; (3) create and enhance use of methods to arrest or reverse the non-cavitated lesions; and (4) improve surgical management of the cavitated lesions. Our philosophy is to separately evaluate the patients’ caries disease process and the individual caries lesion. By not focusing solely on cavity detection, we better manage the disease – dental caries.
Caries risk assessment (CRA) was established at the University Of Iowa College Of Dentistry in 2003. We consider CRA an essential additional diagnostic tool of the risk factors that provide information if the patient is: (1) at risk of developing new caries lesions; (2) at risk of existing lesions progressing; and (3) for decision making and management of surgical and non-surgical treatments necessary for existing lesions.
The “diagnosis” of dental caries implies an objective determination of where the lesions is at one point in time (site), characterization of the lesion (severity) and professional judgment if the lesion is active or arrested (activity). The individualized caries risk assessment has an important influence not only on the non-surgical or surgical treatment plan decision but on the material choice for the restoration, as well as, the maintenance management for each patient.
- Assess caries risk status of every patient; this is essential to develop a treatment plan
- The risk assessment drives decision around preventive, therapeutic, behavioral and restorative approaches and determines which of the risk factors involved needs modification to correct the imbalance between protective and pathological factors.
- If restoration is needed one should us a minimally invasive approach considering the location (site), depth (severity) and activity of the lesion, as well as, caries risk status.