Date of Graduation

Spring 5-19-2017

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


The goal of the Caries Management by Risk Assessment (CAMBRA) initiative was to cultivate a comprehensive oral care program that placed current best practices into the organizational policy of the facility’s palliative and end-of-life care unit. After preliminary unit assessments and root cause analysis, improvement opportunities affecting the consistency and accuracy of oral assessments and documentation were identified as being related to unit assessment forms’ non-conducive formatting. This supported an assessment approach overlooking oral/dental assessments and thereby helped to maintain a perception that deemphasized the nurse’s role in performing and documenting oral/dental assessments. This perception was further supported through academic and institutional oversight regarding the adequate education and training regarding oral/dental assessments. The CAMBRA balance concept, as illustrated by Hurlbutt & Young (2014), was introduced to staff members through a series of in-services designed to: describe the caries disease process, emphasize its relation to systemic health, explain the importance of consistent and accurate oral/dental documentation, introduce the CAMBRA balance concept, and offer recommendations for effective documentation. Appropriating the facility’s strategic goal of using innovative excellence as means of building healthier lives in the post-acute setting, CAMRBA guidelines were selected for their demonstrable ability to statistically reduce both caries and their associated risk factors. While dental caries remains one of the most underreported chronic conditions in the U.S., we know that caries affects nearly 100% of the adult population globally, with studies further showing that elderly adults within long-term care facilities are at a heightened risk for both dental caries and their associated risk factors. Given CAMBRA’s ability to determine therapeutic treatment options in 70% of cases, combined with its ability to reduce the development of new caries cases by 20%, its incorporation into practice has proven to be a vital component to quality patient-centered care. As nursing staff continue to incorporate CAMBRA guidelines into practice, as evident by consistent and accurate oral/dental assessments and documentation, over time we will see an increase in both early caries detection and improved caries management.

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