Because severe tooth decay among young children is difficult to treat effectively and has an alarming and distressing tendency to recur following treatment, scientists at Eastman Institute for Oral Health, who have been awarded multi-million-dollar grants for their innovative research, are making headway.
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 have begun enrolling her patients and gathering samples and data.
“We’re excited to conduct 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, professor of Dentistry and 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) is 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. Approximately 240 children, ages 2-5, 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.