Predicting Caries Risk in Underserved Children, from Toddlers to the School-Age Years, in Primary Healthcare Settings

预测初级医疗机构中服务不足的儿童（从幼儿到学龄儿童）的龋齿风险

基本信息

批准号：
10213006
负责人：
Margherita R Fontana
金额：
$ 154.87万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-23 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10213006
关键词：
5 year old 7 year old 8 year old Academy Affect Age Age-Years American Area Assessment tool Biological Child Childhood Chronic Disease Cohort Studies Data Data Analyses Dental Dental Care Dental caries Dentists Development Disease Dyes Early treatment Enrollment Environment Expenditure Experimental Designs Follow-Up Studies Goals Grant Health Health Care Costs Health Personnel Health Services Accessibility Healthcare Incidence Interdisciplinary Study Intervention Lesion Life Cycle Stages Medicaid Medical Methods Minority Groups Mixed Dentition Modeling Monitor National Institute of Dental and Craniofacial Research Oral Oral health Patients Pattern Pediatrics Physicians Policies Population Group Population Heterogeneity Predictive Value Prevalence Prevention Preventive Preventive therapy Preventive treatment Primary Dentition Primary Health Care Process Provider Publishing Questionnaires Research Research Personnel Resources Risk Risk Assessment Risk Factors School-Age Population Schools Specialist Strategic Planning Subgroup Therapeutic Toddler Tooth structure Triage Visit Work aged base care providers clinical risk cohort cost cost effective craniofacial deciduous tooth design disorder prevention disparity reduction early childhood ethnic minority population evidence base experience health assessment health care delivery health care settings health disparity implementation tool innovation low socioeconomic status multidisciplinary neglect permanent tooth predictive modeling prevent primary caregiver primary outcome programs racial and ethnic racial minority sex tool tooth surface

项目摘要

Project Summary/Abstract: Dental caries, one of the most common chronic diseases of childhood, is a largely preventable disease, yet approximately 23% of U.S. children 2-5 years-of-age experience dental caries, and this number more than doubles to 56% among those aged 6-8. In the current environment of escalating healthcare costs and resource constraints, the large disparities in caries experience and access to care that exist in the U.S., especially among low socioeconomic status (SES) and minority population groups, call for a greater focus on targeted (at the patient and tooth surface level), risk-based caries preventive and therapeutic strategies to be delivered through interprofessional partnerships, including primary healthcare settings. Our team has just finished following 1,326 children from age 1 to age 4, and we have started data analyses to validate a caries risk questionnaire for use by medical providers to accurately identify high caries risk toddlers. The problem is that, while caries experience more than doubles from ages 2-5 to 6-8, caries in primary teeth during mixed dentition is a largely neglected area of research and prevention, there is no validated caries risk tool for medical settings to easily help triage 5- 8 year old children, and there have been almost no studies following the life-course progression of caries in children 1-8. This information is critically important, as designing and targeting efficacious and cost-effective preventive therapies that can adapt to changes in the life-course from toddlers to school-age children is dependent on accurate risk factor and tooth surface assessment. Thus, the objectives of this innovative continuation renewal study are: 1) to develop a practical and easily-scored caries risk tool for use in primary medical healthcare settings to identify high caries risk children, expanding from the toddler (1-4) to the school-age years (5-8); and 2) to determine the relationships between caries risk profiles and caries disease patterns (e.g., occlusal vs. proximal) in the mixed dentition. This will be accomplished by following a cohort of 876 primary caregiver (PCG)-child pairs from our ongoing U01's enrolled pairs. This cohort represents a diverse population, including ethnic/racial minorities and low SES groups. The PCG will complete a caries risk questionnaire and the child will have caries examinations at baseline (child's age 5.5 years old + 3 months), and again at 18 months (child's age 7 years + 3 months) and 36 months after baseline (child's age 8.5 years + 3 months) to monitor the caries disease process. Longitudinal caries risk data and caries disease prevalence/incidence and tooth surface pattern information collected from age 1-4 (ongoing U01) and 5-8 (proposed continuing renewal) will be used to assess risk of caries in children ages 5-8. A great strength of this proposal is that it involves four experienced medical and dental investigator groups, who have successfully worked together for the past 5.5 years and can facilitate follow-up of the study cohort. The significance is that identification of high caries risk children in primary healthcare settings will allow cost- effective preventive and/or referral strategies to be developed, targeted and used in interprofessional settings to prevent caries development from the toddler to the school-age years. This will have immediate broad impact and influence on existing and/or new policies and programs to be delivered by non-dental professionals in medical settings and other non- healthcare settings (e.g., school-based), as well as by dental professionals in dental healthcare settings.

