Predicting Caries Risk in Underserved Toddlers in Primary Healthcare Settings

描述（申请人提供）：龋齿是儿童最常见的慢性疾病，在很大程度上是可以预防的。该提案的重点是解决美国学龄前儿童龋齿经验的不平等。该计划的灵感来自于人口中某些群体（即2-5岁儿童，特别是来自服务不足/少数群体的儿童）龋齿的转变和增加，这要求更加注重有针对性的医疗保健。在医疗保健成本增加和资源限制的环境中，这种方法对于解决口腔健康差距至关重要。由于儿童在生命早期有多次健康儿童儿科就诊，许多社会经济地位较低（SES）和少数民族儿童获得医疗保健的机会比获得牙科保健的机会要大得多。我们的长期目标是通过开发有效的基于风险的龋齿预防和治疗策略，通过口腔卫生保健的新模式，包括初级医疗保健设置，减少美国幼儿龋齿经验的差异。然而，问题是目前没有实用的、经过验证的、易于评分的工具，从业人员可以使用它来准确、可靠地评估和有效地分诊患龋风险最高的儿童。本研究将开发一种急需的工具。因此，本研究的目的是验证龋齿风险问卷，以便开发一种实用且易于评分的龋齿风险工具，用于初级医疗保健机构，以识别具有最高龋齿发展风险的年轻，不同的美国儿童（1-4岁）。为此，将要求1,326名婴儿的父母填写一份龋齿风险问卷，并在基线时（儿童12岁+ 3个月）、18个月时（儿童30岁+ 3个月）和基线后36个月（儿童48岁+ 3个月）对儿童进行龋齿检查，以监测龋齿疾病的进程，以及风险工具预测儿童年龄的龋齿风险状况的能力。这项建议的一大优势在于，它涉及四个经验丰富的调查小组，他们在医疗和牙科小组之间提供强有力的伙伴关系，以及三个具有完善的初级保健医学研究网络的研究站点，这些研究站点提供了对各种风险、不同人群（包括少数民族和种族少数群体以及低社会经济地位群体）的访问并促进了后续行动。每个研究地点也有一个NIH临床和转化科学奖（CTSA），并将受益于纵向临床转化研究的基础设施和经验。这项工作的意义在于，在初级卫生保健机构中确定高龋风险儿童，可以制定具有成本效益的预防和/或转诊战略，并在这些环境中有针对性地使用这些战略，以预防幼儿龋齿。这将对现有的牙科和医疗政策和计划产生直接的广泛影响，这些政策和计划涉及初级医疗和牙科儿科医疗机构中来自不同弱势群体和服务不足亚群体的幼儿的龋齿筛查和预防。

DESCRIPTION (provided by applicant): Dental caries, the most common chronic disease of childhood, is a largely preventable disease. This proposal focuses on addressing inequities in dental caries experience among preschool aged U.S. children. It has been inspired by the shift and increase in dental caries among subsets of the population (i.e., 2-5 year old children, especially from underserved/minority population groups) that calls for a greater focus on targeted healthcare. In an environment of increasing healthcare costs and resource constraints, this approach is paramount in addressing oral health disparities. Because children have multiple well-child pediatric visits in the early years of life, many lower socioeconomic status (SES) and minority children have much greater access to medical care than to dental care. Our long-term goal is to reduce disparities in dental caries experience in young children in the U.S. by developing effective risk-based caries preventive and therapeutic strategies to be delivered through new models for oral health care, including primary medical healthcare settings. However, the problem is that currently there is no practical, validated and easily-scored tool practitioners can use to accurately and reliably assess, and effectively triage children at the highest risk for caries. Such an urgently needed tool will be developed in this proposed research. Thus, the objective of this study is to validate a caries risk questionnaire in order to develop a practical and easily-scored caries risk tool for use in primary medical healthcare settings to identify young, diverse U.S. children (1-4 years of age) with the highest risk for the development of caries. This will be accomplished by having the parents of 1,326 infants complete a caries risk questionnaire and by performing caries examinations on the children at baseline (child's age 12 + 3 months old), and again at 18 months (child's age 30 + 3 months) and 36 months after the baseline (child's age 48 + 3 months) to monitor the caries disease process, and how well the risk tool predicts caries risk status as the child ages. A great strength of this proposal is that it involves four experienced investigator groups who offer strong partnerships between medical and dental teams, and three study sites with well established primary care medical research networks that provide access and facilitate follow up to a variety of at-risk, diverse populations, including ethnic and racial minorities and low SES groups. Each study site also has an NIH Clinical and Translational Science Awards (CTSA), and will benefit from infrastructure and experience in longitudinal clinical translational research. The significance of this work is that identification of high caries risk children in primary healthcare settings allows cost-effective preventive and/or referral strategies to be developed, targeted and used in these settings to prevent early childhood caries. This will have immediate broad impact and influence on existing dental and medical policies and programs regarding screening and prevention of dental caries among young children from diverse disadvantaged and underserved subgroups, in primary medical and dental pediatric healthcare settings.