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

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12 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
the community. We felt strongly that we had to start by engaging pregnant women.” The researcher recruited bilingual, culturally competent promotoras, women from the community who serve as health communicators and as links between the community on one hand and researchers and health care providers on the other. “You need to have the personal touch, and these women really connected,” Ramos-Gomez says. There were few dropouts. “For a border population, the high retention rate in the study is unheard of,” he says. CAN DO, Round Two School of Dentistry researcher Lisa Chung, DDS, MPH, also believes in the importance of reaching out early to pregnant women. Chung is project director of a new, two-year Bay Area study led by Adams. The researchers will develop and test an intervention aimed at promoting oral health by changing behaviors. The intervention will be integrated into the CenteringPregnancy ® curriculum, a group prenatal care model. “Pregnancy is an opportune time for health messages because women are more receptive to behavior change,” Chung says. “We hope that the women will see a dentist and become more inclined to bring their babies to see a dentist.” As it stands, only a small fraction of low-income women see a dentist during pregnancy. For the most recent round of CAN DO studies, the research team has obtained a new clinical trials management software system, says Gansky, who heads the Data Coordinating Center. The new software will initially be used to manage six randomized, controlled clinical trials. “We’re trying to be a resource for the state – and for the whole country.” – Jane Weintraub (below center with, from left, Margaret Walsh, Stuart Gansky, Francisco Ramos-Gomez and Judith Barker) 13
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2010 - UCSF School of Dentistry - University of California, San ...

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