UCSF Awarded Nearly $21 Million to Reduce Children’s Oral Health Disparities

By Scott Maier

Participants of UCSF's CAN DO program.

UC San Francisco has long been a leader in preventing children’s oral disease and promoting children’s oral health, especially in low-income and minority populations. Now, supporting this ongoing work, the National Institutes of Health has awarded the UCSF School of Dentistry three research awards potentially totaling nearly $21 million.

These three awards are part of 10 research cooperative agreements awarded nationwide by the NIH aimed at eliminating inequities in access to care and improving the oral health of children. The awards of up to five years each support the Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children, a new initiative of the NIH’s National Institute of Dental and Craniofacial Research (NIDCR), with funding phased in as milestones are achieved.

"Although significant progress has been made in discovering ways to prevent rampant tooth decay in preschoolers, these new awards will allow for evaluating innovative ways to reduce decay among those populations most at risk,” said John D.B. Featherstone, PhD, MSc, dean of the UCSF School of Dentistry and professor in the Department of Preventive and Restorative Dental Sciences.

Center to Address Disparities in Children’s Oral Health (CAN DO)

Previously, UCSF was awarded two consecutive seven-year NIDCR awards totaling more than $35 million, creating and expanding the UCSF Center to Address Disparities in Children’s Oral Health (known as CAN DO). The three new UCSF awards comprise “CAN DO3.”

CAN DO has conducted transdisciplinary research that includes several large randomized controlled clinical prevention trials together with colleagues at UCLA and communities in San Francisco and San Diego County at high risk for caries in young children. The center is directed by Stuart Gansky, DrPH, John C. Greene Professor of Primary Care Dentistry in the Division of Oral Epidemiology and Dental Public Health and vice chair for research in the Department of Preventive and Restorative Dental Sciences in the UCSF School of Dentistry.

CAN DO researchers are ​studying ways to improve the dental health of groups that have historically had worse oral health. ​The primary focus is preventing tooth decay or early childhood caries in young children, as well as eliminating health disparities among low-income individuals and communities, through sound research, evidence-based practices and policy changes.

”This planned research builds on the body of work of the NIDCR-funded Early Childhood Caries Collaborating Centers, including UCSF’s CAN DO,” Gansky said. ”We are grateful for the opportunity to work on these transdisciplinary research projects because this work has real potential to impact the health triple aim of better care, better health status and lower health care costs.”

Coordinating Center to Help Eliminate/Reduce Oral Health Inequalities in Children

Funded at $11 million, the Coordinating Center to Help Eliminate/Reduce Oral Health Inequalities in Children (CC HEROIC) will provide collaborative research and coordinating center expertise and services to nine NIDCR-funded community-engaged projects. The goal is to enable projects to assess multilevel interventions, programs or policies that will reduce or eliminate oral health disparities in diverse, vulnerable populations of children ages 0-21.

Specifically, CC HEROIC will provide clinical and scientific expertise, including optimizing study designs, instrumentation and data analysis plans; informatics and project management, including secure data collection and management systems, data quality assurance/control, project and safety monitoring, and progress reporting; research staff training as well as training and calibrating project oral health examiners; and coordination of the consortium’s nine collaborating teams across the United States.

Principal investigators are Gansky and Steven Gregorich, PhD, professor of medicine and dentistry at UCSF.

Improving Dental Care Quality and Outcomes Through Evidence-Based Prevention and Treatment

The second NIDCR award of up to $4.8 million is to evaluate the impact of a standardized evidence-based prevention and treatment program on reducing disparities, providing better overall population health, improving the care experience and lowering per capita cost.

Oregon was chosen for this research project because children ages 0-20 in the state from lower-income households have a substantially higher dental caries rate than children from higher-income households. They also have nearly twice the untreated decay rate and more than twice the rate of rampant decay.

This research project will evaluate the disparity reduction and oral health improvement potential of innovative standardized caries prevention approaches implemented in Willamette Dental Group offices in Oregon. It also will assess organizational sustainability, cost and Medicaid policy implications.

The multidisciplinary research team is also multi-institutional, with researchers joining from the Skourtes Institute, Williamette Dental Group, Harvard University, The University of Texas Health Science Center at Houston, and Oregon Health & Science University.

Principal investigators are Elizabeth Mertz, PhD, MA, assistant professor, and Joel White, DDS, MS, professor, of the Department of Preventive and Restorative Dental Sciences in the UCSF School of Dentistry.

Behavioral Economics for Oral Health Innovation

The BEhavioral EConomics for Oral health iNnovation (BEECON) project, funded at up to $4.8 million, will use various methods to design incentives that promote caregiver behaviors to prevent caries in young children, assess child oral health outcomes and evaluate cost-effectiveness of the intervention. The project will enroll underserved, low-income Hispanic/Latino families with children 0-5 years of age in Early Head Start and Women, Infants, and Children (WIC) supplemental nutrition programs in Los Angeles County.

Previous studies have shown that mere health education is insufficient to make a lasting impact on health behaviors. Despite growing evidence that small, cost-effective interventions leveraging theories and insights from behavioral economics can promote behavior change, this will be the first time they are applied to oral health interventions. The multidisciplinary research team is comprised of UCSF and UCLA investigators.

Principal investigators are Gansky and James Kahn, MD, MPH, professor of epidemiology and biostatistics, of UCSF and Francisco Ramos-Gomez, DDS, MS, MPH, professor of pediatric dentistry, of UCLA and UCSF.

The NIDCR is the nation’s leading funder of research on dental, oral and craniofacial health.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.