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Padilla Cáceres TC, Cervantes-Alagón S, Castillo JL, Vera Reyes CM, Rothen M, Mancl LA, Milgrom P. Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment. J Am Dent Assoc 2024; 155:526-535. [PMID: 38678451 DOI: 10.1016/j.adaj.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed. METHODS The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year. RESULTS Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0). CONCLUSIONS Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction. PRACTICAL IMPLICATIONS Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.
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Imani K, Mancl LA, Hill CM, Chi DL. Preventive dental care utilization and dental caries for Medicaid-enrolled adolescents in Oregon. J Public Health Dent 2023; 83:309-316. [PMID: 37525392 PMCID: PMC10528592 DOI: 10.1111/jphd.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES This study aimed to evaluate the relationship between preventive dental care utilization and untreated dental caries for Medicaid-enrolled adolescents and to determine if the relationship is moderated by chronic conditions (CC). METHODS This analysis was based on 2015-2016 Medicaid claims files and survey data collected from adolescents ages 12-18 years enrolled in Oregon Medicaid, who received a dental screening between December 2015 and December 2016 (n = 240). To assess the relationship between preventive dental care utilization and untreated dental caries (defined as decayed tooth surfaces), prevalence ratios (PR) and 95% confidence intervals (CI) were generated using log-linear regression models. We also tested for an interaction between preventive dental care utilization and CC. RESULTS About 60.4% of adolescents utilized preventive dental care, 21.7% had CC, and 29.6% had ≥1 decayed tooth surfaces. There were no significant differences in untreated dental caries between adolescents who did and did not utilize preventive dental care (PR: 0.73, 95% CI: 0.33-1.60; p = 0.43). There was not a significant interaction between preventive dental care utilization and CC (p = 0.65). Preventive dental care utilization was not significantly associated with untreated dental caries for adolescents with CC (PR: 0.51, 95% CI: 0.10-2.65; p = 0.42) nor among adolescents without CC (PR: 0.79, 95% CI: 0.33-1.91; p = 0.61). CONCLUSIONS Preventive dental care was not shown to be associated with lower untreated dental caries for Medicaid-enrolled adolescents or those with CC. Future work that is adequately powered should continue to elucidate this relationship in Medicaid enrollees.
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Affiliation(s)
- Kimia Imani
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Joseph A, Joseph AM, James JP, Sreepriya G, Alammari RB, Mustafa MZ. Evaluation of Age, Chief Complaint, Diagnosis, and Treatment Done during the First Dental Visit among Children in an Academic Dental Institution in Southern Kerala, India. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S641-S645. [PMID: 37654253 PMCID: PMC10466631 DOI: 10.4103/jpbs.jpbs_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 09/02/2023] Open
Abstract
Context A regular and timely first dental visit plays a cardinal role in the future oral health of the child. It is used to begin preventive and corrective interventions in dental care. Aim To evaluate the age, chief complaint, diagnosis, and treatment done during the first dental visit among children in an academic dental institution in southern Kerala, India. Materials and Methods A descriptive cross sectional retrospective survey was conducted between January and June 2022 among children in an academic dental institution in southern Kerala, India. The hospital records at the Pushpagiri College of Dental Sciences were examined to obtain the child's age, chief complaint, diagnosis, and treatment done during the first dental visit among children. Statistical Analysis: The data were expressed in frequencies and percentages. Results The records of 1000 children (680 male and 320 female) were examined. Most children (40%) who came for their first dental visit were aged between 4 and 6 years. Only 16% of children aged 0-3 years came for their first dental visit. Pain and sensitivity (50%) and tooth decay (17%) were the most common chief complaints among children. Dental caries (45%) and pulpal pathology (38%) were the most common diagnoses among children. The most common treatments done were glass ionomer cement restorations (32%), followed by prescribing medications (29%). No treatment was required for 16% of the children. Only a minority (3%) of the children received preventive treatments. Conclusions The first dental visit was delayed, and most children sought treatment only during apparent acute symptoms. There is a high prevalence of oral disease burden and underutilization of preventive dental care among children. Education of parents on the value of first dental visits and the usage of preventative dental care in children is crucial.
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Affiliation(s)
- Ashwin Joseph
- Currently, Consultant Pediatric Dentist, Clear Smiles Multispeciality Dental Care, Kottayam, Kerala, India
- Department of Pedodontics and Preventive Dentistry, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Angel M. Joseph
- Department of Prosthodontics, College of Dentistry, Al-Zulfi, Majmaah University, Riyadh, Saudi Arabia
| | - Joisy P. James
- Department of Pedodontics and Preventive Dentistry, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - G. Sreepriya
- Department of Pedodontics and Preventive Dentistry, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
| | - Rawan B. Alammari
- Department of Prosthodontics, College of Dentistry, Al-Zulfi, Majmaah University, Riyadh, Saudi Arabia
| | - Mohammed Z. Mustafa
- Department of Prosthodontics, College of Dentistry, Al-Zulfi, Majmaah University, Riyadh, Saudi Arabia
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Schmiege SJ, Jiang L, Albino J, Johnson RL, Wilson AR, Brega AG. Patterns of Change in Parental Health Literacy in Relation to Children's Oral Health. Health Lit Res Pract 2023; 7:e89-e98. [PMID: 37162254 PMCID: PMC10169466 DOI: 10.3928/24748307-20230419-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Although health literacy (HL) skills may change over time, most research treats HL as a constant, using baseline HL to predict other health-related constructs. Few studies have explored change in HL over time. OBJECTIVE We examined person-level differences in HL trajectories. We identified subgroups (latent classes) based on longitudinal assessments of HL and examined the association of class membership with demographic and oral health variables. METHODS We used four measurement waves of parental HL data, reflecting the risk of limited HL, collected as part of an intervention to reduce dental decay in American Indian children (N = 579 parent-child dyads at baseline). Repeated measures latent class analysis (RMLCA) models were estimated to identify subgroups of HL trajectories over time. We examined class membership in association with baseline demographics and with 36-month assessments of parental oral health knowledge, beliefs, and behaviors as well as pediatric oral health. KEY RESULTS A four-class model best fit the data. The largest class (high HL; 49.7% of the sample) was characterized by high levels of HL at all waves. A second class (improving HL; 17.7%) improved over all waves. The remaining two classes were characterized as moderate HL (20%) and low HL (12.6%) and maintained relatively stable HL levels over time. Higher educational attainment was associated with membership in the high HL and improving HL classes. Older age among this young-adult sample and higher income also were associated with high HL class membership. Parents in the high HL and improving HL classes exhibited more favorable performance on measures of oral health knowledge, beliefs, and behavioral adherence than did those in the other classes. Class membership was not associated with pediatric oral health. CONCLUSIONS RMLCA demonstrated person-level variability in HL trajectories. Longitudinal patterns were associated with baseline demographics and prospectively with parental oral health knowledge, beliefs, and behaviors, but not with pediatric oral health. [HLRP: Health Literacy Research and Practice. 2023;7(2):e89-e98.].
