Effectiveness of Sealing Caries: A Way to Reduce Disparities in Dental Caries

描述（由申请人提供）：有强有力的证据表明密封剂在预防龋齿方面是有效的，通过学校为基础的项目使用密封剂是为这个国家缺位的高龋齿风险人群提供护理的重要途径。然而，使用密封胶的主要障碍之一是对龋齿的密封。我们的长期目标将是：1)检查牙齿密封剂在控制恒牙坑和裂隙中不同阶段蛀牙过程中的有效性，以及2)帮助确定最合适的治疗阈值，以决定何时封闭蛀牙病变。这一探索性提案的具体目的是：1)评估在使用密封剂的情况下监测龋病的新方法和创新方法的可行性，以及测量密封剂保留和磨损的不同方法；2)评估印第安纳州北部阿米什人7-10岁儿童（二年级、三年级和四年级）恒磨牙龋病不同阶段的患病率、发病率和分布；3)进一步与这个社区建立成功的伙伴关系。阿米什人虽然是一个非常统一的民族和种族群体，但在主要的牙科需求方面却极度缺乏服务。我们不认为他们的加入会对我们的长期结果的普遍性产生负面影响，相反，这将极大地促进对牙科密封剂长期有效性的评估，因为阿米什人的流动性极低，可以很容易地跟踪一段时间。在项目开始时将成立一个咨询委员会，其中包括调查人员和阿米什社区成员。委员会将在指导选择最符合研究纳入标准的学校，以及设计最有效的招聘策略以供社区使用方面发挥重要作用。委员会还将帮助培训研究小组，使其能够根据这个社区的文化信仰和需求开展工作，并将不断审查该项目的所有组成部分和阶段，以确定障碍和解决办法。经过筛选和同意后，60名儿童将被纳入为期一年的探索性临床研究。该提案的优势在于，它将使用国际龋齿检测和评估系统（ICDAS）作为确定龋齿患病率、发病率和龋齿严重程度阶段的结果变量。ICDAS是一种新的经组织学验证的临床鉴定龋齿病变的系统。完全爆发的恒磨牙符合纳入标准，将被密封和监测一年。定量光诱导荧光系统（Quantitative Light induced Fluorescence system， QLF）和诊断系统（DIAGNOdent system）是目前最具创新性、客观和敏感的两种检测龋病的方法，因为它们在检测和监测研究过程中封闭的声音或龋病的可行性，因此将在本研究中使用。这些方法将与传统放射照相的使用进行比较。检查密封胶保留和磨损的可行性将通过比较使用密封胶保留的临床指标，与临床照片和封闭牙齿的印模分析来完成。

DESCRIPTION (provided by applicant): There is strong evidence for the effectiveness of sealants in preventing caries, and their use through school-based programs is an important way of providing access to care for underserved, high caries risk populations in this country. However, one of the major barriers in sealant utilization is the concern of sealing over caries. Our long-term goal will be: 1) to examine the effectiveness of dental sealants in managing different stages of the caries process in the pits and fissures of permanent teeth, and 2) to help determine the most appropriate threshold for treatment decisions on when to seal a caries lesion. The specific aims of this exploratory proposal are to: 1) assess the feasibility of new and innovative ways to monitor caries over time under a sealant, as well as different ways to measure sealant retention and wear; 2) assess the prevalence, incidence, and distribution of different stages of the caries disease process in the permanent molars of 7-10 year old children (2nd, 3rd and 4th grade) in the Amish population in northern Indiana; and 3) further develop a successful partnership with this community. The Amish, although a very uniform ethnic and racial group, are extremely underserved with major dental needs. We do not anticipate that their inclusion will negatively impact the generalizability of our long-term outcomes, but to the contrary will greatly facilitate the evaluation of long-term effectiveness of dental sealants, because the Amish have extremely low mobility and can be easily followed over time. An Advisory Board, including investigators and Amish community members, will be formed at the start of the project. The Board will be instrumental in guiding the selection of schools that best fit the study's inclusion criteria, and in designing the most effective recruitment strategy for use in this community. The Board will also help train the research team to work with this community's cultural believes and needs, and will continuously review all components and stages of this project for identification of barriers and solutions. After screening and consenting, sixty children will be enrolled in the one year exploratory clinical study. A strength of this proposal is that it will use the International Caries Detection and Assessment System (ICDAS) as the outcome variable for determining caries prevalence, incidence, and the stage of caries severity at the time of sealant placement. ICDAS is a new histological-validated system for clinical identification of caries lesions. Fully erupted permanent molars that fit the inclusion criteria will be sealed and monitored over a one year period. Two of the most innovative, objective and sensitive methods for caries detection, the Quantitative Light induced Fluorescence system (QLF) and DIAGNOdent system will be used in this study for their feasibility to detect and monitor sound or carious lesions sealed during the study. These methods will be compared to the use of traditional radiography. Feasibility of examining sealant retention and wear will be done by comparing the use of a clinical index for sealant retention, with analysis of clinical photographs and impressions of the sealed teeth.