{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:45:48Z","timestamp":1786977948870,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Dental Education"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose\/Objectives<\/jats:title>\n                    <jats:p>This study describes the integration of Caries Management by Risk Assessment (CAMBRA) into a medical\u2010dental integrated Epic electronic health record (EHR) at Columbia University's College of Dental Medicine (CDM), with the goal of incorporating risk\u2010based caries management into predoctoral clinical care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multi\u2010phase, mixed\u2010methods approach was used. CAMBRA protocols were embedded into the Epic EHR, including clinical decision support, automated scoring, integration with prescribing and documentation workflows, and patient education after visit summary (AVS). Stakeholder engagement strategies included faculty calibration, student education via a new Population Oral Health Management (POHM) course, and staff training. Adoption was assessed through caries risk assessment (CRA) completion rates and provider agreement with algorithm\u2010generated risk levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Following EHR\u2010integrated CAMBRA tool implementation in July of 2022, CRA completion rates rose from under 5% to a peak of 89% in March of 2024. Integration of the POHM curriculum and faculty calibration efforts were key drivers of adoption. Provider agreement with algorithm\u2010generated caries risk levels exceeded 96% after a mandatory confirmation field was introduced in November of 2023. CRA completion rates varied by student groups, reflecting the importance of consistent faculty leadership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Embedding CAMBRA within the EHR and aligning it with educational and clinical workflows led to rapid adoption of risk\u2010based caries management. Success is driven by strong stakeholder engagement, curriculum integration, and robust informatics infrastructure. Ongoing faculty calibration and analytics feedback are essential to sustain performance. CDM's experience offers a replicable model for implementing evidence\u2010based caries prevention in academic dental settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jdd.70231","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:41:33Z","timestamp":1775821293000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Shifting the Paradigm: CAMBRA Adoption and Medical\u2010Dental Integration Leveraging an Electronic Health Record"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9696-1559","authenticated-orcid":false,"given":"Sharon C.","family":"Perelman","sequence":"first","affiliation":[{"name":"Department of Cariology Columbia University College of Dental Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5606-5094","authenticated-orcid":false,"given":"Tunaidi","family":"Ansari","sequence":"additional","affiliation":[{"name":"Columbia University College of Dental Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D. B.","family":"Featherstone","sequence":"additional","affiliation":[{"name":"School of Dentistry University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biana","family":"Roykh","sequence":"additional","affiliation":[{"name":"Department of Comprehensive Dentistry University of Texas Health San Antonio  San Antonio Texas USA"},{"name":"Department of Oral Surgery Columbia University College of Dental Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513490168"},{"key":"e_1_2_9_3_1","unstructured":"National Institute of Dental Craniofacial Research \u201cOral Health in America: Advances and Challenges \u201dU.S. Department of Health and Human Services accessed August 23 2025 https:\/\/www.nidcr.nih.gov\/research\/oralhealthinamerica."},{"issue":"1","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1186\/1472-6831-15-S1-S9","article-title":"The International Caries Classification and Management System (ICCMS) an Example of a Caries Management Pathway","volume":"15","author":"Ismail A. I.","year":"2015","journal-title":"BMC Oral Health"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100528.2005.00233.x"},{"issue":"10","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1080\/19424396.2007.12221276","article-title":"Caries Risk Assessment in Practice for Age 6 Through Adult","volume":"35","author":"Featherstone J. D.","year":"2007","journal-title":"Journal of the California Dental Association"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2021.657518"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517737022"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517736500"},{"issue":"3","key":"e_1_2_9_10_1","first-page":"217","article-title":"The Clinical, Environmental, and Behavioral Factors That Foster Early Childhood Caries: Evidence for Caries Risk Assessment","volume":"37","author":"Fontana M.","year":"2015","journal-title":"Pediatric Dentistry"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12026"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2015.10.011"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016357.2013.822548"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12776"},{"key":"e_1_2_9_15_1","unstructured":"\u201cADA Caries Risk Assessment Form (Age\u00a0>\u00a06) \u201dAmerican Dental Association 2011 https:\/\/www.ada.org\/\u2010\/media\/project\/ada\u2010organization\/ada\/ada\u2010org\/files\/resources\/library\/oral\u2010health\u2010topics\/topics_caries_under6.pdf."},{"key":"e_1_2_9_16_1","unstructured":"\u201cADA Caries Risk Assessment Form (Age 0\u20136) \u201dAmerican Dental Association 2011 https:\/\/www.ada.org\/\u2010\/media\/project\/ada\u2010organization\/ada\/ada\u2010org\/files\/resources\/library\/oral\u2010health\u2010topics\/topics_caries_under6.pdf."},{"issue":"1","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/19424396.2019.12220742","article-title":"Caries Management by Risk Assessment: Results From a Practice\u2010Based Research Network Study","volume":"47","author":"Rechmann P.","year":"2019","journal-title":"Journal of the California Dental Association"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2025.04.002"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.0022\u20100337.2015.79.5.tb05913.x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2021.656558"},{"key":"e_1_2_9_21_1","unstructured":"\u201cOffice of the National Coordinator for Health Information Technology Clinical Decision Support \u201dHealthIT.gov accessed August 11 2025 https:\/\/www.healthit.gov\/topic\/safety\/clinical\u2010decision\u2010support."},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/978-3-030-58721-5_24","volume-title":"Biomedical Informatics: Computer Applications in Health Care and Biomedicine","author":"Musen M. 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