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EDTC 6332- Practicum

The CAMBRA Approach Instructional Solution Design Document

Raquel Rico EDTC 6332 7/24/2012

Spring Semester


1

Table of Contents:

Goal………………………………………………………………………..2

Learner Analysis………………………………………………………..3

Learning Context Analysis……………………………………………6

Performance Context Analysis……………………………………….7

Subordinate Skills Analysis…………………………………………..9

Performance Objectives………………………………………………10

Assessments……………………………………………………………13

Instructional Strategies……………………………………………….21

Instructional Solution………………………………………………….22

Evaluations………………………………………………………………23


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Goal Analysis:

Background

Dental caries is a disease process that affects many children ages 2 through 11. (CDC,

Centers for Disease Control) The disease process begins very early in life and therefore

it is the most common chronic disease affecting our children. Tooth decay is caused by

a breakdown of tooth enamel due to acid producing bacteria on the teeth. When tooth

decay is left untreated, it can cause pain and infection, tooth loss, and an edentulous

oral cavity.

The history of dental caries management consisted of many restorations placed as well

as many teeth removed and prosthetic replacements provided. However, modern

dentistry has changed its view on how dental caries disease should be managed. The

paradigm shift is towards a “medical” strategy approach that is risk based and

implements appropriate therapeutic intervention. In other words, caries risk should be

assessed just like your physician would assess the risk of cardiovascular disease and,

although, having certain risk factors, like high blood pressure, doesn’t mean that you will

have a heart attack, it definitely does put you at a higher risk for having a heart attack or

stroke and, therefore, it would be wise of you to take preventive measures like changing

some of your life styles which include diet, exercise, and even medications to lower your

risk. The same approach should be taken with the risk of tooth decay. The CAMBRA

method should be used to assess the caries risk factors of each individual patient and

then manage those risk factors to promote healthy teeth.

Goal

The goal of this e-learning module is for the dental hygiene students to be able to

manage dental caries by adopting a new approach of assessment, prevention, and

treatment of the disease in order to provide optimal treatment to their patients. This new

approach is called CAMBRA or Caries Management by Risk Assessment.


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CAMBRA is an assessment tool based on scientific data that will help assess the caries

risk factors of each individual patient and then manage those risk factors to promote

oral health. It determines the caries risk assessment through disease indicators, risk

factors, and protective factors to find the appropriate clinical protocols and interventions.

Since the primary purpose of CAMBRA is to assess the patient’s risk for caries and

determine appropriate preventive and therapeutic approaches, the dental hygienist has

a responsibility to implement and evaluate this assessment tool in their practice.

Learner Analysis:

Entry Behaviors

This e-learning module has been developed for the dental hygiene class in the Dental

Hygiene Program at TSTC. The class consists of thirty four students between the ages

of 19 through 35 years old. The gender of the class consists of mainly females with only

two male students. The students are currently in their third semester of the Hygiene

Program. This is their second semester seeing patients in the clinic and the first

semester providing treatment for children; therefore, recognizing the signs and

symptoms of tooth decay is of upmost importance. In order to succeed in this course,

the learners must have a basic understanding of the following concepts:

Must be knowledgeable with basic computer concepts (keyboarding, logging in,

etc.)

Must have access to the web either from home or a computer lab at school.

Must be able to navigate the web.

Must be able to download and upload course materials.

Prior Knowledge of Topic

Since this is their third semester in the hygiene program, the students already have a

basic understanding of what dental decay is, therefore, most of the information will be a

review for them. They should already be familiar with the process of tooth decay and

how, or in what way, saliva, fluorides, antimicrobials, and sweeteners contribute to the

disease. However, and although they have been introduced to the risk assessment

protocol, they still have trouble understanding the rationale for filling out that piece of


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paper. Also, since hygiene skills are already being practiced, it will be easier to

incorporate the new knowledge to the already known skills.

Attitudes toward Content and Potential Delivery System

Using Weebly as the delivery system may be a little intimidating for the students

because this will be the first time using this source. The students are more familiar with

the Moodle portal because that is what we use for all of our classes in the hygiene

program. However, I don’t anticipate any problems because Weebly is very user friendly

and since most, if not all, of the students are pretty savvy when it comes to technology, I

don’t foresee any problems. Also, even though this is an asynchronous learning course,

the students know that they can contact the instructor through e-mail, phone, and even

Moodle if they have any questions. A blog will also be available through Weebly for the

sole purpose of communicating any questions, problems, or concerns that they may

encounter through the course.

