About 96% of American adults develop cavities at some point. But if we want to help stop those cavities from turning into infected teeth or lost teeth, it’s important to understand how high your personal risk may be. We provide a cavity risk quiz on our site to help you understand your risk, and there are professional versions used by dentists, too. These tests are called cavity risk assessments (CRA) that form the basis of what is known as caries management by risk assessment (CAMBRA), a supposedly scientific approach to treating cavities through adjustable preventive dentistry. The only problem is that until recently we haven’t had good scientific evidence to support this approach. But some recent studies tell us that it actually does work.
What Is CAMBRA?
CAMBRA is an approach to dental care. By evaluating your cavity risk, a dentist can understand how much prevention you might need to protect you from cavities. Your dentist will get a good sense of whether they should recommend a mouth rinse, for example, or antibiotic preventive treatments. Cavity risk is assessed using a CRA, which is typically made up of three types of questions: clinical indicators, biological indicators, and protective indicators.
Clinical indicators are things that your dentist can see when they look in your mouth or at your chart. The most serious clinical indicator is whether you have had tooth decay in the past three years. We actually include two questions on this indicator: one about cavities and another about tooth loss to cavities in the past three years. We also ask about exposed root surfaces because exposed root surfaces are more vulnerable to cavities and may need more preventive care.
Despite their name, biological indicators aren’t all strictly biological. Instead, they are a mixture of genetic risk factors and behavioral or cultural factors that can significantly contribute to your cavity risk. In our questionnaire, biological factors we ask about are snacking on sugary foods, conditions that can impact your ability to care for your teeth, dry mouth, bulimia, and drug or alcohol abuse. Some CRAs may also include saliva flow and the structure of your teeth (pits and fissures).
Protective factors can reduce your risk of cavities. The biggest protective factor is brushing with fluoride toothpaste, so we ask about that. We also ask whether you have a regular dentist. Having a relationship with a regular dentist makes it more likely that you will get preventive care.
New Studies Show Effectiveness of CAMBRA
CAMBRA has garnered a significant amount of interest from dentists who want to improve their ability to prevent dental decay. However, as we said, there wasn’t a lot of scientific support for its effectiveness. But more recent studies have shown that it can actually work.
A study published earlier in the year showed that several CRA factors were associated with cavity risk. The factor associated with the highest risk was the need for restorations in the previous three years, which was associated with a cavity risk 7.31 times higher than average. The presence of Streptococcus mutans–which can be detected using a genetic test of your saliva–was associated with a 7.15 times higher risk of cavities. The presence of heavy visible plaque was associated with a 5.54 times higher risk of cavities.
Then a new study just published in July showed that all clinical and biological risk factors in their shorter, 17-point CRA were associated with elevated cavity risk. Statistical analysis narrowed the relevant risks down to four:
- Visible decay on teeth
- Visible plaque
- Cavities in previous three years
- Frequent snacking
Overall, though, the past level of decay was the strongest predictor of future decay.
Take Our Assessment and See a Dentist
Do you want to get an idea about your cavity risk? Our online assessment can give you a basic idea about your cavity risk, but the best way to really know your risk level is to talk to a dentist.