Planning Parental/Motivational Interventions to Prevent Early Childhood Caries

描述(由申请人提供)：幼儿龋病(ECC)具有高度的公共卫生意义，因为它(A)与疼痛相关，感染、急诊、住院和全身麻醉治疗的风险增加(及其伴随的风险和费用)；(B)增加乳牙和恒牙未来龋齿的风险；(C)对身体发育的影响(由于ECC对饮食和营养造成负面影响)；以及(D)对认知发展的影响(由于旷课增加和疼痛导致学习能力下降)。1988-1994年至1999年-2004年期间，2-5岁儿童的ECC患病率从24%上升到28%，重度ECC(S-ECC)的患病率为5%，即30多万儿童(Dye等人，2007年)。这一增长令人沮丧，因为上升的轨迹和绝对率都是2010年健康人口腔健康目标的两倍多，美国2-4岁儿童的口腔健康目标不到12%。尽管ECC对健康的影响、成本以及广泛的发病率和流行率，但预防ECC--特别是在不同的种族、社会和经济人群中--仍然难以得到临床医生的认可。虽然ECC是由生物膜中某些产酸和耐酸的成员(变形链球菌)引起的，并且几乎完全可以预防，但其顽固的(甚至不断上升的)流行率表明了已知的健康的社会决定因素(例如，家庭、文化、社会、经济、政治、环境因素)的强烈影响(例如，牛顿和鲍尔，2005；瓦特，2007；耶夫拉霍瓦和萨图，2009)。该项目第一次采用了夫妇最大限度地接受口腔、身体和心理健康服务干预的时间段(即在孩子出生后)。这将是第一次与新父母同时干预三个假设的ECC社会决定因素：(A)有害的家庭环境，(B)儿童的日常口腔健康行为/促进，以及(C)定期、推荐的儿童牙科检查。牙医已经讨论了建立一个“牙科之家”，以提供持续、持续、积极的服务。这个项目将这个家从牙医的办公室搬到家庭住所，那里的日常行为和环境增加或减少了ECC的风险。这种范式的转变，我们称之为口腔健康之家，可以通过让家庭每天促进口腔健康，并通过增加建议间隔时间的“牙科之家”的使用，来彻底改变对ECC高危家庭的推广。

DESCRIPTION (provided by applicant): Early Childhood Caries (ECC) is of high public health importance because of its (a) associated pain, and elevated risk for infection, emergency department visits, hospitalization, and treatment under general anesthesia (with its attendant risks and expense); (b) increased risk for future caries in primary and permanent teeth; (c) impact on physical development (due to ECC negatively affecting eating and nutrition); and (d) impact on cognitive development (due to increase in school absences and pain-reduced capacity to learn). ECC has increased from 24% to 28% in 2-5 year-old children between 1988-1994 and 1999-2004, with the prevalence of Severe ECC (S-ECC) at 5%, or over 300,000 children (Dye et al., 2007). This increase is disheartening because of both the upward trajectory and an absolute rate more than double the Healthy People 2010 oral health objective of less than 12% for U.S. 2- 4 year olds. Despite its health impact, cost, and widespread incidence and prevalence, preventing ECC - especially among diverse ethnic, social, and economic populations - continues to elude clinicians. Although ECC is instigated by certain acidogenic and aciduric members of the biofilm (Streptococcus mutans) and is nearly entirely preventable, its intractable (and even rising) prevalence indicates the strong influences of what are known as social determinants of health (e.g., familial, cultural, social, economic, political, environmental factors) (e.g., Newton & Bower, 2005; Watt, 2007; Yevlahova & Satur, 2009). This project is the first to employ a time period when couples are maximally open to intervention in the service of oral, physical, and psychological health (i.e., after the birth of a child). It will be the first to intervene with new parents on three hypothesized social determinants of ECC simultaneously: (a) noxious family environments, (b) daily oral health behaviors/promotion for children, and (c) regular, recommended child dental check-ups. Dentistry has discussed building a "dental home" for consistent, ongoing, positive services. This project moves this home out of the dentist's office and into the family abode, where the daily behaviors and environments that either increase or mitigate the risk for ECC are. This paradigm shift, what we term the oral healthy home, could revolutionize outreach to families at high risk for ECC, both by having the home promote oral health on a daily basis and by increasing the use of the "dental home" at recommended intervals.