Henshaw M M, Borrelli B, Gregorich S E, Heaton B, Tooley E M, Santo W, Cheng N F, Rasmussen M, Helman S, Shain S, Garcia R I
Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
University of California, San Francisco, San Francisco, CA, USA.
JDR Clin Trans Res. 2018 Oct;3(4):353-365. doi: 10.1177/2380084418794377. Epub 2018 Aug 22.
Caries experience among preschool-age children has remained relatively unchanged for the past 2 decades, despite recently documented decreases in untreated decay.
In a community-based cluster-randomized controlled trial, a motivational interviewing (MI) intervention administered to primary caregivers was hypothesized to reduce caries increment over 2 y as compared with controls, among children aged 0 to 5 y at baseline living in public housing.
Public housing residents, who served as interventionists, were trained in MI with a focus on early childhood caries prevention. All 26 eligible public housing developments were randomized to either control (quarterly clinical examinations, fluoride varnish applications, toothbrush/toothpaste, and educational brochures) or intervention (same procedures as control plus MI counseling). Quarterly MI sessions were delivered in English or Spanish over 2 y, audio recorded, and assessed for treatment fidelity. The primary outcome was the increment in dmfs (decayed, missing, and filled tooth surfaces) as assessed by clinical examination at baseline, 12 mo, and 24 mo. Secondary outcomes included caregiver oral health knowledge and child oral health behaviors (child toothbrushing and sugar-sweetened beverage intake). Baseline characteristics were compared between groups and adjusted for housing-site clusters. Longitudinal outcomes were analyzed with mixed models.
A total of 1,065 children (49% female, 55% non-White, 61% Hispanic, 89% below poverty level, = 686 control) and their caregivers were enrolled. During 2 y of follow-up, the mean dmfs increment increased in both groups; however, there were no statistically significant group differences at 24 mo or group × time interactions. The mean increase in intervention caregivers' knowledge was significantly greater than that of control, (2, 1,593) = 3.48, = 0.0310, but there were no significant intervention effects on caregiver-reported child sugar-sweetened beverage intake or child toothbrushing.
MI counseling plus intensive caries prevention activities resulted in knowledge increases but did not improve oral health behaviors or caries increment (ClinicalTrials.gov NCT01205971).
When viewed in light of the findings from the companion Pine Ridge study and other recent MI studies, the results of this study suggest that when the complex disease of early childhood caries is addressed in high-risk populations, MI is not effective, and alternative approaches are warranted.
在过去20年中，学龄前儿童的龋齿患病情况相对保持不变，尽管最近有记录显示未经治疗的龋齿有所减少。
在一项基于社区的整群随机对照试验中，假设对主要照料者实施动机性访谈（MI）干预，与对照组相比，可减少基线时居住在公共住房中的0至5岁儿童2年内的龋齿增量。
作为干预者的公共住房居民接受了以预防幼儿龋齿为重点的MI培训。所有26个符合条件的公共住房开发项目被随机分为对照组（每季度进行临床检查、涂氟、提供牙刷/牙膏和教育宣传册）或干预组（与对照组相同的程序加上MI咨询））。在2年时间里，每季度用英语或西班牙语进行MI课程，进行录音，并评估治疗保真度。主要结局是通过基线、12个月和24个月时的临床检查评估的dmfs（龋坏、缺失和充填牙面）增量。次要结局包括照料者的口腔健康知识和儿童的口腔健康行为（儿童刷牙和含糖饮料摄入量）。比较两组的基线特征，并对住房地点集群进行调整。采用混合模型分析纵向结局。
共纳入1065名儿童（49%为女性，55%为非白人，61%为西班牙裔，89%生活在贫困线以下，对照组686名）及其照料者。在2年的随访期间，两组的平均dmfs增量均有所增加；然而，在24个月时两组之间没有统计学上的显著差异，也没有组×时间交互作用。干预组照料者的知识平均增加量显著大于对照组，F(2, 1593) = 3.48，P = 0.0310，但干预对照料者报告的儿童含糖饮料摄入量或儿童刷牙情况没有显著影响。
MI咨询加上强化龋齿预防活动导致了知识的增加，但没有改善口腔健康行为或龋齿增量（ClinicalTrials.gov NCT01205971）。
根据同期的派恩岭研究和其他近期MI研究的结果来看，本研究结果表明，在高危人群中处理幼儿龋齿这种复杂疾病时，MI无效，需要采用其他方法。
