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

项目摘要/摘要： 龋齿是儿童最常见的慢性病之一，是一种基本上可以预防的疾病，但大约 23%的美国2-5岁儿童患有龋齿，这一数字翻了一番多，达到56% 年龄6-8岁。在当前医疗成本不断上升和资源紧张的环境下，龋齿方面的巨大差距 美国存在的经验和获得护理的机会，特别是在低社会经济地位(SES)和少数族裔中 人口群体，呼吁更多地关注有针对性的(在患者和牙面层面)、基于风险的龋齿预防 以及通过跨专业伙伴关系提供的治疗战略，包括初级卫生保健环境。 我们的团队刚刚完成了从1岁到4岁的1326名儿童的跟踪调查，我们已经开始进行数据分析，以验证 龋齿风险问卷，供医疗机构使用，以准确识别高龋齿幼儿。问题是， 虽然龋齿在2-5岁到6-8岁期间经历了两倍以上的增长，但在混合牙列期间乳牙的龋齿在很大程度上是 被忽视的研究和预防领域，没有经过验证的医疗环境下的龋病风险工具来轻松帮助分类5- 1-8岁儿童患龋齿的情况，而且几乎没有关于1-8岁儿童龋齿发展过程的研究。 这一信息是至关重要的，因为设计和瞄准有效和具有成本效益的预防疗法 能否适应从蹒跚学步到学龄儿童的生命历程的变化取决于准确的危险因素和牙齿 表面评估。因此，这项创新的持续更新研究的目标是：1)开发一个实用的和 易于评分的龋齿风险工具，用于初级医疗保健环境，以识别高龋齿风险儿童，扩展 从幼儿(1-4岁)到学龄儿童(5-8岁)；以及2)确定龋病风险分布与 混合牙列中的龋病类型(例如，咬合与近中)。这将通过遵循 来自我们正在进行的U01‘S登记的876对主要照顾者(PCG)-儿童对的队列。这一队列代表了一个 不同人群，包括少数族裔和低社会经济地位群体。盈科将完成一项龋齿风险 调查问卷和儿童将在基线(儿童年龄5.5岁+3个月)进行龋病检查，并在 18个月(儿童7岁+3个月)和基线后36个月(儿童8.5岁+3个月)监测 龋病过程。纵向龋病危险数据与龋病患病率/发病率及牙面形态 从1-4岁(正在进行的U01)和5-8岁(建议继续更新)收集的信息将用于评估 5-8岁儿童的龋齿。这项建议的一大优点是，它涉及四名经验丰富的医疗和牙科医生 调查员小组，他们在过去5.5年中成功地合作，可以促进研究的后续行动 一群人。重要的是，在初级卫生保健环境中识别高龋齿风险儿童将使成本- 制定有效的预防和/或转诊战略，并在跨专业环境中使用，以预防 龋齿从学龄儿童到学龄儿童的发展。这将立即产生广泛的影响和影响 由医疗机构和其他非牙科专业人员提供的现有和/或新的政策和计划 卫生保健环境(例如，以学校为基础)以及牙科保健环境中的牙科专业人员。

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.