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NABARRETTE M, SANTOS PRD, ASSAF AV, AMBROSANO GMB, MENEGHIM MDC, VEDOVELLO SAS, CORTELLAZZI KL. Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys. Braz Oral Res 2023; 37:e023. [PMID: 37018805 DOI: 10.1590/1807-3107bor-2023.vol37.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/24/2022] [Indexed: 04/05/2023] Open
Abstract
This study aimed to make a longitudinal analysis of interexaminer calibration reproducibility in diagnosing dental caries in posterior teeth, by examiners without previous experience in epidemiological studies. A group of 11 inexperienced examiners underwent theoretical-practical training and calibration assessments, assisted by a standard examiner. An examiner who did not participate directly in the research selected 5-year-old children with and without caries. The D3 diagnostic threshold was used to evaluate dental caries, based on the World Health Organization (WHO) criteria. The initial calibration (baseline) was performed after the theoretical-practical training session, and consisted of examining 20 children; the second calibration occurred three months later, and involved evaluating another 18 children. The interexaminer agreement was obtained by kappa statistics, and by overall percentage agreement. The paired t-test was applied to compare the values for kappa means and overall percentage agreement between the time points studied. At baseline, the values for kappa (> 0.81) and overall percentage agreement (> 95.63%) were considered high. At the 3-month calibration assessment, all the examiners showed some decrease in both kappa (p < 0.0001) and overall percentage agreement (p = 0.0102). The calibration process currently proposed by the WHO is effective. However, reproducibility was not maintained over time for inexperienced examiners evaluating the posterior teeth of 5-year-old children, under epidemiological conditions.
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Abdel Fattah MA, Barghouth MH, Wassel MO, Deraz OH, Khalil AE, Sarsik HM, Mohsen AMA, Qenawy AS, Abou El Fadl RK. Epidemiology of dental caries in permanent dentition: evidence from a population-based survey in Egypt. BMC Public Health 2022; 22:2438. [PMID: 36575430 PMCID: PMC9794108 DOI: 10.1186/s12889-022-14844-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In recognition of the risk factors common between oral diseases and various chronic conditions and the intersection between oral health and some sustainable development goals, the current cross-sectional study was designed to quantify the burden of dental caries and identify factors associated with its occurrence in permanent teeth. METHODS Using data from Egypt's population-based survey (2013-2014), two individual-level outcomes; past caries experience (DMFT > 0) and presence of untreated carious lesions (DT > 0) were assessed using the WHO basic methods for oral health surveys. Information on potential explanatory variables including sociodemographic characteristics, exposure to fluoridated water, dental attendance, and dental anxiety was gathered using a structured questionnaire. Stratified multistage cluster random sampling was used to recruit survey participants. Multivariable logistic regression was performed to identify significant potential risk factors for caries in the permanent dentition of Egyptians. FINDINGS A total of 9,457 participants were included of which 70.3% had at least one untreated carious lesion. After adjusting for all covariates, analphabetic Egyptians were found to have significantly higher odds of caries experience in permanent dentition DMFT > 0 (OR 1.54, 95% CI [1.20-1.98]), DT > 0 (OR 1.62, 95% CI [1.32-2.00]). Males, however, had significantly lower caries risk DMFT > 0 (OR 0.75, 95% CI [0.67-0.85]), DT > 0 (OR 0.81, 95% CI [0.73-0.89]) when compared to females. Regarding age, mean DMFT scores were significantly lower in age groups (6-15 years) (OR 0.03, 95% CI [0.014; 0.082]), (16- 20 years) (OR 0.09, 95% CI [0.037; 0.23]), and (21-35 years) (OR 0.22, 95% CI [0.09; 0.53]) than among people ≥ 60 years. CONCLUSION Addressing individual-level caries risk factors should be complemented by addressing upstream factors to reduce burden of untreated dental caries among Egyptians.
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Affiliation(s)
| | - Muhammad Helmi Barghouth
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
| | - Mariem Osama Wassel
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
| | - Omar Hassan Deraz
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM U970, 56 Rue Leblanc, 75015 Paris, France
| | - Ahmed Essam Khalil
- grid.440862.c0000 0004 0377 5514British University in Egypt, Suez Desert Road El Sherouk City, Cairo, 11837 Egypt
| | - Hazem Magdy Sarsik
- grid.412258.80000 0000 9477 7793Faculty of Dentistry, Tanta University, Tanta Qism 2, Tanta, Gharbia Governorate, Cairo, 6624033 Egypt
| | | | - Amr Shaaban Qenawy
- grid.415762.3Ministry of Health and Population, 3 Magles El Shaab Street, Cairo, Egypt
| | - Reham Khaled Abou El Fadl
- grid.7269.a0000 0004 0621 1570Faculty of Dentistry, Ain Shams University, Organization of African Unity st. Abbasia, 11566 Cairo, Egypt
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Amarante BC, Arima LY, Pinheiro E, Carvalho P, Michel-Crosato E, Bönecker M. Diagnosis training and calibration for epidemiological studies on primary and permanent teeth with hypomineralization. Eur Arch Paediatr Dent 2022; 23:169-177. [PMID: 34990003 DOI: 10.1007/s40368-021-00686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The objective of this study was to assess the impact on diagnostic accuracy and Kappa values improvement during the three-phase training and calibration process for MIH/HSPM. METHODS Thirty dentists were calibrated as examiners for diagnosis of Molar Incisor Hypomineralization (MIH) using Ghanim's index. The whole process was divided into three phases. Phase 1: three meetings with the dentists for the first diagnosis training and calibration (sessions 1a and 1b); phase 2: for a period of 1 month, the dentists started practicing MIH/HSPM diagnosis in the Basic Health Units and an online follow-up group was created to discuss cases and resolve doubts; phase 3: two meetings with the dentists for the second calibration (sessions 2a and 2b). A webpage with educational material was prepared as support during the whole process to improve the dentists' skills in diagnosing MIH/HSPM. The examiners' responses were compared to a gold standard and the Kappa value was obtained. RESULTS The average clinical criteria kappa value of the examiners was 0.76 ± 0.19 for the first calibration and 0.93 ± 0.07 (p < 0.05) for the second calibration. For the eruption criteria, the average kappa value was 0.89 ± 0.14 for the first calibration and 0.98 ± 0.08 for the second calibration. Extension criteria had an average kappa value of 0.59 ± 0.15 during the first calibration and 0.75 ± 0.14 during the second calibration. CONCLUSION This study demonstrated that the methodology used was an effective tool for improving the diagnostic accuracy of MIH/HSPM.
