Planning Parental/Motivational Interventions to Prevent Early Childhood Caries

描述（由申请人提供）：幼儿龋齿（ECC）具有高度的公共卫生重要性，因为它(a)与疼痛相关，感染、急诊就诊、住院和全身麻醉治疗的风险增加（伴随风险和费用）；(b)增加日后乳牙和恒牙患龋的风险；(c)对身体发育的影响（由于ECC对饮食和营养产生负面影响）；(d)对认知发展的影响（由于缺课增加和疼痛导致的学习能力下降）。1988-1994年和1999-2004年期间，2-5岁儿童的ECC从24%上升到28%，其中重度ECC （S-ECC）患病率为5%，或超过30万名儿童（Dye等，2007年）。这一增长令人沮丧，因为上升的轨迹和绝对比率是2010年健康人群口腔健康目标（美国2- 4岁儿童口腔健康低于12%）的两倍多。尽管其对健康的影响、成本和广泛的发病率和流行程度，预防ECC -特别是在不同种族、社会和经济人群中-仍然是临床医生的难题。虽然ECC是由生物膜的某些致酸性和嗜酸性成员（变形链球菌）引起的，并且几乎是完全可以预防的，但其难以治愈（甚至不断上升）的患病率表明，所谓的健康社会决定因素（例如，家庭、文化、社会、经济、政治、环境因素）的强烈影响（例如，Newton & Bower, 2005; Watt, 2007; Yevlahova & Satur, 2009）。该项目是第一个利用夫妻在口腔、身体和心理健康服务方面（即孩子出生后）最大限度地接受干预的时间段。这将是第一个同时对新父母进行干预的三个假设的ECC社会决定因素：(a)有害的家庭环境，(b)儿童日常口腔健康行为/促进，以及(c)定期推荐儿童牙科检查。牙科已经讨论过建立一个“牙科之家”，以提供持续、积极的服务。这个项目将这个家从牙医办公室搬到了家庭住所，在那里，日常行为和环境要么增加要么减少ECC的风险。这种模式的转变，我们称之为口腔健康之家，可以通过让家庭每天促进口腔健康，并在推荐的时间间隔内增加“牙科之家”的使用，彻底改变向ECC高风险家庭的延伸。

DESCRIPTION (provided by applicant): Early Childhood Caries (ECC) is of high public health importance because of its (a) associated pain, and elevated risk for infection, emergency department visits, hospitalization, and treatment under general anesthesia (with its attendant risks and expense); (b) increased risk for future caries in primary and permanent teeth; (c) impact on physical development (due to ECC negatively affecting eating and nutrition); and (d) impact on cognitive development (due to increase in school absences and pain-reduced capacity to learn). ECC has increased from 24% to 28% in 2-5 year-old children between 1988-1994 and 1999-2004, with the prevalence of Severe ECC (S-ECC) at 5%, or over 300,000 children (Dye et al., 2007). This increase is disheartening because of both the upward trajectory and an absolute rate more than double the Healthy People 2010 oral health objective of less than 12% for U.S. 2- 4 year olds. Despite its health impact, cost, and widespread incidence and prevalence, preventing ECC - especially among diverse ethnic, social, and economic populations - continues to elude clinicians. Although ECC is instigated by certain acidogenic and aciduric members of the biofilm (Streptococcus mutans) and is nearly entirely preventable, its intractable (and even rising) prevalence indicates the strong influences of what are known as social determinants of health (e.g., familial, cultural, social, economic, political, environmental factors) (e.g., Newton & Bower, 2005; Watt, 2007; Yevlahova & Satur, 2009). This project is the first to employ a time period when couples are maximally open to intervention in the service of oral, physical, and psychological health (i.e., after the birth of a child). It will be the first to intervene with new parents on three hypothesized social determinants of ECC simultaneously: (a) noxious family environments, (b) daily oral health behaviors/promotion for children, and (c) regular, recommended child dental check-ups. Dentistry has discussed building a "dental home" for consistent, ongoing, positive services. This project moves this home out of the dentist's office and into the family abode, where the daily behaviors and environments that either increase or mitigate the risk for ECC are. This paradigm shift, what we term the oral healthy home, could revolutionize outreach to families at high risk for ECC, both by having the home promote oral health on a daily basis and by increasing the use of the "dental home" at recommended intervals. PUBLIC HEALTH RELEVANCE: Early Childhood Caries (ECC) is of high public health importance because of its (a) associated pain, and elevated risk for infection, emergency department visits, hospitalization, and treatment under general anesthesia (with its attendant risks and expense); (b) increased risk for future caries in primary and permanent teeth; (c) impact on physical development (due to ECC negatively affecting eating and nutrition); and (d) impact on cognitive development (due to increase in school absences and pain-reduced capacity to learn). This project is the first to employ a time period when couples are maximally open to intervention in the service of oral, physical, and psychological health (i.e., after the birth of a child) and will plan and pilot interventions with new parents on three hypothesized social determinants of ECC simultaneously: (a) noxious family environments, (b) daily oral health behaviors/promotion for children, and (c) regular, recommended child dental check-ups.