More than 50 percent of U.S. elementary school–age children have had a dental cavity, and more than 20 percent 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, 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 shows that with each preventive visit, there is a reduction in caries, acute infection, and caries risk.
The overall goal of our 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 more than 50 percent 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, New York, 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 have similar outcomes.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.