2010 - UCSF School of Dentistry - University of California, San ...

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program, began to cover fluoride
varnish application – reimbursing
not only dentists, but also physicians
as well as trained personnel in their
medical practices. Nationally, the
ADA now recommends the varnish
for the youngest children at high
risk of developing ECC.
Costly Lack of
Knowledge
During the first phase of CAN DO
research, investigators also began
exploring why disadvantaged kids
were so prone to cavities.
Judith Barker, PhD, a medical
anthropologist in the School of
Medicine and CAN DO associate
director, led an ethnographic study
in Mendota, a rural, largely Hispanic
farm town in California’s Central
Valley, and in an ethnically similar,
low-income neighborhood in urban
San Jose. One of the researchers
lived in Mendota for nine months,
establishing relationships in the
community. The researchers hired
local residents as interviewers
and sometimes even provided
transportation to clinics. Mothers
were more accessible, as fathers
often were at work.
Study results point to a need for
better oral health education, for
better prevention practices and for
better access to care, Barker says.
“We found that a majority of mothers
had a poor understanding of the
mechanisms that drive caries and a
poor understanding of when they
should be taking their children to
the dentist,” she explains. “Many
parents would not visit a dentist until
a child was 3 or 4 years old, and
often not until a child’s teeth were
extensively damaged and the child
complained of pain. The mothers
generally do not recognize early signs
of caries in children.”
Parents were shocked to learn that
what they thought were dark stains
that could be cleaned away by the
dentist were, in fact, cavities.
As with childhood obesity, sugary
drinks play an insidious role, but often
seem to fly under the radar. Barker
Community meeting at the Mendota
Rotary Club.
“Many parents would
not visit a dentist
until a child was 3 or
4 years old, and often
not until a child’s
teeth were extensively
damaged and the child
complained of pain.”
– Judith Barker
recounts an interviewer’s tale of a
mother and grandmother of a cavityafflicted
3-year-old discussing at
length their rationing of candy and
cookies, even as the child was
walking around the entire time
drinking from a bottle of chocolate
milk. “Neither the mother nor the
grandmother understood how much
sugar was in the milk,” Barker says.
Children often were put to bed
with a bottle of juice. Toothbrushing
was rarely supervised after age 3,
and some parents did not believe
brushing was merited until the child
had all of his or her primary teeth or
was eating an adult diet.
In the rural areas, dentists were
few and far between; the closest
pediatric dentists were in Fresno.
Furthermore, dentists in both rural
and urban areas often were unwilling
to treat children less than 6 years old,
largely because they had never
rotated through a pediatrics clinic
during their training and they felt
unprepared as a consequence. Many
dentists did not accept Denti-Cal.
Even where municipal water
supplies were fluoridated, most
Hispanic residents in the study
preferred to drink bottled water, which
usually does not contain fluoride,
believing it to be safer than tap water.
In new, related research, Barker
will gauge parents’ acceptance of
various measures – including
fluoridation of water or food supplies
– for preventing tooth decay in
Hispanic communities. Similarly,
Susan Hyde, DDS, MPH, PhD, from
the School of Dentistry, and Sally
Adams, RN, PhD, from the School
of Medicine, earlier explored
attitudes toward caries prevention
activities among mothers of young
children in urban minority populations
(see page 6).
Community-Based,
Participatory
Research
Like Barker, Ramos-Gomez knows
the importance of engaging the
community to achieve the success of
local research and health initiatives.
Ramos-Gomez, who recently joined
the faculty at UCLA but remains a
CAN DO project leader, launched
another clinical trial, this time at the
San Ysidro Health Center near the
California-Mexico border, with more
than 500 pregnant women.
The research team provided
counseling to all the mothers-to-be,
educating them about mother-tochild
bacterial transmission. In
addition, once the children were born,
the researchers randomly assigned
half the women to use chlorhexidine
mouth rinse twice daily to kill
bacteria, and assigned the infants of
these same women to twice-yearly
fluoride varnish treatments starting
at age 1. The data for children up to
age 3 are now being analyzed.
Enrollment in the study proceeded
quickly, thanks to the community
connections nurtured by the research
team. An understanding of family
traditions and community social
structures and sensitivity toward
them are crucial, Ramos-Gomez
says, as is an active community
advisory board.
“Community-based, participatory
research is not business as usual,”
Ramos-Gomez says. “You really
have to establish links and relate to