Center to Address Disparities in Children's Oral Health

描述(由申请人提供)：幼儿龋病(ECC)是美国最常见的儿童慢性疾病，尤其是在经济困难、服务不足的儿童中。我们建议继续我们现有的中心，以解决儿童口腔健康方面的差异(U54DE014251)及其了解、预防和减少口腔健康差异的努力，重点是预防ECC。我们以社区为基础的合作项目的主题是(1)为预防口腔健康差异人群中的ECC的新方法提供高质量的证据基础，(2)确定提供氟化物清漆(FV)的最有效的传播方法，这是一种有效的预防方法。我们将积极邀请加州社区和提供者参与两项大规模干预研究，利用随机临床试验(RCT)方法，按环境分层，评估不同预防方法对低收入儿童龋齿发病率和增量的有效性或临床效果。利用RE-AIM框架，项目1将确定向最多1-3岁儿童传播FV的最有效环境(医疗、社会服务机构或牙科)。根据背景分层，将在加州大学旧金山分校初级保健协作研究网络的24个社区初级保健诊所(CPCCs)和24个加州妇女、婴儿和儿童特别补充营养计划(WICS)中进行平行团体实用随机对照试验。每个非牙科网站(CPCC或WIC)将随机接受父母咨询和现场FV申请计划，或接受父母咨询和转介到牙医进行儿童FV申请。我们还将比较两种自动电话咨询方法，并利用远程识别方法进行盲性龋齿评估。项目2是一项干预研究，将在牙科和非牙科环境中进行，这两个环境都隶属于靠近美国-墨西哥边境的联邦合格健康中心，以比较四种方案在3-6岁儿童中的相对防龋效果：1)父母口腔健康咨询(C)单独；2)C FV；3)C氟化物释放，玻璃离子(Gl)封闭剂应用于乳磨牙，以及4)C FV Gl。我们的行政核心、统计和数据协调中心以及社区联络计划将支持我们的两个区域协调和发展项目。这些努力与其他教育和职业发展活动一起，将培养新的研究人员，以提高口腔健康差距的研究能力。

DESCRIPTION (provided by applicant): Early childhood caries (ECC) is the most prevalent chronic childhood disease in the U.S., particularly among economically disadvantaged, underserved children. We propose to continue our existing Center to Address Disparities in Children's Oral Health (U54DE014251) and its efforts to understand, prevent, and reduce oral health disparities, with a focus on preventing ECC. The themes of our collaborative, community-based program are (1) to provide the high-quality evidence base for new methods to prevent ECC in populations experiencing oral-health disparities and (2) to identify the most effective dissemination methods for delivering fluoride varnish (FV), an efficacious preventive method. We will actively engage California communities and providers in two large-scale intervention studies utilizing randomized clinical trial (RCT) methodology, stratified by settings, to assess the effectiveness or clinical efficacy of different preventive methods on caries incidence and increment among low-income children. Using the RE-AIM framework, Project 1 will identify the most effective setting (medical, social service agency or dental) to disseminate FV to the greatest number of 1-3-year-old children. Stratifying on setting, a parallel groups practical RCT will be conducted in 24 community-based primary care clinics (CPCCs) from the UCSF primary care collaborative research network, and 24 California Special Supplemental Nutrition Programs for Women, Infants and Children (WICs). Each non-dental site (CPCC or WIC) will be randomized to a program of parental counseling and onsite FV application or to parental counseling and referral to a dentist for child's FV application. We will also compare two automated telephone counseling methods and utilize teledentistry approaches for blinded caries assessments. Project 2 is an intervention study to be conducted in dental and non-dental settings, both affiliated with Federally Qualified Health Centers near the US-Mexico border, to compare the relative caries prevention efficacy of four protocols in 3-6 year-old children: 1) parental oral-health counseling (C) alone; 2) C+ FV; 3) C+ fluoride-releasing, glass ionomer (Gl) sealants applied to primary molars, and 4) C+FV+ Gl. Our Administrative Core, Statistics and Data Coordinating Center, and Community Liaison Program will support our two RCTs and developmental projects. These endeavors, with other education and career development activities, will foster new investigators to increase oral-health-disparity research capacity.