All of the students must have computer access either from home or school. Since most

of the dental hygiene students have technology capabilities, I don’t foresee any

problems with this e-learning module. On the contrary, it will be highly beneficial for

them because the students will have access to this portal from school, home, library,

and anywhere they can connect to their laptops and/or other networked devices.

Academic Motivation (ARCS)

The learners will be highly motivated to complete this module because it will ultimately

help them understand that risk factors and assessment are an important part of patient

care. This will help the students to become more efficient and proficient when providing

patient care in the clinic; therefore, the students will save time going from patient to

patient and be able to fulfill the requirements in less time. This is a good motivation for

them because they are always trying to find ways to manage their time in order to finish

all the requirements listed during the semester. Also, all the material covered in this

course is related to patient treatment and the students are familiar with most of the


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information presented in the module, thus, this will be a great review for them that will

help to get them ready for state exams.

Educational and Ability Levels

All of the students already have a basic understanding and/or have been exposed to

most of the information covered in this module; therefore, they are at the same

educational level. They are in the third semester of dental hygiene and have taken the

same hygiene classes as well as pre-requisites for the program. Their ability in clinic is

also very close with some variances in the level of strength in skills from one student to

another. They all have been treating patients for the same number of semesters with

the exception of one or two students that are returning for the second time and may

have a couple of semesters more delivering patient treatment which may account for

the more proficient skills in clinic.

General Learning Preferences

E-learning is not the preferred method of instruction for the learners. Since the learners

are very young they don’t really like the idea of spending so much time “working” online.

Our program is well aware of this student preference; however, because of so much

information that has to be presented to the students and not enough time to do this

during each semester, we have been adding more asynchronous instruction through the

Moodle portal. This is a good way of providing instruction for the students and, although,

they complain at times, at the end they understand the necessity of learning through an

online format and they come to appreciate it.

Attitudes Towards the Training Organization

Since the learners are already part of the dental hygiene program, they understand that

a web-based training module will allow the dental hygienist in solving certain patient

problems or concerns by following the steps to better assess their patients and evaluate

all possible solutions to arrive to optimal patient care. The students are interested in


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becoming more proficient in clinic, thus, this learning object will help them achieve this

goal.

Group Characteristics

The class consists of thirty four learners between the ages of 19 through 35 years old.

The gender of the class consists of mainly females with only two male students. They

are technologically savvy; therefore, no foreseen problems are expected. The students

will be able to work individually and at their own pace. This will avoid students’ anxiety

and will help them perform better. The instruction provided and the variances in the

different assignments will help the different learning styles of the students.

Estimate Statement

The learners will be motivated to incorporate the new knowledge to the already known

skills because it will help them to become more proficient when assessing their patients

consequently allowing them to be effective during patient treatment thus managing their

time better. Understanding the CAMBRA approach will also make them more

marketable once they are ready to seek employment.

Learning Context Analysis:

Compatibility of Site with Instructional Requirements

The training site is well suited to the instructional requirements of this course. This is an

asynchronous course and although the students are not familiar with this program, it is

very user friendly and easy to navigate through the instructional pages. Furthermore,

because this is an e-learning course, the students will be able to have access to this

portal from school, home, library, and anywhere they can connect to their laptops and/or

other networked devices.


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Adaptability of Site to Simulate Workplace

This training does not provide any simulations. This e-learning course has been

developed to train the student learner on how to assess their patients in order to

achieve a more comprehensive patient care treatment by making the best decisions

concerning their needs.

Adaptability for Delivery Approaches

The learners will be able to access this web course through Weebly.com. This delivery

approach accommodates the different clinical and current employment schedules for

those students that have to work through their education. Since this is a self-paced e-

learning module, this type of instructional delivery is appropriate for this course. This

module can also be adapted to a hybrid class and even to a face-to-face instruction.

Learning-Site Constraints Affecting Design and Delivery

There are no constraints affecting the design and delivery of this module.

