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Centers for Research to Reduce Oral Health Disparities Irene V. Hilton, DDS, MPH San 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

“There are profound and consequential oral health disparities within the U. S. population. ” “There are profound and consequential oral health disparities within the U. S. population. ”

 • Research to Reduce/Eliminate Oral Health Disparities • Enhance Research Capacity • Information • Research to Reduce/Eliminate Oral Health Disparities • Enhance Research Capacity • Information Dissemination

United States Department of Health & Human Services United States Department of Health & Human Services

5 Centers for Research to Reduce Oral Health Disparities Funded by DHHS/NIH: – National 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, $7 M for 5 centers per year for 7 years University Based, but Community Involvement essential

The 5 Oral Health Disparities Centers The 5 Oral Health Disparities Centers

Early Childhood Caries Disparities % 2 -4 y/o Untreated Decay Data Source: NHANES IV, Early Childhood Caries Disparities % 2 -4 y/o Untreated Decay Data Source: NHANES IV, 1999 -2000, NCHS/CDC.

NACROHD Opportunities to Reduce Oral Health Disparities: Basic Sciences to Clinical Practice Center Director- NACROHD Opportunities to Reduce Oral Health Disparities: Basic Sciences to Clinical Practice Center Director- Peter Milgrom, DDS

MISSION Perform research aimed at reducing oral health disparities in the Pacific Northwest and 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. . .

Caries Transmission Prevention in Alaska Native Infants PI: David Grossman, MD, MPH Community based, 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.

Early Orthodontic Intervention Under Medicaid PI: Greg King, DMD, DMSc Examine the usefulness of Early Orthodontic Intervention Under Medicaid PI: 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

Xylitol Randomized Clinical Trials for Prevention PI: Peter Milgrom, DDS Prospective control, double blind Xylitol Randomized Clinical Trials for Prevention PI: Peter Milgrom, DDS Prospective control, double blind RCT. Daily xylitol dose of 0. 00 g (G 1), 3. 44 g (G 2), 6. 88 g (G 3), or 10. 32 g (G 4).

Distance Psychology for Treating Dental Fear in Rural Communities PI: Philip Weinstein, Ph. D Distance Psychology for Treating Dental Fear in Rural Communities PI: Philip Weinstein, Ph. D 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).

Beta-Defensins (h. BD-1) in Caries-Prone Children PI: Beverly Dale-Crunk, Ph. D B-defensins are natural Beta-Defensins (h. BD-1) in Caries-Prone Children PI: Beverly Dale-Crunk, Ph. D 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 h. BD 1? Do caries-prone populations have genetic modifications in h. BD-1 that are associated with caries risk?

UCSF Center to Address Disparities in Children’s Oral Health (CANDO) Center Director- Jane Weintraub, UCSF Center to Address Disparities in Children’s Oral Health (CANDO) Center Director- Jane Weintraub, DDS, MPH

Goal To understand, prevent and reduce oral health disparities among young children Primary focus: 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

Multi-faceted Approach: Octahedron Model Environment + Health Care System Health Child Community + Social Multi-faceted Approach: Octahedron Model Environment + Health Care System Health Child Community + Social Factors Family Disease Time

Prevention of Early Childhood Caries Using Fluoride Varnish PI: Jane Weintraub, DDS, MPH Randomized Prevention of Early Childhood Caries Using Fluoride Varnish PI: 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

MAYA- Mother and Youth Access Program PI: Francisco Ramos-Gomez, DDS, MPH Randomized clinical trial MAYA- Mother and Youth Access Program PI: Francisco Ramos-Gomez, DDS, 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

Cultural Factors Affecting Access to Preventive Oral Health Care PI: Irene Hilton, DDS, MPH Cultural Factors Affecting Access to Preventive Oral Health Care PI: 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

RAE (Risk Assessment for ECC) PI: Stuart Gansky, Dr. PH, MS Develop, test and RAE (Risk Assessment for ECC) PI: Stuart Gansky, Dr. PH, 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

New! Analysis of Gene Expression in Kids with Dental Caries PI: Pui-Yan Kwok, MD, New! Analysis of Gene Expression in Kids with Dental Caries PI: Pui-Yan Kwok, MD, Ph. D 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.

Detroit Dental Health Project Research Focused on Action and Service Center Director- Amid Ismail, Detroit Dental Health Project Research Focused on Action and Service Center Director- Amid Ismail, BDS, MPH, Dr. PH

– Why do some African-American children (0 -5 years old) and their main caregivers – 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?

Detroit Dental Health Project Surveying and tracking 1, 021 families Community Advisory Board We 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

Social and Cultural Determinants of Caries PI: Kristine Seifert, MPH, Ph. D Diet and Social and Cultural Determinants of Caries PI: Kristine Seifert, MPH, Ph. D 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

Lead Levels and Caries PI: Brian Burt, BDS, MPH, Ph. D National mean 1. Lead Levels and Caries PI: Brian Burt, BDS, MPH, Ph. D National mean 1. 66 µg/dl for ages 1 year and older.

