Predicting Caries Risk in Underserved Children, from Toddlers to the School-Age Years, in Primary Healthcare Settings

预测初级医疗机构中服务不足的儿童（从幼儿到学龄儿童）的龋齿风险

• 批准号: 9751077
• 负责人: Margherita R Fontana
• 金额: $ 173.82万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-23 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751077
• 关键词: 5 year old; 7 year old; 8 year old; Academy; Affect; Age; Age-Years; American; Area; Assessment tool; Biological; Child; Childhood; Chronic Disease; Cohort Studies; Data; Data Analyses; Dental; Dental Care; Dental caries; Dentists; Development; Disease; Dyes; Early treatment; Enrollment; Environment; Expenditure; Experimental Designs; Follow-Up Studies; Goals; Grant; Health; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; Incidence; Interdisciplinary Study; Intervention; Lesion; Life Cycle Stages; Medicaid; Medical; Methods; Minority; Minority Groups; Mixed Dentition; Modeling; Monitor; National Institute of Dental and Craniofacial Research; Oral; Oral health; Patients; Pattern; Pediatrics; Physicians; Policies; Population Group; Population Heterogeneity; Predictive Value; Prevalence; Prevention; Preventive; Preventive therapy; Preventive treatment; Primary Dentition; Primary Health Care; Process; Provider; Publishing; Questionnaires; Research; Research Personnel; Resources; Risk; Risk Assessment; Risk Factors; School-Age Population; Schools; Specialist; Strategic Planning; Subgroup; Therapeutic; Toddler; Tooth structure; Triage; Visit; Work; aged; base; care providers; clinical risk; cohort; cost; cost effective; craniofacial; deciduous tooth; design; disorder prevention; disparity reduction; early childhood; ethnic minority population; evidence base; experience; health assessment; health care delivery; health care settings; health disparity; innovation; low socioeconomic status; multidisciplinary; neglect; permanent tooth; predictive modeling; prevent; primary caregiver; primary outcome; programs; racial and ethnic; racial minority; sex; tool; tooth surface

Project Summary/Abstract: Dental caries, one of the most common chronic diseases of childhood, is a largely preventable disease, yet approximately 23% of U.S. children 2-5 years-of-age experience dental caries, and this number more than doubles to 56% among those aged 6-8. In the current environment of escalating healthcare costs and resource constraints, the large disparities in caries experience and access to care that exist in the U.S., especially among low socioeconomic status (SES) and minority population groups, call for a greater focus on targeted (at the patient and tooth surface level), risk-based caries preventive and therapeutic strategies to be delivered through interprofessional partnerships, including primary healthcare settings. Our team has just finished following 1,326 children from age 1 to age 4, and we have started data analyses to validate a caries risk questionnaire for use by medical providers to accurately identify high caries risk toddlers. The problem is that, while caries experience more than doubles from ages 2-5 to 6-8, caries in primary teeth during mixed dentition is a largely neglected area of research and prevention, there is no validated caries risk tool for medical settings to easily help triage 5- 8 year old children, and there have been almost no studies following the life-course progression of caries in children 1-8. This information is critically important, as designing and targeting efficacious and cost-effective preventive therapies that can adapt to changes in the life-course from toddlers to school-age children is dependent on accurate risk factor and tooth surface assessment. Thus, the objectives of this innovative continuation renewal study are: 1) to develop a practical and easily-scored caries risk tool for use in primary medical healthcare settings to identify high caries risk children, expanding from the toddler (1-4) to the school-age years (5-8); and 2) to determine the relationships between caries risk profiles and caries disease patterns (e.g., occlusal vs. proximal) in the mixed dentition. This will be accomplished by following a cohort of 876 primary caregiver (PCG)-child pairs from our ongoing U01's enrolled pairs. This cohort represents a diverse population, including ethnic/racial minorities and low SES groups. The PCG will complete a caries risk questionnaire and the child will have caries examinations at baseline (child's age 5.5 years old + 3 months), and again at 18 months (child's age 7 years + 3 months) and 36 months after baseline (child's age 8.5 years + 3 months) to monitor the caries disease process. Longitudinal caries risk data and caries disease prevalence/incidence and tooth surface pattern information collected from age 1-4 (ongoing U01) and 5-8 (proposed continuing renewal) will be used to assess risk of caries in children ages 5-8. A great strength of this proposal is that it involves four experienced medical and dental investigator groups, who have successfully worked together for the past 5.5 years and can facilitate follow-up of the study cohort. The significance is that identification of high caries risk children in primary healthcare settings will allow cost- effective preventive and/or referral strategies to be developed, targeted and used in interprofessional settings to prevent caries development from the toddler to the school-age years. This will have immediate broad impact and influence on existing and/or new policies and programs to be delivered by non-dental professionals in medical settings and other non- healthcare settings (e.g., school-based), as well as by dental professionals in dental healthcare settings.

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