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Affiliation(s)
- Bruna Cordeiro Amarante
- Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo (USP), São Paulo, Brazil.
| | - Letícia Yumi Arima
- Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Emanuella Pinheiro
- Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Patricia Carvalho
- Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Edgard Michel-Crosato
- Department of Public Health, Dental School, University of São Paulo (USP), São Paulo, Brazil
| | - Marcelo Bönecker
- Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo (USP), São Paulo, Brazil
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Uribe SE, Innes N, Maldupa I. The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria. Int J Paediatr Dent 2021; 31:817-830. [PMID: 33735529 DOI: 10.1111/ipd.12783] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
AIM To estimate the global prevalence of early childhood caries using the WHO criteria. DESIGN Systematic review of studies published from 1960 to 2019. DATA SOURCES PubMed, Google Scholar, SciELO, and LILACS. Eligibility criteria were articles using: dmft-WHO diagnostic criteria with calibrated examiners, probability sampling, and sample sizes. STUDY SELECTION Two reviewers searched, screened, and extracted information from the selected articles. All pooled analyses were based on random-effects models. The protocol is available on PROSPERO 2014 registration code CRD42014009578. RESULTS From 472 reports, 214 used WHO criteria and 125 fit the inclusion criteria. Sixty-four reports of 67 countries (published 1992-2019) had adequate data to be summarised in the meta-analysis. They covered 29 countries/59018 children. Global random-effects pooled prevalence was (percentage[95% CI]) 48[43, 53]. The prevalence by continent was Africa: 30[19, 45]; Americas: 48 [42, 54]; Asia: 52[43, 61]; Europe: 43[24, 66]; and Oceania: 82[73, 89]. Differences across countries explain 21.2% of the observed variance. CONCLUSIONS Early childhood caries is a global health problem, affecting almost half of preschool children. Results are reported from 29 of 195 countries. ECC prevalence varied widely, and there was more variance attributable to between-country differences rather than continent or change over time.
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Affiliation(s)
- Sergio E Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia.,Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia.,School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Nicola Innes
- School of Dentistry, Cardiff University of Dundee, Cardiff, UK
| | - Ilze Maldupa
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia.,School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
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Brega AG, Johnson RL, Jiang L, Wilson AR, Schmiege SJ, Albino J. Influence of Parental Health Literacy on Change over Time in the Oral Health of American Indian Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115633. [PMID: 34070347 PMCID: PMC8197463 DOI: 10.3390/ijerph18115633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
In cross-sectional studies, parental health literacy (HL) is associated with children’s oral health. It is unclear, however, whether HL influences pediatric outcomes. We examined the relationship of HL with change over time in parental oral health knowledge, beliefs, and behaviors, as well as pediatric oral health outcomes. We used longitudinal data from a study designed to reduce dental decay in American Indian children (N = 579). At baseline and annually for three years, parents answered questions assessing HL; oral health knowledge, beliefs, and behaviors; and pediatric oral health status. The number of decayed, missing, and filled tooth surfaces (dmfs) was computed based on annual dental evaluations. Linear mixed models showed that HL was significantly associated with all constructs, except dmfs, at their reference time points and persistently across the three-year study period. HL predicted change over time in only one variable, parents’ belief that children’s oral health is determined by chance or luck. HL is strongly associated with oral health knowledge, beliefs, behaviors, and status prospectively but is not a key driver of change over time in these oral health constructs.
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Affiliation(s)
- Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Correspondence: ; Tel.: +1-303-724-1470
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (R.L.J.); (S.J.S.)
| | - Luohua Jiang
- Department of Epidemiology & Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA 92697, USA;
| | - Anne R. Wilson
- Department of Pediatric Dentistry, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Sarah J. Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (R.L.J.); (S.J.S.)
| | - Judith Albino
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
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Parental Ethnic Identity and Its Influence on Children's Oral Health in American Indian Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084130. [PMID: 33919721 PMCID: PMC8070676 DOI: 10.3390/ijerph18084130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
Objectives: To examine the relationship between ethnic identity and oral health knowledge, beliefs, behavior, and outcomes in American Indian families. Methods: Secondary data were analyzed for 579 parent–child dyads in a randomized controlled trial aimed at reducing early childhood caries in a Northern Plains tribal community. Data included demographic characteristics; parental ethnic identity; oral health knowledge, beliefs, and behavior; and parental/pediatric oral health outcomes. Ethnic identity was assessed using two measures: perceived importance of tribal identity and tribal language proficiency. We examined the association of baseline ethnic identity with baseline and longitudinal oral health measures. Results: At baseline, importance of tribal identity was significantly associated with several oral health beliefs, and one’s locus of control measure (external-chance). Baseline scores on importance of tribal identity were also associated with one’s oral heath belief (perceived severity), the same locus of control measure, and oral health knowledge and behavior over the three years of study follow up. Tribal language proficiency was not associated with any study measures at baseline, although it was associated with parental oral health status over the three years. Conclusions: Ethnic identity was associated with a range of oral health constructs expected to influence American Indian children’s oral health.