Multi-Component Individually Tailored Intervention PI: Jorge Delva, Ph. D 5 components implemented sequentially – Multi-Component Individually Tailored Intervention PI: Jorge Delva, Ph. D 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

Evaluation of Dental Access and Utilization After Medi-Caid Fee Leveling PI: Stephen Eklund, Dr. Evaluation of Dental Access and Utilization After Medi-Caid Fee Leveling PI: 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.

The CREEDD – “we believe” THE NORTHEAST CENTER FOR RESEARCH TO EVALUATE & ELIMINATE The CREEDD – “we believe” THE NORTHEAST CENTER FOR RESEARCH TO EVALUATE & ELIMINATE DENTAL DISPARITIES Center Director Raul I. Garcia, DMD MMed. Sc Boston University School of Dental Medicine

CREEDD Mission “to improve oral, dental and craniofacial health through research, research training, and CREEDD Mission “to improve oral, dental and craniofacial health through research, research training, and the dissemination of health information” to eliminate oral health disparities

Original CREEDD Partners Boston University Boston Medical Center/Boston Health. Net Boston Public Health Commission Original CREEDD Partners Boston University Boston Medical Center/Boston Health. Net Boston Public Health Commission Children’s National Medical Center Columbus Children’s Hospital Forsyth Institute Harvard University New Partnerships Associated Early Childhood Education Crispus Attucks Childrens Center Dorchester House Multi. Service Center Early Head Start Centers in Boston Holyoke Health Center Massachusetts Society for the Prevention of Cruelty to Children

Oral Health & Related Quality of Life in Children and Adolescents PI Ron Spiro, Oral Health & Related Quality of Life in Children and Adolescents PI Ron Spiro, Ph. D Co. PI Judith Jones, DDS, DSc. D Develop, refine and validate a measure of pediatric OHQo. L for children and adolescents in English and Spanish Develop short-form measures of OHQo. L for use as screening measures in pediatric practices, schools, and other sites.

Decreasing Rates of ECC through a Health Care Provider Intervention PI: Nancy Kressin, Ph. Decreasing Rates of ECC through a Health Care Provider Intervention PI: Nancy Kressin, Ph. D 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.

The Effect of Severe ECC & Comprehensive Dental Intervention on Weight of Children PI: The Effect of Severe ECC & Comprehensive Dental Intervention on Weight of Children PI: Catherine Hayes, DMD, MS, DMed. Sc Examine the impact of Severe ECC on weight in young children Evaluate treatment effects and treatment delay, on growth velocity

Microbiota of Children with Oral Health Disparities PI: Anne Tanner, BDS, Ph. D Evaluate Microbiota of Children with Oral Health Disparities PI: Anne Tanner, BDS, Ph. D Evaluate the role of the oral microbiota associated with dental caries/gingivitis Evaluate the ability of samples taken in the pediatrician’s 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

Oral Cancer Disparities 5 -year Survival Rates NCI, Surveillance, Epidemiology, and End Results and Oral Cancer Disparities 5 -year Survival Rates NCI, Surveillance, Epidemiology, and End Results and NCHS Vital Statistics Reports

NYU ORAL CANCER RAAHP* CENTER *Research for Adolescent and Adult Populations Center Director Ralph NYU ORAL CANCER RAAHP* CENTER *Research for Adolescent and Adult Populations Center Director Ralph V. Katz, DMD, MPH, Ph. D

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

12 COLLABORATING INSTITUTIONS DENTAL SCHOOLS: – NYU, University of Puerto Rico – Pittsburgh University, 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 A&M University, Memorial Sloan-Kettering

Environmental and Genetic Risk Factors for Oral Epithelial Dysplasia (OED) in Puerto Rico PI: Environmental and Genetic Risk Factors for Oral Epithelial Dysplasia (OED) in Puerto Rico PI: Doug Morse, DDS, SM, Ph. D major risk factors under study: – gene polymorphisms – tobacco habits – alcohol consumption – diet – mouthwash use – denture history

Detection of Oral Cancer: Comparison of Current and Emerging Technologies PI: David Sirois, DMD, Detection of Oral Cancer: Comparison of Current and Emerging Technologies PI: David Sirois, DMD, Ph. D 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

Factors Affecting Minority Participation in Cancer Screenings and in Biomedical Research Studies PI: Ralph Factors Affecting Minority Participation in Cancer Screenings and in Biomedical Research Studies PI: Ralph Katz, DMD, MPH, Ph. D 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

Personalized Risk Feedback in Dental Clinic Smokers: a Randomized Clinical Trial PI: Jamie Ostroff, Personalized Risk Feedback in Dental Clinic Smokers: a Randomized Clinical Trial PI: Jamie Ostroff, Ph. D 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)

Conclusion Interesting research is going on. Some of these research results will be coming 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!