Randomized Efficacy Trial of MySmileBuddy, a Family-centered Behavioral Intervention to Reduce Early Childhood Caries

摘要/项目摘要 长期的实践主要通过外科牙齿修复来治疗儿童早期龋齿(ECC)， 目前的支付系统加强了这种方法，这种方法没有解决疾病的自然历史 或者是影响其发生的口腔卫生和饮食行为。专业人士对其价值的共识 ECC疾病管理正在兴起，但在西班牙裔中，行为策略基本上仍未得到研究 美国的儿童。拟议研究的长期目标是减少口腔健康差距和 实现从注重治疗到同样重视预防的范式转变。众所周知，使用 每天两次含氟牙膏和低致龋性饮食既有预防作用，也有治疗作用。 价值。尚不清楚的是，如何最好地将有益行为的采用和维护转化为 面临最大风险的人群。建议的随机对照试验将评估一个家庭的疗效 有针对性的行为干预，MySmileBuddy，以减少高危西班牙裔的ECC进展 学龄前儿童。我们建议招募和招收858名2至5岁的儿童，他们都有ECC，以及他们的 来自纽约市曼哈顿北部儿科医疗诊所的护理员。具体目标是：(1)考核 MySmileBuddy在减少ECC进展(定义为数量的积极变化)方面的有效性(与对照组相比) 随机化12个月后测量的龋齿、缺失或充填的牙齿(∆DMFT&>0)或表面(∆DFS&>0) (2)评估MySmileBuddy的疗效(与对照组相比) 加强每天两次含氟牙膏的使用和低龋齿饮食；及(3) 评估MySmileBuddy影响每天两次含氟牙膏使用和 食用低致龋性饮食。这项拟议的研究具有创新性，并与 将重点从治疗转移到预防，将教育从口头指导和书面教育转移到现状 由牙科专业人员提供的材料，以使用由 社区卫生工作者，并利用普通儿科实践作为促进 儿童口腔健康。在这项研究完成后，我们将知道MySmileBuddy在多大程度上 促进父母养成和保持口腔卫生和饮食行为，以降低ECC 西班牙裔学龄前儿童高危人群的进展。归根结底，这种知识具有 有可能减少不必要地受到这种可预防疾病影响的儿童人数。

ABSTRACT/ PROJECT SUMMARY Longstanding practice has treated early childhood caries (ECC) primarily through surgical dental repair, reinforced by current payment systems, an approach that does not address the natural history of the disease or the oral hygiene and dietary behaviors that mediate its occurrence. Professional consensus on the value of ECC disease management is emerging but behavioral strategies remain largely unstudied among Hispanic children in the United States. The long-term goal of the proposed study is to reduce oral health disparities and inform a paradigm shift from a focus on treatment to one that also embraces prevention. It is known that using fluoridated toothpaste twice daily and consumption of a low cariogenic diet has both preventive and therapeutic value. What is not known is how to best translate the adoption and maintenance of salutary behaviors to populations at greatest risk. The proposed randomized controlled trial will evaluate the efficacy of a family focused behavioral intervention, MySmileBuddy, to reduce ECC progression in high-risk Hispanic preschoolers. We propose to recruit and enroll 858 two to five year-old children, all with ECC, along with their caregiver from pediatric medical clinics in northern Manhattan, New York City. Specific Aims are: (1) to assess MySmileBuddy's efficacy (versus control) to decrease ECC progression (defined as positive change in number of decayed, missing, or filled teeth (∆dmft>0) or surfaces (∆dfs>0)) measured 12-months post-randomization (and assessed again 24-months post-randomization); (2) to assess MySmileBuddy's efficacy (versus control) to enhance adoption of twice daily fluoridated toothpaste use and consumption of a low cariogenic diet; and (3) to assess causal pathways through which MySmileBuddy influences twice daily fluoridated toothpaste use and consumption of a low cariogenic diet. The proposed research is innovative and represents a departure from the status quo by shifting focus from treatment to prevention, shifting education from verbal instructions and written materials provided by dental professionals to using interactive Health Information Technology delivered by Community Health Workers, and capitalizing on general pediatrics practices as a conduit for promoting children's oral health. At the completion of this study, we will know the extent to which MySmileBuddy promotes parents' acquisition and maintenance of oral hygiene and dietary behaviors that reduce ECC progression in a high-risk population of Hispanic preschool children. Ultimately, such knowledge has the potential to reduce the number of children needlessly affected by this preventable disease.