Predicting Caries Risk in Underserved Toddlers in Primary Healthcare Settings

描述(申请人提供)：龋齿，最常见的儿童慢性病，是一种基本上可以预防的疾病。这项提案的重点是解决美国学龄前儿童在龋齿方面的不平等问题。它的灵感来自于人口亚群(即2-5岁儿童，特别是来自服务不足/少数群体的儿童)中龋齿的转移和增加，这要求更多地关注有针对性的医疗保健。在日益增加的医疗成本和资源限制的环境中，这种方法在解决口腔健康差距方面至关重要。由于儿童在早年有多次健康儿童儿科就诊，许多社会经济地位较低的儿童和少数族裔儿童获得医疗保健的机会比获得牙科保健的机会多得多。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，通过包括初级医疗保健环境在内的口腔保健新模式来提供有效的预防和治疗策略，从而减少美国幼儿患龋齿的差异。然而，问题是，目前还没有实用、有效和易于评分的工具可供从业者用来准确可靠地评估和有效地对患龋病风险最高的儿童进行分诊。在这项拟议的研究中，将开发这样一个迫切需要的工具。因此，这项研究的目的是验证龋齿风险问卷的有效性，以便开发一种实用的、易于评分的龋病风险工具，用于初级医疗保健环境，以确定具有最高龋齿风险的年轻、多样化的美国儿童(1-4岁)。这将通过让1,326名婴儿的父母完成一份龋齿风险问卷，并在基线(儿童12+3个月)、18个月(儿童30+3个月)和基线后36个月(儿童48+3个月)对儿童进行龋齿检查来实现，以监测龋病过程，以及风险工具预测儿童年龄时龋病风险状况的准确性。这项建议的一大优点是，它涉及四个经验丰富的研究小组，他们在医疗和牙科团队之间提供强有力的合作伙伴关系，以及三个研究地点，这些研究地点拥有完善的初级保健医学研究网络，提供机会并促进对各种高危、多样化人口的跟踪，包括少数族裔和种族少数群体以及低SES群体。每个研究站点还拥有NIH临床和翻译科学奖(CTSA)，并将受益于纵向临床翻译研究的基础设施和经验。这项工作的意义是，在初级卫生保健环境中识别高龋齿风险儿童，可以制定具有成本效益的预防和/或转诊战略，并在这些环境中使用，以预防儿童早期龋齿。这将立即对现有的牙科和医疗政策和方案产生广泛影响，这些政策和方案涉及在初级医疗和牙科儿科保健环境中筛查和预防来自不同弱势和服务不足亚群的幼儿的龋齿。

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.