PREDICTING CARIES RISK IN UNDERSERVED CHILDREN, FROM TODDLERS TO THE SCHOOL-AGE YEARS, IN PRIMARY HEALTHCARE SETTINGS

基金资助的奖学金摘要： 龋齿是儿童最常见的慢性疾病之一，是一种在很大程度上可以预防的疾病， 23%的美国2-5岁儿童患有龋齿，这一数字翻了一番多，达到56%。 6-8岁。在当前医疗保健成本不断上升和资源限制的环境下， 龋齿经验和获得护理的机会，特别是社会经济地位低的人， 少数人群，呼吁更多地关注有针对性的（在患者和牙齿表面水平），基于风险的龋齿 通过包括初级保健在内的专业间伙伴关系提供预防和治疗战略 设置.我们的团队刚刚完成了对1,326名1岁至4岁儿童的跟踪调查，我们已经开始进行数据分析， 验证龋齿风险问卷，供医疗提供者使用，以准确识别高龋齿风险幼儿。的 问题是，虽然从2-5岁到6-8岁，龋齿的发生率增加了一倍多，但在混合期间，乳牙的龋齿 牙列是一个很大程度上被忽视的研究和预防领域，没有有效的龋齿风险工具的医疗设置 帮助5-8岁的儿童进行分类，而且几乎没有研究跟踪儿童的生命过程进展。 儿童龋齿1-8。这一信息至关重要，因为设计和瞄准有效和具有成本效益的 能够适应从幼儿到学龄儿童生命过程变化的预防性治疗依赖于 准确的风险因素和牙齿表面评估。因此，这项创新性延续更新研究的目标是： 1)开发一种实用且易于评分的龋齿风险工具，用于初级医疗保健环境，以识别高龋齿风险。 龋齿风险儿童，从幼儿（1-4）扩展到学龄期（5-8）;和2）确定关系 龋齿风险概况和龋齿疾病模式之间的关系（例如，咬合对近端）。这将是 通过跟踪来自我们正在进行的U 01的登记对的876个主要照顾者（PCG）-儿童对的队列来完成。这 队列代表不同的人群，包括少数民族/种族和低社会经济地位群体。PCG将完成一个 龋齿风险问卷，儿童将在基线（儿童年龄6.5岁+3个月）进行龋齿检查， 并在基线后18个月（儿童年龄8岁+3个月）和36个月（儿童年龄9.5岁+3个月）再次进行 监测龋齿的进程。纵向龋齿风险数据和龋齿患病率/发病率以及牙齿 从1-4岁（正在进行的U 01）和5-8岁（建议继续更新）收集的表面图案信息将用于 评估5-8岁儿童患龋齿的风险。这项建议的一大优点是，它涉及四个经验丰富的医疗和 牙科研究小组，他们在过去的5.5年里成功地合作，可以促进对 研究队列。重要的是，在初级卫生保健环境中识别高龋齿风险儿童将允许成本- 制定有效的预防和/或转诊战略，有针对性地在跨专业环境中使用， 从幼儿到学龄期的龋齿发展。这将立即产生广泛的影响和影响， 现有的和/或新的政策和计划将由非牙科专业人员在医疗环境和其他非 保健环境（例如，以学校为基础），以及牙科保健机构的牙科专业人员。

SUMMARY OF FUNDED PARENT GRANT: Dental caries, one of the most common chronic diseases of childhood, is a largely preventable disease, yet approximately 23% of U.S. children 2-5 years-of-age experience dental caries, and this number more than doubles to 56% among those aged 6-8. In the current environment of escalating healthcare costs and resource constraints, the large disparities in caries experience and access to care that exist in the U.S., especially among low socioeconomic status (SES) and minority population groups, call for a greater focus on targeted (at the patient and tooth surface level), risk-based caries preventive and therapeutic strategies to be delivered through interprofessional partnerships, including primary healthcare settings. Our team has just finished following 1,326 children from age 1 to age 4, and we have started data analyses to validate a caries risk questionnaire for use by medical providers to accurately identify high caries risk toddlers. The problem is that, while caries experience more than doubles from ages 2-5 to 6-8, caries in primary teeth during mixed dentition is a largely neglected area of research and prevention, there is no validated caries risk tool for medical settings to easily help triage 5-8 year old children, and there have been almost no studies following the life-course progression of caries in children 1-8. This information is critically important, as designing and targeting efficacious and cost-effective preventive therapies that can adapt to changes in the life-course from toddlers to school-age children is dependent on accurate risk factor and tooth surface assessment. Thus, the objectives of this innovative continuation renewal study are: 1) to develop a practical and easily-scored caries risk tool for use in primary medical healthcare settings to identify high caries risk children, expanding from the toddler (1-4) to the school-age years (5-8); and 2) to determine the relationships between caries risk profiles and caries disease patterns (e.g., occlusal vs. proximal) in the mixed dentition. This will be accomplished by following a cohort of 876 primary caregiver (PCG)-child pairs from our ongoing U01’s enrolled pairs. This cohort represents a diverse population, including ethnic/racial minorities and low SES groups. The PCG will complete a caries risk questionnaire and the child will have caries examinations at baseline (child’s age 6.5 years old + 3 months), and again at 18 months (child’s age 8 years + 3 months) and 36 months after baseline (child’s age 9.5 years + 3 months) to monitor the caries disease process. Longitudinal caries risk data and caries disease prevalence/incidence and tooth surface pattern information collected from age 1-4 (ongoing U01) and 5-8 (proposed continuing renewal) will be used to assess risk of caries in children ages 5-8. A great strength of this proposal is that it involves four experienced medical and dental investigator groups, who have successfully worked together for the past 5.5 years and can facilitate follow-up of the study cohort. The significance is that identification of high caries risk children in primary healthcare settings will allow cost- effective preventive and/or referral strategies to be developed, targeted and used in interprofessional settings to prevent caries development from the toddler to the school-age years. This will have immediate broad impact and influence on existing and/or new policies and programs to be delivered by non-dental professionals in medical settings and other non- healthcare settings (e.g., school-based), as well as by dental professionals in dental healthcare settings.