Longstanding practice has treated early childhood caries (ECC) primarily through surgical dental repair, reinforced by current payment systems, an approach that does not address the natural history of the disease or the oral hygiene and dietary behaviors that mediate its occurrence. Professional consensus on the value of ECC disease management is emerging but behavioral strategies remain largely unstudied among Hispanic children in the United States. The long-term goal of the proposed study is to reduce oral health disparities and inform a paradigm shift from a focus on treatment to one that also embraces prevention. It is known that using fluoridated toothpaste twice daily and consumption of a low cariogenic diet has both preventive and therapeutic value. What is not known is how to best translate the adoption and maintenance of salutary behaviors to populations at greatest risk. The proposed randomized controlled trial will evaluate the efficacy of a family focused behavioral intervention, MySmileBuddy, to reduce ECC progression in high-risk Hispanic preschoolers. We propose to recruit and enroll 858 two to five year-old children, all with ECC, along with their caregiver from pediatric medical clinics in northern Manhattan, New York City.
Specific Aims are: (1) to assess MySmileBuddy's efficacy (versus control) to decrease ECC progression (defined as positive change in number of decayed, missing, or filled teeth (?dmft>0) or surfaces (?dfs>0)) measured 12-months post-randomization (and assessed again 24-months post-randomization); (2) to assess MySmileBuddy's efficacy (versus control) to enhance adoption of twice daily fluoridated toothpaste use and consumption of a low cariogenic diet; and (3) to assess causal pathways through which MySmileBuddy influences twice daily fluoridated toothpaste use and consumption of a low cariogenic diet. The proposed research is innovative and represents a departure from the status quo by shifting focus from treatment to prevention, shifting education from verbal instructions and written materials provided by dental professionals to using interactive Health Information Technology delivered by Community Health Workers, and capitalizing on general pediatrics practices as a conduit for promoting children's oral health. At the completion of this study, we will know the extent to which MySmileBuddy promotes parents' acquisition and maintenance of oral hygiene and dietary behaviors that reduce ECC progression in a high-risk population of Hispanic preschool children. Ultimately, such knowledge has the potential to reduce the number of children needlessly affected by this preventable disease.

Public Health Relevance

Affecting more than one-in-four children under age six, tooth decay in young children is common and harmful, yet largely preventable. The proposed research is relevant to the public's health by testing a novel family- centered program's ability to help families learn and practice healthful behaviors, stop decay from progressing in children who already have cavities, and explain how and why the program works.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01DE026739-01A1
Application #
9522676
Study Section
Special Emphasis Panel (ZDE1)
Program Officer
Riddle, Melissa
Project Start
2018-09-15
Project End
2023-08-31
Budget Start
2018-09-15
Budget End
2019-08-31
Support Year
1
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Dentistry
Type
Schools of Dentistry/Oral Hygn
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032