Paul D. Herrera D.D.S.

   We follow the CAMBRA (Caries Management By Risk Assessesment) model developed by University researchers in Cariology, the study of dental caries. 

   The CariFree/Oral BioTech company was developed with the vision of helping patients become cavity-free by assessing risks for dental disease (CAMBRA). They also provide products that diagnose the presence of the bacterial caries infection that causes cavities and treating the infection using preventive dental techniques vs. traditional drill and fill methods. CariFree works hand-in-hand with practitioners who desire to practice preventive, wellness care and give patients the opportunity to enjoy a healthy, natural beautiful smile for life.

   The latest research on the caries infection has now identified a few key concepts:

•This infection is not pathogen specific, it is a biofilm disease (dental plaque) and there are now 23 identified strains of bacteria, any combination of which may contribute in an individual.

•pH is the strongest “selection pressure” that determines whether these cariogenic strains are present at pathogenic levels.

•There are some key risk factors that can determine our patients' susceptibility to this infection.

  1. There have been extensive clinical trials done to identify and correlate the significance of dental caries risk factors.  Dr. John Featherstone has done a great majority of this at the University of California San Francisco.  His research has been the basis for many of the most commonly accepted and identified risk factors in clinical practice as well as university studies.
  2. Clinically observed disease factors include visible cavitations, a cavity within the last 3 years, radiographic lesions, and white spot lesions. In the absence of the clinically observed disease factors, other risk factorsinclude heavy visible plaque, deep pits and fissures, inadequate saliva flow, exposed roots, Orthodontic, Proshtetic and other oral appliances present, Gastro-Esophageal Reflux Disease (GERD), Sjogren's Syndrome, hyposalivary medications, radiation therapy, frequent snacking between meals, acidic beverages, and recreational drug use.
  3. These risk factors will increase our patients' susceptibility to dental caries, and the identification of them allows us to educate our patients on their presence and work to eliminate them, or at least limit their effect where possible.

   Dr. John Kois states that “caries risk assessment identifies patients at risk for dental caries even before they have expressed the disease and best targets treatment for those patients that have already expressed the disease. We need to find ways to help our patients move from the repair model to the wellness model.”

Our Practice Solutions

•  Simple risk assessment protocol to determine your susceptibility to dental caries. This will help identify those patients who will need caries management in addition to restorative work.

•  Recommend products to treat both the caries infection and remineralize the damage.

•  In some cases, recommending neutralizing products to encourage healthy bacterial growth.



Caries Diagnosis

   Advances in technology allow us the opportunity to not only assess our patients risk for caries based on clinically proven risk factors, but also to diagnose the presence of a biofilm infection, dental caries. While some methods focus on targeting the presence of a few prevalent markers for the infection such as Mutans Streptococci and Lactobacillus, and usually involve an incubation period, there are also chair-side, real-time diagnostic devices that assess the prevalence of acid-producing organisms in the biofilm, thus giving a more broad-spectrum based result on the biofilm disease model.  One thing to note, this is not a cavity detection tool but a method for identifying the presence of a bacterial infection.  Once you know it's there, then you just have to treat it!

    Caries Treatment 

   The first step in caries management is realizing that it is totally different from restorative treatment.  Restorative dentistry surgically repairs and replaces the damage from caries lesions, while caries management includes correcting the biofilm disease responsible for the lesions.

   Treating the caries infection involves eliminating the current infected population of bacteria from the biofilm, and also altering the environment to ensure that they don't return. We must use therapy that will promote the regrowth of healthy bacteria, reestablishing the natural microflora of the mouth.

   This process is two-fold in terms of using broad spectrum antimicrobial agents to treat the infection, but also using alkaline or basic products to leverage the pH selection pressure that will ensure cariogenic bacteria cannot flourish and will promote healthy bacterial growth.  Products for caries prevention are far reaching in their application. Not only will these be critical in the long-term maintenance high caries risk patients, but also helpful in maintaining your healthy patients. 

  • Fluoride has a long documented success in remineralizing carious lesions.  Fluoride can also be helpful in remineralizing white spot lesions and the incipient decay that may have resulted from the infection.
  • Xylitol
  • has also been demonstrated to have many positive benefits in caries treatment and potentiates the effects of fluoride when used in combination.
  • pH+ neutralizing products encourage the growth of healthy bacteria.

   Our office uses the following products in Caries Treatment and Management

  • Prescription strength 0.2% neutral sodium fluoride gel containing 5000 ppm fluoride for home use.  Fluoride rinses for home use, and in office Fluoride Varnish applications.     
  • Non-alcohol, 0.12% chlorhexidine-gluconate solution, an oral antibacterial rinse for home use.


  • Anti-cavity Xylitol containing gum or rinses for home use.
  • Calcium phosphate pastes to remineralize tooth enamel and white spot lesions for home use.

   In addition, all CariFree products are available as individual needs dictate.  The CariFree products are all alkaline in nature and contain no abrasives so they are safe for patients to use for a lifetime.  All products also contain therapeutic levels of xylitol which will work to fight decay.


   Last but not least, we recommend Oral B electric toothbrushes.  They are proven to be superior to manual toothbrushing and are now a well established method for improving oral health. We provide the SmartSeries  5000 with SmartGuide.  Benefits of purchasing through the dental office are double rebate and extended warranty.  These benefits cannot be found at any retail store. 




645 Country Club Terrace • Lawrence, KS 66049
p. (785) 331-0027


© 2008 Paul D. Herrera, DDS, PA