项目摘要/摘要：龋齿是儿童最常见的慢性疾病之一，在很大程度上是可以预防的疾病，但大约 23% 的 2-5 岁美国儿童患有龋齿，这一数字增加了一倍多，达到 56% 6-8岁。在当前医疗费用不断上升和资源紧张的环境下，龋齿的巨大差异美国现有的经验和获得护理的机会，特别是低社会经济地位 (SES) 和少数族裔人群，呼吁更加关注有针对性（在患者和牙齿表面水平）、基于风险的龋齿预防通过跨专业合作伙伴关系（包括初级医疗保健机构）提供治疗策略。我们的团队刚刚完成对 1,326 名 1 岁至 4 岁儿童的跟踪，并开始数据分析来验证龋齿风险调查问卷供医疗服务提供者使用，以准确识别高龋齿风险的幼儿。问题是，虽然从 2-5 岁到 6-8 岁，龋齿数量增加了一倍多，但混合牙列期间乳牙的龋齿在很大程度上是被忽视的研究和预防领域，没有经过验证的龋齿风险工具可供医疗机构轻松帮助分类 5- 8岁儿童，几乎没有研究跟踪1-8岁儿童龋齿的生命过程进展。这些信息至关重要，因为设计和瞄准有效且具有成本效益的预防疗法能否适应从幼儿到学龄儿童生命历程的变化取决于准确的风险因素和牙齿表面评估。因此，这项创新性持续更新研究的目标是：1）开发实用且可行的方法。易于评分的龋齿风险工具，用于初级医疗保健机构，以识别高龋齿风险儿童，扩大从幼儿（1-4）到学龄（5-8）； 2) 确定龋齿风险状况与混合牙列的龋病模式（例如，咬合面与近端面）。这将通过以下方式完成来自我们正在进行的 U01 注册对的 876 组主要看护者 (PCG)-儿童对。这个群体代表了多样化的人口，包括少数族裔/种族和低社会经济地位群体。 PCG 将完成龋齿风险调查问卷，孩子将在基线（孩子年龄 5.5 岁 + 3 个月）进行龋齿检查，并在基线后 18 个月（儿童年龄 7 岁 + 3 个月）和 36 个月（儿童年龄 8.5 岁 + 3 个月）监测龋病过程。纵向龋齿风险数据和龋齿疾病患病率/发病率和牙齿表面模式从 1-4 岁（正在进行的 U01）和 5-8 岁（建议继续更新）收集的信息将用于评估以下风险： 5-8岁儿童的龋齿。该提案的一大优势在于它涉及四位经验丰富的医疗和牙科人员研究小组，在过去 5.5 年里成功地合作，可以促进研究的后续工作队列。重要的是，在初级卫生保健机构中识别高龋齿风险儿童将有助于降低成本在跨专业环境中制定、有针对性和使用的有效预防和/或转介策略，以预防从幼儿到学龄期的龋齿发展。这将立即产生广泛的影响和影响由非牙科专业人员在医疗环境和其他非牙科环境中实施的现有和/或新政策和计划医疗机构（例如学校）以及牙科医疗机构中的牙科专业人员。