Project 1: Glass Ionomer Sealant & Fluoride Varnish Study to Prevent Early Childhood Caries (GIFVT)
Principal Investigators: Stuart Gansky, DrPH and Francisco Ramos-Gomez, DDS
Resin and glass ionomer (GI) dental sealants are used to prevent cavities in the grooves of back teeth. Their use in children younger than 5 is rare.
While Medicaid programs in seventeen states provide reimbursement for the use of dental sealants on the primary or baby teeth of younger children, not all private insurance plans do so; recipients are typically older than 5 years.
Cavities in very young children tend to first appear on the smooth surfaces of the front teeth.
The next cavities usually appear in the grooves of the back teeth, where fluoride varnish (FV) is less effective.
Unfortunately, young children do not often receive treatment to prevent the appearance of early childhood tooth decay or caries on the smooth surfaces of their front teeth or the grooved biting surfaces of their back teeth.
The goal of the GIFVT study is to determine whether younger children can benefit from GI sealants on their back teeth and whether GI sealants in conjunction with fluoride varnish (FV) are better at preventing tooth decay than FV alone.
This is the first time that GI sealants have been used in a clinical trial featuring children between 2.5 and 5 years of age.
If the GIFVT study finds that dental sealants can successfully protect young children from cavities or tooth decay, this could greatly impact health policy.
Children participating in the study live in San Diego County near the Mexican border.
Children without cavities are randomly placed in one of two groups: one receives only FV, while the other receives both GI sealants and FV (GI+FV).
Researchers will then determine which of the two groups has more cavities over 36 months.
It is hypothesized that the GI+FV group will have fewer cavities than the FV group.
This randomized, controlled trial has enrolled 597 children.
Saliva samples are being collected from 80 of the enrolled children both before and after they receive FV.
Intraoral photographs will help researchers to assess GI sealant application and retention in these 80 children.
Researchers will also measure fluoride ions in their saliva to determine the levels of fluoride exposure for children in the FV and GI+FV groups.
Principal Investigator: Patricia Braun, M.D
The goal of this project is to adapt and test a dental disease prevention strategy for Early Childhood Caries, targeted to mothers of newborns living on a Northern Plains American Indian reservation. This project will develop a culturally-adapted, client-centered technique called Motivational Interviewing to promote positive oral health behaviors with mothers on behalf of their young children. Motivational Interviewing supports early implementation of positive oral health behaviors for young children through dialogue with mothers of newborns. This project will engage mothers in selecting key ways to reduce the risk of tooth decay for their child and will support the development of healthy dental habits to last a lifetime. Children in the study will be followed for 36 months, and their dental caries scores compared with those of a comparable group of children whose parents received standard recommendations for prevention of caries. Oral health knowledge and behaviors, and other relevant mediating variables will be examined for the two groups as well.
As an intervention RC2 is focused on strategies for placing powerful disease prevention information and tools in the hands of the community. The strength of systems for tribal health and child care support this project based in the Tribal Head Start program. Skill and capacity building efforts will be shared among community members to develop a cadre of Community Oral Health Specialists who will work proactively in their local Head Start centers on a Southwestern American Indian reservation to deliver health promotion and dental disease prevention services. The demonstration project will implement and evaluate the Community Oral Health Specialists’ delivery of fluoride varnish and oral health promotion when compared to usual care modalities. Oral health disparities are addressed as we work together to identify and confront the ‘real world’ issues challenging our partners in reservation communities. Oral health indicators for children in these Head Start Centers will be compared with those of children in comparable Centers receiving usual approaches to caries prevention.
Principal Investigator: Judith Bernstein, PhD
This project will evaluate the effectiveness of a training program for pediatric clinicians to administer fluoride varnish and patient centered counseling. The training program will be compared to a fluoride varnish only program. Evaluation will focus on the reduction of Early Childhood Caries (ECC), the improvement of oral health related quality of life, the increase of clinician knowledge of ECC and counseling to reduce ECC, and reduction of exposure, among children, to ECC risk factors. This project will be based in community health centers in Maryland and Ohio.
Project 2: Oral Health Advocates in Public Housing
Principal Investigator: Michelle Henshaw, DDS
This project will evaluate the effectiveness of a multimodal, community based approach to prevent Early Childhood Caries (ECC). The multimodal intervention will include oral health assessment and feedback, fluoride varnish application, and motivational interviewing delivered by oral health advocates. The research aims to determine if the multimodal intervention can reduce incidence of ECC and reduce ECC behavioral risk factors. The project will also evaluate the facilitators and barriers to the multimodal intervention in public housing sites. This study will be based in Boston, Massachusetts.