Are you CAMBRA ready?

April 14, 2014
The evolution of dentistry and how we practice, and even how we are perceived in society today, is shifting as we speak.

By Nancy Dukes, RDH, BS, CBM

The evolution of dentistry and how we practice, and even how we are perceived in society today, is shifting as we speak. We are in the midst of an incredible opportunity to take the way we serve our patients to a new level of preventive care and education. And center stage in this mindset shift is CAMBRA.

Within the last five years, much has been published about CAMBRA. CAMBRA is now taught in 100% of dental schools, yet the adoption of CAMBRA in practices today has been slow. As we transition from a surgical model of drill, fill, and bill toward a medical model that treats the cause of caries, a bacterial infection, we enhance the opportunity for preventive care and to find the true cause of the disease of caries. Making this shift will enable us to educate patients so they can gain a greater understanding of their actual situation and thus make truly wise decisions about their dental care.

What is different now?

In the past, when a patient had caries, we always explored the reasons by asking some standard questions about snacking frequency, sugary foods, home care, etc. We generally made recommendations as to behavior modifications; however, we did not fully utilize the science to diagnose the cause and contributing factors of their disease.

  • In 2006, the ADA created two forms (depending on patient age) that can be downloaded at to help us evaluate patients easily as to their risk for caries.
  • Then in 2009, the ADA Council on Scientific Affairs released a position statement endorsing the use of caries risk assessment as a standard of care.
  • Now in 2014, the ADA has added three CDT codes D0601, D0602, and D0603 (low, moderate, and high risk) for caries risk assessment, because they consider it to be a distinct and separate procedure.

Yes, caries is dental disease … a bacterial infection. We have always known this. What is different now is that we have greater understanding of the science, detection, and treatment options.

What must we do to change?

The first step is to change our thinking about caries as the disease that it is and, therefore, expand our view of what it means to truly treat comprehensively.

  • Our desire is to treat comprehensively, but are we actually doing so?
  • What is standing in our way?

The approach cannot stop with asking questions. Protocols and action plans must be developed to maximize the talents of team members to gain greater patient success. We have the science, the tools, the skills, the ADA coding, and support, so probably lack of time, lack of protocols/systems, lack of team development, and insurance challenges stand in the way.

How can we proceed?

If and when we move forward, how will we practice dentistry differently? Once the decision has been made to move forward, there are further decisions that must be made such as:

  • How will we approach caries differently?
  • What will be our protocols?
  • Who should be evaluated and treated?
  • What products and treatments will we recommend?
  • What barriers will we encounter, and how will we overcome barriers?

With the groundwork laid, an action plan must be formulated. It may look like the following:

  • Educate yourselves and patients.
  • Choose evaluation tools.
  • Develop protocols for evaluation, diagnosis, treatment planning, and treatment.
  • Market your philosophy.


We are well into 2014. The time to take your practice to the next level is now. The CAMBRA philosophy of care where each patient is assessed for his or her unique individual disease indicators, risk factors, and protective factors is critical in taking a truly comprehensive approach to successful dental care. Then and only then have we truly honored the trust our patients place in us.

Nancy Dukes, RDH, BS, CBM, is director of clinical advising for Jameson Management, a comprehensive coaching firm dedicated to increasing productivity and profitability of dental practices while controlling stress through effective management, communication, and clinical skills. For more information about Nancy and the Jameson team of advisors, contact [email protected].

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