Comparative Study of Methods for Caries Risk Evaluation: CAMBRA, the Cariogram, and Caries Risk Semaphore
Abstract
1. Introduction
2. Materials and Methods
2.1. Ethical Compliance
2.2. Sample Size Calculation
2.3. Clinical Examination and Questionnaire
2.4. Radiographic Examination
2.5. Saliva Collection
2.6. Statistical Analysis
3. Results
Diagnostic Agreement Among Different Models
4. Discussion
4.1. Limitations of the Study
4.2. Future Perspectives
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Value | % | n | |
---|---|---|---|---|
Caries experience | Caries-free and no fillings | 0 | 12.6% | 85 |
Better than normal | 1 | 19.2% | 129 | |
Normal for age group | 2 | 35.1% | 236 | |
Worse than normal | 3 | 43% | 222 | |
Related general diseases | No disease | 0 | 84.7% | 569 |
Disease/conditions, mild degree | 1 | 11% | 74 | |
Severe degree, long-lasting | 2 | 4.3% | 29 | |
Diet, contents | Very low fermentable carbohydrate | 0 | 17.3% | 116 |
Low fermentable carbohydrate, “non cariogenic” diet | 1 | 46.3% | 311 | |
Moderate fermentable carbohydrate content | 2 | 29.8% | 200 | |
High fermentable carbohydrate intake, inappropriate diet | 3 | 6.7% | 45 | |
Diet, frequency | Maximum three meals per day (including snacks) | 0 | 23.1% | 155 |
Maximum five meals per day | 1 | 51.5% | 346 | |
Maximum seven meals per day | 2 | 10.4% | 70 | |
More than seven meals per day | 3 | 15% | 101 | |
Plaque, amount | Extremely good oral hygiene, plaque index, PI < 0.4 | 0 | 17.7% | 119 |
Good oral hygiene, PI = 0.4–1.0 | 1 | 41.4% | 278 | |
Less than good oral hygiene, PI = 1.1–2.0 | 2 | 32.9% | 221 | |
Poor oral hygiene, PI > 2 | 3 | 8.0% | 54 | |
Streptococcus mutans | Strip mutans class 0 | 0 | 34.1% | 229 |
Strip mutans class 1 | 1 | 34.2% | 230 | |
Strip mutans class 2 | 2 | 19.2% | 129 | |
Strip mutans class 3 | 3 | 12.5% | 84 | |
Fluoride program | Receives “maximum” fluoride program | 0 | 17.6% | 118 |
Additional fluoride measures, measures, infrequently | 1 | 28.3% | 190 | |
Fluoride toothpaste only | 2 | 47.0% | 316 | |
Avoiding fluorides, no fluoride | 3 | 7.1% | 48 | |
Saliva secretion-amount | Normal saliva secretion | 0 | 45.5% | 306 |
Low, 0.9–1.1 mL stimulated saliva/min | 1 | 20.7% | 139 | |
Low, 0.5–0.9 mL saliva/min | 2 | 25.0% | 168 | |
Very low, xerostomia, <0.5 mL saliva/min | 3 | 8.8% | 59 | |
Saliva buffer capacity | Adequate | 0 | 56.5% | 380 |
Reduced | 1 | 28.1% | 189 | |
Low | 2 | 15.3% | 103 | |
Clinical judgement | More positive than what the Cariogram shows based on the scores entered | 0 | 10.4% | 70 |
Normal setting risk according to the other values entered | 1 | 73.4% | 493 | |
Worse than what the Cariogram shows based on the scores entered | 2 | 14.6% | 98 | |
Very high caries risk, examiner is convinced that caries will develop, irrespective of what the Cariogram shows based on the scores entered | 3 | 1.6% | 11 |
