OCTOBER CAMBRA Clinical Protocols Journal Products - Caries risk assessment Douglas A. Young, DDS, MS, MBA; John D.B. Featherstone, MSc, PhD; and Jon R. Roth, MS, CAE CDA Journal Volume 35, Number 10 Journal october 2007 departments 665 The Editor/Health Illiteracy 667 Letters to the Editor 671 Impressions 754 Dr. Bob/Dental Spa-ahhhhh features 679 CARIES MANAGEMENT BY RISK ASSESSMENT — A PRACtitioner’S GUIDE An introduction to the issue. Douglas A. Young, DDS, MS, MBA; John D.B. Featherstone, MSc, PhD; and Jon R. Roth, MS, CAE 681 CURING THE SILENT EPIDEMIC: CARIES MANAGEMENT IN the 21sT CENTURY AND BEYOND This paper will present key concepts necessary for the most current management of dental caries and sets the stage for subsequent papers in this issue to cover the clinical implementation of a caries management by risk assessment model (CAMBRA). Douglas A. Young, DDS, MS, MBA; John D.B. Featherstone, MSc, PhD; and Jon R. Roth, MS, CAE 687 CARIES RISK ASSESSMENT APPROPRIATE FOR THE Age 1 VISIT (INFANTS AND Toddlers) The latest maternal and child Caries Management By Risk Assessment tools for children age 0 to 5 (CAMBRA 0-5), developed for oral health promotion and disease prevention starting with the recommended age 1 dental visit is presented in this paper. Francisco J. Ramos-Gomez, DDS, MS, MPH; James Crall, DDS, ScD; Stuart A. Gansky, DrPH; Rebecca L. Slayton, DDS, PhD; and John D.B. Featherstone, MSc, PhD 703 CARIES RISK ASSESSMENT IN PRACTICE FOR Age 6 THROUGH ADULT A practical caries risk assessment procedure and form for patients age 6 through adult are presented. The content of the form and the procedures have been validated by outcomes research after several years of experience using the factors and indicators that are included. John D.B. Featherstone, MSc, PhD; Sophie Domejean-Orliaguet, DDS; Larry Jenson, DDS, MA; Mark Wolff, DDS, PhD; and Douglas A. Young, DDS, MS, MBA 714 CLINICAL PROTOCOLS FOR CARIES MANAGEMENT BY RISK ASSESSMENT This article seeks to provide a practical, everyday clinical guide for managing dental caries based upon risk group assessment. Also included are some sample treatment plans to help practitioners visualize how CAMBRA may impact a patient’s treatment. Larry Jenson, DDS, MA; Alan W. Budenz, MS, DDS, MBA; John D.B. Featherstone, MSc, PhD; Francisco J. Ramos-Gomez, DDS, MS, MPH; Vladimir W. Spolsky, DMD, MPH; and Douglas A. Young, DDS, MS, MBA 724 PRODUCTS: OLD, NEW, AND EMERGING The purpose of this review is to present the evidence base for current products and those that have recently appeared on the market. Vladimir W. Spolsky, DMD, MPH; Brian Black, DDS; and Larry Jenson, DDS, MS Editor CDA JOURNAL, VOL 35, N 1 0 º Health Illiteracy ALAN L. FELSENFELD, DDS uch has been written about health literacy in recent The promontora programs are an example of months. The October 2006 issue of the Journal of Ameri- attempts to overcome the difficulty of health can Dental Association had an Meditorial by Dr. Michael Glick supporting literacy in selected populations. efforts to alleviate the increasing amount of health illiteracy. That same year, the American Dental Association established a committee to study the problem and access to health care. These are people their ability to communicate with their report back to the 2007 House of Del- who may have substantial difficulty in the patients and ensure a depth of under- egates. The committee was charged to comprehension of health care concepts, standing. Providers need to understand assist the Council on Access, Prevention a lack of individuals to attempt to teach cultural values and systems for their and Interpersonal Relations in developing them, or language barriers. As a result, potential patient populations. Social programs and identifying approaches to there is likely to be a less aggressive use mores and beliefs need to be addressed enabling this all-important concept. The of available facilities and personnel for in the planning for health care programs Association took a good approach to the health care or lack of adequate preventive and delivery. We need to update ourselves problem, not so much in the establish- practices on their part. The promontora continually on techniques that enable us ment of a group to look at the problem programs are an example of attempts to to relate to our patients who have cultural but rather their charge relative to the overcome the difficulty of health literacy differences to be effective in educating definition of the issue. in selected populations by using local them on health matters. The American Illiteracy can be viewed at three levels. community health care workers to edu- Dental Association has charged the Coun- For some, there is difficulty in compre- cate the masses. Caregivers for the elderly cil on Dental Education and Licensure to hending the necessity of good health or the infirm are