Leading the Way in Early Childhood Caries Research

Because severe tooth decay among young children is difficult to treat effectively and has an alarming and distressing tendency to recur following treatment, researchers at Eastman Institute for Oral Health have been awarded multi-million-dollar grants for their innovative research.

Data from the National Health and Nutritional Examination Surveys indicate that the prevalence of Early Childhood Caries in U.S. preschool children ranges between 24% and 28%.

The clinical, social and public health impact of ECC and Severe-ECC is underscored by its association with increased risk of new caries lesions in the primary dentition, a higher risk of caries onset in the permanent dentition, hospitalizations, emergency room visits, high treatment costs, lost school days, diminished ability to learn and a profound negative impact on a child’s quality of life.

“These grants support our commitment to reduce health disparities among underserved communities,” said Eli Eliav, DMD, PhD, director of Eastman Institute for Oral Health. “We’re delighted we’ve continued to earn the trust of NIDCR to pursue this important research with innovation and collaboration throughout the University. We need novel approaches to reduce the relapse rate and improve oral health of our youngest patients.”

Can Iodine Make a Difference?

Dorota Kopycka-Kedzierawski, DDS, MPH (GenDen ’02, MPH ’03) landed a $6 million NIDCR grant to see if a topical anti-microbial agent will help reduce the high number of children who experience recurrent tooth decay after they’ve been treated in the operating room. After finalizing the study protocol, quality and data management plans, and developing study procedures, she and her team are ready to begin gathering samples and data.

“We’re excited to begin this study to determine if this approach will help prevent, in part or in whole, these children from returning back to surgical treatment,” said Dr. Kopycka-Kedzierawski, the director of the EIOH Clinical and Translational Research Core.

The standard of care for severe tooth decay in young children Severe Early Childhood Caries (S-ECC) revolves around treatment in a surgical operating suite under general anesthesia, followed by application of topical fluoride varnish, family counseling regarding feeding behaviors and oral hygiene instruction. But clinical studies demonstrate that approximately 40% of children treated for S-ECC will develop new caries lesions within 12 months after dental surgery.

The late Dr. Robert Berkowitz, previous chair of the EIOH Pediatric Dentistry Division, was one of the early investigators to show the potential of povidone iodine (PVPI) in preventing dental caries in young children. His work showed that this commonly used pre-surgical antimicrobial agent applied topically to the teeth could suppress growth of the bacteria most commonly associated with tooth decay. His work suggested that povidone iodine showed promise in preventing recurrent cavities following treatment and rehabilitation.

This new Povidone Iodine Efficacy Study (PIES) will implement a single center randomized, double-blind, placebo-controlled trial to assess the efficacy of povidone iodine (PVPI) to prevent new cavities from developing following treatment. Children enrolled in the study will be randomly assigned to have either povidone iodine and fluoride varnish applied to their teeth or a placebo and fluoride varnish.

The study agents will be reapplied every three months for up to 24 months. The team will measure the severity and incidence of new dental caries in children with S-ECC following oral rehabilitation who are receiving quarterly topical 10% PVPI or placebo. To better understand how the PVPI behaves on the oral microbiome, the team will examine intraoral bacteria and yeast species and assess the effect of topical 10% PVPI on diversity and composition of oral microbiota, including cariogenic species to better understand the mechanism of action of 10% PVPI on the oral microbiome. More than 245 children, ages 2 – 6, who have S-ECC and require operating room treatment are invited to participate in the trial.

Along with Dr. Kopycka-Kedzierawski, other EIOH investigators involved in the study are Drs. Ronald Billings, Sean McLaren, Gene Watson, and Cynthia Wong. University of Rochester School of Medicine and Dentistry co-investigators include Dr. Steve Gill, professor, Department of Microbiology and Immunology, Dr. Michael McDermott, professor, Dr. Michael Sohn, assistant professor, both with the Department of Biostatistics and Computation Biology.

Study Aims to Predict Severe Tooth Decay in Early Infancy

Led by Jin Xiao, DDS, PhD, (GenDen ’13, GPR ’14) EIOH associate professor and perinatal oral health expert, this first-ever study is examining early-life biological factors related to severe tooth decay among underserved racial and ethnic minority groups.

