Improving the design and implementation of school-based oral health programs using secondary data analysis - PROJECT SUMMARY Dental caries is the world’s most prevalent noncommunicative disease and negatively impacts child development. Both the NIDCR Oral Health in America report and the World Health Organizations’ Global Oral Health Status report call for improved access to and delivery of effective preventive oral care across the lifespan. School-based caries prevention can increase access to critical care for underserved children, reducing caries risk and mitigating its severe health and socioemotional consequences. The CariedAway study was a longitudinal pragmatic randomized trial of novel approaches to prevent and control dental caries in a school-based program, with a particular focus on low-income children. Previous findings from CariedAway demonstrated that (1) silver diamine fluoride (SDF) is equivalent to dental sealants and atraumatic restorations in the arrest and prevention of dental caries; (2) SDF can be effectively provided by school nurses, who are comparable to dental hygienists; and (3) treatment with SDF for caries prevention and control resulted in improved oral health-related quality of life. These findings support the large-scale utilization of SDF for school- based caries prevention, especially in severely under-resourced areas. In this R03 proposal we will conduct secondary analysis of the CariedAway data in order to support the wider implementation of silver diamine fluoride into school-based caries prevention. We will first explore the longitudinal arrest capabilities of school- based SDF in greater detail, including the additive effect of repeat application, the effect of posterior application on anterior caries incidence, and the transition probabilities between sound, carious, and arrested states. Second, we will estimate the surface-level risks of dental caries following treatment with SDF, modified by the severity of baseline disease. In this analysis, we will account for interval-censoring that occurs in school-based care using semi-parametric G-estimation. Finally, we will estimate the overall treatment time required for SDF in a school-based model and compare it to the time required for similar application of dental sealants and atraumatic restorations. The proposing investigators possess relevant, complementary expertise to ensure the success of this project: the PI is an epidemiologist and education researcher focusing on school-based care and was a Principal Investigator of the CariedAway project. The Co-I is a public health dentist with expertise in dissemination and implementation research, and was previously the Director and Supervising Dentist of the CariedAway project.
