Dr. Francisco Ramos-Gomez (UCLA) and Dr. R.S. Jones (U. Minn)
with Dr.Wendy Slusser,
Venice Family Simms Mann (SMVF) Healt...
Goal
  Develop an integrated care plan that effectively addresses
shared dental caries and childhood obesity risk factors...
Obesity Background
  Childhood obesity has more than doubled in children and tripled in
adolescents in the past 30 years....
4
Communities with Obese children
5
Overweight* Children in the U.S.
(*BMI > 95th percentiles)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
1963-65 &
1966-70
1971...
Early Childhood Caries (ECC)
  ECC is a chronic, highly infectious, easily transmittable
disease, which can progress rapi...
Background
Early Childhood Caries Childhood Obesity
Early Prevention Needed
Surgical Model of
Treating Decay has
high recu...
Key Reasons for Integration of Oral
Health & Obesity Prevention
1)  Children's oral health diseases (e.g. dental caries) s...
Research Questions
  To accomplish the overall goal of the project, the following specific
aims will be pursued:
  Speci...
4 Pieces of Data
 BMI
 Salivary Bacterial markers
 Steptococcus Mutans,
Lactobacillus
 Sensory Phenotype
 Caries Mana...
Research Design & Methods
Implement a health program of preventive caries risk assessment (CRA)
to change the overall heal...
Research Design & Methods
  Participants:
  Sample size: 30-50 pediatric patients of Simms MannVenice
Family Clinic
  C...
Sample Question
Was the Dentist respectful and caring in discussing food choices
that can improve your child’s teeth?
1. N...
Outcomes: Healthy Teeth/Healthy
Bodies
CTSI CERP UCLA/UMN
Initial Appt
Integrated Oral
Health/BMI
Plan
Intervention
proces...
Lab Bacterial Analysis
CTSI CERP UCLA/UMN
Initial Appt
Integrated Oral
Health/BMI
Plan
Intervention
process evaluation
by ...
CERP Aims
Promote bidirectional knowledge exchange between community
and academia.
Build community and academic infrastruc...
Added-Value of CTSI funding
Established a two site clinical collaboration
UCLA School of Dentistry and School of Medicine ...
Next Steps and Future Plans
Get a move on it!!!!!
Specific Aims for the CTSI Pilot
  Can the dental/oral healthcare delivery system develop an
integrated care approach tha...
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Early Childhood Risk and Obesity in Preschool-age Children via Salivary Testing

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Principal Investigators: Francisco Ramos-Gomez (UCLA) and Robert Jones (University of Minnesota)

UCLA CTSI and University of Minnesota Cross-Institutional Award Projects

The overall goal of our study is to develop an integrated care plan that effectively addresses the shared risk factors of early childhood dental decay, early childhood cavities (ECC) and obesity. It encourages parents of disadvantaged and of minority backgrounds to adopt broad self-management goals and overall comprehensive health-promoting habits. There is a pressing need for community-based participatory early intervention approaches to prevent both early childhood dental decay and obesity at a younger age. Within the recent healthcare environment, oral health (dentistry) may play an important role within the whole community approach to obesity prevention as an entry point for discussing diet and nutrition early on. Some key reasons for the importance of oral health integration into obesity prevention is that children’s oral health diseases share key risk factors with early obesity. In our study, the Infant Oral health visit promotes dietary guidance early in childhood, and oral health promotion is done in a culturally manner, which we use to discuss other broad health-promoting habits. Our immediate goal utilizes a university and community-based team to improve the ability to predict future dental decay in children and integrate oral health risk assessment with broad health-promoting habits that may one day prevent obesity in the key early years of the child development.

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Early Childhood Risk and Obesity in Preschool-age Children via Salivary Testing

