Effectiveness of Sealing Caries: A Way to Reduce Disparities in Dental Caries

描述(由申请人提供)：有强有力的证据表明密封剂在预防龋齿方面的有效性，通过以学校为基础的项目使用密封剂是在这个国家为服务不足、高龋齿风险人群提供护理的重要途径。然而，封闭剂应用的主要障碍之一是对龋齿的封闭性问题。我们的长期目标将是：1)检查牙齿密封剂在恒牙凹陷和裂隙中管理龋齿过程的不同阶段的有效性，以及2)帮助确定何时封闭龋损的治疗决定的最合适阈值。这项探索性建议的具体目的是：1)评估新的创新方法在封闭剂下随时间监测龋齿的可行性，以及测量封闭剂固位力和磨损量的不同方法；2)评估印第安纳州北部阿米什人7-10岁儿童(2、3和4年级)恒磨牙中不同阶段龋病过程的患病率、发病率和分布；以及3)进一步与该社区发展成功的合作伙伴关系。阿米什人虽然是一个非常统一的民族和种族群体，但在主要的牙科需求方面，他们的服务极其不足。我们预计它们的加入不会对我们的长期结果的普适性产生负面影响，但相反将极大地促进牙科封闭剂的长期有效性的评估，因为阿米什人的流动性极低，很容易随着时间的推移而遵循。在项目开始时，将成立一个咨询委员会，成员包括调查人员和阿米什社区成员。委员会将在指导选择最符合研究纳入标准的学校方面发挥重要作用，并在设计最有效的招聘策略方面发挥作用。董事会还将帮助培训研究团队，使其与该社区的文化信仰和需求合作，并将继续审查该项目的所有组成部分和阶段，以确定障碍和解决方案。经过筛选和同意，60名儿童将被纳入为期一年的探索性临床研究。这项建议的一个优点是，它将使用国际龋病检测和评估系统(ICDAS)作为结果变量，以确定龋患率、发病率和放置封闭剂时的龋病严重程度。ICDAS是一种新的组织学鉴定系统，可用于龋损的临床鉴定。符合纳入标准的完全萌出的恒磨牙将在一年内被密封和监测。定量光诱导荧光系统(QLF)和诊断系统是两种最创新、最客观和最灵敏的龋齿检测方法，本研究将使用它们来检测和监测研究期间密封的声音或龋损。这些方法将与传统放射摄影术的使用进行比较。检查封闭剂固位和磨损的可行性将通过将封闭剂固位的临床指标与临床照片和封闭牙的印模进行比较来完成。

DESCRIPTION (provided by applicant): There is strong evidence for the effectiveness of sealants in preventing caries, and their use through school-based programs is an important way of providing access to care for underserved, high caries risk populations in this country. However, one of the major barriers in sealant utilization is the concern of sealing over caries. Our long-term goal will be: 1) to examine the effectiveness of dental sealants in managing different stages of the caries process in the pits and fissures of permanent teeth, and 2) to help determine the most appropriate threshold for treatment decisions on when to seal a caries lesion. The specific aims of this exploratory proposal are to: 1) assess the feasibility of new and innovative ways to monitor caries over time under a sealant, as well as different ways to measure sealant retention and wear; 2) assess the prevalence, incidence, and distribution of different stages of the caries disease process in the permanent molars of 7-10 year old children (2nd, 3rd and 4th grade) in the Amish population in northern Indiana; and 3) further develop a successful partnership with this community. The Amish, although a very uniform ethnic and racial group, are extremely underserved with major dental needs. We do not anticipate that their inclusion will negatively impact the generalizability of our long-term outcomes, but to the contrary will greatly facilitate the evaluation of long-term effectiveness of dental sealants, because the Amish have extremely low mobility and can be easily followed over time. An Advisory Board, including investigators and Amish community members, will be formed at the start of the project. The Board will be instrumental in guiding the selection of schools that best fit the study's inclusion criteria, and in designing the most effective recruitment strategy for use in this community. The Board will also help train the research team to work with this community's cultural believes and needs, and will continuously review all components and stages of this project for identification of barriers and solutions. After screening and consenting, sixty children will be enrolled in the one year exploratory clinical study. A strength of this proposal is that it will use the International Caries Detection and Assessment System (ICDAS) as the outcome variable for determining caries prevalence, incidence, and the stage of caries severity at the time of sealant placement. ICDAS is a new histological-validated system for clinical identification of caries lesions. Fully erupted permanent molars that fit the inclusion criteria will be sealed and monitored over a one year period. Two of the most innovative, objective and sensitive methods for caries detection, the Quantitative Light induced Fluorescence system (QLF) and DIAGNOdent system will be used in this study for their feasibility to detect and monitor sound or carious lesions sealed during the study. These methods will be compared to the use of traditional radiography. Feasibility of examining sealant retention and wear will be done by comparing the use of a clinical index for sealant retention, with analysis of clinical photographs and impressions of the sealed teeth.