Interview with Doug Young {Part III}
See the first two parts of Doug’s interview {here} and {here}
Q: What is your ‘WHY‘?
A: The simple answer would be- why don’t you treat all patients the way you want to be treated? If you know drilling teeth alone is doing nothing to solve the disease, then anything you do to treat disease is better than doing nothing. To me there is a lot we can do now; there is a lot we know.
In my mind when we see our special needs clinic and we see our hospital clinic being successful at implementing CAMBRA on the very highest risk people then there is no doubt that it can be implemented in private practice too. My problem is that this is ‘expert opinion’; it is how it works in my hands, not a publishable clinical trial that will get any respect in the scientific community. I think the best thing I can tell people is I know it works, and I get results and I know scientifically it is the best thing to do for patients. It is our responsibility to take the best available evidence and treat our patients the best way that we can as long as we don’t cause harm.
Q: Some think it takes mastery of something that they didn’t learn in dental school- since they didn’t learn it is school they are not as confident- is this true? What would you tell them?
Game Changer – ADA approves 3 New CAMBRA CDT Codes
Big changes are coming for dental practices performing CAries Management By Risk Assessment (CAMBRA). After extensive review by the American Dental Association and the CDT (Current Dental Terminology) Code Committee, 3 new CAMBRA codes will be introduced in the 2014 codebook!
CAMBRA
image credit:http://thebehindthescenes.blogspot.com/
Tooth decay is out of control. We are not okay with that. This series: CAMBRA Behind the Scenes is meant to provide a clearer and more comprehensive view of how CAMBRA operates day to day all over the country. Each snapshot will highlight both the logistical processes of CAMBRA as well as the motivation behind its implementation within the practice. Each practice model will bring forth real challenges and how individual offices are finding solutions to those issues. Together, let us learn, deliberate, collaborate and come up with reasonable and helpful ideas and resources on how to take our practice of Caries Management by Risk Assessment into the future. It can be done, it is being done and together we are forging a new future.
Behind the scenes with Dr. Jack Stellpflug of Beaver Dam, Wisconsin
See the first part of his series here
Q: What (if anything) has improved in your practice/business because of your CAMBRA system?
I’ll be very honest in responding this question! CAMBRA is an anathema to the business of restorative dentistry!! We do far less operative dentistry than in years past. When we see an incipient interproximal lesion that we used to call a ‘watch’, we shift into high gear with remineralization protocols. To educate a patient in this concept in such a way as to insure compliance and therefore successful remineralization takes staff time. That time is poorly compensated relative to the old drill-fill-bill concept. In the short view the practice suffers, because of that education time and the lack of restorative business.
CAMBRA
Tooth decay is out of control. We are not okay with that. This series: CAMBRA Behind the Scenes is meant to provide a clearer and more comprehensive view of how CAMBRA operates day to day all over the country. Each snapshot will highlight both the logistical processes of CAMBRA as well as the motivation behind its implementation within the practice. Each practice model will bring forth real challenges and how individual offices are finding solutions to those issues. Together, let us learn, deliberate, collaborate and come up with reasonable and helpful ideas and resources on how to take our practice of Caries Management by Risk Assessment into the future. It can be done, it is being done and together we are forging a new future.
Behind the scenes with Dr. Jack Stellpflug of Beaver Dam, Wisconsin
Q: Why do you implement a CAMBRA system in your practice?
A: The simple answer to why is that it seems to me to be the right thing to do. I became aware of a different way to think about caries 6 years ago. The information that confronted me back then was very compelling. I thought that we were prevention oriented in my practice before that. We even actively discussed home care, sugar, etc. with patients. But the idea that caries could be reversed given the right environmental change and the emerging strategies to remineralize really got my attention. You might say that my previous ignorance was blissful.
My first tutor in this realm was Steve Steinberg. The ideas came to life through the October and November 2010 issues of the CDA Journal in which the parameters of CAMBRA were first laid out for me in an organized manner. I gained great impetus from Kim Kutsch, Doug Young and the WCMID.
I find that following CAMBRA protocols focus the patient and my staff on the realities of caries in their lives and gives us an ongoing framework to address caries and the risk for caries.
Q: How does your CAMBRA program work?
Continue reading
Practice Research Group- CRA Data, Part II
You can read Part 1 of this series here.
In my previous entry, I detailed the changes we made to the risk assessment form and implementation and how it affected my practice. Today I will continue that discussion and share simple concepts to make risk assessment more understandable and how the patients in my practice profile in terms of data.