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Tiwari T, Rai N, Wilson A, Gansky S, Albino J. What Can We Learn from Parents of Caries-Free and Caries-Active Hispanic Children? JDR Clin Trans Res 2021; 6:47-58. [PMID: 32040929 PMCID: PMC7755946 DOI: 10.1177/2380084420904043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study evaluated strength-based motivators within Hispanic families that support the creation of health in their children. A mixed-methods approach was used to understand differences in Hispanic parental factors between caries-free (CF) and caries-active (CA) children. METHODS A cross-sectional survey was conducted with 200 parent-child triads (primary child: between 0 and 6 y; reference child: between 0 and 10 y) recruited from health centers in the Denver Metro area. All the participating children received an oral examination, and the triads were grouped as CF or CA based on the caries status of the primary child. Qualitative data were collected through in-depth individual interviews with the parents. The analysis only involved the primary child. Bivariable analysis were conducted between parent factors (independent variables) and presence or absence of caries (outcome variable). The variables with P < 0.20 in the bivariable analysis were subjected to 2 multivariable logistic regression models. The children in the CF group had mean (SD) age of 2.8 (1.28) y compared to the CA group at 4.0 (1.55) y (P < 0.001). Bivariable analysis demonstrated that parents in the CF group reported higher oral hygiene behavior scores (P = 0.047), perceived fewer barriers (P = 0.009) to accessing preventive dental care, and considered their children more susceptible to cavities (P = 0.001) compared to parents in the CA group. Multivariable model (adjusting for socioeconomic characteristics) demonstrated that parents of CF children perceived high susceptibility to caries for their children (P = 0.040). Multivariable model (adjusting for acculturation) demonstrated an association of parental oral hygiene behavior (P = 0.040) and parent-perceived susceptibility to caries (P = 0.010) with CF child status. Qualitative interviews revealed that parents in the CF group were concerned about their children's higher susceptibility to caries and tried to establish good oral hygiene routines for their children. CONCLUSION The results of this study demonstrated that parental behaviors and health beliefs could be significant determinants of caries status in Hispanic children. KNOWLEDGE TRANSFER STATEMENT Results of this study indicate that parental oral health beliefs and behaviors are significant determinants of caries status in children of Hispanic population. Parental beliefs could motivate them to take action or establish behavior that prevents dental caries in their children. Health care providers and caries prevention efforts can incorporate this information to tailor oral health promotional messaging and approaches to improve the oral health of Hispanic children.
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Affiliation(s)
- T. Tiwari
- School of Dental Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - N.K. Rai
- School of Dental Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - A.R. Wilson
- School of Dental Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - S.A. Gansky
- School of Dentistry, University of California, San Francisco, CA, USA
| | - J. Albino
- School of Dental Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Milgrom P, Tut O, Rothen M, Mancl L, Gallen M, Tanzer JM. Addition of Povidone-Iodine to Fluoride Varnish for Dental Caries: A Randomized Clinical Trial. JDR Clin Trans Res 2020; 6:195-204. [PMID: 32437626 DOI: 10.1177/2380084420922968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Dental caries is the most common chronic childhood disease. Products of metabolism by bacteria populating the tooth surface induce development and progression of cavities. OBJECTIVES We sought to determine whether a polyvinylpyrrolidone-iodine (PVP-I; povidone-iodine) and NaF topical varnish was superior to one containing only NaF in prevention of new dental caries lesions in a single-center randomized active-controlled trial based on a double-blind, parallel-group design. METHODS The site was Pohnpei State, Federated States of Micronesia. The study population was healthy children 49 to 84 mo old who were enrolled in early childhood education: 284 were randomized (1:1 allocation), and 273 were included in year 1 analysis and 262 in year 2. The test varnish contained 10% PVP-I and 5.0% NaF. The comparator contained only 5.0% NaF but was otherwise identical. Varnishes were applied every 3 mo during 2 y. The primary outcome was the surface-level primary molar caries lesion increment (d2-4mfs) at 2 y. Caries lesion increments from baseline to year 1 and year 2 were compared between conditions with log-linear regression, adjusting for age and sex and whether the tooth was sound at baseline (free of caries lesions). RESULTS At year 1, the caries lesion increment for primary molars sound at baseline was 0.9 surfaces (SD = 1.5) for the test varnish versus 1.8 (SD = 2.2) for the comparator varnish with fluoride alone (adjusted rate ratio, 0.50; 95% CI, 0.31 to 0.81; P = .005). At year 2, the caries lesion increment for primary molars sound at baseline was 2.3 surfaces (SD = 2.8) for the test varnish as compared with 3.3 (SD = 2.7) for the comparator (adjusted rate ratio, 0.74; 95% CI, 0.52 to 1.03; P = .073). Teeth that were already cavitated at baseline did not show a preventive effect. There were no harms. CONCLUSIONS A dental varnish containing PVP-I and NaF is effective in the primary prevention of cavities in the primary dentition (NCT03082196). KNOWLEDGE TRANSFER STATEMENT This study demonstrates that periodic application of a varnish containing NaF and PVP-I is effective in prevention of caries lesions and useful in assessing the potential of combined treatment.
