Low-income children, particularly Mexican-Americans, are especially at high risk for early childhood caries(ECC). While caries prevalence in other age groups has been declining in past decades, it is increasingamong preschool-aged children. Our research team already demonstrated fluoride varnish (FV) efficacy inpreventing ECC. This proposal continues our effort with our community partners to seek effectiveinterventions. Resin-based dental sealants have been under-utilized in preschool children because ofapplication difficulty. New materials, such as the refined fluoride-releasing, self-bonding glass ionomer (Gl)sealant, decrease the need for meticulous tooth-surface drying during application and provide an advantagefor treating young children. The goal of this project is to conduct a community-based randomized clinical trial(RCT) to determine the relative efficacy of different combinations of Gl sealants on occlusal surfaces ofprimary molars, FV on all teeth, and parental counseling/anticipatory guidance (C) in reducing the cariesincidence/increment in 3-6-year-old children. A 2x2 factorial design RCT, stratified by study site (one dentaland one non-dental), will be conducted among initially 3-year-old children. Those eligible will be randomizedto four groups (C, C+FV, C+GI, C+FV+GI) and followed for 3 years. The RCT will take place at two sitesserving primarily Hispanic low-income populations in Southern California: the dental facility of the SanYsidro Health Center located near the U.S.-Mexican Border and the location of our current ECC preventionRCT for 0-3 year olds and a new partnership with La Maestra Health Center, in a non-dental setting neartheir dental clinic. Both sites are affiliated with WIC and Head Start.
Other aims are (1) to identify child,family and community-level factors affecting caries incidence/increment; (2) to assess parental acceptanceof interventions, retention in the study as well as compliance with multiple treatment visits in the RCT; and(3) to compare oral-healthcare settings/delivery systems and to assess differences as they relate tointervention outcomes. Information about the non-dental setting will inform future dissemination approaches.The proposed research will continue to establish the scientific evidence base for interventions to preventECC among underserved communities where oral health disparities still prevail.
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