Performance Context Analysis:

Managerial Support

The Dental Hygiene Program as well as TSTC supports web instruction for all the

programs at the college. The college is striving to make our programs more web-

enhanced and to be able to offer more hybrid and fully online classes to our students.

Also, our program wants to be able to provide more continuing education classes for

colleagues that are in need of those CE’s in order to renew their licensure; however,

most of the time they can’t get time off from work or other commitments. Therefore, this

would be a great way of providing web-enhanced CE’s that they could take in the

comfort of their own home and at their own time.


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Physical Aspects of the Site

Since this is an asynchronous course there are no concerns with the physical aspect of

the site. The students will be able to access this course from home, school, or any place

where they can access the Internet. Most, if not all, students own a computer or laptop;

therefore, there should be no problems accessing this site. However, if there are

students who do not have or own a personal computer, the college does have computer

labs where the students can work from without a problem. The Learning Resource

Center (LRC) is also available for the students.

Social Aspects of the Site

This is an asynchronous course where students will work individually and at their own

pace; therefore, the social aspects of this site is minimal. However, the students will be

able to interact with the instructor and other classmates via e-mail, phone, and blogs

that have been created specifically for this site and for the dental hygiene students to

express concerns or problems regarding this training as well as for other classes in the

program.

Relevance of Skills to Workplace

The training of this course is very important to the workforce because it focuses

specifically on patient care. It also focuses on how to work as a team member with one

another when you are in the workforce specifically on how to run certain procedures for

the well being of the patient. Furthermore, working together also helps to comply with

the specific tasks that go on in a dental setting and are relevant to the workplace.


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Subordinate Skills Analysis:

The dental hygiene students will be able to manage dental caries by

adopting a new approach of assessment, prevention, and treatment of

the disease in order to provide optimal treatment to their patients.

PO-1

Given an asynchronous web

presentation the dental

hygiene students will be able

to recognize trends in caries

epidemiology.

PO-2


presentation the dental


to identify indicators for

increased risk of dental

caries.

PO-3


presentation the dental hygiene

students will be able to

implement a medical approach

for the management of dental

hard tissues.

Final

Assessment

EO-1.1

After reviewing the

asynchronous presentation on

Dental Caries the dental

hygiene students will be able to

identify the different stages of

dental caries.

EO-2.1

After reviewing the

asynchronous presentation the

dental hygiene students will be

able to discuss parental caries

risk factors and protective factors

that may affect the oral health of

the child.

EO-3.1

After reviewing the asynchronous

presentation, the dental hygiene

students will be able to define the

CAMBRA Approach and

demonstrate understanding of a case

study.

EO-1.2

Given a crossword puzzle

assignment online the dental


to define the key terms and

concepts related to dental

caries.

EO-2.2

Given a case study the dental


demonstrate proficiency in

identifying risk factors for oral

disease in children.

EO-3.2

Given a matching assignment the


able to differentiate between the

various agents used to arrest or

reverse the demineralization

process.

EO-3.3

Given a matching assignment the


able to identify the relationship

between fluoride, antimicrobials,

calcium phosphate products, and

xylitol in the reduction of caries

risk.

EO-1.3

After reviewing the

asynchronous presentation the

dental hygiene students will

be able to describe the caries

process.

EO- 2.3

Given an asynchronous space

for discussion, the dental


discuss the role of the dental

hygienist in providing early oral

care intervention.


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Performance Objectives:

Instructional Goal

The dental hygiene students will be able to manage dental caries by adopting a new

approach of assessment, prevention, and treatment of the disease in order to provide

optimal treatment to their patients.

Steps in Instructional Goal Performance Objectives

Learners will be introduced to a web-

enhanced overview and presentation on

the process of dental caries.

PO-1

Given an asynchronous web presentation

on dental caries (C), the dental hygiene

students (A) will be able to recognize (B)

trends in caries epidemiology without

error (D).

Learners will review the asynchronous

powerpoint presentation on the different

stages of dental caries.

EO-1.1


presentation on Dental Caries (C), the

dental hygiene students (A) will be able to

identify (B) the different stages of dental

caries without error (D).

Learners will review flashcards

developed for the key terms and

concepts related to dental caries.

Learners will complete the crossword

puzzle assignment on key terms and

concepts related to dental caries.