Variable | Value | % | n |
---|---|---|---|
Active caries in dentin | 0 | 68.9% | 463 |
1 | 15.5% | 104 | |
2 | 6.1% | 41 | |
≥3 | 9.5% | 64 | |
Presence of interproximal caries | 0 | 80.8% | 543 |
≥1 | 19.2% | 129 | |
Presence of fillings | 0 | 29.9% | 201 |
1 | 8.9% | 60 | |
2 | 9.8% | 66 | |
3 | 9.8% | 66 | |
4 | 41.5% | 279 | |
Plaque amount | 0 | 18.8% | 126 |
0.1–0.9 | 22.9% | 154 | |
1.0–1.9 | 36.7% | 247 | |
2.0–2.9 | 16.5% | 111 | |
3 | 5.1% | 34 | |
Prothesis or orthodontics appliance | YES | 28.6% | 192 |
NO | 71.4% | 480 | |
Streptococcus mutans count | HIGH | 68.3% | 459 |
LOW | 31.7% | 213 | |
Stimulated saliva volume | 0 | 2.1% | 14 |
<0.5 | 5.2% | 35 | |
0.5–0.9 | 18.6% | 125 | |
0.91–1.1 | 17.4% | 117 | |
>1.1 | 56.7% | 381 | |
Saliva buffer capacity | HIGH | 78.7% | 529 |
LOW | 21.3% | 143 | |
Cariogenic diet | YES | 25.4% | 171 |
NO | 74.6% | 501 | |
Number of toothbrushing/day | 0 | 20.1% | 135 |
1 | 17.0% | 114 | |
2 | 36.8% | 247 | |
3 | 26.6% | 176 | |
Adequate fluor exposure | YES | 79.5% | 534 |
NO | 20.5% | 138 | |
Intake of substances that reduce salivary flow | YES | 2.1% | 14 |
NO | 97.9% | 658 | |
Radiotherapy treatment | YES | 4.9% | 33 |
NO | 95.1% | 639 | |
Diseases that reduce salivary flow | YES | 5.1% | 34 |
NO | 94.9% | 638 | |
Unfavorable social condition | YES | 3.0% | 20 |
NO | 97.0% | 652 |
Variable | YES | n | NO | n | |
---|---|---|---|---|---|
Disease indicators (any “Yes” signifies likely “High Risk”) | Cavities (visible or on radiograph) to dentin | 32.4% | 218 | 67.6% | 454 |
Approximal enamel lesions (on radiograph) | 17.9% | 120 | 82.1% | 552 | |
Active white-spot lesions on smooth surfaces | 13.5% | 91 | 86.5% | 581 | |
Restorations in the past 3 years due to caries | 48.5% | 326 | 51.5% | 346 | |
Risk factors | High counts of S. mutans and Lactobacillus sp. | 23.2% | 156 | 76.8% | 516 |
Visible heavy plaque on teeth | 61.8% | 415 | 38.2% | 257 | |
Frequent snacking (>3 times daily between meals) | 19.6% | 132 | 80.4% | 540 | |
Deep pits and fissures | 17.6% | 118 | 82.4% | 554 | |
Recreational drug use | 4.2% | 28 | 95.8% | 644 | |
Inadequate saliva flow, measured <1 mL/min stimulated | 19.6% | 132 | 80.4% | 540 | |
Saliva-reducing factors (medication/radiation/systemic) | 9.5% | 64 | 90.5% | 608 | |
Orthodontic and other appliances with heavy plaque retention potential | 7.1% | 48 | 92.9% | 624 | |
Protective factors | Lives/works/school fluoridated water | 39.6% | 266 | 60.4% | 406 |
Fluoride toothpaste at least once daily | 29.3% | 197 | 70.7% | 475 | |
Fluoride toothpaste at least two times daily | 63.8% | 429 | 36.2% | 243 | |
Fluoride mouth rinse (0.05% sodium fluoride) daily | 20.4% | 137 | 79.6% | 535 | |
5000-ppm fluoride toothpaste daily | 16.4% | 110 | 83.6% | 562 | |
Fluoride varnish in past 6 months | 3.3% | 22 | 96.7% | 650 | |
Office fluoride topical in past 6 months | 3.1% | 21 | 96.9% | 651 | |
