Prevention of Dental Caries in Early Head Start Children

幼儿龋齿是儿童期最常见的慢性疾病， 全国百万儿童。疾病负担主要福尔斯在处境不利的儿童身上。的目的 这项研究是为了评估一项已经资助和正在进行的干预措施，旨在防止ECC， 0-2岁的儿童，通过在医疗办公室的预防性牙科活动和早期 Head Start（EHS）中心。北卡罗来纳州的EHS工作人员正在接受培训，以提供牙齿健康教育 为儿童及其家庭举办的宣传和推广活动，并将参加EHS的儿童与医疗保健联系起来， 提供预防性牙科服务的社区提供者。作为全州医疗补助计划的一部分 大约500个医疗机构正在为儿童提供预防性牙科服务，包括 筛查、风险评估和转诊、家长咨询和局部应用氟化物。儿童和 他们的父母在该州28个县的18个EHS项目中与75个地点地理位置接近 那里的医疗机构提供预防性牙科服务。牙科教育干预 EHS工作人员主要以社会学习理论为基础，包括全州范围的论坛，研讨会， 审计和反馈做法，以及教育讲习班和资源材料。教育 对父母的干预部分基于跨理论模型，该模型使用变化阶段作为其 关键概念和动机访谈。工作人员为儿童提供课堂预防牙科活动 以及在当地牙科公共卫生服务提供者的支持下对父母进行教育。一个非- 随机、前测-后测嵌套队列对照组群集试验将确定 EHS计划和医疗办公室提供的关于预防非空化和 EHS儿童的蛀牙病变。每一所学校将招收大约800名0岁和1岁的儿童， 研究组和ECC检查在3岁。年龄和种族匹配的儿童参加了 医疗补助而不是EHS将作为社区特定的控制措施。家长们会在基线时接受采访， 并将在他们的研究登记子女年满18个月和36个月时进行随访。 3岁儿童的临床检查将在最终随访家长访谈时进行。 次要结果包括认知（牙科知识）和情感（重视牙科健康， 自我效能，结果期望，准备改变）的特点，建立牙科之家 以及父母报告的口腔健康相关生活质量（OHRQoL）的改善 为了孩子和他们自己。这项研究的最终目的是确定牙齿健康在多大程度上 识字改变了干预措施在改善成果方面的有效性。OHRQoL，牙齿健康 识字率和牙齿“家常”将用研究小组在年开发的仪器来测量。 以前的研究。意向治疗分析将确定干预对牙科结果的影响。幼儿牙病在低收入儿童中处于流行水平， 他们面临着许多障碍，使他们无法获得所需的牙科护理。这 一项研究将测试几种获得预防性牙科服务的方法， 在参加早期开端方案的0-2岁儿童中， 北卡罗来纳州。成功实施预防性牙科计划的结果 应该减少疾病，提高儿童及其家庭的生活质量。

Early childhood caries (ECC) is the most common chronic disease of childhood, affecting more than 4 million children nationwide. The burden of disease falls mostly on disadvantage children. The purpose of this research is to evaluate an already funded and ongoing intervention designed to prevent ECC in children 0-2 years of age through a combination of preventive dental activities in medical offices and Early Head Start (EHS) centers. EHS staff in North Carolina are being trained to provide dental health education and promotion activities for children and their families, and to link children enrolled in EHS with medical providers in their communities who provide preventive dental services. As part of a statewide Medicaid program, about 500 medical offices are providing preventive dental services for children, including screening, risk assessment and referral, parent counseling and topical fluoride applications. Children and their parents in 18 EHS programs in 28 counties in the state have close geographic proximity to 75 sites where medical providers are offering preventive dental services. The dental educational intervention with EHS staff is based mainly on Social Learning Theory and consists of statewide forums, workshops with audit and feedback of practices, and educational workshops and resource materials. The educational intervention for parents is based in part on the Transtheoretical Model, which uses Stages of Change as its key concept, and motivational interviewing. Staff provide classroom preventive dental activities for children and education for parents, with support provided from local dental public health providers. A non- randomized, pretest-posttest nested cohort control group cluster trial will determine the effects of the combined dental exposures provided in EHS programs and medical offices on preventing noncavitated and cavitated carious lesions in EHS children. About 800 0- and 1-year old children will be enrolled in each of the study groups and examined for ECC at 3 years of age. Age- and race-matched children enrolled in Medicaid but not EHS will serve as community-specific controls. Parents will be interviewed at baseline, and follow-up interviews will take place when their study-enrolled children are 18 and 36 months of age. The clinical examination of the child at 3 years of age will occur at the final follow-up parent interview. Secondary outcomes include cognitive (dental knowledge) and affective (value placed on dental health, self-efficacy, outcome expectations, readiness to change) characteristics, establishment of a dental home for the child and family, and improvements in parent reported oral health-related quality of life (OHRQoL) for the child and themselves. A final aim of the study will determine the extent to which dental health literacy modifies the effectiveness of the intervention in improving outcomes. OHRQoL, dental health literacy and dental "homeness" will be measured with instrument developed by the research team in previous research. Intent-to-treat analyses will determine effects of the intervention on dental outcomes. Dental disease in young children is at epidemic levels among low-income children and they face a number of barriers that prevent them from getting needed dental care. This study will test several ways in which access to preventive dental services can be increased among children 0-2 years of age enrolled in Early Head Start programs across North Carolina. The result of successful implementation of preventive dental programs should be less disease and improved quality of life among children and their families.