EO-1.2

Given a crossword puzzle assignment

online (C), the dental hygiene students

(A) will be able to define (B) the key terms

and concepts related to dental caries

without error (D).


powerpoint presentation on the caries

process.

EO-1.3

Given a web presentation on the caries

process (C), the dental hygiene students

(A) will be able to describe (B) the caries

process without error (D).


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powerpoint presentation on risk factors.

PO-2


on risk factors (C), the dental hygiene

students (A) will be able to identify (B)

indicators for increased risk of dental

caries without error (D).


overview presentation on parental caries

risk factors and protective factors.

EO-2.1


presentation (C), the dental hygiene

students (A) will be able to discuss (B)

parental caries risk factors and protective

factors that may affect the oral health of

the child without error (D).

Learners will complete the case study on

identifying risk factors for oral disease in

children.

EO-2.2

Given a case study (C), the dental

hygiene students (A) will be able to

demonstrate (B) proficiency in identifying

risk factors for oral disease in children

without error (D).

Learners will discuss the role of the

dental hygienist in early oral care

intervention

EO- 2.3

Given an asynchronous space for

discussion (C), the dental hygiene

students (A) will be able to discuss (B)

the role of the dental hygienist in

providing early oral care intervention

without error (D).

Learners will review the CAMBRA

overview on the web site.

PO-3


on the CAMBRA Approach (C), the dental

hygiene students (A) will be able to

implement (B) a medical approach for the


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management of dental hard tissues

without error (D).


the CAMBRA Approach.

EO-3.1


presentation (C), the dental hygiene

students (A) will be able to define (B) the

CAMBRA Approach and demonstrate

understanding of a case study without

error (D).


powerpoint presentation on fluorides.

EO-3.2

Given a matching assignment (C), the


differentiate (B) between the various

agents used to arrest or reverse the

demineralization process without error

(D).

Learners will complete the matching

exercise on fluorides, antimicrobials, and

other products.

EO-3.3

Given a matching assignment (C), the


identify (B) the relationship between

fluoride, antimicrobials, calcium

phosphate products, and xylitol in the

reduction of caries risk without error (D).


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Assessments:

There will be one final multiple choice exam taken at the end of the module. The exam

is made up of 20 questions worth 5 points each. The students will be allowed to take the

exam only once and the correct answer will be provided after each question. The

student will be required to pass with an 80% or better. If the learners do not pass the

exam, they will be required to go back to the module.

Assessment Questions:

NOTE: There is an * provided next to the correct answer.

PO-1:

1. All of the following statements regarding dental caries are true except one. Which

of the following statements is incorrect?

a. Caries is an infectious disease

b. Caries is a transmissible disease

c. Caries is an eradicated disease *

d. Caries is a communicable disease

e. Caries is a preventable disease

EO-1.1:

1. Acids are a byproduct of sugar digestion. All of the following acids are produced

during sugar digestion except one. Which acid is not a byproduct of sugar

digestion?

a. Acetic acid

b. Lactic acid

c. Formic acid

d. Phosphoric acid *

e. Propionic acid


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2. Remineralizing tooth surfaces should not be scratched or altered in any way.

Which of the following techniques would be the most acceptable way to detect

coronal caries on a demineralized surface?

a. Panorex radiograph

b. Sharp explorer

c. Irrigating syringe

d. Curing light

e. Blunt probe *

3. Your patient presents with a definitive carious lesion diagnosed by the dentist.

What is the treatment plan for a definitive carious lesion?

a. Take a “wait and see” approach

b. Send the patient for a second opinion

c. Expose a radiograph just to be sure

d. Wait until symptoms develop before treatment

e. Appoint for a restoration *

4. All of the following changes seen on the tooth surface can be described as a

carious lesion except one. Which one is the exception?

a. White spots

b. Brown spots

c. Enamel dysplasia *

d. Cavitation

EO-1.2:

1. The microorganism most commonly found in the saliva of children who present

with early childhood caries is called…

a. Treponema denticola

b. Bacterioids forsythus

c. Fusobacterium nucleatum

d. Prevotella intermedia

e. Streptococcus mutans *


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2. A habit, behavior, lifestyle, or condition that when present increases the

probability of a disease occurring is a term often used in medical research. Which

of the following best fits this definition?

