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News — CHICAGO — In 2014, the University of Illinois Chicago had a waiting list of over 1,000 children whose severe cavities required treatment under general anesthesia. Some families, enrolled in Medicaid, needed to drive hours across the state to UIC to access care. Unfortunately many families, after overcoming several barriers to dental care, will experience childhood cavities within six to 12 months after their child’s dental surgery.

With a new $3.9 million grant from the National Institutes of Health, Helen Lee, MD, MPH a pediatric anesthesiologist at UIC, and Joanna Buscemi, PhD, a clinical psychologist at DePaul University, will test whether these surgeries can be a window of opportunity for improving oral health long-term. The researchers will conduct a trial of a new intervention called , which deploys community health workers to empower families to make positive behavioral changes with their child after surgery.

The parenting support program takes an interdisciplinary approach to go beyond education to support healthy behaviors. Drs. Lee and Buscemi identified the need to acknowledge other social determinants of health, such as food and housing insecurity while balancing work and childcare.

“What drove us is that the health system can do better. Socially, we can do better. When we asked parents about their child’s teeth, we realized that everything connected to how parents and children interact,” said in the Department of Anesthesiology at University of Illinois College of Medicine.

Lee and Buscemi designed PROTECT with two main goals: Increasing the frequency of adult-assisted tooth brushing and reducing a child’s sugar intake. Community health workers initially meet with caregivers during their child’s surgery and then deliver the program through regular sessions over the subsequent six months.

A pilot study with a small group of families showed sustained behavior changes: 100% of families reported brushing twice daily and dramatically reducing sugar intake. This additional funding over the next five years will support a large, randomized control trial, testing the efficacy of the program.

Developing an intervention that works for families of children at high risk for severe cavities

Persuading any child to brush their teeth twice a day can be a challenge, and most children do not have the dexterity to properly brush their teeth independently until they are 10 years old, Buscemi noted. On diet, the World Health Organization recommends children eat less than 10% of their daily calories from added sugar, and meeting that benchmark can reduce cavities, Lee said.

But while most parents and caregivers are already aware of the importance of brushing daily and reducing sugar intake, life challenges often make it difficult to follow these recommendations. In the pilot study, families answered questions about social determinants of health and shared they were facing food insecurity, poverty and stress. That led the researchers to focus on empowering parents and caregivers with strategies for parenting and stress management.

“We're not just handing out informational sheets about brushing teeth. Instead, we're using evidence-based behavioral tools to teach caregivers how to problem-solve around barriers, such as when a kid's having a tantrum in the morning and they're trying to brush their teeth,” said . “We know positive reinforcement — praising the child when they’re brushing their teeth or making nutritious food choices — is really powerful.”

As experts in helping families make behavioral changes, Buscemi said community health workers were the ideal people to deliver the intervention.

“Community health workers understand the stress and challenges, unique to the communities that UIC serves, that families are going through in their day-to-day lives,” Buscemi said.

The intervention is also offered in Spanish by bilingual community health workers and tailored to each individual family.

“There's not one solution for every family, because every family runs differently,” Lee said. “Every intervention is going to look different from household to household.”

Creating change for entire households

Lee emphasized that the program is meant to supplement, not replace, the important work of dentists and other clinicians. The research team includes a pediatric anesthesiologist (Lee), psychologist with parenting expertise (Buscemi), a pediatric dentist, a pediatrician, two dietitians and a biostatistician. Researchers believe the program has the potential to improve overall health of a child’s entire household, connect families to social support services and reduce healthcare costs.

“When we look at links between oral health and other chronic diseases across the lifespan, there are connections to diabetes, heart diseases and other major causes of death,” Buscemi said. “By starting with young kids, we’re hoping PROTECT will also have long-term health benefits down the road.” 

Community health workers will engage with caregivers for six months following the child’s surgery to deliver PROTECT and support parents in behavioral change. Lee notes that a surgical event offers a unique opportunity to create change, especially in systemically oppressed families that may not typically go to the dentist.

“If we can change a child's health behaviors at that critical time of surgery, our hope is that we can promote health over a lifetime,” Lee said. “We see this intervention as a high impact way to potentially affect the lives of households and generations.”

The team created PROTECT with support from the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH). Additional researchers on the team are affiliated with the UIC colleges of dentistry, medicine and applied health sciences and the Institute for Health Research and Policy.