UW News

September 23, 2003

UW to study preventing cavities in underserved populations

Researchers from the University of Washington School of Dentistry and health care providers in the Yakima Valley will cooperate on a clinical trial this fall to explore a new way of using fluoride varnishes to prevent cavities in high risk children.

The research is funded by a $2.25 million grant from the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health.

“Many of the nation’s oral health advances have yet to adequately benefit the underserved in our society, and we need to change that,” said NIDCR Director Dr. Lawrence Tabak. “Through this research partnership with UW, we’ll add to our understanding of new strategies for oral disease prevention that could help those at highest risk.”

This latest research effort is an outgrowth of The Northwest/Alaska Center to Reduce Oral Health Disparities, also supported by NIDCR and based at the School of Dentistry.

“Faculty in the UW School of Dentistry have been among the nation’s pioneers in emphasizing that identification of children at risk, coupled with early intervention to prevent dental disease, will benefit a child throughout his or her life. This latest research also complements our school’s research and outreach efforts to address the great disparities in oral health among children across the state and around the nation,” said Dr. Timothy DeRouen, executive associate dean for research and academic affairs.

Researchers say their findings may eventually be applied nationwide to help prevent cavities in small children at risk of dental disease. The clinical trial will determine whether three fluoride varnish treatments completed within two weeks are as effective as three treatments spaced out over a year and a half, which is a more difficult treatment to practice because of the space between appointments. The advantage of the two-week regimen is that children would more likely be in the same school or living near the same clinic and would be able to finish treatment, the researchers said.

“Good care begins with baby teeth. Children with caries in their baby teeth have an increased risk of developing decay in their permanent teeth,” said Dr. Philip Weinstein, lead investigator and a professor of dental public health sciences in the UW School of Dentistry. “There will never be enough dentists and dental hygienists to treat every decayed tooth of every person; it’s best to control the disease when the child is young.”

The study will be conducted at Enterprise for Progress in the Community (EPIC) Head Start and Washington Migrant Council Head Start in cooperation with the Yakima Valley Farmworkers Clinic and Spavinaw Dental in Sunnyside, Wash. The Head Start dentist involved is Dr. Greg Norell, who provides dental care for Head Start in the Yakima Valley.

Fluoride varnish is a gummy but palatable substance that releases fluoride for a considerable period of time after being painted on a tooth. It’s been known for decades that the presence of this fluoride is beneficial for teeth — fluoride varnish will stop and even reverse the early process of decay by remineralizing the enamel and by killing bacteria.

Europeans have been receiving these topical fluoride treatments for decades, but the technology has been slow to catch on in this country. Consequently, there have been few studies on how fluoride varnish could help children in high-risk populations: children who get little dental care, whose diet is poor, and whose mothers have dental disease. About five years ago, UW researchers conducted a pilot study of three applications of fluoride varnish on teeth over two weeks. The study of over 150 children found that after a year children who received fluoride varnish had fewer cavities than children who had the traditional two applications a year.

In the new study, 500 children who will be followed for three years. Researchers are hopeful that treatments over a short period of time are at least as effective as less frequent treatments. In 2000, the first-ever Surgeon General’s Report on Oral Health identified a “silent epidemic” of dental and oral diseases that disproportionately burden the nation’s poor. For more information, go to http://www.nidcr.nih.gov/sgr/oralhealth.asp on the Internet.

Weinstein has been involved in UW’s well-known UW Dental Fears Research Clinic and has co-written several books on dental care. Weinstein said he became interested in preventing cavities in hopes of preventing the sorts of fears that he sees among children in the clinic. “Children with no dental disease are not fearful of dental care,” he said

“My work has more and more over the years been aimed at the gap between those who have good oral health, and those who do not. Before, I was working primarily in the areas of pain and anxiety — but my emphasis has been shifting toward public health as I became aware of the suffering of children in our state,” Weinstein said.