another area where encourage development of programs to practices. This level of illiteracy is difficult health literacy can be promoted. Ad- train health care professionals in preven- to overcome in that the individuals may ditional programs such as these need to tive care for patients. not be able to understand the information continue to be developed for future pre- The final level of illiteracy is igno- they are given. For others, there may be vention and treatment of dental, as well rance. The lack of ability to learn in our a lack of education. These are individuals as general health issues. Patients need to patients or lack of education for our who have the capacity to learn but have be educated on the need for proper diet, health care providers, while unfortunate, not been taught or have learned errone- oral hygiene, and utilizing dental profes- is understandable and somewhat excus- ous things. Finally, there is ignorance for sionals and facilities to prevent problems able. Ignorance, the process of ignoring those who are educated and ignore that and treat disease. what is known, is not. The programs for which they have learned. This ignorance is The uneducated groups might include health care at the government level and a blatant disregard of evidence in fact for those who deliver health care. Physi- with private carriers cannot be excused various reasons. cians, nurses, dentists, hygienists, dental for ignoring the people who need health Recipients of outreach programs are assistants, and others certainly have the care at the most basic level. Federal, state, the poor, working poor, undocumented knowledge to inculcate health care values and local programs need to reassess their immigrants, language-challenged citizens, in their patients. Lacking may be cultural priorities for inclusion and reimburse- elderly and those who have limited or no sensitivity and language skills that foster ment for dental and general health care. OCTOBER 2007 665 CDA JOURNAL, VOL 35, N º 1 0 Then, and only then, can we say that we are progressing from illiteracy to literacy. Health literacy is a multilevel issue that has impact in California as well as nationally. It involves patients, provid- ers, and payers. It reflects a meshing of values at all three levels that ultimately will improve the health of the population. This is a significant problem that needs to be addressed if we are to continue to ad- dress prevention of disease in the patient populations who most need it. REFERENCES 1. Glick M, The tower of Babel and health outcomes. J Am Dent Assoc 137(10):1356-8, 2006. Address comments, letters, and questions to the editor at [email protected]. 666 OCTOBER 2007 Letters CDA JOURNAL, VOL 35, N 1 0 º Kudos for the New AHA Endocarditis Prevention Guidelines he Journal of the California scribe them — go away ... ” At some point number of dental procedures for which Dental Association should be in time, I think dentistry needs to make prophylaxis is indicated has also enlarged commended for the excellent the point that we are every bit as much from previous recommendation in this article by Dr. Thomas Pal- “doctors” as they are, and we need to tell select high-risk group. lasch regarding the new AHA our patients what to do based on research The American Academy of Oral Medi- Tendocarditis prevention guidelines. Dr. and not based on what individual medical cine supports these recommendations Pallasch’s analysis of the situation was ex- practitioners tell us what to do. and would like to assist dentists in mak- cellent. But his article begs some needed It is my prediction that it will take ing the transition to the new guidelines issues and questions … years for MDs to stop telling their as smooth as possible. This article then . Knowing that the evidence for patients they need antibiotics prior to is not intended as a substitute for an in- antibiotic prophylaxis was lacking, why dental procedures, in spite of the new depth review of these important changes did we as a profession bow to the medi- AHA recommendations. but an aid in the process of making the cal profession’s demands for something GUY G. GIACOPUZZI, DDS transition to the new regimen. that was truly dangerous for our patients? Lake Arrowhead, Calif. Included are two documents that The needless antibiotic prescribing has should assist in this process. The first is a certainly bred resistant bacteria and summary for posting in one’s office or in generated allergic reactions. We’ve had NO DOUBT a clinical area as a reminder of just what the science to support the “no-antibiot- conditions are now covered, for what ics-necessary” position for a number of the word will procedures, and with what medications. years. Had ADA come up with an official eventually spread This one-page sheet is intended to cue position, I think we could have not only providers in their daily practice.