CAMBRA Caries Risk Assessment and Clinical Decision-Making

The need for a risk assessment has been reported in many domains in dentistry.  Considerable research has been published related to the validation of specific caries risk assessment (CRA) systems but very little is known about how practitioners use a specific system to assign a caries risk level to their patients.  “Objectives: ”, To explore the decision-making in terms of caries risk score assignment when using the validated CAries Management by Risk Assessment (CAMBRA) system.  “Methods: ”, CRA data-collection was done retrospectively using electronic data and paper charts from UCSF pre-doctoral dental clinic patients.  The study population consisted of 12,952 patients aged ≥6 years, who had a baseline-CRA between July 1, 2003 and June 30, 2009.  Multiple Correspondence Analysis (MCA) and Chi-squared Automated Interaction Detector (CHAID) analysis were performed.  “Results: ”, The MCA identified four clusters according to patient characteristics in terms of disease indicators, biological risk factors and protective factors.  For example, Cluster 1 was characterized by restorations during the past three years, appliances, no white-spot lesions on smooth surfaces and no deep pits and fissures (p<0.05).  The range of percentages between the three scores for specific patient profiles illustrated the variability of the caries risk level assignment – in Cluster 1, 8%, 18% and 74% of the patients were respectively placed at low, moderate and high risk.  The CHAID analysis showed that decision-making was mainly based on four factors: presence of cavities or lesions into dentin on radiograph, restorations during the past three years, visible heavy plaque and interproximal enamel lesions.  “Conclusion: ”, The present study shows that CRA decision-making by multiple providers, using the CAMBRA system, relied mostly upon a limited number of disease indicators and biological risk factors.  The decision flow chart obtained by CHAID may lead to a simplified and standardized decision-making process for use in everyday clinical practice.