Centers for Research to Reduce Oral Health Disparities

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Centers for Research to Reduce Oral Health
Disparities

• Irene V. Hilton, DDS, MPH
• San Francisco Department of Public Health
• La Clinica de la Raza CHC
• UCSF CANDO
• National Primary Oral Health Care Conference
• Atlanta GA
• August 8, 2005

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There are profound and consequential oral
health disparities within the U.S. population.
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• Research to Reduce/Eliminate Oral Health
  Disparities
• Enhance Research Capacity
• Information Dissemination

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United States Departmentof Health Human
Services
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5 Centers for Research to Reduce Oral Health
Disparities

• Funded by DHHS/NIH
• National Institute of Dental and Craniofacial
  Research
• National Center for Minority Health and Health
  Disparities
• Funded September 2001, 7M for 5 centers per year
  for 7 years
• University Based, but Community Involvement
  essential

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The 5 Oral Health Disparities Centers
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Early Childhood Caries Disparities 2-4 y/o
Untreated Decay
Data Source NHANES IV, 1999-2000, NCHS/CDC.
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NACROHD Opportunities to Reduce Oral Health
Disparities Basic Sciences to Clinical
Practice Center Director- Peter Milgrom, DDS
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MISSION

• Perform research aimed at reducing oral health
  disparities in the Pacific Northwest and Alaska.
  The Center seeks to develop basic and applied
  knowledge that addresses the needs of the poor,
  minority and rural children and their
  caretakers...

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Caries Transmission Prevention in Alaska Native
Infants PI David Grossman, MD, MPH

• Community based, clinical trial to determine if
  use of chlorhexidine and xylitol in mothers will
  reduce the vertical transmission of caries
  between Alaska Native mothers and infants.

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Early Orthodontic Intervention Under
MedicaidPI Greg King, DMD, DMSc

• Examine the usefulness of early orthodontic
  intervention as a means of increasing access to
  orthodontic services for low-income families
• Includes a group receiving treatment at Yakima
  Valley Farms Workers CHC by general dentists
  supervised by orthodontists at a remote site

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Xylitol Randomized Clinical Trials for
PreventionPI Peter Milgrom, DDS

• Prospective control, double blind RCT.
• Daily xylitol dose of 0.00g (G1), 3.44 g (G2),
  6.88 g (G3), or 10.32 g (G4).

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Distance Psychology for Treating Dental Fear in
Rural CommunitiesPI Philip Weinstein, PhD

• Fear contributes to disparities because greater
  frequencies of women and minorities exhibit
  dental fear than do males and Caucasians.
• Investigate the effectiveness of an automated
  Internet-based intervention (CARL- a computer
  program designed to administer exposure therapy
  for dental injection fear).

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Beta-Defensins (hBD-1) in Caries-Prone
ChildrenPI Beverly Dale-Crunk, PhD

• B-defensins are natural antibiotics expressed by
  oral epithelia and secreted in saliva. These
  peptides have broad specificity against bacteria,
  fungi, and some viruses.
• Do caries-prone children have low levels of
  hBD-1?
• Do caries-prone populations have genetic
  modifications in hBD-1 that are associated with
  caries risk?

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UCSF Center to Address Disparities in Childrens
Oral Health (CANDO)

• Center Director- Jane Weintraub, DDS, MPH

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Goal

• To understand, prevent and reduce oral health
  disparities among young children
• Primary focus
• Preventing Early Childhood Caries
• Partners
• San Francisco Department of Public Health
• San Ysidro Community Health Center

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Multi-faceted Approach Octahedron Model
Time
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Prevention of Early Childhood Caries Using
Fluoride VarnishPI Jane Weintraub, DDS, MPH

• Randomized clinical trial testing the efficacy of
  fluoride varnish in preventing tooth decay in
  young children
• Results show fluoride varnish is effective in
  reducing incidence of new decay, with dose
  response

