I'm here in Utah, having just taken Gordon Christensen's "Annual Update" continuing education course. He is arguably the finest dental educator in the country, if not the world. What makes this course so valuable to me is that Gordon is a practicing dentist just like me, but he also runs an independent testing laboratory that has no tie-in or financial support from any manufacturer. 

Most people would assume that the FDA or some other federal agency tests or regulates the materials that are used in your mouth. Not true. Manufacturers do their own research and in some cases manipulate the testing to get the most favorable results. Once the product is on the market, the real testing happens "in the field" - that is to say, in patients' mouths. This is NOT a good situation. What Gordon Christensen does is perform clinical trials on real people, publish the results, and teach several courses every year to get the word out on what works and what doesn't. I have subscribed to his newsletter for many years and consider it the single most valuable resource to ensure that I am doing the right thing for my patients. 

After taking this year's edition of the course, I feel very good about what we do in the office. We are providing good value for our patients. There will be just a few incremental changes to incorporate improved products and we will consider adding some new technology that has proven benefits, but that's about it.

It's nice that this particular course was given in Utah. My only brother lives in Seattle, so we rarely see each other, but he just bought a ski house in Park City. Consequently, I can get educated, visit the family, and do a little skiing at the same time.

Frustration and Hope - CAMBRA

Life does not seem to have any shortage of frustrations. Getting this blog up and running has been one of them and so, frustration being fresh in my mind, it's a good time to launch into my struggle to deal with one of the ongoing frustrations of my entire dental career. There is a small but significant number of patients who get decay no matter what we seem to do. What's more frustrating, the number seems to be growing. It's becoming more common to find a patient who has had no decay for 30 years begin to get cavities on the roots of teeth and around otherwise serviceable fillings and crowns. Until recently, our only real tool for dealing with this was high-dose fluoride prescription toothpaste. It was a hit or miss proposition.

I recently took a enlightening CE course that gave me reason to hope there is help for this monumentally frustrating problem. It's CAMBRA, short for CAries Management By Risk Assessment. Essentially, it's a way to determine who is at risk for decay, evaluate the risk factors particular to that individual, and prescribe targeted treatment using a combination of approaches.

The latest research tells us that tooth decay is an infectious disease caused by acid-producing bacteria. If the bacteria produce acid and the acid is not neutralized by saliva, sooner or later the teeth begin to dissolve. When we fill a cavity, we are not actually treating the disease of tooth decay. We are treating the RESULT of the disease. What we want to be able to do is treat the disease itself. That's what CAMBRA enables us to do. It gives us a number of ways to reduce the amount of time that acid is in contact with the teeth so that no damage occurs.

The process works like this:

• We determine who is at risk. This involves a visual and xray examination that looks for specific signs of disease much like the exam that we do when you have your teeth cleaned
• We analyze for factors that cause the risk. We might look at dietary habits, sugar consumption, quality and quantity of saliva, etc.
• We test for acid producing bacteria. This is done with a new type of quick, painless saliva test. This test is revolutionary because, for the first time, we can actually measure disease activity. 
• A treatment regimen is designed to minimize risk factors and increase things that will protect against decay. This usually involves some combination of special rinses, neutralizing gels, various types of fluoride treatments, sealants, etc. 
• After 3 months of treatment we repeat the test for acid-producing bacteria. If the levels are reduced we design a maintenance program to keep them that way.

This is a really big deal for us and for you. At last there is hope that we can deal with a process that has defeated our best efforts for years. It's simple, painless and pretty inexpensive. It does require that the patient make some lifestyle changes and use the rinses and gels at home. It also requires us to completely change the way we think about tooth decay and develop a whole new way of seeing. It's a paradigm shift for us and that may be the hardest part of all.