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Affiliation(s)
- P Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Advantage Silver Dental Arrest, LLC, Salem, Oregon
| | - O Tut
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M Rothen
- Regional Clinical Dental Research Center, Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - L Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M Gallen
- Department of Dental Services, Pohnpei State Department of Health Services, Kolonia, Federated States of Micronesia
| | - J M Tanzer
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Connecticut Health, Farmington, CT, USA
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Wilson AR, Tiwari T, Thomas JF, Henderson WG, Braun PA, Albino J. Validation of Psychosocial Measures Assessing American Indian Parental Beliefs Related to Control over Their Children's Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E403. [PMID: 31936256 PMCID: PMC7014362 DOI: 10.3390/ijerph17020403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To validate questionnaire items assessing American Indian (AI) parental beliefs regarding control over their children's oral health within the context of psychosocial measures and children's oral health status. METHODS Baseline questionnaire data were collected as part of a randomized controlled trial (n = 1016) addressing early childhood caries. Participants were AI parents with preschool-age children in the Navajo Nation Head Start program. Questionnaire items assessed parental oral health locus of control (OHLOC) and agreement with beliefs indicating that they were in control of their children's oral health (internal), the dentist was in control (external powerful others), or children's oral health was a matter of chance (external chance). Exploratory factor analysis was conducted, and convergent validity was assessed using linear regression. RESULTS Parents with more education (p < 0.0001) and income (p = 0.001) had higher scores for internal OHLOC. Higher internal OHLOC scores were associated with higher scores on knowledge (p < 0.0001), perceived seriousness and benefits (p < 0.0001), higher self-efficacy, importance, sense of coherence (p < 0.0001 for all), and lower scores for perceived barriers (p < 0.0001) and distress (p = 0.01). Higher scores for both types of external OHLOC were associated with lower scores on knowledge (p < 0.0001), perceived seriousness (p < 0.0001), and higher scores on perceived susceptibility (p = 0.01 external chance; <0.0001 powerful others) and barriers (<0.0001). Higher scores for external powerful others were associated with lower scores for importance (p = 0.04) and sense of coherence (p = 0.03). Significant associations were not found for OHLOC beliefs and children's oral health status. CONCLUSIONS Questionnaire items addressing OHLOC functioned in accordance with the theoretical framework in AI participants.
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Affiliation(s)
- Anne R Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B240, Aurora, CO 80045, USA
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B240, Aurora, CO 80045, USA
| | - Jacob F Thomas
- Adult and Child Consortium of Outcomes Research and Dissemination Science University of Colorado, Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO 80045, USA
| | - William G Henderson
- Adult and Child Consortium of Outcomes Research and Dissemination Science University of Colorado, Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO 80045, USA
| | - Patricia A Braun
- Adult and Child Consortium of Outcomes Research and Dissemination Science University of Colorado, Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO 80045, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview, Blvd, Suite 300, W359-G, Aurora, CO 80045, USA
| | - Judith Albino
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview, Blvd, Suite 300, W359-G, Aurora, CO 80045, USA
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White JM, Mertz EA, Mullins JM, Even JB, Guy T, Blaga E, Kottek AM, Kumar SV, Bangar S, Vaderhobli R, Brandon R, Santo W, Jenson L, Gansky SA. Developing and Testing Electronic Health Record-Derived Caries Indices. Caries Res 2019; 53:650-658. [PMID: 31167186 DOI: 10.1159/000499700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022] Open
Abstract
Caries indices, the basis of epidemiologic caries measures, are not easily obtained in clinical settings. This study's objective was to design, test, and validate an automated program (Valid Electronic Health Record Dental Caries Indices Calculator Tool [VERDICT]) to calculate caries indices from an electronic health record (EHR). Synthetic use case scenarios and actual patient cases of primary, mixed, and permanent dentition, including decayed, missing, and filled teeth (DMFT/dmft) and tooth surfaces (DMFS/dmfs) were entered into the EHR. VERDICT measures were compared to a previously validated clinical electronic data capture (EDC) system and statistical program to calculate caries indices. Four university clinician-researchers abstracted EHR caries exam data for 45 synthetic use cases into the EDC and post-processed with SAS software creating a gold standard to compare the -VERDICT-derived caries indices. Then, 2 senior researchers abstracted EHR caries exam data and calculated caries indices for 24 patients, allowing further comparisons to VERDICT indices. Agreement statistics were computed among abstractors, and discrepancies were resolved by consensus. Agreement statistics between the 2 final-phase abstractors and the VERDICT measures showed extremely high concordance: Lin's concordance coefficients (LCCs) >0.99 for dmfs, dmft, DS, ds, DT, dt, ms, mt, FS, fs, FT, and ft; LCCs >0.95 for DMFS and DMFT; and LCCs of 0.92-0.93 for MS and MT. Caries indices, essential to developing primary health outcome measures for research, can be reliably derived from an EHR using VERDICT. Using these indices will enable population oral health management approaches and inform quality improvement efforts.
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Affiliation(s)
- Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA, .,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA,
| | - Elizabeth A Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Joanna M Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Joshua B Even
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Trey Guy
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Elena Blaga
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Aubri M Kottek
- Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Shwetha V Kumar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Suhasini Bangar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ram Vaderhobli
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - William Santo
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA
| | - Larry Jenson
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Stuart A Gansky
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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15
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Brega AG, Henderson WG, Harper MM, Thomas JF, Manson SM, Batliner TS, Braun PA, Quissell DO, Wilson A, Tiwari T, Albino J. Association of Ethnic Identity with Oral Health Knowledge, Attitudes, Behavior, and Outcomes on the Navajo Nation. J Health Care Poor Underserved 2019; 30:143-160. [PMID: 30827975 PMCID: PMC6400317 DOI: 10.1353/hpu.2019.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
American Indians and Alaska Natives (AI/ANs) experience poor oral health. Children and adults living on the Navajo Nation have a particularly high rate of dental decay. The literature suggests that health outcomes are often associated with the strength of one's ethnic identity. We investigated the association of ethnic identity among Native parents with oral health knowledge, attitudes, behavior, and outcomes. Analyses used baseline data from a randomized controlled trial designed to reduce dental decay among AI/AN preschoolers enrolled in the Navajo Nation Head Start Program. Greater perceived importance of ethnic identity was associated with better oral health knowledge and attitudes but was unassociated with oral health behavior and was linked to worse oral health status. Parents who were better able to speak their tribal language had greater confidence in their ability to manage their children's oral health, engaged in better oral health behavior, and reported better parental oral health status.