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MAYA- Mother and Youth Access ProgramPI
Francisco Ramos-Gomez, DDS, MS, MPH

• Randomized clinical trial testing various
  interventions including counseling, chlorhexidine
  and fluoride varnish on pregnant women, mothers
  and their new babies to determine most effective
  approach for managing dental decay at San Ysidro
  CHC in San Diego, CA

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Cultural Factors Affecting Access to Preventive
Oral Health CarePI Irene Hilton, DDS, MPH
Patricia Evans, MD, MPH

• Identify cultural beliefs, practices and
  experiences that influence access to preventive
  care among African American, Chinese, Filipino
  and Hispanic caregivers of children between 1-5
  years of age
• Beliefs about baby teeth and caregiver fear
  influenced access to preventive dental care

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RAE (Risk Assessment for ECC)PI Stuart Gansky,
DrPH, MS

• Develop, test and refine an ECC risk association
  model simultaneously examining individual, family
  and community-level characteristics related to
  ECC with data mining techniques

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• New! Analysis of Gene Expression in Kids with
  Dental Caries
• PI Pui-Yan Kwok, MD, PhD
• Conduct a case-control study of children, with
  and without ECC, to determine if there are
  differences in oral gene expression patterns
  (using DNA microarray technology) associated with
  susceptibility to dental caries.

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Detroit Dental Health Project

• Research Focused on
• Action and Service
• Center Director- Amid Ismail, BDS, MPH, DrPH

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• Why do some African-American children (0-5 years
  old) and their main caregivers have better oral
  health than others who live in the same community
  and share similar social, economic, and cultural
  characteristics?

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Detroit Dental Health Project

• Surveying and tracking 1,021 families
• Community Advisory Board
• We serve and we care
• Partial funding for two dental clinics in
  community
• Funding for special services (biopsies and
  surgeries)
• Immediate referral for care

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Social and Cultural Determinants of CariesPI
Kristine Seifert, MPH, PhD

• Diet and Caries- children 3-5 in high caries
  group average 4.4 intakes of soda per week
• Mothers Self-Efficacy
• Maternal depression symptoms (34 likely or
  probably)
• Cigarette smoking (42 of caregivers)
• Multilevel Analysis of Neighborhood
  Characteristics and Dental Caries

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Lead Levels and CariesPI Brian Burt, BDS, MPH,
PhD
National mean 1.66 µg/dl for ages 1 year and
older.
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Multi-Component Individually Tailored
InterventionPI Jorge Delva,PhD

• 5 components implemented sequentially
• Motivational interviewing (MI) after dental
  examination
• Oral Health Educational DVD
• MI Individual goals
• MI Identification of barriers and resources to
  overcome barriers
• Follow-up telephone calls and newsletters

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Evaluation of Dental Access and Utilization
After Medi-Caid Fee LevelingPI Stephen Eklund,
Dr.P.H., D.D.S., M.H.S.A.

• Higher percentage of children received regular
  (annual) care- 50 higher than regular
  Medi-Caid kids
• More comprehensive mix of services received per
  treated child.

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The CREEDD we believe THE NORTHEAST CENTER
FOR RESEARCH TO EVALUATE ELIMINATE DENTAL
DISPARITIESCenter Director Raul I. Garcia, DMD
MMedScBoston University School of Dental
Medicine
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CREEDD Mission

• to improve oral, dental and craniofacial health
  through research, research training, and the
  dissemination of health information
• to eliminate oral health disparities

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Original CREEDD Partners

• Boston University
• Boston Medical Center/Boston HealthNet
• Boston Public Health Commission
• Childrens National Medical Center
• Columbus Childrens Hospital
• Forsyth Institute
• Harvard University
• New Partnerships
• Associated Early Childhood Education
• Crispus Attucks Childrens Center
• Dorchester House MultiService Center
• Early Head Start Centers in Boston
• Holyoke Health Center
• Massachusetts Society for the Prevention of
  Cruelty to Children

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Oral Health Related Quality of Life in Children
and AdolescentsPI Ron Spiro, PhD CoPI Judith
Jones, DDS, DScD

• Develop, refine and validate a measure of
  pediatric OHQoL for children and adolescents in
  English and Spanish
• Develop short-form measures of OHQoL for use as
  screening measures in pediatric practices,
  schools, and other sites.

