This is a proposal to conduct a survey of dental caries in 2400 infants and children, ages 1-4, in two cities with large minority populations: Baltimore, and Washington, D.C. A third community, Columbia, MD, will provide a substantial percentage of minorities with a different socioeconomic profile. The primary goal is to determine, for the first time, the influences of age, race, sex, and socioeconomic factors on a broad representation of minority v non-minority infants and pre-school children. The primary emphasis will be on determining the age of onset of caries and the identification of profiles of children at risk for high caries experience, including both nursing bottle caries (NBC) and other forms of serve caries. Once such profiles are established, studies can be planned that evaluate alternative methods of utilizing resources, resulting in reduced financial costs for individuals and society.
The specific aims, with respect to minority and non-minority populations are: (1) to assess the prevalence of caries and treatment needs; (2) determine the relationship between socioeconomic status (SES) and caries prevalence; (3) to establish the frequency of nursing bottle caries (NBC) in conditions of varying socioeconomic status; (4) to establish a familial profile of children at risk for high caries experience, and identify ethnic, economic, social, educational, demographic, and other etiologic risk factors; (5) to determine, for high-risk children who have been counseled to receive dental care, the level of compliance, reasons for non-compliance, and difficulties experienced in gaining access to dental care. A minimum of 2400 children (600 per age), ages 1 to 4, will be selected from private pediatric practices, well-baby clinics, day-care centers, and Head Start programs in equal numbers from the three communities. A stratified sampling design will be used that considers age, race, and socioeconomic make-up. Informed consent will be obtained for each child. Parents will also be asked to fill out a questionnaire relating to their child's oral health practices, fluoride history, and SES. Six months after the start of the study, examinations including DMFS(T), defs(t) and sealants will be performed two days per week by a team of calibrated examiners. All children will receive a brief report of their oral condition, and appropriate recommendations to seek care will be made. The clinical phase will be completed 20-21 months after funding. In the latter part of the clinical phase, follow-up contacts will be made with children with high caries levels to determine factors related to the seeking of dental care. These activities will be completed during the third year of the grant. The response variable will be dichotomous variable categorizing subjects into NBC subjects and subjects without NBC. Independent variables will be age, race, sex, and SES. Data analysis will be done with logistic regression, allowing the analysis of multiple main effects (and appropriate interactions) in the same logistic model. The age of onset will be estimated for the combined sample and also for black and white children.
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