The National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, has awarded a research team at New York University College of Dentistry (NYU Dentistry) funding to study cavity prevention and cost effectiveness in school-based dental programs in New Hampshire.
The $3.6 million, five-year grant (R01MD011526) will fund a statewide program in six rural New Hampshire counties providing dental care to approximately 12,000 children, from preschool to sixth grade, in over 40 schools.
NYU Dentistry’s Richard Niederman, DMD, and Ryan Richard Ruff, MPH, PhD, will lead the study comparing the effectiveness of two cavity-prevention techniques — a “simple” treatment of topical silver and fluoride, and a “complex” treatment of traditional sealants and fluoride.
Nearly 30 percent of school-age children in the U.S. have untreated cavities. For children in rural areas, this number is even higher: more than 35 percent have untreated cavities. For rural populations, the primary barrier to care is the distance required to travel to dentists.
Children with cavities and associated toothaches face multiple disadvantages, including reduced quality of life, school absences, difficulty paying attention in school, and lower standardized test scores. Traditional office-based dental care presents barriers to treatment, including cost, fear of dentists, and geographic isolation.
“Bringing care to children instead of children to care eliminates these barriers,” said Dr. Niederman, professor and chair of the Department Epidemiology & Health Promotion at NYU Dentistry.
Through prior work in New Hampshire, New York, Massachusetts, Maine, and Colorado, NYU Dentistry researchers determined that “complex” school-based cavity prevention programs are effective in reducing cavities by two-thirds. Preliminary results suggest that “simple” prevention can be equally effective and is preferred by patients.
In the NIH-funded study, the New Hampshire schools will be selected at random to receive either the “simple” treatment of silver diamine fluoride and fluoride varnish, or the “complex” treatment of sealants and fluoride varnish. The simpler method takes six minutes to deliver, compared to the more complex method that takes 20 minutes. All children will receive the same preventive dental care twice each year. The researchers will assess oral health to compare the outcomes of both treatments.
The researchers expect that both treatments will be similarly effective in reducing untreated cavities. However, for the same time and cost, nearly four times more children can be treated with the simpler prevention. Therefore, if the simpler, less expensive strategy is found to be as effective as the more complex, more expensive method, the findings could support clinical and policy changes.
“In the short term, this trial will improve the health of New Hampshire children. In the long term, our findings can inform New Hampshire and U.S. policy planning to reduce oral health disparities through the creation of a cost effective, evidenced-based, and school-based cavity prevention model,” said Dr. Ruff, assistant professor of Epidemiology & Health Promotion at NYU Dentistry.
Partners for the program include several state organizations: New Hampshire Department of Health and Human Services, Northeast Delta Dental, and the New Hampshire Dental Society. Local partner organizations include the Alice Peck Day Memorial Hospital’s Community Health Department, Concord Dental Sealant Coalition, Coos County Family Health, HealthFirst Family Care Center, and Sullivan County Oral Health Collaborative.
The same research team also received funding to compare cavity prevention techniques in urban elementary schools. The five-year study, funded by the Patient-Centered Outcomes Research Institute, focuses on high-need elementary schools in the Bronx that serve largely Hispanic/Latino communities. The Bronx program will also assess educational outcomes and quality of life. In contrast, the NIH-funded study focuses on high-need rural New Hampshire schools serving largely white communities. If both studies show that the “simple” treatment is as effective as the “complex” treatment in preventing decay, the findings should be generally applicable nationwide.