Defining microbiological drivers of early childhood caries in preschoolers of Native Hawaiian and other Pacific Islander descent

In the US, Early Childhood Caries is the most prevalent chronic disease in children, occurring 5 times as frequently as asthma, and when left untreated costing $1.6 billion in emergency dental care in 2012 alone. Nationwide, caries rates of Hispanic, Native American, and Native Hawaiian and Other Pacific Islander children, are almost double those of white children. Approximately 52% of pre-school aged Hispanic children (in Yuma County, Arizona) and 50% of NH/OPI children (on Hawai’i Island) have untreated caries.

Traditional socioeconomic factors (poverty and access to dental care) explain only a portion of the elevated ECC incidence rates in ethnic minorities, with biological components likely having a strong impact. Infection by bacteria from mutans streptococci group (S. mutans and S. sobrinus), have been implicated as the cause of ECC. When established in the oral cavity, these bacteria metabolize carbohydrates and produce highly acidic byproducts that change the pH of the oral cavity, leading to demineralization of tooth enamel. The impact of the genomics, virulence (acid production), and bacterial load of mutans streptococci in the oral cavity on observed ethnic ECC incidence disparities are unknown but are likely significant. Similarly unknown is the role that preschool classrooms perform in selecting for highly acidic strains of mutans streptococci.

We have proposed to address these knowledge gaps in our existing project titled: “Defining Microbiological Drivers of Early Childhood Caries in Preschoolers in Southern Arizona”. However, while the parent study is well-poised to explore the biological component of ECC in Hispanic and, to a lesser extent, Native American children, Native Hawaiians and Pacific Islanders are insufficiently represented in Arizona (and elsewhere in the continental US) to draw statistically significant conclusions. With this administrative supplement we propose to focus on disambiguating the biological drivers of dental decay in NH/OPI children. At 33.9%, the proposed catchment area for this supplement (Hawai’i County, HI), has one of the highest concentrations of Native Hawaiians, per capita, in the country, making it an ideal option to disambiguate NH/OPI from other ethnicities.

This supplement is the first large-scale effort to explicitly understand the biological factors driving caries formation, both at home and at the school (or daycare), in NH/OPI children. Existing continental US-based studies typically do not have sufficient populations (and thus statistical power) to disaggregate NH/OPI children from the Asian population. 

Study name: Defining Microbiological Drivers of Early Childhood Caries in Preschoolers of Native Hawaiian and Other Pacific Islander Descent
Funding: This study was funded by NIMHD/NIH 3U54MD012388-03S2
IRB project number: 2020-00156 (UH-Hilo)

About the investigators

Viacheslav “Slava” Fofanov, PhD

Co-Investigator

Associate Director for Research and Graduate Programs in the School of Informatics, Computing and Cyber Systems (SICCS)

Email: Viacheslav.Fofanov@nau.edu

Research interests: Statistical methods, database design, data quality, data entry, and coding, honest broker operations

Misty Pacheco, PhD

Co-Investigator

Associate Professor and Department Chair of Kinesiology and Exercise Sciences

University of Hawaii at Hilo

Email: mistyp@hawaii.edu

Research interests: Early Childhood caries in preschoolers of Native Hawaiian and Pacific Islanders, HIV prevention, chlamydia knowledge and prevention, diverse & rural populations