  1. 1. Dr. Francisco Ramos-Gomez (UCLA) and Dr. R.S. Jones (U. Minn) with Dr.Wendy Slusser, Venice Family Simms Mann (SMVF) Health andWellness Center And Dr. JackYeung, UCLA Pediatric Resident Correlation of Early Childhood Caries Risk and Obesity in Preschool Age Children Via Salivary Testing
  2. 2. Goal   Develop an integrated care plan that effectively addresses shared dental caries and childhood obesity risk factors and early detection to encourage parents of disadvantaged background to adopt broad health-promoting habits.
  3. 3. Obesity Background   Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.   The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.   In 2010, more than one third of children and adolescents were overweight or obese.
  4. 4. 4 Communities with Obese children
  5. 5. 5 Overweight* Children in the U.S. (*BMI > 95th percentiles) 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 1963-65 & 1966-70 1971-74 1988-94 1999-2002 2007-8 2009-10 6-11 years old 12-19 years old Source: NICHQ;JAMA. 2010;303(3):242-249; JAMA.2012;307(5):483-490
  6. 6. Early Childhood Caries (ECC)   ECC is a chronic, highly infectious, easily transmittable disease, which can progress rapidly, and when left untreated, may result in pain, infection, and development issues.   This is a dangerous approach to oral health since ECC can be difficult to detect until significant damage has already occurred.
  7. 7. Background Early Childhood Caries Childhood Obesity Early Prevention Needed Surgical Model of Treating Decay has high recurrence Weight Reduction is difficult and has high relapse Multifactorial Disease Nutrition Risk Factors Low Income Minorities Highly Effected
  8. 8. Key Reasons for Integration of Oral Health & Obesity Prevention 1)  Children's oral health diseases (e.g. dental caries) share key risk factors with early obesity 2)  Oral health promotes dietary restrictions early in childhood 3)  Oral health promotion is a cultural sensitive area to discuss broad health promoting habits
  9. 9. Research Questions   To accomplish the overall goal of the project, the following specific aims will be pursued:   Specific Aim #1: will implement a health program of preventive caries risk assessment (CRA) to change the overall health promoting habits in underserved and low income children.   Specific Aim #2: will optimize the caries risk assessment tool in a low- income population while providing means to improve preventive habits.   This aim will test the hypothesis that cariogenic (caries associated) bacterial markers along with additional BMI related taste and dietary information will improve the diagnostic evaluation of our CRA.   Specific Aim #3: will also investigate the hypothesized mediators of caries and BMI change in relation to our taste sensory phenotype results and cariogenic bacterial markers.
  10. 10. 4 Pieces of Data  BMI  Salivary Bacterial markers  Steptococcus Mutans, Lactobacillus  Sensory Phenotype  Caries Management by Risk Assessment (CAMBRA)
  11. 11. Research Design & Methods Implement a health program of preventive caries risk assessment (CRA) to change the overall health promoting habits in minority and low income children. CAMBRA tool expanded to include assessing: 1.  fermentable carbohydrate snacks 2.  frequency of sweeten beverages 3.  availability to fruits and vegetables 4.  BMI information 5.  Taste Phenotyping: response to a bitter taste test compound (PROP) 6.  Novel Oral BacterialTesting
  12. 12. Research Design & Methods   Participants:   Sample size: 30-50 pediatric patients of Simms MannVenice Family Clinic   Children aged 3-5 years with a Body Mass Index (BMI) of greater than 50% **Exclude nonverbal children and siblings of participants.
  13. 13. Sample Question Was the Dentist respectful and caring in discussing food choices that can improve your child’s teeth? 1. Not at All 2.A Little Bit 3. Somewhat 4. Quite A Bit 5. Completely
  14. 14. Outcomes: Healthy Teeth/Healthy Bodies CTSI CERP UCLA/UMN Initial Appt Integrated Oral Health/BMI Plan Intervention process evaluation by phone R01 Award Period Recall Evaluation Appt Evaluation Appts (3,6,12 months) process evaluation by phone process evaluation by phone 4-6m recall Process Evaluation 1.  Parental Recall on Appointment Overall Objectives 2.  Parental Acceptance of Objectives 3.  Baseline Information Long-Term Evaluation 1.  Adoption of Overall Health Promoting Habits (e.g. servings of sugary beverages) 2.  Objective measures of improvements of dental outcomes (e.g. Oral Hygiene Plaque Index) 3.  Parental Knowledge on Nutrition Risk Factors 4.  BMI related information recorded
  15. 15. Lab Bacterial Analysis CTSI CERP UCLA/UMN Initial Appt Integrated Oral Health/BMI Plan Intervention process evaluation by phone R01 Award Period Recall Evaluation Appt Evaluation Appts (3,6,12 months) process evaluation by phone process evaluation by phoneFinal Bacterial Analysis 4-6m recall Lab Analysis 1.  Novel Bacterial Screening identifying live versus dead bacterial DNA (pre-crosslinked PCR) 2.  Allows for Lab Analysis of S. mutans levels at a remote location 3.  Correlate BMI with ECC severity within the taste sensory phenotypes (aversion to bitter compounds). Outcomes: Biological Risk Factors
  16. 16. CERP Aims Promote bidirectional knowledge exchange between community and academia. Build community and academic infrastructure for sustainable partnered research. Simms MannVenice Family (SMVF) clinic UCLA/UMN School of Dentistry Drive innovation in community engagement and education that accelerates the volume and impact of partnered research in diverse communities. We will implement a health program of preventive caries risk assessment (CRA) to change the overall health promoting habits in minority and low income children. We will optimize the caries risk assessment tool in a low-income population while providing means to improve overall preventive habits in a dental delivery care model.
  17. 17. Added-Value of CTSI funding Established a two site clinical collaboration UCLA School of Dentistry and School of Medicine (Peds) Simms MannVenice Family (SMVF) clinic Secured a collaboration with University of Minnesota that can “accelerate design, production, and adoption of evidence-based” application to identify biological risk factors in Early Childhood Caries Pilot Cross-Sectional Clinical Study
  18. 18. Next Steps and Future Plans Get a move on it!!!!!
  19. 19. Specific Aims for the CTSI Pilot   Can the dental/oral healthcare delivery system develop an integrated care approach that effectively addresses shared dental caries and childhood obesity risk factors?   Since oral health promotes dietary restrictions early in childhood, can oral health promotion be a cultural sensitive means to address some key obesity related risk factors?   Can oral health promotion help parents to adopt broad health promoting habits?   Can more effective biological markers be integrated into caries and obesity related assessment?

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