DECREASING RATES OF EARLY CHILDHOOD CARIES

幼儿龋齿（ECC）是影响幼儿乳牙列的一种严重形式的龋齿，其不成比例地影响来自种族/少数民族群体的贫困儿童。为了预防ECC，至关重要的是，有风险的儿童和他们的照顾者应该得到关于预防这种疾病的建议和咨询，并且那些确实患有这种疾病的儿童可以尽早被识别出来，这样他们就可以接受必要的恢复性治疗和咨询。因此，儿科医生可以成为对抗ECC的天然盟友，通过检查他们的患者是否患有ECC，并向父母和护理人员提供建议和咨询，减少儿童接触疾病的危险因素。我们提出了一个创新的社区为基础的干预试验，将利用一个行之有效的教育方法，提高儿科医生的能力，建议和咨询他们的病人的父母或照顾者有关降低儿童早期龋齿的风险。这样的教育计划改变了医生的行为，并通过他们，影响父母或照顾者的行为的变化。这一系列的事件预计将降低儿童ECC的风险和发病率。我们将提供培训和教育计划，以指定的儿科医生在实践中主要服务于低收入的非洲裔美国人和拉丁美洲儿童。这些计划旨在增加对父母/护理人员的建议和咨询，以减少ECC风险因素，并使用简短的临床口腔检查和应用氟化物保护漆进行ECC，而其他人将提供常规护理。此外，对于干预组，我们将实施基于办公室的提醒系统，以方便实践先前教授的干预。为了评估干预的有效性，我们将首先测量初始年龄为12个月、24个月和36个月的儿童队列中ECC和ECC相关危险因素的基线患病率，这些儿童在他们的儿科医生办公室进行健康儿童访问，然后我们将在一年和两年后评估ECC的发病率和患病率。我们还将评估儿科医生在基线时以及一年和两年后对队列和对照组儿童进行咨询、检查或涂氟清漆的情况。

Early childhood caries (ECC) is a serious form of dental caries that affects the primary dentition of young children, which disproportionately affects poor children from racial/ethnic minority group. In order to prevent ECC, ti is vital that at-risk children and their caregivers be advised and counseled about ways to prevent this disease, and that those children who do develop it can be identified as early as possible, so they can receive necessary restorative treatment and counseling to year, so pediatricians could be natural allies in the battle against ECC by examining their patients for ECC and advising and counseling parents and caregivers about decreasing the child's exposure to risk factors for the disease. We propose an innovative community based intervention trial that will utilize a proven education methodology for enhancing pediatricians' ability to advise and counsel their patients' parents or caregivers regarding decreasing risks for early childhood caries. Such educational programs change physician behaviors and through them, effect changes in parent or caregiver behavior This chain of events is anticipated to decrease the risks and rates of ECC among children. We will provide training and educational programs to specified pediatricians in a practice serving primarily low income African American and Latino children. These programs are designed to increase advising and counseling parents/caregivers about decreasing ECC risk factors, and the use of a brief clinical oral examination and application of fluoride varnish for ECC, while others will provide usual care. In addition, for the intervention group, we will implement an office-based reminder system to facilitate the practice of the previously-taught intervention. To assess the efficacy of the intervention, we will first measure the baseline prevalence of ECC and ECC related risk factors among a cohort of children with initial ages of 12, 24 and 36 months, who present for well- child visits at their pediatricians's office, then we will assess ECC incidence and prevalence one and two years later. We will also assess the pediatrician's use of counseling, examining, or applying fluoride varnish to members of the cohort and control groups of children at baseline, and one and two years later.