As the dental caries disease model continues to become more complex, and currently there are a lot of studies being published on the genetic influences in decay, risk assessment becomes more complicated and confusing. The key to successfully implement CAMBRA is in keeping the process simple. One of the concepts I have been teaching for a couple of years now is the “Usual Suspects”. While the disease can be complex and there are infinite reasons to explain why an individual may have the disease, I routinely see major patterns over and over again. Being able to recognize the major patterns simplifies the process, or as John Kois teaches us, diagnose them at hello.
A photo letter from Dr. Doug Young
Reader Response Part {II} with Dr. Mike Nelson
In Dr. Nelson’s previous post he discussed barriers to CAMBRA implementation and his observations over the past 6 years. He ended his message with this: “You must find a way to motivate to action”. Today he introduces a concept that he believes applies, called the Motivational Triad.
I LOVE a talk by Doug Lisle, PhD called The Pleasure Trap, here is the TED talk. It is a valuable watch, (and will explain the image of the bird above).
Dr. Lisle discusses The Motivational Triad that states all people are motivated by one of three things.
1) Pleasure Seeking
2) Pain Avoidance
3) Energy Conservation
I have had the opportunity to think a bit about how this motivational triad applies to CAMBRA, and think the conclusions can be helpful as we all do our best to motivate our patients to action.
Continue reading
Reader Response: Dr. Mike Nelson
Dr. Mike Nelson responds to Dr. Young’s previous post and shares some fascinating and honest insight on practicing CAMBRA for the past 6 years.
Doug, I really like your take on CAMBRA. I appreciate the comments on WHY as well. That is a great book and a great concept. I have lived the “barriers” to implementation of CAMBRA, which to me means using CariFree forms and products (although there is more to CAMBRA than just CariFree). My office has been doing biofilm screening with the CariScreen Testing Meter screening since . . . you know, that date: April 2007, when you spoke at Red Bluff. I have lived through 6 years of evolution and growth of CAMBRA in my own office. I have a few thoughts on the things you mentioned in your previous post.
Is ignorance a significant barrier? I have seen people “know” it and believe in it, good hygienists, that were not ignorant, yet they didn’t ever take CAMBRA as far as I liked. The webinars given by Dr. Kutsch were valuable in motivating everyone to action. They grasped the ‘why’ but everyday patients aren’t as obvious as those examples given in the webinar. I did make sure everyone watched them, and as a result our program improved.
The Future of CAMBRA with Debi Gerger
Debi Gerger, Dean of Dental Hygiene at West Coast University talks about how CAMBRA is being taught to hygiene students, she also provides insight into WHY (see article links below) CAMBRA is an essential part of the University’s mission.
Q: How is Caries Management by Risk Assessment currently being taught in your institution?
A: We use the dental hygiene educators modules created in collaboration the Western CAMBRA Coalition SMEs. Each term includes another element of CAMBRA knowledge, skills, and values so that the concepts are integrated throughout the curriculum. The modules include:
Dental Caries Process
Caries Management by Risk Assessment
The Role of Saliva
The Role of Diet
The Role of Preventive and Therapeutic Products
The Role of Patient Education
Detection and Interpretation
Q. Is CAMBRA being implemented in any of the school clinics?
A: We require students to perform a “PCP Assessment” (Perio, Caries, and Pathology) on all patients in the Dental Hygiene Clinic. For the caries risk assessment form, the students use the CAMBRA form published in the CDA Journal. Students also use a variety of assessment measures such as saliva testing, pH testing, and caries detection devices. Based on the patient’s risk level, the student develops the dental hygiene care plan and then uses BMI (Brief Motivational Interviewing) skills with preventive and therapeutic products to decrease the patient’s risk.
Q: Are graduating dental/hygiene students planning to practice CAMBRA when they begin working?
Interview with Dr. Doug Young {part II}
Dr. Doug Young talks about the roadblocks to practicing CAMBRA in private practice today. He answers the question: “Where do I start if I am thinking about implementing a CAMBRA program?”
Check out Dr. Young’s first post of the series {here}
Q: What are the barriers to private practices when trying to implement CAMBRA?
A: The reasons practitioners aren’t doing CAMBRA vary across the board, but it boils down to two common themes either ignorance or indecision to take action.
