Epidemiology of Dental Caries and Immunity in Children

描述（由申请人提供）：龋齿是一种感染性和传播性疾病，是多因素和复杂的，然而，变形链球菌（MS）一直涉及病因。因此，研究龋齿的自然史，因为它涉及到MS感染/定植在儿童是至关重要的了解这种疾病。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，指数儿童，MS收购;在这个高风险人群中的龋齿特征;并确定关键的免疫关系，以进一步了解龋齿的病因和预防。在上一个供资期间，按年龄定义的两个队列，即，5-6岁和6- 18个月奥尔兹，已经纵向跟踪了新萌出牙齿的定植，因为这与龋齿发展中的关键因素有关。我们已经确定了有限数量的MS菌株（变形链球菌），在这个高风险的人群，现在可以跟踪随着时间的推移，从最初的殖民化的口腔和特定的牙齿的龋齿的发展。我们已经证明，在这个群体中的个人有一个“主要”菌株（基因型），保持相对稳定的时间。这种菌株特异性稳定性允许对感染/定殖进行流行病学评估，其中因素如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MS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，我们提出在年龄上连接两个群组，并超出原始年龄范围延伸到另一个重要的牙齿发育里程碑（即，青少年，和恒牙第二磨牙的出现），继续跟踪这些儿童，并增加一个额外的老年队列。因此，这项建议将继续并以头五年获得的重要信息为基础，并纳入所学到的知识，以提高数据收集和处理的效率。我们已经发现，重复的基因外回文PCR（rep-PCR）和数据输入系统的开发大大提高了我们迄今为止进行研究的能力。在当前供资期间开发的这些创新将在我们继续进行拟议的更新时提高数据收集和分析的效率和有用性。一个由牙医、基础科学家、流行病学家和统计学家组成的跨学科团队参与了这项研究，这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有助于预防这种传染病的战略提供关键信息。继续在位于“黑带”的亚拉巴马的尤宁敦进行研究，将改善这一服务不足人群的口腔健康。在这个服务不足的人群中建立社区联系对于继续这项研究以及我们了解这个高危人群中牙齿保健的差距至关重要。 公共卫生相关性：该项目将提供高风险人群中龋齿流行病学的关键知识，从而为牙科未来预防治疗的设计提供有价值的数据。此外，在亚拉巴马的尤宁敦（也称为“黑带”）进行的拟议研究将为儿童及其家庭成员提供急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/不同人群的口腔健康。在我们期待2020年的目标时，本项目中获得的信息将大大有助于实现NIH报告“2010年健康人群”（www.healthypeople.gov/document/html/objectives/21-01.htm）中概述的口腔健康目标。

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.