Reducing dental caries and oral health disparities among adolescents: The impact of increasing 2nd molar sealants through school-based sealant programs

项目摘要/摘要： 青少年龋齿及其并发症会降低生活质量，并可能导致丧失 学生时代，急诊室就诊，在极端情况下甚至死亡。牙科封闭剂是一种 有效的干预措施可以减少龋齿，但封闭剂在青少年中的流行 仍然较低，并因社会人口特征而存在差异。而第二磨牙是 在中学之前很少喷发到足以接受密封剂涂抹的程度，大多数 以学校为基础的密封剂计划(SBSP)-一项有效的公共卫生倡议，通常旨在 低收入学校--只为小学提供服务，因此主要限制了它们的覆盖范围 到第一颗磨牙。第二磨牙缺乏对SBSP的采用是一个严重的缺口 对青少年实施有效的口腔健康干预也很好 记录在案，以减少差距。本研究的目的是探讨黄连的作用。 第二磨牙封闭剂治疗龋齿，美国中学封闭剂课程的覆盖范围，以及 通过SBSP获得第二磨牙封闭剂对口腔健康的影响及相关因素 青少年之间的差异。 第一个目标是确定第二磨牙封闭剂的流行率和由此产生的 不同种族/民族和收入群体对青少年龋齿的影响。 将使用多变量回归模型来检验接受第二磨牙的概率 密封剂和在密封剂存在/不存在的情况下发生龋齿的风险。第二 目的是通过调查国家口腔健康状况来收集美国中学封闭剂项目的数据 项目主管、SBSP协调人和提供商。将对这些数据进行分析，以了解 对青少年的SBSP的可获得性和覆盖范围，包括中学课程的数量， 它们的规模、项目特点、资助机制、成本和学生参与率。 第三个目标是评估增加SBSP对青少年使用的影响 来自目标1、目标2和文献的估计和数据。将建立一个模拟模型来 模拟各种SBSP特性并测量密封剂数量的结果影响， 避免腐烂，以及按种族/族裔和收入水平避免修复的成本节约。 这项研究将填补有关SBSP的信息的一个关键空白，并提供更清晰的 了解第二磨牙使用封闭剂及相关龋齿的经验 种族/民族和收入水平。调查结果将提供有关 全国中学密封剂项目的现状。它将产生可靠的估计 将SBSP扩大到更多青少年的潜在影响及其对 缩小差距。这一R21将导致后续的R01项目支持增加 为青少年实施SBSP，找出提高效率的方法 计划，并减少口腔健康差距。

Project Summary/Abstract: Adolescent dental decay and its complications diminish quality of life and can lead to lost school days, emergency room visits, and in extreme cases even death. Dental sealants are an effective intervention to reduce dental decay, but sealant prevalence among adolescents remains low and has disparities by sociodemographic characteristics. While 2nd molars are seldom erupted enough to receive sealant application prior to middle school, the majority of school-based sealant programs (SBSP) — an efficient public health initiative typically aimed at low-income schools — serve elementary schools only, and thus predominantly limit their reach to 1st molars. This lack of adoption of SBSPs for 2nd molars represents a critical gap in implementation of an effective oral health intervention for adolescents that is also well documented to reduce disparities. The objective of this research is to investigate the effect of 2nd molar sealants on dental caries, the reach of middle school sealant programs in the US, and the impact of increasing access to 2nd molar sealants through SBSPs on oral health and related disparities among adolescents. The first aim is to determine the prevalence of 2nd molar sealants and the resulting impact on dental caries in adolescents among various racial/ethnic and income groups. Multivariable regression models will be used to examine the probabilities of receiving 2nd molar sealants and of experiencing dental caries in the presence/absence of sealants. The second aim is to gather data on middle school sealant programs in the US by surveying state oral health program directors, SBSP coordinators, and providers. This data will be analyzed to understand availability and reach of SBSPs to adolescents including number of middle school programs, their size, program characteristics, funding mechanisms, costs and student participation rates. The third aim is to estimate the impact of increasing availability of SBSPs to adolescents using estimates and data from Aim 1, Aim 2, and the literature. A simulation model will be built to model various SBSP characteristics and to measure resulting impact in number of sealants, averted decay, and cost-savings of averted restoration by race/ethnicity and income level. This research will fill a critical gap in information on SBSPs and provide clearer understanding of the sealant and related dental caries experience for 2nd molars by race/ethnicity and income level. The findings will furnish comprehensive information about the status of middle school sealant programs in the country. It will produce reliable estimates of the potential impact of increasing the reach of SBSPs to more adolescents and its contribution to reducing disparities. This R21 will lead to a subsequent R01 project to support increased implementation of SBSPs for adolescents, identify ways to improve the efficiency of these programs and reduce oral health disparities.