UCSF

Purpose: To evaluate the effectiveness of a modified Caries Management by Risk Assessment (CAMBRA) model in a clinical trial amongst children between the ages of 5-9 years old, treated in a school-based community pediatric dental clinic setting.

Methods: In a one-year, randomized clinical trial, 66 children between the ages of 5-9 years old were randomized into control or intervention groups. The control group received conventional treatment, including exam, prophy, caries risk assessment and fluoride varnish at baseline, 6 months, and one year follow up. The intervention group, in addition to receiving conventional treatment, also received CAMBRA, if considered high caries risk, which consisted of additional fluoride treatments at 3 and 9 months as well as daily xylitol mint consumption. Saliva samples for mutans streptococci (MS) and lactobacilli (LB) enumerations (CFU/ml) and dmfs/DMFS scores were collected from each subject at baseline and one year examinations.

Results: Of the 66 participants, 60 subjects completed the study. At baseline there was no statistical differences in subject demographics, MS and LB levels, along with DMFS/dmfs scores between the two groups. At six months and one year, there were no statistically significant differences in logMS and logLB levels between the two groups (Student t- test p>0.05). Also, at one year, we did not find any significant difference in the change of decayed surfaces (DS/ds), smooth surface decay (SS-DS/ds) and overall decayed surfaces (DMFS/dmfs) between the intervention and the control groups (Student t-test, P>0.05). Although the difference is not statistically significant, the change of dental caries at one year in the intervention group displayed a consistent decrease in all scores compared to a consistent increase in the control group with a borderline statistically significant difference in SS-DS/ds (Student t- test, P=0.06). The caries risk assessment tools reviewed the oral habits of the children, such as oral hygiene and diet. An increase in tooth brushing frequency was reported from both control and intervention groups, with a decrease in snacking frequency per day. Although neither was statistically significant, it presents a positive trend towards a reduction of risk factors along with an increase in protective factors for both groups.

Conclusions: Although the modified CAMBRA intervention in children did not significantly reduce MS levels or change DMFS/dmfs scores, it did show positive trends towards reducing caries, especially on smooth surfaces. It has also shown decreased lactobacillus levels in children ages 5-9 years old. Due to limitations within the study, we were unable to recruit a sufficient number of subjects to meet the sample-size calculation. Future studies with sufficient number of subjects is needed to validate the success and positive benefits of the modified CAMBRA protocol in young children.