Buscemi Joanna, Borowski Teresa G, Avenetti David, Tussing-Humphreys Lisa, Martin Molly, Atkins Marc S, Marshall Teresa, Berbaum Michael, Lee Helen H
Department of Psychology, DePaul University, Chicago, IL, United States.
Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States.
Front Public Health. 2025 Jan 22;13:1488910. doi: 10.3389/fpubh.2025.1488910. eCollection 2025.
Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease, and some require subsequent surgeries. To improve post-surgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. This study aims to test the efficacy of the PROTECT intervention compared to Usual Care (UC), to improve behavioral oral health outcomes. We will conduct a randomized clinical trial to test the efficacy of PROTECT ( = 210) compared to UC ( = 210) in the pediatric DGA (dental surgery under general anesthesia) population. We developed PROTECT through an iterative process, incorporating feedback from caregivers, dentists, and community health workers and through a small pilot trial. Caregivers will be recruited at their dental clinic and then will engage in a 10-session intervention with a community health worker. Topics covered will include education about toothbrushing and sugar consumption, behavioral strategies (e.g., goal setting, problem solving, self-monitoring), positive parenting and stress management and maintenance. Our two primary outcomes are parental assisted toothbrushing (twice/day, 2 min each time) and reduced added sugar consumption (less than 10% of overall daily caloric intake). Proposed mechanisms of change are self-efficacy and positive parenting. The ultimate goal of PROTECT is to prevent subsequent surgical events for children presenting with S-ECC to prevent further chronic disease and reduce costs and stress for families who already experience high levels of systemic barriers to their health.
重度幼儿龋齿（S-ECC）是边缘化儿科人群中的常见疾病。S-ECC通常在全身麻醉下进行治疗，以便于对幼儿进行广泛治疗，但这种治疗并未解决源于健康行为的传染病病因。如果不改变与刷牙和糖摄入相关的行为，许多儿童会出现疾病复发，有些儿童还需要后续手术。为了改善术后口腔健康，我们开发了PROTECT（预防复发性手术针对幼儿龋齿治疗），这是一种由社区卫生工作者（CHW）为照顾者提供的行为干预措施，重点关注儿童的口腔健康行为。本研究旨在测试PROTECT干预措施与常规护理（UC）相比的疗效，以改善口腔健康行为结果。我们将进行一项随机临床试验，以测试PROTECT（n = 210）与UC（n = 210）在儿科全身麻醉下牙科手术（DGA）人群中的疗效。我们通过一个迭代过程开发了PROTECT，纳入了照顾者、牙医和社区卫生工作者的反馈，并通过一项小型试点试验。照顾者将在其牙科诊所招募，然后与社区卫生工作者进行为期10节的干预。涵盖的主题将包括刷牙和糖摄入教育、行为策略（如目标设定、问题解决、自我监测）、积极育儿以及压力管理和维持。我们的两个主要结果是家长协助刷牙（每天两次，每次2分钟）和添加糖摄入量减少（占每日总热量摄入的比例低于10%）。提出的改变机制是自我效能感和积极育儿。PROTECT的最终目标是预防患有S-ECC的儿童发生后续手术事件，以预防进一步的慢性病，并降低已经面临高水平健康系统障碍的家庭的成本和压力。