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16
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Wilson AR, Brega AG, Thomas JF, Henderson WG, Lind KE, Braun PA, Batliner TS, Albino J. Validity of Measures Assessing Oral Health Beliefs of American Indian Parents. J Racial Ethn Health Disparities 2018; 5:1254-1263. [PMID: 29508373 PMCID: PMC6123310 DOI: 10.1007/s40615-018-0472-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This aimed to validate measures of constructs included in an extended Health Belief Model (EHBM) addressing oral health beliefs among American Indian (AI) parents. METHODS Questionnaire data were collected as part of a randomized controlled trial (n = 1016) aimed at reducing childhood caries. Participants were AI parents with a preschool-age child enrolled in the Navajo Nation Head Start program. Questionnaire items addressed five EHBM constructs: perceived susceptibility, severity, barriers, benefits, and parental self-efficacy. Subscales representing each construct underwent reliability and validity testing. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of each EHBM subscale with oral health-related measures. RESULTS Internal consistency reliability was high for self-efficacy (α = 0.83) and perceived benefits (α = 0.83) compared to remaining EHBM subscales (α < 0.50). Parents with more education (p < 0.0001) and income (p = 0.0002) perceived dental caries as more severe younger parents (ps = 0.02) and those with more education (ps < 0.0001) perceived greater benefits and fewer barriers to following recommended oral health behavior. Female parents (p < 0.0001) and those with more education (p = 0.02) had higher levels of self-efficacy. Parental knowledge was associated with all EHBM measures (ps < 0.0001) excluding perceived susceptibility (p > 0.05). Parents with increased self-efficacy had greater behavioral adherence (p < 0.0001), whereas lower behavioral adherence was associated with parents who reported higher perceived barriers (p < 0.0001). Better pediatric oral health outcomes were associated with higher levels of self-efficacy (p < 0.0001) and lower levels of perceived severity (p = 0.02) and barriers (p = 0.05). CONCLUSIONS Results support the value of questionnaire items addressing the EHBM subscales, which functioned in a manner consistent with the EHBM theoretical framework in AI participants.
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Affiliation(s)
- Anne R Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B240, Aurora, CO, 80045, USA.
| | - Angela G Brega
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
| | - Jacob F Thomas
- Children's Outcomes Research/Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA
| | - William G Henderson
- Children's Outcomes Research/Colorado Health Outcomes Programs, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd., Suite 300 F443, Aurora, CO, 80045, USA
| | - Kimberly E Lind
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
- School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Ave, Aurora, CO, 80045, USA
| | - Patricia A Braun
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
- School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Ave, Aurora, CO, 80045, USA
| | - Terrence S Batliner
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
| | - Judith Albino
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13199 E. Montview Blvd, Suite 300, W359-G, Aurora, CO, 80045, USA
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Henshaw M, Borrelli B, Gregorich S, Heaton B, Tooley E, Santo W, Cheng N, Rasmussen M, Helman S, Shain S, Garcia R. Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in Public Housing. JDR Clin Trans Res 2018; 3:353-365. [PMID: 30238060 PMCID: PMC6139579 DOI: 10.1177/2380084418794377] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Caries experience among preschool-age children has remained relatively unchanged for the past 2 decades, despite recently documented decreases in untreated decay. OBJECTIVES In a community-based cluster-randomized controlled trial, a motivational interviewing (MI) intervention administered to primary caregivers was hypothesized to reduce caries increment over 2 y as compared with controls, among children aged 0 to 5 y at baseline living in public housing. METHODS Public housing residents, who served as interventionists, were trained in MI with a focus on early childhood caries prevention. All 26 eligible public housing developments were randomized to either control (quarterly clinical examinations, fluoride varnish applications, toothbrush/toothpaste, and educational brochures) or intervention (same procedures as control plus MI counseling). Quarterly MI sessions were delivered in English or Spanish over 2 y, audio recorded, and assessed for treatment fidelity. The primary outcome was the increment in dmfs (decayed, missing, and filled tooth surfaces) as assessed by clinical examination at baseline, 12 mo, and 24 mo. Secondary outcomes included caregiver oral health knowledge and child oral health behaviors (child toothbrushing and sugar-sweetened beverage intake). Baseline characteristics were compared between groups and adjusted for housing-site clusters. Longitudinal outcomes were analyzed with mixed models. RESULTS A total of 1,065 children (49% female, 55% non-White, 61% Hispanic, 89% below poverty level, n = 686 control) and their caregivers were enrolled. During 2 y of follow-up, the mean dmfs increment increased in both groups; however, there were no statistically significant group differences at 24 mo or group × time interactions. The mean increase in intervention caregivers' knowledge was significantly greater than that of control, F(2, 1,593) = 3.48, P = 0.0310, but there were no significant intervention effects on caregiver-reported child sugar-sweetened beverage intake or child toothbrushing. CONCLUSION MI counseling plus intensive caries prevention activities resulted in knowledge increases but did not improve oral health behaviors or caries increment (ClinicalTrials.gov NCT01205971). KNOWLEDGE TRANSFER STATEMENT When viewed in light of the findings from the companion Pine Ridge study and other recent MI studies, the results of this study suggest that when the complex disease of early childhood caries is addressed in high-risk populations, MI is not effective, and alternative approaches are warranted.