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Decreasing Rates of ECC through a Health Care
Provider InterventionPI Nancy Kressin, PhD

• Enhance pediatricians and nurses skills at
  advising and counseling parents and caregivers
  about their practice of ECC risk factors.
• Reduce parents/caregivers practice of ECC risk
  factors.

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The Effect of Severe ECC Comprehensive Dental
Intervention on Weight of ChildrenPI Catherine
Hayes, DMD, MS, DMedSc

• Examine the impact of Severe ECC on weight in
  young children
• Evaluate treatment effects and treatment delay,
  on growth velocity

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Microbiota of Children with Oral Health
DisparitiesPI Anne Tanner, BDS, PhD

• Evaluate the role of the oral microbiota
  associated with dental caries/gingivitis
• Evaluate the ability of samples taken in the
  pediatricians office to diagnose and predict
  dental caries in young children.
• Compare the microbiota of children with severe
  ECC, pre and post surgical therapy, with that of
  caries-free children

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Oral Cancer Disparities5-year Survival Rates
NCI, Surveillance, Epidemiology, and End Results
and NCHS Vital Statistics Reports
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NYU ORAL CANCER RAAHP CENTER

• Research for Adolescent and Adult Populations
• Center Director Ralph V. Katz, DMD, MPH, PhD

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GOAL

• Conduct studies and promote activities that will
  reduce oral cancer disparities in the United
  States, especially in African-Americans and in
  Hispanics

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12 COLLABORATING INSTITUTIONS

• DENTAL SCHOOLS
• NYU, University of Puerto Rico
• Pittsburgh University, Howard University
• SCHOOLS OF PUBLIC HEALTH
• Johns Hopkins University, Boston University
• University of Alabama/Birmingham
• OTHER
• Tuskegee University, NYU Medical School
• Puerto Rico Health Department, Texas AM
  University, Memorial Sloan-Kettering

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Environmental and Genetic Risk Factors for Oral
Epithelial Dysplasia (OED) in Puerto Rico PI
Doug Morse, DDS, SM, PhD

• major risk factors under study
• gene polymorphisms
• tobacco habits
• alcohol consumption
• diet
• mouthwash use
• denture history

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Detection of Oral Cancer Comparison of Current
and Emerging TechnologiesPI David Sirois, DMD,
PhD

• 5 current technologies to be tested
• physical and visual exam
• cells obtained from saliva
• oral speculoscopy
• toluidine blue
• cyto-brush biopsy
• gold standard surgical biopsy

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Factors Affecting Minority Participation in
Cancer Screenings and in Biomedical Research
StudiesPI Ralph Katz, DMD, MPH, PhD

• Are there differences in willingness to
  participate in cancer screenings and as research
  subjects in biomedical studies between different
  ethnic groups?
• Explore
• socio-demographic and psychosocial factors that
  account for any observed differences
• factors that would increase participation by
  individuals

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Personalized RiskFeedback in Dental Clinic
Smokers a Randomized Clinical TrialPI Jamie
Ostroff, PhD

• Compare 3 smoking cessation interventions
• Standard Care (SC) dentist advice and
  assistance
• SC Motivational Counseling (MC) RDH
  motivational smoking cessation counseling
• SC MC Personalized Risk Feedback biomarker
  feedback
• level of tobacco exposure (alveolar CO in
  saliva)
• level of tobacco-related oral damage (mouth
  exam)

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Conclusion

• Interesting research is going on.
• Some of these research results will be coming to
  a Health Center near you to assist us in our own
  daily work to eliminate oral health disparities.
• Thank you for attending!