Practical implementation of caries disease management in the era of CAMBRA: a guide for the general dentist.

Abstract

Although the philosophy of caries management by risk assessment (CAMBRA) is widely accepted as an essential part of comprehensive disease management, its implementation in daily clinical practice has historically been hindered by a lack of concise guidance that bridges the gap between scholarly research and the logistics of patient care. With the aim of guiding comprehensive disease management for dental caries by integrating available evidence-based systems such as the American Dental Association Caries Classification System (ADA CCS) and caries risk assessment (CRA), this review presents clinical strategies in a functional format. Clinical caries management strategies that integrate the ADA CCS with CRA were compiled and evaluated by clinicians representing a variety of practice settings. Examples of clinical protocols were selected to illustrate the use of CRA at the patient level and ADA CCS lesion classification at the tooth level to comprehensively manage caries lesions in a high-caries-risk population. Comprehensive caries management combines the clinical use of CRA and caries lesion classification to guide clinical decisions and to support tooth preservation in high-risk populations. These strategies should be individualized and fulfill evidence-based clinical practice criteria with oral health as the primary outcome. Person-centered comprehensive caries management integrating CRA and classification of caries lesions has the potential to improve patient outcomes by addressing the underlying causes of caries disease. Documenting and measuring the processes at the tooth, patient, and practice levels are essential for generating outcomes that will drive future approaches aimed at improving patient health.