This project proposes to leverage innovative data collected as part of a large, ongoing, cluster randomized trial of therapies to arrest and prevent dental caries in low-income, minority children to (1) investigate the potential microbial determinants of oral health inequities across racial/ethnic children and (2) explore the degree of susceptibility and responsiveness to conventional therapeutic interventions for caries. Over the past ten years, we have conducted multiple studies on the effectiveness and feasibility of preventive treatments for dental caries applied in pragmatic settings across the United States. In each study, an average of 30% of children was observed to have untreated decay at baseline, a prevalence which was consistently higher amongst minority children. Following receipt of therapeutic interventions for caries prevention and observed longitudinally, some children stayed caries free (responders) while others experienced new incidence of tooth decay (non-responders). This phenomenon of resistance and susceptibility to caries occurred in children with or without prior caries experience, was found amongst children living in both fluoridated and non-fluoridated communities, and was not related to sex or age. In total, re-occurrence of dental caries following preventive therapies was observed in approximately 15% of children regardless of prior caries. Our intention is to study these phenomena. We propose to collect new data from the oral microbiome in a cohort of children receiving biannual silver diamine fluoride (SDF) for dental caries, as well as data on key confounders including dietary intake and oral hygiene behavior. This new data will be linked to data collected from clinical examinations and participant demographics. Children identified for this study will be participants in the referenced clinical trial. Uncovering the role of the microbiome in health disparities could enhance our understanding of why some populations have poorer success rates, greater severity of disease, or overall elevated disease risks compared to others. Our primary goals are to (1) utilize microbiome sequence analysis and taxonomic assignment to identify the potential microbiota and metabolites of caries that exist within different racial/ethnic groups with and without untreated caries, (2) compare the distribution of these microbiota prior to and following receipt of silver diamine fluoride to arrest and prevent caries, and (3) develop a predictive model of responsiveness to SDF using artificial neural networks and LASSO/elastic nets. This will be the first study to longitudinally examine the microbial determinants of innate caries susceptibility and resistance to traditional preventive therapies. Results may improve the precision, targeting, and impact of caries prevention programs.
This project focuses on (1) the microbiota determinants of oral health inequities in US children and (2) the degree of susceptibility and responsiveness to conventional therapeutic interventions to arrest and prevent dental caries. Using data from an ongoing, large scale, cluster randomized trial of preventive therapies for caries, we will collect additional data from the oral microbiome to explore disparities in untreated caries across racial/ethnic groups, compare the distribution of relevant microbiota and their metabolites in children with and without caries before and after receipt of silver diamine fluoride, and generate a predictive model to predict whether children are more or less susceptible to the effects of traditional preventive therapies. Together this research will improve the precision, targeting, and anticipated impact of caries prevention programs.
