"A scientifically based approach that includes a toothdecay risk assessment aggressive preventive measures and conservative restorations can dramatically reduce decay in community dental practices according to a study by researchers at UC San Francisco.  The findings which support earlier research demonstrating positive results of the assessment and treatment method in a university setting have the potential to transform dental care for highrisk patients at a lower cost to both patients and dental clinics and practices. Results appear online Jan.   in Advances in Dental Research. We put the  UCSF clinical study into the real world and showed it works said lead author Peter Rechmann DMD PhD professor of preventive and restorative dental sciences in the UCSF School of Dentistry. The patients at high caries risk who used prescription products went down significantly over time in their risk level. Those in the control group also reduced their risk to a lesser degree simply by using overthecounter products that also protect teeth and affect the bacteria. Dental caries tooth decay is caused by bacteria on the tooth surface feeding on carbohydrates then making acids as waste. These acids destroy the protective tooth enamel and the dentin layer beneath it. If not halted or reversed this leads to a cavity.  CAries Management By Risk Assessment CAMBRA is an evidencebased approach to preventing or treating dental caries at its earliest stages. It was launched in  through the UCSF School of Dentistry by the papers senior author John Featherstone PhD MSc former dean of the school and distinguished professor of preventive and restorative dental sciences.  A dentist who uses CAMBRA obtains the patients dental and medical history and conducts a clinical exam to assess caries early enough to reverse or halt progression and to determine caries risk factors. These factors include among other things acidproducing bacteria frequent eating and drinking of fermentable carbohydrates snacking and abnormally low saliva flow and function. From this assessment the dentist utilizes behavioral approaches and chemical treatments to optimize protective factors. The treatment plan typically incorporates remineralization through the use of fluoride andor antibacterial therapies such as chlorhexidine and xylitol minimally invasive restorative procedures to conserve tooth structure and regular patient follow up.  The authors published their initial validation of CAMBRA for ages  through adult in  followed by several additional years of data published in    and . Since then more than half of the U.S. schools and colleges of dentistry have adopted CAMBRA in one form or another as part of their standard curriculum. The authors said now that this has been shown to be effective in a nonacademic clinical setting there also is potential for insurance companies to reimburse CAMBRA and other preventive therapies for adults thereby lowering patient costs while increasing profits for dental practices. Treatment Effective Even Without Prescription Products In the Advances in Dental Research study Rechmann and his colleagues recruited  dentists   in private practice three in community clinics  to participate in a twoyear CAMBRA trial of  patients ages  years old with  in a CAMBRA group and  in a control group.  In the CAMBRA group highrisk patients received prescription fluoride toothpaste chlorhexidine antibacterial rinse xylitol mints and fluoride varnish. The control group received regular fluoride toothpaste an assumed inactive mouth rinse sorbitol candies and a nonfluoride varnish.  Followup visits occurred at six   and  months in which new caries lesions or changes in caries risk level were recorded. Overall the researchers found that a significantly greater percentage of highrisk participants were classified at lower risk after receiving CAMBRA preventive therapies. Dental decay was low in both groups. Among  patients  intervention  control initially identified as high risk for caries only a quarter of the patients remained at high risk in the CAMBRA group at  months while just over half  percent of the control group did. Of the  lowrisk participants  intervention  control most participants remained low risk indicating that the assessment correctly identifies who is at risk for caries. The researchers said the risk reduction among the control group may have been caused by the fluoride toothpaste enhancing tooth repair as well as the mouth rinse enhancing saliva flow and having bactericidal effects. While not as significant as the CAMBRA group in this study the risk level of these patients dropped more dramatically over time than for those in the  UCSF CAMBRA study.  It was surprising to see the benefits gained by the control group Rechmann said. More research is needed to see if the products and treatment administered to this group function in the way we speculate and if so they might be made easily available to dental patients. Doing so can change the whole picture of caries control. Among the study limitations the researchers noted a high study attrition  percent which partly may have contributed to observed declines in risk level at each subsequent recall visit.  Coauthors on the paper were Benjamin Chafee DDS MPH PhD assistant professor of preventive and restorative dental sciences and director of the Global Oral Health program and Beate Rechmann research associate both from the UCSF School of Dentistry. Funding was provided by the National Institutes of Health National Center for Advancing Translational Sciences PacifiCareUnited Healthcare DentaQuest and California Dental Association. Proctor  Gamble M Espe and Epic provided products for study participants at reduced or no cost. UC San Francisco UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research graduatelevel education in the life sciences and health professions and excellence in patient care. It includes topranked graduate schools of dentistry medicine nursing and pharmacy a graduate division with nationally renowned programs in basic biomedical translational and population sciences and a preeminent biomedical research enterprise. It also includes UCSF Health which comprises three topranked hospitals UCSF Medical Center and UCSF Benioff Childrens Hospitals in San Francisco and Oakland and other partner and affiliated hospitals and healthcare providers throughout the Bay Area. 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