EARLY CHILDHOOD CARIES--PREVENTION AND TREATMENT OUTCOMES

幼儿蛀牙（ECC），以前被称为奶瓶蛀牙和哺乳蛀牙，是一种影响婴儿和幼儿的龋齿。这种疾病通常很严重，治疗起来既困难又昂贵。确定极年幼儿童患ECC风险的战略和对干预措施的严格测试尚未得到很好的发展。该项目有两个主要组成部分，具有不同的研究设计；两者都将决定与ECC发病率增加相关的某些因素，但涉及的研究人群非常不同：A)一项以人群为基础的回顾性队列研究，研究对象为1986-1993年间出生在太平洋西北地区凯撒永久健康计划（KPNW）成员家庭的6058名儿童；B)一项前瞻性随机临床试验（RCT），研究对象为旧金山两家公共卫生机构中最初没有龋齿的三岁以下儿童，其中一家主要服务于拉丁裔人群，另一家主要服务于亚洲人群。A)从KPNW患者记录中评估的因素包括儿童、父母、母亲（即怀孕期间的药物处方）、兄弟姐妹和牙科提供者的信息。行为信息（即瓶子的使用，口腔卫生）将从问卷调查中确定。在1986- 1990年间出生的儿童中，我们将确定初级牙列的ECC是否会增加第一恒磨牙龋齿治疗的风险。B) RCT将1)比较1次或2次/年氟化清漆（FV）加咨询与单独咨询在预防ECC方面的效果；2)评估干预前唾液标志物（生物和化学）、行为和人口统计学因素作为ECC的预测因素；3)比较这些干预措施在ECC高发的不同民族人群站点间的效果；4)确定应用于一组受试者的氟化物清漆的唾液氟化物释放概况。如果成功，本研究将提供针对有ECC风险的儿童的方法，并证明干预措施在预防这一年轻年龄组的ECC方面是有效的。UCSF， KPNW，旧金山公共卫生界和工业界之间的合作将有助于将研究结果转化为牙科公共卫生和私营部门。

Early Childhood Caries (ECC), previously called Baby Bottle Tooth Decay and Nursing Caries, is a form of dental caries that affects infants and young children. The often severe disease is difficult and expensive to treatment. Strategies to identify very young children at risk for ECC and rigorous testing of interventions are not well developed. This project has two major components with different research designs; both will determine in certain factors are associated with increased ECC incidence, but will involve very different study populations: A) a population-based retrospective cohort study among 6,058 children born between 1986-1993 to members of the Kaiser Permanente Health Plan in the Pacific Northwest (KPNW) and B) a prospective, randomized clinical trial (RCT) among initially caries-free children under age three at two public health facilities in San Francisco, one serving a primarily Latino and one a primarily Asian population. A) Factors to be assessed from KPNW patient records include information about the child, the parents, the mother (i.e., medications prescribed during pregnancy), the siblings, and the dental providers. Behavioral information (i.e., bottle use, oral hygiene) will be ascertained from questionnaires. Among children born between 1986-90, we will determine if ECC in the primary dentition increases the risk of caries treatment on first permanent molars. B) The RCT will 1) Compare the efficacy of once or twice/year fluoride varnish (FV) application plus counseling to counseling alone in preventing ECC; 2) Assess pre-intervention salivary markers (biologic an chemical), behavioral and demographic factors as predictors of ECC; 3) Compare the efficacy of these interventions between sites serving different ethnic populations with a high prevalence of ECC; and 4) Determine the salivary fluoride release profile from fluoride varnish applied to a sub-set of subjects. If successful, this study will provide methods for targeting children at risk for ECC and evidence that an intervention is efficacious in preventing ECC in this young age group. Collaboration among UCSF, KPNW, the San Francisco public health community and industry will facilitate translation of findings into the dental public health and private sectors.