In a separate study, EIOH scientists learned that a certain type of yeast— Candida albicans—is largely present in the mouths of pregnant women in underserved communities. “We learned this yeast is also largely present in their children’s mouths as early as one week after birth and stays in the mouth if not treated,” explained Dr. Xiao, principal investigator for the newly funded grant, Oral Microbiome in Early Infancy (OMEI). “If this type of yeast was found in the mother’s mouth, our research showed a strong connection between the mother and her baby both having tooth decay. Therefore, we want to further examine how this yeast plays a role in shaping the oral environment in early life that leads to ECC.”

Funded by the National Institute of Dental and Craniofacial Research, part of National Institutes of Health, the $3.5 million, five-year study is examining 2,000 saliva samples previously collected from a cohort of minority mothers and babies to sequence the whole spectrum of oral microbes, including bacteria and fungi. The team will then build tooth decay prediction models by integrating multi-platform data, including the microbiome, human candidate genes, immune markers and maternal and socio-behavioral information.

“If we learn that infants in underserved communities have a higher amount of bacteria and yeast in early life, we could predict sooner and with more accuracy who is at increased risk of developing ECC and then work to prevent it,” said Dr. Xiao. “For example, we could generate chair-side risk detection and intervention, such as detecting certain bacteria and fungi in mothers’ and on various projects to help combat severe tooth decay: (back to front row, l to r) Dr. Tong Tong Wu, Dr. Kevin Fiscella, Ms. Johana Ren, Dr. Oriana Ly-Mapes, Ms. Sherita Bullock, Dr. Noha Roshwan, Mrs. Molly Parameter, Mrs. Kathy Bohn, Dr. Nisreen Al Jallad, Dr. Jin Xiao and Dr. Jiebo Luo. babies’ mouths during OB visits and check-ups, provide interventions and subsequently prevent tooth decay.”

The harmful short- and long-term effects of ECC result in a substantial adverse impact on children, families, and healthcare systems, but if detected and addressed in its early stages, it can be reversed.

Dr. Xiao is collaborating with co-principal investigators

Steve Gill, PhD, professor of Microbiology and Immunology, and Tong Tong Wu, PhD, associate professor of Biostatistics and Computational Biology. The research team includes UR investigators Kevin Fiscella, MD, MPH, professor of Family Medicine, Michael Sohn, PhD, assistant professor, Biostatistics and Computational Biology, and Ying Meng, PhD, RN, School of Nursing assistant professor.

Complex Problems Take Innovative Solutions

Will pregnant women getting a dental checkup--at their obstetrician’s office—actually help prevent severe tooth decay among young children?

Using artificial intelligence and digital technology, Jin Xiao, DDS, PhD, certainly thinks so. The Eastman Institute for Oral Health researcher has been awarded a grant to test the idea.

“Education and prevention are critical to resolving this significant public health problem,” said Dr. Xiao, EIOH associate professor and perinatal oral health expert, “and pregnancy is an ideal time to promote prevention given the profound influence of maternal oral health and behaviors on their children’s oral health.” For example, research shows that women with gum disease are at a higher risk to deliver low birth weight and preterm babies.

While at a routine obstetrician visit, a participating patient will have intra-oral photos taken, and install a smartphone app, AICaries, (developed by Dr. Xiao and her team) which can detect signs of tooth decay on herself or her other children. If she has dental pain or concerns, she can secure a virtual dental visit and then an appointment for treatment, if needed.

With collaboration throughout the University of Rochester, Dr. Xiao has been studying this issue for years. This project, SMARTeeth-Smart Connected Oral Health Community: Using AI and Digital Technologies to Close the Gaps in Oral Health Disparity, is the latest in her creative approach to tackling the problem at the root cause.

The project, funded by the University of Rochester Medical Center’s Health Equity Program Support Office, aims to treat 1,000 patients throughout the year, thanks to collaborations with URMC obstetricians and a University of Rochester computer science data expert.

Education about the importance of oral hygiene for mom and her children, as well as support and advocacy to eliminate other barriers to care such as transportation, will occur throughout the pregnancy.