Integrating Oral Biology and Behavioral and Social Mechanisms for ECC Onset

 描述（由申请人提供）： 国家健康和营养调查数据表明，在过去十年中，美国儿童的幼儿龋齿（ECC）患病率显著增加，在2至5岁儿童中达到28%。ECC对儿童的生活质量有深远的影响，难以有效治疗，并且在治疗后有令人痛苦的复发趋势。导致ECC的口腔生物学是公认的，但生物学机制的知识并没有导致减少ECC的非常实质性的进展。针对最近的研究证据，越来越多的人认识到，ECC的评估和干预需要解决风险的社会和行为机制;这现在是一个研究重点（RFA-14-143）。然而，对于哪些社会和行为因素可能最相关，证据的强度以及它们的运作机制仍然存在相当大的不确定性。例如，社会经济地位（SES）是ECC的可靠预测指标，但索引了广泛的合理机制，本身并不是一个实际的干预目标。我们改编了行为科学的研究结果，这些研究结果反复表明，低SES通过近距离测量儿童压力暴露，特别是家庭压力和家庭压力来影响儿童健康。 我们提出了一个多学科的前瞻性纵向研究，206名儿童在ECC的风险凭借低SES。最初，1-3岁的无龋儿童将被随访2年。在5次牙科访问中，我们将进行口腔检查并评估社会和行为风险，包括自杀和家庭压力。横断面和纵向分析将考虑口腔生物学标志物和ECC发病和病程的可接受性和结构效度和临床相关性的Eschervin和家庭压力措施。这些分析的结果将为下一阶段的因果治疗研究确定关键的社会和行为目标，以改善幼儿的口腔健康。 该项目的具体目标是：1）识别儿童牙科环境可接受的与ECC相关的社会和行为风险; 2）评估目标社会和行为风险的结构验证和临床相关性。 ECC的行为风险; 3）将风险的社会和行为措施纳入更广泛的ECC预测模型。拟议的ECC发病的纵向研究将通过制定适合儿童牙科环境的社会和行为风险措施来指导ECC干预的下一阶段，并可能索引导致ECC的部分因果途径。

 DESCRIPTION (provided by applicant): National Health and Nutritional Examination Survey data indicate that the prevalence of early childhood caries (ECC) in US children has increased significantly in the last decade, to 28% in 2 to 5 year-old children. ECC has a profound impact on a child's quality of life, is difficult to treat effectively, and has a distressing tendency to ecur following treatment. The oral biology leading to ECC is well-established, but knowledge of the biological mechanism has not led to very substantial progress in reducing ECC. In response to recent research evidence, there is a growing appreciation that assessments and interventions for ECC need to address social and behavioral mechanisms of risk; this is now a research priority (RFA-14-143). However, there remains considerable uncertainty about which social and behavioral factors may be most relevant, the strength of the evidence, and the mechanisms by which they operate. For example, socio-economic status (SES) is a reliable predictor of ECC, but indexes a broad array of plausible mechanisms and is not itself a practical intervention target. We adapt the findings from behavioral science which repeatedly show that low SES influences child health via proximal measures of child stress exposure, particularly caregiving and family stress. We propose a multi-disciplinary prospective longitudinal study of 206 children at-risk for ECC by virtue of low SES. Initially caries-free children aged 1-3 years will be followe over a 2-year period. At each of 5 dental visits we will conduct oral exams and assess social and behavioral risks, including caregiving and family stress. Cross-sectional and longitudinal analyses will consider the acceptability and construct validity and clinical relevance of caregivin and family stress measures for oral biology markers and ECC onset and course. Results from these analyses will identify key social and behavioral targets for the next stage of causal treatment research to improve oral health in young children. The specific aims of the project are to: 1) Identify social and behavioral risks relevant to ECC that are acceptable for a pediatric dentistry setting; 2) Assess construct validation for and clinical relevance of targeted social and behavioral risks for ECC; 3) Incorporate social and behavioral measures of risk in a broader prediction model of ECC. The proposed longitudinal study of ECC onset will guide the next stage of ECC interventions by developing social and behavioral risk measures that are suitable for pediatric dental setting and may index part of the causal pathway leading to ECC.