“Brushing More” is Not the Cure

Barbara Tritz
· April 7, 2014 ·

5 minutes

CAMBRA stands for “Caries Management by Risk Assessment.”   The term caries is what the dental profession calls tooth decay or cavities.

Having said all that, what does CAMBRA mean? 

Just like your family physician assesses your risk of a heart attack by looking at your cholesterol, blood work, age, dietary habits etc., so too can we in the dental field look at risk factors that can lead to tooth decay, and thus prevention of tooth decay.   Do you remember from the last blog post that tooth decay is caused by bacteria, carbohydrates, an acidic environment, poor oral hygiene, and lack of good saliva?  This combination creates a “perfect storm” for the bacteria to cause cavitationor a cavity.   CAMBRA looks at each of these risk factors individually to see where the weak link might be, and encourages change in your mouth’s environment to help you prevent future decay.  
Let’s look at each risk factor:


The technicalities: the two main bacteria present in decay are called Streptococcal mutans and Lactobacillus, but there may be up to 40 or more other bacteria that also may contribute to decay.  Recent research has shown that the fungus Candida albicans also plays a role in aggressive early childhood caries (ECC).  (We’ll go into ECC in another post so stay tuned!)   C. albicans combines with S.mutans to create an environment that grows not just plaque, but extra sticky plaque.
Simply: Two different bacteria can combine and make extra sticky plaque.  Extra sticky plaque is harder to get off, and leads to too much plaque.  Too much plaque equals high bacteria counts on your teeth.  How can you tell if you have too much bad bacteria?   If your teeth feel sticky or fuzzy between tooth brushings or if you see plaque on your teeth you may have plaque that is growing (housing bacteria babies) more quickly than usual.
How can your dentist find out if you have these decay bacteria in your mouth?   There are tests that can be performed in your dental office to check for the presence of these baddies.



The technicalities:  There are two main issues with diet; the frequency of eating and the acidic environment that eating creates in the mouth. Every time you eat, your mouth becomes acidic—think of all the fruit, coffee, soda, Altoids, or sour candies you eat.   Decay bacteria love this, and they thrive. 

From Pinterest

Throughout the day, minerals flow in and out of your teeth— that’s normal.  When the environment becomes acidic, the minerals  seep out of your teeth.  Your body works to make the mouth healthy by secreting more saliva.  In a healthy mouth the minerals go back into the teeth when the environment becomes neutral again.  However, when the decay bacteria take over, the saliva can’t get through the plaque so minerals just keep flowing out of your teeth, and decay results. 

Simply:  Frequent snacking and drinking of sugary/acidic items causes this demineralization to occur, because the mouth can’t return itself to a neutral state.

Dry Mouth

Technicalities:  So now you know that you need healthy saliva to help remineralize your teeth.  Your saliva is liquid gold for your mouth—it contains the minerals that you need to have and keep healthy teeth.  Unfortunately, many medications reduce your saliva flow, and some diseases do as well, and people without healthy saliva can have teeth that literally crumble apart.  Research1shows that as much as 46% of the population suffers from dry mouth.  Most people do not know they have it.   Since changing medication may not be an option, we must work around dry mouth issues.  I have many new products and suggestions for combating this and will devote an entire post to it next week.   
Simply: For now, know that good saliva is vitally important.
Really, though, the diagram is pretty good! FunnyJunk.com


Technicalities: We all know how important brushing our teeth is to our oral health.  With the advent of electric brushes and fluoride toothpastes, you’d think that would be enough.  Unfortunately, it’s obviously not since tooth decay is on the rise—a rise of epidemic proportions.  What I see as a dental hygienist is that people do not clean their teeth correctly.  They leave lots of plaque on their teeth, leaving the bacteria homes to poop acid in peace (remember that?).  Research shows2that folks who use a manual toothbrush brush for approximately 40 to 45 seconds, then the toothpaste foams, so they rinse, spit and call it good.  That’s not nearly enough time to get all that sticky plaque off the teeth.  
Simply:  Since plaque is the home of the decay bacteria, it is vital to remove it all, every day.  Ask your hygienist for an honest appraisal of your brushing and flossing skills (she can tell, I promise). 
Other things to look at that can contribute to decay- oral appliances such as retainers, partial dentures or dental bridges (Clean them! Don’t worry, I’ll tell you how in another post.  I’m going to be busy!), tobacco use, acid reflux, diabetes, bulimia, drug use, and head and neck radiation.  
Disease indicators are another area of concern.  Current decay, history of decay, and current white spot lesions (early decay signs) are good predictors of future decay. 
Just telling you to brush and floss more will have no effect if other causes are not addressed—this is part of the ‘risk assessment’ in CAMBRA.  Your dental team can and should be looking at all of these risk factors that may be contributing to tooth decay. 
Your dental professional can work with you to look at your habits, lifestyle and risk potential, and then design a program to help you prevent new cavities.  Everyone with teeth is at some risk of future tooth decay, the best thing you can do is lower that risk.   CAMBRA is the tool to help you achieve that goal!  As the title of today’s blog states- brushing more is not the cure to stop tooth decay.  

from Wikipedia

The Queen of Dental Hygiene’s Dental Pearls of Wisdom

  • Manage tooth decay prevention by looking at the risk factors:  tooth decay needs decay bacteria, carbohydrates, salivary dysfunction, and poor oral hygiene practices.

CAMBRA makes sense–mention it to your dental professional.  If they don’t know what you are talking about- find a dental team that does.  If you need help finding a dental hygienist that practices the CAMBRA philosophy, let me know, I’ll be happy to help you! 

Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing.
                                                                                                ~Mother Teresa

Keep Smiling,

Barbara Tritz

1.  Leo M. Streebny and Arjan Vissink: Dry Mouth, the Malevolent Symptom. 12, fig 1.2.2. Hoboken, NJ: Wiley-Blackwell, 2010
2.   MacGregor, I., Rugg-Gunn, A.: A survey of Toothbrushing Sequence in Children and Young Adults. J of Perio Res 14:225-230, 1979
Other research cited is directly linked to the source, if you have any difficulties finding it, please let me know.

Hello, I'm Barbara Tritz

Unveiling the Stories Behind Dental Hygiene

Loving science, especially biology, from an early age, Barbara is a registered dental hygienist, certified biological hygienist, and orofacial myofunctional therapist. In 2019, she received the Hu-Friedy/ADHA Master Clinician Award from the American Dental Hygienist Association.

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