Epidemiology of Dental Caries and Immunity in Children

描述(申请人提供)：龋病是一种多因素和复杂的传染病和传播性疾病，然而，变形链球菌(MS)一直与病因有关。因此，研究龋病的自然病史及其与儿童MS感染/定植的关系，对于了解这种疾病是至关重要的。我们项目的总体目标是对不同的儿童群体进行纵向研究，即索引儿童以获取多发性硬化症；确定这一高危人群中的龋齿特征；并确定关键的免疫学关系，以促进我们对龋齿病因和预防的理解。在上一个供资期间，纵向跟踪了两个按年龄划分的队列，即5-6岁和6-18个月的儿童，以确定新长出的牙齿的定植情况，因为这与龋齿发展的关键因素有关。我们已经在这个高危人群中发现了有限数量的MS菌株(变形链球菌)，现在可以随着时间的推移，从最初的口腔和特定牙齿的定植到龋齿的发展。我们已经证明，这一群体中的个体具有一种随着时间的推移保持相对稳定的“主要”菌株(基因)。这种菌株的特异性稳定性允许对感染/定植进行流行病学评估，包括龋齿发生率和患病率、唾液免疫、饮食和其他行为风险因素。我们还记录了来自儿童家庭成员的信息，以评估与指数儿童相关的多发性硬化症遗传多样性、龋齿和行为风险因素，并将继续这项工作。在本申请中，我们建议将这两个年龄组连接起来，并将年龄范围扩展到另一个重要的牙齿发育里程碑(即青少年和永久第二磨牙的出现)，方法是继续跟踪这些儿童并增加一个额外的较年长的组。因此，这项建议将继续并以头五年获得的重要信息为基础，并吸收所学知识，以提高数据收集和处理的效率。我们已经发现，重复基因外回文-聚合酶链式反应(rep-PCR)和数据录入系统的开发极大地提高了我们到目前为止进行研究的能力。在本供资期间开发的这些创新将扩大数据收集和分析的效率和有用性，因为我们将继续进行这一拟议的更新。参与这项研究的牙医、基础科学家、流行病学家和统计学家组成的跨学科团队将提高我们对儿童龋齿宿主-寄生虫关系的理解。这些研究的结果将为制定帮助预防这种传染病的战略提供关键信息。在阿拉巴马州尤宁敦的继续研究将改善这一未得到充分服务的人群的口腔健康。在这一缺乏服务的人群中建立的社区联系将对这项研究的继续以及我们对这一高危人群在牙科保健方面的差距的理解至关重要。 公共卫生相关性：该项目将提供关于高危人群龋齿流行病学的关键知识，从而为设计未来的牙科预防疗法提供有价值的数据。此外，在阿拉巴马州尤宁敦(也被称为“黑带”)进行的拟议研究将为儿童及其家庭成员提供亟需的口腔健康教育和一些预防性口腔护理，以改善这一服务不足/分散的人群的口腔健康。在这个项目中获得的信息将大大有助于实现美国国立卫生研究院报告《2010年健康人》(www.healthypeople.gov/document/html/objectives/21-01.htm)中概述的口腔健康目标，因为我们期待着2020年的目标。

DESCRIPTION (provided by applicant): Dental caries is an infectious and transmissible disease that is multifactorial & complex, however, the mutans streptococci (MS) are consistently implicated in the etiology. Therefore, studies on the natural history of dental caries as it relates to MS infection/colonization in children are critical to understanding this disease. The overall goal of our project is to perform a longitudinal study of a disparate population of children, i.e., index children, for MS acquisition; characterize dental caries within this high risk population; and identify critical immunological relationships in order to further our understanding of dental caries etiology and prevention. In the previous funding period, two cohorts defined by age, i.e., 5-6 year and 6- 18 month olds, have been longitudinally followed for colonization of newly erupting teeth as this relates to factors critical in caries development. We have identified a finite number of MS strains (Streptococcus mutans) in this high risk population, which can now be followed over time from initial colonization of the oral cavity and specific teeth to the development of caries. We have demonstrated that individuals in this population have a "primary" strain (genotype) that remains relatively stable with time. This strain specific stability allows for epidemiological evaluation of infection/colonization with factors such as caries incidence and prevalence, salivary immunity, diet, and other behavioral risk factors. We have also documented information from the children's household family members to evaluate MS genetic diversity, dental caries and behavioral risk factors associated with the index children and will continue this work. In the present application, we propose to connect the two cohorts in age and extend beyond the original age ranges to another important dental developmental milestone (i.e., adolescents, and emergence of permanent 2nd molar teeth) by continuing to follow these children and add an additional older cohort. This proposal will, therefore, continue and build on the important information gained in the first five years and incorporate what has been learned to improve the efficiency of data collection and processing. We have found that repetitive extragenic palindromic-PCR (rep- PCR), and the development of a data entry system vastly improves our ability to carry out the studies thus far. These innovations developed in the current funding period will extend the efficiency and usefulness of data collection and analysis as we continue in this proposed renewal. An interdisciplinary team of dentists, basic scientists, epidemiologists and statisticians that has been involved in this study will improve our understanding of the host-parasite relationship of dental caries in children. The results of these studies will provide key information for the development of strategies to help prevent this infectious disease. The continuation of studies in Uniontown, Alabama, which is located in the "Black Belt", will improve oral health in this underserved population. The established community links in this underserved population will be critical for the continuation of this study as well as our understanding of gaps in dental health care in this high risk population. PUBLIC HEALTH RELEVANCE: This project will provide critical knowledge of the epidemiology of dental caries in a high-risk population, which resulting in valuable data useful in the design of future preventive therapeutics in dentistry. Additionally, the proposed studies conducted in Uniontown, Alabama, also referred to as the "Black Belt", will provide much needed oral health education and some preventive oral care to children and their household family members improving oral health in this underserved/disparate population. The information obtained in this project will contribute significantly to the achievement of goals outlined for oral health in the NIH report, "Healthy People 2010" (www.healthypeople.gov/document/html/objectives/21-01.htm) as we look forward to the goals for 2020.