Braun P A, Quissell D O, Henderson W G, Bryant L L, Gregorich S E, George C, Toledo N, Cudeii D, Smith V, Johs N, Cheng J, Rasmussen M, Cheng N F, Santo W, Batliner T, Wilson A, Brega A, Roan R, Lind K, Tiwari T, Shain S, Schaffer G, Harper M, Manson S M, Albino J
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Dent Res. 2016 Oct;95(11):1237-44. doi: 10.1177/0022034516658612. Epub 2016 Jul 20.
The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).
作者测试了一种基于社区、由部落提供的口腔健康促进（OHP）干预措施（INT）在减少参加“启智计划”的纳瓦霍儿童龋齿增量方面的效果。在一项为期3年的整群随机试验中，我们在纳瓦霍人的参与下开发了一种OHP干预措施，由经过培训的纳瓦霍非专业卫生工作者提供给在52个纳瓦霍“启智计划”教室上课的儿童（26个接受干预组，26个接受常规护理[UC]组）。该干预措施被设计为一套高度个性化的、以口腔健康为重点的互动活动（针对儿童的有5项，针对家长的有4项），以及在2011至2012学年和2012至2013学年在“启智计划”期间进行的4次氟化物涂漆。作者评估了与常规护理相比，干预措施对龋失补牙面（dmfs）增量的影响。其他结果包括龋齿患病率以及照顾者与口腔健康相关的知识和行为。进行了改良意向性分析和符合方案分析。作者招募了1016对照顾者-儿童二元组。干预组的基线平均dmfs/龋齿患病率分别为19.9/86.5%，常规护理组为22.8/90.1%。干预措施的依从率为53%（即≥3次儿童OHP活动、≥1次照顾者OHP活动以及≥3次氟化物涂漆）。3年后，两组的dmfs均有所增加（干预组增加12.9，常规护理组增加10.8；P = 0.216），在对接受1年干预的897对照顾者-儿童二元组进行的改良意向性分析中，龋齿患病率也有所增加（干预组从86.5%增至96.6%，常规护理组从90.1%增至98.2%；P = 0.808）。两组照顾者的口腔健康知识得分均有所提高（干预组从75.1%增至81.2%，常规护理组从73.6%增至79.5%；P = 0.369）。与常规护理组相比，干预组照顾者的口腔健康行为得分提高得更快（P = 0.006）。在符合方案分析中，坚持干预措施的儿童的dmfs增量（+8.9）小于常规护理组儿童（+10.8；P = 0.028）。总之，纳瓦霍“启智计划”儿童的牙科疾病严重程度极高且难以改善。作者认为，成功的预防方法可能需要更具高度个性化的方法，这些方法要受文化观念影响，并关注口腔健康的社会决定因素（ClinicalTrials.gov NCT01116739）。
