Prevention of Dental Caries in Early Head Start Children

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Early childhood caries (ECC) is the most common chronic disease of childhood, affecting more than 4 million children nationwide. The burden of disease falls mostly on disadvantage children. The purpose of this research is to evaluate an already funded and ongoing intervention designed to prevent ECC in children 0-2 years of age through a combination of preventive dental activities in medical offices and Early Head Start (EHS) centers. EHS staff in North Carolina are being trained to provide dental health education and promotion activities for children and their families, and to link children enrolled in EHS with medical providers in their communities who provide preventive dental services. As part of a statewide Medicaid program, about 500 medical offices are providing preventive dental services for children, including screening, risk assessment and referral, parent counseling and topical fluoride applications. Children and their parents in 18 EHS programs in 28 counties in the state have close geographic proximity to 75 sites where medical providers are offering preventive dental services. The dental educational intervention with EHS staff is based mainly on Social Learning Theory and consists of statewide forums, workshops with audit and feedback of practices, and educational workshops and resource materials. The educational intervention for parents is based in part on the Transtheoretical Model, which uses Stages of Change as its key concept, and motivational interviewing. Staff provide classroom preventive dental activities for children and education for parents, with support provided from local dental public health providers. A non- randomized, pretest-posttest nested cohort control group cluster trial will determine the effects of the combined dental exposures provided in EHS programs and medical offices on preventing noncavitated and cavitated carious lesions in EHS children. About 800 0- and 1-year old children will be enrolled in each of the study groups and examined for ECC at 3 years of age. Age- and race-matched children enrolled in Medicaid but not EHS will serve as community-specific controls. Parents will be interviewed at baseline, and follow-up interviews will take place when their study-enrolled children are 18 and 36 months of age. The clinical examination of the child at 3 years of age will occur at the final follow-up parent interview. Secondary outcomes include cognitive (dental knowledge) and affective (value placed on dental health, self-efficacy, outcome expectations, readiness to change) characteristics, establishment of a dental home for the child and family, and improvements in parent reported oral health-related quality of life (OHRQoL) for the child and themselves. A final aim of the study will determine the extent to which dental health literacy modifies the effectiveness of the intervention in improving outcomes. OHRQoL, dental health literacy and dental "homeness" will be measured with instrument developed by the research team in previous research. Intent-to-treat analyses will determine effects of the intervention on dental outcomes. Dental disease in young children is at epidemic levels among low-income children and they face a number of barriers that prevent them from getting needed dental care. This study will test several ways in which access to preventive dental services can be increased among children 0-2 years of age enrolled in Early Head Start programs across North Carolina. The result of successful implementation of preventive dental programs should be less disease and improved quality of life among children and their families.