CAMBRA - PBRN Caries Management By Risk Assessment In A Practice-Based Research Network

The clinical part of the project will prove that CAMBRA principles can successfully be disseminated into everyday dental practices and that by applying the principles of Caries Management by Risk Assessment to subjects in those practices a major reduction in caries can be seen in the intervention group in comparison to the control group. At the end of the two year clinical part performed in the Practice Based Research Network data will show that the positive results of the first CAMBRA study achieved in the university setting at UCSF can also be accomplished in a dental practice setting to the benefit of patients. If CAMBRA can be successfully disseminated into dental practices dental care costs can significantly be reduced.

The overall study objective is to build a Practice Based Research Network (PBRN) and to conduct in this setting a 2-year randomized, controlled, double blind clinical trial to provide clinical evidence that scientifically based caries risk assessment, in conjunction with aggressive preventive measures and conservative restorations will result in dramatically reduced further caries increment. If successful this study performed in a PBRN will provide substantial evidence for changing the practice of caries management. The planned study is a double blind practice-based clinical study. The California Dental Association Foundation will help to select up to 30 participating dentists. Practitioners will perform a Caries Management by Risk Assessment (CAMBRA) evaluation and will instruct and provide treatment suggestions for the study subjects according to the CAMBRA protocol.

The hypothesis to be tested is that caries management based on caries-risk status (low, moderate or high) will significantly reduce the need for caries restorative treatment over two (plus) years compared to usual dental treatment in the practice based setting. The primary outcome measure will be caries increment.

At the end of the two year clinical part performed in the Practice Based Research Network data will show that the positive results of the first CAMBRA study achieved in the university setting at UCSF can also be accomplished in a dental practice setting to the benefit of patients. If CAMBRA can be successfully implemented into dental practices in the future dental care costs can significantly be reduced.

Inclusion criteria

• These criteria will not be based on race or gender.
• Participants will be new patients and must:
• be at least 12 years old and not older than 65 years
• be able to give informed consent in English
• be unlikely to move from the area during the study period (as determined by residential history and questioning, and be unlikely to move in the next 2.5 years for work, educational, or personal reasons.)
• be willing to participate regardless of group assignment
• be willing to comply with all study procedures and protocol
• be dentate with at least sixteen teeth
• will have all treatment needs for caries completed within three months of entry into the study

Exclusion criteria

• People who want to limit radiation exposure from dental radiographs
• Persons with:
• significant past or current medical problem history especially conditions that may affect oral health or oral flora (i.e., diabetes, HIV, heart conditions that require antibiotic prophylaxis)
• medication use that may affect the oral flora or salivary flow (e.g., antibiotic use in the past three months, drugs associated with dry mouth/xerostomia)
• root caries at enrollment (study will focus on coronal caries)
• periodontal disease that requires surgery, chemotherapeutic agents, or frequent prophys
• another household member participating in the study (to prevent sharing F, CHX rinses, etc.)
• drug or alcohol addiction, or other conditions that may decrease the likelihood of adhering to study protocol
• missed screening visit without cancellation or rescheduling
• rescheduled screening visit more than once
• subjects with extreme high caries risk
• sensitive to Chlorhexidine or the ethyl alcohol vehicle in CHX