"Preventive care, particularly for infants and toddlers, is one of the most cost-effective ways to improve oral health,” explained Karin Weber-Gasparoni, professor and chair of the Department of Pediatric Dentistry at the University of Iowa.

Unfortunately, in the current landscape of oral health care in the United States, preventive oral health care for very young children faces three major challenges.

• Although pediatric dentists recommend that children should be seen by a dentist no later than one year of age, only a small percentage of infants see a dentist by this time. 

• Additionally, low-income children are at particular risk of falling through the cracks of our oral health care system.

• Caregivers of high-risk young children will often know what they should do, but they often aren’t motivated to do it.

Weber-Gasparoni and her team of clinicians and researchers have been working to meet these three challenges.

“It is essential that we understand the psychology of motivation and for us to use educational strategies that actually change behaviors,” Weber-Gasparoni said.

Weber-Gasparoni has been using a particular psychological theory of motivation, self-determination theory, which has been particularly effective at changing behavioral patterns related to preventing early childhood caries. This psychological theory relies on the caregiver personally and autonomously buying-in to what should be done by having a health care professional develop a personal relationship with the caregiver that improves their confidence and competence in carrying out a given task. These interventions and preventive strategies for reducing the risk of cavities begin even before a child is born during pregnancy and throughout the first several years of the child’s life.

The team’s preliminary studies have been promising as they showed that interventions designed to improve the parent or caregiver’s autonomy, confidence, and buy-in effectively changed several desirable oral health behaviors for the prevention of early childhood caries among their children.

Drawing from these results, Weber-Gasparoni and her team spent the past two years developing a clinical trial to measure the effectiveness of the interventions using this theory. The National Institutes of Health and the National Institute for Dental and Craniofacial Research recently funded the clinical trial with an award for over $4.4 million. The award will allow the team to determine whether interventions based on self-determination theory can prevent cavities in those critical first three years of a child’s life.

“If we can keep a child cavity-free in the first three years of life, it will increase the opportunity for this child to enjoy better oral health for their lifetime,” Weber-Gasparoni exclaimed.

Since the intervention is connected to the Special Supplemental Food Program for Women, Infants and Children (WIC) through the Johnson County Department of Public Health, it does not require parents or caregivers to take their infant or toddler to the dentist for care. Likewise, since the WIC program supports low-income families, it directly meets a need for an underserved population.

Weber-Gasparoni’s coinvestigators for the grant include Jennifer Bowman-Reif, David Drake, Stuart Gansky (University of California, San Francisco), Steven Levy, Teresa Marshall, Johnmarshall Reeve (Australian Catholic University), John Warren, and Jin Xie.