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Affiliation(s)
- M.M. Henshaw
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - B. Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S.E. Gregorich
- University of California, San Francisco, San Francisco, CA, USA
| | - B. Heaton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | | | - W. Santo
- University of California, San Francisco, San Francisco, CA, USA
| | - N.F. Cheng
- University of California, San Francisco, San Francisco, CA, USA
| | - M. Rasmussen
- University of California, San Francisco, San Francisco, CA, USA
| | - S. Helman
- University of California, San Francisco, San Francisco, CA, USA
| | - S. Shain
- University of California, San Francisco, San Francisco, CA, USA
| | - R.I. Garcia
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
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Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent 2018; 77:8-17. [DOI: 10.1016/j.jdent.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022] Open
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Batliner TS, Tiwari T, Henderson WG, Wilson AR, Gregorich SE, Fehringer KA, Brega AG, Swyers E, Zacher T, Harper MM, Plunkett K, Santo W, Cheng NF, Shain S, Rasmussen M, Manson SM, Albino J. Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in American Indian Children. JDR Clin Trans Res 2018; 3:366-375. [PMID: 30238061 DOI: 10.1177/2380084418787785] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction In a randomized controlled trial, the effectiveness of motivational interviewing (MI) combined with enhanced community services (MI + ECS) was compared with ECS alone for reducing dental caries in American Indian children on the Pine Ridge Reservation. The intervention was developed and delivered with extensive tribal collaboration. Methods A total 579 mother-newborn dyads were enrolled and randomized to the MI + ECS and ECS groups. They were followed for 36 mo. Four MI sessions were provided, the first shortly after childbirth and then 6, 12, and 18 mo later. Both groups were exposed to ECS, which included public service announcements through billboards and tribal radio, as well as broad distribution of brochures on behavioral risk factors for early childhood caries (ECC), toothbrushes, and toothpaste. MI impact was measured as decayed, missing, and filled tooth surfaces (dmfs). Secondary outcomes included decayed surfaces, caries prevalence, and maternal oral health knowledge and behaviors. Modified intention-to-treat analyses were conducted. Eighty-eight percent of mothers completed at least 3 of 4 MI sessions offered. Results After 3 y, dmfs was not significantly different for the 2 groups (MI + ECS = 10, ECS = 10.38, P = 0.68). In both groups, prevalence of caries experience was 7% to 9% after 1 y, 35% to 36% at 2 y, and 55% to 56% at 3 y. Mean knowledge scores increased by 5.0, 5.3, and 5.9 percentage points at years 1, 2, and 3 in the MI + ECS group and by 1.9, 3.3, and 5.0 percentage points in the ECS group (P = 0.03), respectively. Mean maternal oral health behavior scores were not statistically significantly different between the treatment arms. Conclusion In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of ECC (ClinicalTrials.gov NCT01116726). Knowledge Transfer Statement The findings of this study suggest that motivational interviewing focusing on parental behaviors may not be as effective as previously hoped for slowing the development of childhood caries in some high-risk groups. Furthermore, social factors may be even more salient determinants of oral health than what we previously supposed, perhaps interfering with the capacity to benefit from behavioral strategies that have been useful elsewhere. The improvement of children's oral health in high-risk populations characterized by poverty and multiple related life stresses may require more holistic approaches that address these formidable barriers.
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Affiliation(s)
- T S Batliner
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W G Henderson
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A R Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S E Gregorich
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - K A Fehringer
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A G Brega
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - E Swyers
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Zacher
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M M Harper
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - K Plunkett
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W Santo
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - N F Cheng
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - S Shain
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - M Rasmussen
- Center to Address Disparities in Children's Oral Health (CAN DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - S M Manson
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Albino
- Center for Native Oral Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Albino J, Tiwari T, Henderson WG, Thomas JF, Braun PA, Batliner TS. Parental psychosocial factors and childhood caries prevention: Data from an American Indian population. Community Dent Oral Epidemiol 2018; 46:360-368. [PMID: 29637583 DOI: 10.1111/cdoe.12376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to examine the association among psychological and social variables reported by American Indian parents/caregivers of preschool children and changes in their Oral Health Knowledge and Behaviors related to care of their children's teeth. We also investigated the relationship of these factors with progression of caries, as reflected by changes in their children's dmfs. METHODS The data used for this study were collected at baseline in a clinical trial of an oral health promotion intervention comprising behavioural and clinical interventions for caries prevention delivered by tribal members on a large Southwestern American Indian reservation. Linear regression analyses were performed for changes (baseline to Year 1) in dmfs, Oral Health Knowledge and Oral Health Behavior scores, with baseline psychosocial measures, taken individually, as the independent variables. RESULTS Parents' attitudes and beliefs were associated with increases in their Oral Health Knowledge and Behavior and also with the progression of caries for their children. When all participants were considered together, increases in children's dmfs were smaller when the caregiver had higher Internal Oral Health Locus of Control (e = -1.33, P = .004), higher Health Literacy (e = -1.55, P < .01), and higher Financial Stability (e = -4.46, P = .03), and lower scores for the Barriers subscale (e = 1.57, P < .01) of the Health Belief Model. For parents in the Intervention group, higher scores on Locus of Control, reflecting beliefs that chance, or other people determine their children's oral health, were associated with larger increases in Oral Health Knowledge (e = 1.73, P = .04) and Behaviors (e = 4.00, P = .005). CONCLUSIONS Prevention of early childhood caries in American Indian children has proved to be especially challenging. Some of the measures identified in this report may suggest promising directions to prevention through approaches that build on competencies and skills to be learned and used within a context more broadly focused on parenting and management of health and family challenges.
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Affiliation(s)
- Judith Albino
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William G Henderson
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob F Thomas
- Adult and Child Consortium of Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patricia A Braun
- Adult and Child Consortium of Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Terrence S Batliner
- Center for Native Oral Health Research (CNOHR), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rechmann P, Jue B, Santo W, Rechmann BMT, Featherstone JDB. Calibration of dentists for Caries Management by Risk Assessment Research in a Practice Based Research Network - CAMBRA PBRN. BMC Oral Health 2018; 18:2. [PMID: 29301527 PMCID: PMC5755129 DOI: 10.1186/s12903-017-0457-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022] Open
Abstract
Background To prove that Caries Management by Risk Assessment (CAMBRA) can be successfully implemented in dental practices outside of the university setting, dentists in the San Francisco Bay Area (CA) were approached to participate in a Practice Based Research Network (PBRN) study. The overall goal of the CAMBRA-PBRN study was to recruit 30 dentists to perform a two-year study involving approximately 900 patients. Goal of the calibration study was to standardize and calibrate dentists potentially participating in the CAMBRA-PBRN study. Methods To minimize inter-examiner variability in data collection, including classification of carious lesions and recording of existing restorations, participating dentists were trained and calibrated in accurate DMFS (decayed, missing, filled surfaces) charting. Dentists were also trained and calibrated to diagnose and differentiate between sound surfaces and non-cavitated caries lesions (International Caries Detection and Assessment - ICDAS scores 1 and 2) for posterior occlusal surfaces. Thirty dentists were calibrated to a single gold standard examiner (BJ) during 6 calibration sessions, between 2011 and 2014. Kappa statistics were used to determine inter-examiner reliability on 13 or more patients, aged 12–63 (average age 38 ± 15 years), per examiner during each session, resulting in 94 patient encounters over the course of all 6 sessions. To participate in the main study, examiners needed to achieve a minimum required kappa of 0.75. During the calibration process, examiners scored between 1036 and 2220 tooth surfaces. Results The kappa values (unweighted kappa) of the participating dentists compared to the gold standard examiner ranged from 0.75 to 0.90, with an average kappa of 0.84 ± 0.03. 90% of the examiners achieved overall kappa values above 0.8. However, separate reliability for assessment of non-cavitated lesions, as in other studies, was lower (0.55 ± 0.15). Multiple subcategories were evaluated. All dentists reached sufficient reliability values to proceed into the study; nevertheless, one dentist discontinued with the study due to scheduling conflicts. Conclusions The high inter-examiner reliability results have shown that dentists who work in primarily non-research based practices can be effectively standardized and calibrated in data collection, based on specific guidelines created to anticipate potential research study scenarios.
