PREVENTING NURSING CARIES IN WIC CHILDREN

预防 WIC 儿童的哺乳期龋齿

• 批准号: 6238508
• 负责人: NORMAN TINANOFF
• 金额: $ 35.17万
• 依托单位: UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-08-01 至 1998-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6238508
• 关键词: behavioral /social science research tag; child rearing; dental caries; dental health education; dentifrices; developmental nutrition; human subject; infant human (0-1 year); mother /infant health care; oral behavior; preventive dentistry; public assistance; toothbrushing

Nursing caries is a distinct caries pattern that is most often ascribed to frequent, especially night time, bottle feeding. The seriousness and societal cost of this caries process is enormous. Estimates of the prevalence of nursing caries range from 6% to as high as 85% in certain Native American populations. Besides the impact of this disease on the primary maxillary anterior incisors, the condition usually progresses to rampant caries on the other teeth in a child's mouth. Dental treatment often involves general anesthesia or deep sedation because of the lack of cooperative behavior at such a young age. Such extensive therapy usually requires hospitalization and may present morbidity and mortality risks for young children. Current preventive efforts have been unsuccessful. This nursing caries intervention study will follow 400 high risk Infants and their parents from the Hartford and Newark WIC programs. Parents that report that their one year old child is using a feeding bottle at night will be recruited for the study. Subjects visit the W.l.C. programs monthly to receive food stamps, making it an ideal situation for the proposed interventions. Child/parent pairs will be assigned to either the control or one of the two interventions. The Control Group will receive annual education regarding the potential harm of frequent and prolonged feeding with a nursing bottle after age 1. The parents also will be given an infant size toothbrush and 0.4% SnF2 (1,000 ppm F). They will be instructed to use a pea sized amount of gel once daily on their child's teeth instead of dentifrice. Dental examinations will be performed at baseline and after 1 and 2 years. The Self-Efficacy Group will receive the same Instruction and examinations as the Control group. In addition parents will receive behavioral training, positive outcome expectancy, self-efficacy enhancement, and performance feedback, to improve their confidence in eliminating the nursing bottle habit and in performing their child's daily tooth brushing with fluoride gel. The High Frequency Professional Fluoride Group will received the same instruction and examinations as those in the Control group. In addition the children will receive monthly supervised professional topical fluoride treatment, 0.1 ml of 1.23% topical fluoride that is "brushed-on" for one minute. Logistic regression and structural equation models will be designed to predict the development of more carious lesions. These approaches allow for the estimate of the effect of various independent variables on the dependent variable (e.g., the effect of mutans streptococci levels or continued nursing bottle usage on caries increment in the control and treatment groups). Logistic regression also offers a perspective for directly estimating expected costs and benefits of intervention. We will also measure differences in dental knowledge, and tooth brushing and bottle behavior between groups before and 1 and 2 years after instruction. This study, therefore, will examine the effect of parentally or professionally directed preventive treatments on caries progression in children at high risk for nursing caries. Effective prevention protocols should have immediate and Ion term effects on improving dental health and lessening health care costs in children from low-income families.

哺乳期龋齿是一种独特的龋齿模式，最常归因于 经常，尤其是夜间，奶瓶喂养。事情的严重性和 这种龋齿过程的社会成本是巨大的。的估计 在某些地区，哺乳期龋齿的患病率从 6% 到高达 85% 不等。 美洲原住民人口。除了这种疾病对身体的影响 原发性上颌前切牙，病情通常会进展到 儿童口腔中其他牙齿上的龋齿猖獗。牙科治疗 由于缺乏足够的药物，通常需要全身麻醉或深度镇静 这么小的年纪就有合作的行为。如此广泛的治疗通常 需要住院治疗，并可能带来发病和死亡风险 年幼的孩子。目前的预防措施并未取得成功。 这项护理龋齿干预研究将跟踪 400 名高危婴儿 以及来自哈特福德和纽瓦克 WIC 项目的父母。家长们认为 报告称他们一岁的孩子晚上使用奶瓶 将被招募参加该研究。受试者参观 W.l.C.节目 每月领取食品券，这对于 提议的干预措施。子/父对将被分配给 控制或两种干预措施之一。对照组将收到 关于频繁和长期的潜在危害的年度教育 1岁后用奶瓶喂养。父母也会得到 婴儿尺寸的牙刷和 0.4% SnF2 (1,000 ppm F)。他们将是 指示每天一次在孩子的皮肤上使用豌豆大小的凝胶 牙齿代替牙膏。牙科检查将在 基线以及 1 和 2 年后。自我效能组将获得 与对照组相同的指导和检查。此外 父母将接受行为训练，积极的结果预期， 自我效能感增强和绩效反馈，以提高他们的 对消除奶瓶习惯和履行职责的信心 孩子每天用含氟凝胶刷牙。高频 专业氟化物集团将收到相同的指示并 与对照组的检查相同。 此外，孩子们还将 每月接受监督的专业局部氟化物治疗，0.1 毫升 1.23% 的局部氟化物“刷涂”一分钟。 逻辑回归和结构方程模型将被设计为 预测更多龋损的发展。 这些方法允许 用于估计各种自变量对 因变量（例如，变形链球菌水平或 对照组和对照组中继续使用奶瓶对龋齿的增加有影响 治疗组）。逻辑回归还提供了一个视角 直接估计干预的预期成本和收益。我们将 还衡量牙科知识、刷牙和刷牙方面的差异 指导前以及指导后 1 年和 2 年各组之间的奶瓶行为。 因此，本研究将考察父母或 对龋齿进展进行专业指导的预防性治疗 哺乳期龋齿高危儿童。有效的预防方案 应该对改善牙齿健康有立竿见影的效果 减少低收入家庭儿童的医疗保健费用。