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Comparative effectiveness of school-based caries prevention programs for children in underserved, low-income, Hispanic communities
Investigator (PI): Niederman, Richard
Performing Organization (PO): (Current): New York University, College of Dentistry, Department of Epidemiology and Health Promotion / (212) 998-9800
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2018
Final Year: 2024
Record Source/Award ID: PCORI/PCS-1609-36824
Funding: Total Award Amount: $13,343,026
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: More than 50% of U.S. elementary school age children have had a dental cavity, and more than 20% have untreated dental cavities. For Hispanic/Latino and low-income children, the prevalence of dental cavities is significantly higher. Children with dental cavities and associated toothaches face multiple disadvantages in life, including reduced quality of life, frequent school absences, difficulty paying attention in school, and lower standardized test scores. Unfortunately, traditional office-based care presents multiple barriers to care, the foremost of which are cost, fear of dentists, and geographic isolation. Through our preliminary research in Massachusetts, Colorado, and New York, we have determined that school-based caries prevention programs are effective in improving oral health. More specifically, our results showed that with each preventive visit, there is a reduction in caries, acute infection, and caries risk. The overall goal of the proposed research is to improve oral health equity by determining the most effective, patient centered, and efficient school-based caries prevention interventions. To achieve this goal, researchers will compare two school-based cavity prevention programs: a "simple" treatment of topical silver and fluoride, and a "complex" treatment of traditional sealants and fluoride. Our expectation is that both will be similarly effective. Our estimates indicate that either simple or complex prevention will reduce untreated caries by >50% and exceed the Healthy People 2020 Oral Health goals prior to 2020. However, for the same time and cost, we can see four times as many children with simple prevention. The proposed work is grounded in discussions and surveys of patient and stakeholder partners, beginning in 2013. We found that school-based care was overwhelmingly preferred over office-based care. We then conducted a pilot study to test feasibility in two elementary schools with high Hispanic/Latino, low-income student populations. We now propose a larger program in 60 Bronx, NY, elementary schools that serve the highest need, low-income, Hispanic/Latino community. Participating schools will be randomized to receive either simple or complex prevention. All children in a given school, with informed consent, will receive the same preventive care twice per year and be followed for at least three years. We will assess untreated cavities, quality of life, and school performance to determine if both treatments are similar.
MeSH Terms:
  • Absenteeism
  • Child
  • Colorado
  • Comparative Effectiveness Research
  • Dental Caries /*ethnology
  • /*prevention & control
  • Fluorides /therapeutic use
  • Geography
  • Health Education, Dental /methods
  • Health Equity
  • Hispanic Americans
  • Humans
  • Massachusetts
  • Medically Underserved Area
  • New York
  • Office Visits
  • Oral Health
  • Patient-Centered Care
  • Pilot Projects
  • Poverty
  • Prevalence
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Risk
  • School Dentistry /*organization & administration
Country: United States
State: New York
Zip Code: 10010
UI: 20181684
Project Status: Ongoing
Record History: ('2018: Project initial year changed to 2018 and final year extended to 2024.',)