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Affiliation(s)
- Peter Rechmann
- School of Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, 707 Parnassus Avenue, San Francisco, CA, 94019, USA.
| | - Bonnie Jue
- School of Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, 707 Parnassus Avenue, San Francisco, CA, 94019, USA
| | - William Santo
- School of Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, 707 Parnassus Avenue, San Francisco, CA, 94019, USA
| | - Beate M T Rechmann
- School of Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, 707 Parnassus Avenue, San Francisco, CA, 94019, USA
| | - John D B Featherstone
- School of Dentistry, Department of Preventive and Restorative Dental Sciences, University of California, 707 Parnassus Avenue, San Francisco, CA, 94019, USA
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22
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Villhauer AL, Lynch DJ, Warren JJ, Dawson DV, Blanchette DR, Drake DR. Genotypic characterization and comparison of Streptococcus mutans in American Indian and Southeast Iowa children. Clin Exp Dent Res 2017; 3:235-243. [PMID: 29416899 PMCID: PMC5788224 DOI: 10.1002/cre2.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 01/15/2023] Open
Abstract
Early childhood caries is a complex health care issue that has a multifactorial etiology. One aspect of this etiology is the colonization and propagation of acidogenic bacteria at an early age. There have been several bacterial species associated with caries but 1 common species is Streptococcus mutans. Here, we describe genotypic diversity and commonality of Streptococcus mutans recovered from children representing 2 groups with similar socioeconomic demographics: a Northern Plains American Indian Tribe and a Southeast Iowa population. Forty 36‐month‐old American Indian children were selected from a cohort of 239 mothers and children, and forty 2‐ to 5‐year‐old children from Southeast Iowa were selected to compare the genotypic profiles of Streptococcus mutans recovered from each child's plaque. S. mutans isolates were selected from whole mouth plaque samples; DNA was extracted and amplified via AP‐PCR to show specific genotype patterns. These patterns were compared with GelComparIIv6.5 gel analysis software. We found 18 distinct genotypes from 524 isolates; 13 of which were common between the 2 communities. Five genotypes were unique to only the American Indian children while the Southeast Iowa children harbored no unique genotypes. Although the American Indian children had some genotypes that were not present in the Southeast Iowa children, these were not widely distributed among the community. Furthermore, the levels of genotypic diversity and commonality were similar between the 2 populations. This study sets the groundwork for a comprehensive comparison of genotypes and caries among larger subsections of both populations.
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Affiliation(s)
- Alissa L Villhauer
- Iowa Institute for Oral Health Research University of Iowa, College of Dentistry Iowa USA
| | - David J Lynch
- Iowa Institute for Oral Health Research University of Iowa, College of Dentistry Iowa USA
| | - John J Warren
- Preventive and Community Dentistry University of Iowa, College of Dentistry Iowa USA
| | - Deborah V Dawson
- Iowa Institute for Oral Health Research University of Iowa, College of Dentistry Iowa USA
| | - Derek R Blanchette
- Iowa Institute for Oral Health Research University of Iowa, College of Dentistry Iowa USA
| | - David R Drake
- Iowa Institute for Oral Health Research University of Iowa, College of Dentistry Iowa USA
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23
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Braun PA, Widmer-Racich K, Sevick C, Starzyk EJ, Mauritson K, Hambidge SJ. Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers. Am J Public Health 2017; 107:S97-S103. [PMID: 28661802 DOI: 10.2105/ajph.2017.303817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess an oral health promotion (OHP) intervention for medical providers' impact on early childhood caries (ECC). METHODS We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention's impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. RESULTS Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0-7), and 4.5 (4-7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. CONCLUSIONS An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years.
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Affiliation(s)
- Patricia A Braun
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katina Widmer-Racich
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Carter Sevick
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Erin J Starzyk
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katya Mauritson
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Simon J Hambidge
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
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Sutton JC, Fay RM, Huynh CP, Johnson CD, Zhu L, Quock RL. Dental Faculty Accuracy When Using Diagnostic Codes: A Pilot Study. J Dent Educ 2017; 81:554-560. [PMID: 28461632 DOI: 10.21815/jde.016.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.
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Affiliation(s)
- Jeanne C Sutton
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Rose-Marie Fay
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Carolyn P Huynh
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Cleverick D Johnson
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Liang Zhu
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Ryan L Quock
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston.
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25
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Braun PA, Quissell DO, Henderson WG, Bryant LL, Gregorich SE, George C, Toledo N, Cudeii D, Smith V, Johs N, Cheng J, Rasmussen M, Cheng NF, Santo W, Batliner T, Wilson A, Brega A, Roan R, Lind K, Tiwari T, Shain S, Schaffer G, Harper M, Manson SM, Albino J. A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children. J Dent Res 2016; 95:1237-44. [PMID: 27439724 DOI: 10.1177/0022034516658612] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).
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Affiliation(s)
- P A Braun
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D O Quissell
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W G Henderson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - L L Bryant
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S E Gregorich
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C George
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Toledo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D Cudeii
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - V Smith
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Johs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Cheng
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Rasmussen
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N F Cheng
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W Santo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Batliner
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Wilson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Brega
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - R Roan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - K Lind
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Shain
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - G Schaffer
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Harper
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S M Manson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Albino
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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