Improving Clinical Outcomes for Early Childhood Caries

描述（由申请人提供）：幼儿龋齿（ECC）一直是影响全世界婴儿和学龄前儿童的公共卫生保健问题。目前的临床护理标准忽略了ECC是一种传染病的概念，其特征是压倒性的变形链球菌（MS）感染和腐烂促进喂养行为。治疗通常局限于龋齿的去除和修复，并结合有关龋齿促进喂养行为的咨询。牙科手术对口腔MS储存库的影响很小，关于饮食习惯的咨询也收效甚微。毫不奇怪，在全麻下接受ECC治疗的儿童中，约有40%在治疗后6-12个月内复发并出现新的龋齿病变。改善临床结果的治疗ECC可能实现通过治疗策略，重点是这种疾病的感染方面。用抗微生物剂抑制口服质谱库是一种很有前途的方法。在这方面，10%聚维酮碘被批准作为儿童皮肤和粘膜的手术前消毒剂，初步数据表明

DESCRIPTION (provided by applicant): Early Childhood Caries (ECC) continues to be a public health care problem that affects babies and young pre-school children world wide. The current clinical standard of care ignores the concept that ECC is an infectious disease that is characterized by an overwhelming mutans streptococci (MS) infection and decay promoting feeding behaviors. Treatment is usually restricted to removal and restoration of carious teeth coupled with counseling regarding decay promoting feeding behaviors. Dental surgery has minimal impact on oral MS reservoirs and counseling regarding feeding habits has had minimal success. Not surprisingly, approximately 40% of children treated for ECC under general anesthesia relapse with new carious lesions within 6-12 months post treatment. Improved clinical outcomes for treatment of ECC are likely to be realized through treatment strategies that focus the infectious aspect of this disease. Suppressing oral MS reservoirs with an anti-microbial agent is a promising approach. In this regard, 10% povidone iodine is approved as a presurgical disinfectant to the skin and mucous membranes of children and preliminary data indicates that it has prolonged suppressive effects on oral MS populations even in the setting of ECC. Accordingly, the prospect of developing a Phase III clinical trial to test the efficacy of topical application of 10% povidone iodine in improving clinical outcomes for children treated for ECC is most attractive. However, prior to developing a Phase III clinical trial, gathering additional preliminary data are warranted. In this regard, response to dose data are required to establish the proper doing schedule for 10% povidone iodine and strategies need to be developed to enhance subject retention in a Phase III clinical trial. On this basis, this research proposal plans to: 1) establish a dosing schedule for the dental application of the lO% povidone iodine solution and 2) develop retention strategies that will enhance subject retention in a Phase III clinical trial.