Those claiming ignorance is not as common. I am hearing less and less that “I don’t know about CAMBRA” because of all the publications in the last decade or so. CAMBRA is also getting more publicity in organized dentistry. More concerning are those who know CAMBRA has relative advantages over the surgical/restorative only approach yet fail to take action to implement it. Some common reasons are lack of a solid economic model, lack of billing and diagnostic codes, lack of agreement on protocols, and of course those who feel they need more scientific evidence. Are these excuses or like Dr. Kutsch and others have been talking about so much recently another way of saying that they haven’t yet figured out “Why” CAMBRA is beneficial to their practice. They are thinking with their brain and not listening to their heart. They really struggle because they haven’t made a passionate decision to accept CAMBRA. Knowing “why” you strongly believe in something questions the soul of who you really are and what you really stand for. You have to know “why” you are doing CAMBRA before you can worry about “what” and “how” to do it. It has to be a decision between right and wrong.
If an office starts there, and concludes it is the right thing to do, then the next step is figuring out how to do it on a daily basis. This is where an office team needs to take courses, read and obtain knowledge, and to partner with those who already know how to do it. This blog is an excellent way to do this.
The insurance reimbursement is also an issue that a lot of people focus on. I believe it may be more of an excuse than anything else. Decades ago insurance did not cover white fillings in the posterior and people still paid for that because there was a value placed on cosmetic dentistry. Doctors need to know the value of CAMBRA and translate that to their conversations.
An uninformed public is something that also needs to be addressed. We can’t depend on the insurance industry or the dental profession to do everything. We need to educate our patients and the public at large. The public message needs to be clear that only doing restorations is not going to solve a patient’s disease- you need to visit a dentist who is going to treat your disease.
At the end of the day, it is a partnership. Patients along with dentists, hygienists, assistants, and front office need to take responsibility and demand chance in how dentistry is delivered.
In summary, all stakeholders (patients, dental professionals, insurance) knowing”why” CAMBRA is the right thing for patients will be an essential first step to remove the main barriers for CAMBRA at this point.
Q: Is there movement in any of these areas?
A: I can’t say too much about things that haven’t happened yet but I feel we are close to having ADA CDT codes for caries risk assessment. We see some insurance companies, like in Massachusetts, who have made progress in the direction to pay for CAMBRA. They are reallocating funds because they know if they reallocate, they may spend more money on the front end by doing CAMBRA, but will benefit patients in the long run by doing less restorative work with less likelihood for recurrent decay. So some states and some insurance carriers have already taken the plunge – once they get publishable data to show cost effectiveness I think the snowball will start to roll downhill.
In part 3 of the interview Dr. Young will provide an in depth view of WHY he practices CAMBRA-and gives some quick tips on making CAMBRA work for you- stay tuned!
Douglas A. Young DDS, MS, MBA
Dr. Young is an active and ardent educator in the field of minimally invasive dentistry, dental materials, and cariology. He serves on several boards and has presented at congresses around the world including the World Clinical Laser Institute, the Academy of Laser Dentistry, the World Congress of Minimal Invasive Dentistry, as well as several universities. Dr. Young has also been published in several peer-reviewed dental journals and textbooks.
In addition to speaking and publishing, Dr. Young also conducts extensive research on minimal invasive dentistry, lasers, and cariology. He has performed clinical trials using lasers, as well as studying caries inhibition by laser irradiation, and optical caries detection technologies.
Dr. Young is an Associate Professor, University of the Pacific and is also an Associate Clinical Professor, Adjunct, at the University of California- San Francisco.
Dr. Young also has an AB in Bacteriology from the University of California, Berkeley, a DDS from the University of California, San Francisco, a MBA from the University of the Pacific, Stockton, and a MS in Oral Biology from the University of California, San Francisco. Dr. Young completed a General Practice Residency at the VA Hospital, San Francisco in 1982. He decided to pursue full time teaching after 15 years of successful private practice in California. He is currently active in teaching clinical dentistry to the students at UOP and research at UCSF.
The opinions expressed in this article are of the author and the author alone. They do not reflect the opinions of Oral BioTech or any of its affiliates and they have not been reviewed by an expert in a related field or any member of the CariFree editorial staff for accuracy, balance or objectivity. Content and other information presented on the blog are not a substitute for professional advice, counseling, diagnosis, or treatment. Never delay or disregard seeking professional medical or oral health advice from your dentist or physician or other qualified health provider because of something you have read on this blog.