Chlorhexidine prescribed/used 1 week each for past 6 months | 8.3% | 56 | 91.7% | 616 | |
Xylitol gum/lozenges 5 times daily past 6 months | 3.1% | 21 | 96.9% | 651 | |
Calcium and phosphate paste during past 6 months | 3.1% | 21 | 96.9% | 651 | |
Adequate saliva flow (<1 mL/min stimulated) | 50.3% | 338 | 49.7% | 334 |
Low Risk | Moderate Risk | High Risk | Total | |
---|---|---|---|---|
CAMBRA vs. Cariogram | −0.17 (−0.23 to −0.11) | 0.04 (−0.04 to 0.12) | −0.18 (−0.25 to 0.11) | −0.23 (−0.30 to −0.16) |
CRS vs. Cariogram | −0.18 (−0.25 to −0.11) | 0.05 (−0.03 to 0.13) | −0.24 (−0.31 to −0.16) | −0.26 (−0.33 to 0.19) |
CRS vs. CAMBRA | 0.46 (0.39 to 0.53) | 0.14 (0.05 to 0.23) | 0.40 (0.34 to 0.47) | 0.48 (0.42 to 0.54) |
Cariogram ocp vs. CAMBRA | 0.25 (0.16 to 0.34) | 0.04 (−0.04 to 0.12) | 0.23 (0.16 to 0.30) | 0.30 (0.22 to 0.37) |
Cariogram ocp vs. CRS | 0.15 (0.10 to 0.21) | −0.003 (−0.08 to 0.07) | 0.25 (0.19 to 0.32) | 0.25 (0.19 to 0.31) |
Variables | Cambra | Cariogram | CRS |
---|---|---|---|
Radiographic approximal enamel lesions | X | X | |
Active lesions in dentine | X | X | |
Orthodontic appliances or removable prosthesis | X | X | |
Brushing frequency | X | X | |
Buffer saliva capacity | X | X | |
Lactobacillus sp. count | X | X | |
Plaque amount | X | X | X |
Streptococcus mutans count | X | X | X |
Stimulated saliva flow in 5 min | X | X | X |
Diet | X | X | X |
Fluoride exposure | X | X | X |
Saliva-reducing factors | X | X | X |
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Català-Benavent, I.; Iranzo-Cortés, J.E.; Almerich-Torres, T.; Márquez-Arrico, C.F.; Almerich-Silla, J.M.; Montiel-Company, J.M. Comparative Study of Methods for Caries Risk Evaluation: CAMBRA, the Cariogram, and Caries Risk Semaphore. J. Clin. Med. 2025, 14, 5378. https://doi.org/10.3390/jcm14155378
Català-Benavent I, Iranzo-Cortés JE, Almerich-Torres T, Márquez-Arrico CF, Almerich-Silla JM, Montiel-Company JM. Comparative Study of Methods for Caries Risk Evaluation: CAMBRA, the Cariogram, and Caries Risk Semaphore. Journal of Clinical Medicine. 2025; 14(15):5378. https://doi.org/10.3390/jcm14155378
Chicago/Turabian StyleCatalà-Benavent, Iris, José Enrique Iranzo-Cortés, Teresa Almerich-Torres, Cecilia Fabiana Márquez-Arrico, José Manuel Almerich-Silla, and José María Montiel-Company. 2025. "Comparative Study of Methods for Caries Risk Evaluation: CAMBRA, the Cariogram, and Caries Risk Semaphore" Journal of Clinical Medicine 14, no. 15: 5378. https://doi.org/10.3390/jcm14155378
APA StyleCatalà-Benavent, I., Iranzo-Cortés, J. E., Almerich-Torres, T., Márquez-Arrico, C. F., Almerich-Silla, J. M., & Montiel-Company, J. M. (2025). Comparative Study of Methods for Caries Risk Evaluation: CAMBRA, the Cariogram, and Caries Risk Semaphore. Journal of Clinical Medicine, 14(15), 5378. https://doi.org/10.3390/jcm14155378