DentaQuest Institute

The Problem
Dental disease is a bacterial infection in the mouth, and as with other bacterial infections, by treating the causes of the infection, the disease can be effectively controlled. Evidence-based research has shown there are identifiable risk factors associated with the development, severity and progression of the disease – caries (cavities) and gum disease. However, the following barriers have been identified to changing dental care practice to emphasize disease management:

• A gap between what evidence suggests are the most effective and efficient methods to prevent and manage oral disease and what the care delivery system pays for and provides
• Lack of tested tools, protocols and technical assistance to help dental care providers easily integrate EBD concepts into their routine clinical practice
• Little hard data to demonstrate the concrete impact of EBD on the delivery, cost and outcomes of oral health care

The Oral Health Center was founded in 1999, with the goal of building a model dental practice that delivers cost-effective and appropriate dental care using proven, scientific, evidence-based technologies and treatments that are tailored to the unique dental needs of each patient.

What We’re Doing
With the goal of beginning to address these challenges, we launched an initiative in 2008 to improve oral health by applying the key elements of evidence-based dentistry to narrow and close the gaps between what we know and what we practice. These elements include:

• Risk assessment: Helps dental care providers identify, isolate and target the unique health and social factors that contribute to a patient’s oral disease
• Risk-based treatment planning: Provides guidelines for dental care providers in prioritizing prevention and treatment methods that will be most effective based on each patient’s unique circumstances
• Clinical protocols of care: Ensures consistency and comprehensiveness of the prevention and treatment provided to patients with caries and periodontal disease
• Prescription of preventive therapies: Strengthens traditional care by promoting the use of antimicrobial agents that have been proven to prevent, limit and reverse oral disease
• Use of technology to guide clinical decision-making: Reduces provider error and oversight in providing prevention and treatment to patients

The DentaQuest Oral Health Center (OHC) is one of a small number of U.S. dental practices that are making CAMBRA the core of their clinical practices. The acronym CAMBRA stands for “CAries Management By Risk Assessment”. The key difference of CAMBRA-centered practices is the focus on risk-based treatment and patient education.

By combining behavioral and the clinical assessments, OHC dentists are often able to treat the dental or gum disease without drilling. This is more than just preventive care; it’s an entirely new approach that helps patients keep their teeth for life.

To learn more visit www.dentaquestohc.com.

What We’re Finding
“The idea of care by risk assessment is generating interest among dental practices,” explains Dr. Peter Blanchard, President of the DentaQuest Oral Health Center. “I think we’ll see more dentists think about CAMBRA principles to manage dental disease in high–risk individuals, especially children, and possibly prevent restorations down the road. Because the Oral Health Center already has several years of experience with the CAMBRA approach, we are now being asked to share our insights and lessons learned with other dental offices."

The products of this initiative will target the identified barriers to the widespread adoption of evidence-based dentistry by providing tools, resources and technical assistance needed by practitioners to incorporate these concepts into routine clinical practice. In addition, the data resulting from this project will be useful to payers as they consider benefit designs that promote disease management and reward dental care practitioners for providing risk-appropriate care. We will “package” all the secondary driver elements into an overall evidence-based dentistry protocol. This protocol will focus on improving both patient self-management of oral disease and the delivery of preventive and restorative care. The overall outcome of reducing rates of new cavitation will demonstrate that the protocol is successful in arresting existing, and preventing new, disease in at-risk adult patients. In addition to measuring this primary outcome goal, we will track key process measures for all of the secondary drivers on a monthly basis. The final “product” of this effort will be a care protocol and “change package” that can be disseminated and implemented in both private dental practices and safety net dental programs. This package will include:

• Background data and rationale demonstrating the protocol’s impact
• Tested risk assessment tool and protocol
• Guidelines for risk-based treatment planning
• Disease protocols for caries and periodontal disease
• Guidelines for the use of prescription preventive therapies
• Oral Health IQ evaluation tool and scripts to educate patients
• Recommendations for using practice management and dental record technology to assist in clinical decision-making

For more information about CAMBRA principles in dental clinics, contact Dr. Peter Blanchard, President, DentaQuest Oral Health Center at peter.blanchard@dentaquestohc.com.