a. Risk factor *

b. Common factor

c. Likely factor

d. Arbitrary factor

EO-1.3:

1. Which of the following bacteria are the infectious organisms that colonize the

teeth, help to form dental biofilm, and are responsible for the dental caries

process?

a. Bacterioides forsythus

b. Streptococcus mutans *

c. Prevotella intermedia

d. Eubacterium nodatum

e. Streptococcus intermedius complex

PO-2:

1. An individual can be in the “high-risk” or “low-risk” category for development of

dental caries. All of the following factors are low-risk factors in the development

of dental caries for adults except one. Which one of the following factors is not

low risk?

a. Normal salivary flow

b. Uses xylitol gum

c. Sealants in pits and fissures

d. Poor manual dexterity *

e. Regularly scheduled dental visits


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EO-2.1:

1. Saliva has many protective functions in the oral cavity. Which of the following is

the most important protective property of saliva in the caries process?

a. Buffering of acids *

b. Aid in digestion

c. Aid in speech

d. Carrier of antibodies

EO-2.2:

1. The appropriate time for scheduling the child’s first visit to the dental office is…

a. After the first tooth appears in the mouth *

b. At one year of age

c. After the primary dentition has fully erupted

d. When the child is able to sit upright in a dental chair

e. When the parent feels that the child is ready to be cooperative

2. All of the following are dietary considerations that impact early childhood oral

disease except one. Which one is the exception?

a. Use of a non-fluoridated toothpaste *

b. Giving the baby sweetened liquids in a bottle

c. Insufficient fluoride in the water supply

d. Diet high in fermentable carbohydrates

e. Prolonged breast/bottle feeding

EO-2.3:

1. Providing oral health information to parents related to the child’s stage of

development to better meet the child’s needs is known as ________________.

a. Oral health planning

b. Oral health education

c. Preventive dental education

d. Anticipatory guidance *

e. Assessment and preventive care


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2. The concept of establishing a dental home is to provide which of the following?

a. Early dental care

b. Caries risk assessment

c. Parent and caregiver education

d. All of the above *

PO-3:

1. Which of the following radiographs is the best choice to detect caries on

proximal tooth surfaces?

a. Periapical radiographs

b. Occlusal radiographs

c. Panorex radiographs

d. Bitewing radiographs *

e. Cepahlometric radiographs

EO-3.1:

1. Which of the following childhood diseases is the most common?

a. Polio

b. Measles

c. Caries *

d. Chicken pox

EO-3.2:

1. All of the following are mechanisms of action of fluoride in the prevention of

caries except one. Which of the following actions of fluoride is not associated

with the prevention of caries?

a. Inhibits demineralization

b. Passes through diffusion channels to increase acid level *

c. Enhances remineralization

d. Inhibits bacteria in the biofilm

e. Interferes with enzyme activity in bacteria


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2. There has been a reduction in caries in the United States since 1945 attributed to

the fluoridation of the water supplies in certain communities. Which of the

following is the percentage reduction in caries found?

a. 80%

b. 10%

c. 40% *

d. 30%

e. 70%

EO-3.3:

1. All of the following are considered fermentable carbohydrates except one. Which

of the following is not a fermentable carbohydrate?

a. Xylitol *

b. Sucrose

c. Fructose

d. Cooked starch

e. Glucose

2. A protocol for caries control in very young children with high caries risk

includes…

1) Balanced diet

2) Chlorhexidine rinses

3) Xylitol wipes

4) Home fluoride therapy

5) High fluoride dentifrices

a. 1 and 3 *

b. 2 and 4

c. 1, 2, and 5

d. All of the above


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Objectives Assessment Tools

PO-1

Given an asynchronous web presentation,

the dental hygiene students will be able to

recognize trends in caries epidemiology.

EO-1.1:

Identify the different stages of dental

caries.

EO-1.2:

Define the key terms and concepts related

to dental caries.

EO-1.3:

Describe the caries process.

1. Crossword puzzle used for

comprehension of related concepts

and key terms.

2. Exam at the end of the web module.

PO-2



identify indicators for increased risk of

dental caries.

EO-2.1:

Discuss parental caries risk factors and

protective factors that may affect the oral

health of the child.

EO-2.2:

Identify risk factors for oral disease in

children.

