A research team at the New York University College of Dentistry (NYU Dentistry) will receive $13.3 million from the Patient-Centered Outcomes Research Institute (PCORI) to study cavity prevention, quality of life, and school performance.
The 5-year study will compare the effectiveness of a simple treatment of topical silver and fluoride and a complex treatment of traditional sealants and fluoride in cavity prevention. It will be conducted in elementary schools in the Bronx, NY, which has a scarcity of dental providers.
More than half of elementary school-age children in the United States have had a cavity, NYU Dentistry said, and more than 20% have untreated cavities. The prevalence of cavities in the Bronx, the poorest borough in New York City, is almost twice the national average.
Children with cavities face disadvantages such as reduced quality of life, school absences, difficulties paying attention in school, and lower standardized test scores, according to NYU Dentistry. But traditional office-based dental care can be a challenge due to costs, fear of dentists, and geographic isolation. Bringing care to children eliminates these barriers.
Previous NYU Dentistry research has determined that complex school-based treatment can reduce cavities by two thirds. Preliminary results suggest that simple prevention can be equally effective. Additional discussions and surveys have revealed that families prefer school-based care over office-based care and simple treatment over complex treatment.
The new study will compare cavity prevention programs in 60 high-need elementary schools in the Bronx that serve low-income Hispanic and Latino families. Schools will be randomly selected to receive either the simple silver diamine fluoride and fluoride varnish or the complex care of sealants and fluoride varnish.
All children will receive the same preventive dental care twice each year. The researchers will assess untreated cavities, quality of life, and student achievement to compare the outcomes of both treatments.
NYU Dentistry also is collaborating with the NYU Rory Meyers College of Nursing (NYU Meyers) to deliver care along with NYU dental hygienists. With 3 million nurses in the United States and only 250,000 dental hygienists, the researchers will compare the care delivered by nurses and dental hygienists. This will build upon NYU Meyers’ efforts to expand oral health nursing education and practice and to strengthen existing oral health and nursing initiatives.
“The overall goal of our proposed research is to improve oral health equity by determining the most effective, patient-centered, and efficient school-based cavity prevention methods,” said Richard Niederman, DMD, professor and chair of the NYU Dentistry Department of Epidemiology & Health Promotion and co-leader of the study.
“Our expectation is that both will be similarly effective in reducing untreated cavities by two thirds,” Niederman said. “However, for the same time and cost, hygienists or nurses can treat 4 times more children with the simpler prevention.
The study was selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a diverse range of patients and care situations and can be more quickly taken up in routine clinical practice.
“This is an unparalleled opportunity to explore the long-term impact of oral health on quality of life and student achievement,” said Ryan Richard Ruff, PhD, MPH, co-leader of the study and assistant professor of epidemiology and health promotion at NYU Dentistry. “This research has the potential to improve multiple outcomes relevant to children and their families.”
Many clinical studies test whether a treatment works under ideal conditions in specialized research centers, but healthcare is rarely delivered in such idealized settings, NYU Dentistry said. Pragmatic clinical studies test effectiveness in real-life situations, such as schools, and can include a wider range of participants for more generally applicable findings.
“The project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other healthcare stakeholders in a major study conducted in real-world settings, but also for its potential to answer an important question about oral health and fill a crucial evidence gap,” said PCORI executive director Joe Selby, MD, MPH.
The NYU Dentistry study was selected through a highly competitive review process in which patients, caregivers, and other stakeholders joined scientists in evaluating the proposals. The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.