CAMBRA System

The CAMBRA (Caries Management by Risk Assessment) system is an evidence-based framework designed to prevent, arrest, or reverse dental caries by addressing the full disease process.^2,4 CAMBRA uses a "caries balance" approach, evaluating both disease-promoting factors (the “bad”) and protective factors (the “good”) in order to define a patient’s risk level and guide individualized care.

The CAMBRA system provides a more in-depth assessment tool as a key element of the overall approach and takes account of:

• Caries disease indicators: Includes Socio-economic status, developmental conditions, and the presence of lesions, restorations or extractions due to decay within the previous 3 years.

• Caries risk factors: Includes visible plaque, frequent sugar intake, low salivary flow or medications affecting saliva, complex tooth morphology, exposed root surfaces, and use of orthodontic appliances or removable prostheses.⁴

• Caries protective factors: Includes use of fluoride (systemic and topical) and adequate salivary function .

• Clinical examination findings: Includes observation of white spot lesions, demineralization areas, restorations, and plaque accumulation

After evaluating these categories, CAMBRA assigns a risk level of low, moderate, high, or extreme and provides tailored recommendations. There are age-specific versions for children aged 0-5 years and for individuals aged 6 years and older.

CAMBRA’s comprehensive, evidence-based design encourages both clinicians and patients (or their caregivers) to focus on disease etiology rather than solely on repair. It guides personalized preventive strategies, fosters shared decision-making, and enhances communication within the dental team.^4,25 The approach is supported by clinical outcomes data demonstrating reduced caries incidence and improved patient engagement.^5,30