1. Case Study related to dental caries.

2. Exam at the end of the web module.


20

EO-2.3:

Discuss the role of the dental hygienist in

providing early oral care intervention.

PO-3



implement a medical approach for the

management of dental hard tissues.

EO-3.1:

Define the CAMBRA approach.

EO-3.2:

Differentiate between the various agents

used to arrest or reverse the

demineralization process.

EO-3.3:

Identify the relationship between fluoride,

antimicrobials, calcium phosphate

products, and xylitol in the reduction of

caries risk.

1. Case Study related to the CAMBRA

and ICDAS code system.

2. Exam at the end of web module.


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Instructional Strategies:

Teacher Activities

This is an asynchronous e-learning course, thus, there are no specific teacher activities.

The students will take this course individually from home, school, library, or at any place

where they can access the internet. They will work at their own pace and at their own

time. However, the instructor will be available via e-mail, Moodle, and phone in case of

any problems or concerns that the students may encounter.

Learner Activities

The learners will be able to learn this material in four hours. The students will be able to

work at their own leisure, therefore, they can decide if they want to do it all at once or

break it down and review it at one or two hour intervals.

Learner Activities Time Technology or Media Assessment

Items

Unit One: The Process of Dental Caries

Learners will navigate through the web page

and review the course overview.

40-60

minutes

Computer/laptop/Inter

net access

None


powerpoint presentation on the process of

dental caries.

10-20

minutes


net access

None

Learners will review the flashcards provided

on the web site.

20

minutes


net access

Crossword

Puzzle

Unit Two: Childhood Caries


powerpoint presentation on childhood caries.

10-20

minutes


net access

None


childhood caries.

30

minutes


net access

None


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Unit Three: Risk Factors


powerpoint presentation on fluorides.

10-20

minutes


net access

Matching

Assignment


powerpoint presentation on risk factors.

10-20

minutes


net access

None

Learners will complete the case study on risk

factors and the CAMBRA Approach.

30

minutes


net access

None

Learners will take the final exam. 30

minutes


net access

20 multiple

choice

questions

Instructional Solution:

The instructional solution for this module can be found at:

http://raqueleportfolio.weebly.com/the-cambra-approach.html

Formative Evaluation:

The formative evaluations were not done according to the way that I had anticipated

due to time availability. I wanted to do several evaluations including small group and

SME evaluations; however, due to concerns with time running out, I was not able to

take more time to do them. I also was hoping to ask all of the students to take the

course for the learner evaluations and field trials but with the end of the semester

approaching, final exams, and other clinic requirements, the students were not available

to review the e-learning course. I only had one single student try it out and her

comments are outlined below.

The colors are good.

It is very organized and easy to navigate.

The powerpoints take a little while to load.

http://raqueleportfolio.weebly.com/the-cambra-approach.html


23

All the links are working except for one. Specifically, the supplemental materials

page “back button”.

I don’t like that each link opens in a different tab.

The Risk Factor page does not have a next and back button; try and keep it

uniform that way the person does not have to go through the tabs if they have

begun using those buttons, the learner will be confused and might get lost in the

process.

Change the color or the shadow on the words on top of each page.

Adding some videos to the lecture would have enhanced the site.

Prezi presentations make me dizzy; may want to just use pdf powerpoints

instead.

The changes have been taken into account and I did go back to revise the course

according to the student’s feedback; however, I would need more time in order to add

more videos and media to the site. This will have to be done at a later time. I did go

back and removed the Prezi presentations and added just pdf powerpoints as per

request of the student. I was never happy with those presentations to begin with. I

started to use Prezi just because I had trouble doing the Camtasia lectures which was

my initial plan. Eventually I will do those lectures in Camtasia. I just need to figure out

why it didn’t work for me this time around and this semester I just couldn’t manage my

time well due to my work schedule. Therefore, I went back and uploaded just plain pdf

powerpoint presentations to the project. Again, this was not my initial plan, however, it

was just the way it ended up to be. Again, eventually I will record the lectures using

Camtasia and make this project more effective.

Summative Evaluation:

Summative evaluations will be followed once this course is taken by the students in the

following semester. Once taken and feedback received from the students, appropriate

changes and revisions will be made to this e-learning course.

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