Kentucky - Consortuim for Applied Oral Health Research and Treatment (Ky-CARAT) OB-GYN scope

We propose to use established medical centers and facilities at the Center for Oral Health Research at the Uni\"ersity of Kentucky in Lexington (Central Kentuch), The Center for Rural Health in Hazard, KY and the Mountain Comprehensive Health Corporation facilitv in Whitesburg, KY (Eastern Kentucky), the St. Clair Hospital in Morehead, KY (~orthern Kentuck'y) and the Tro\'er Clinic and Foundation in Madisonville, KY (Western Kentucky) to create the Kentuck): - Consortium for Applied Oral Health Research ;!nd Treatment (Ky-CARAT), The dewlopment and use of dental facilities at each of these sites will prO\ide an infrastructure for educating dental professionals. prO\iding state-of-the-art clinical care of patients in these communities. and enabling the development of outreach research capabilities in rural regions of the Commonwealth. The Ky-CARAT will: (i) de\"elop research and dental clinical relationships bet\\"een UK and these regional sites for the first time in the history of Kentucky; (ii) define new ways to utilize existing health care resources; and, (iii) enhance expansion of a nationally competitive oral health research and treatment enterprise in Kentucky. The Ky-CARAT 'Aill dewlop demonstration projects to target research and treatment studies of oral health and disease linked to pre-term/low birth weight babies and impro\'ed infant development related to early childhood caries, The consortium \,ill focus its funding on 3 primary areas of emphasis: (1) development of a research and treatment infrastructure for imprO\ing oral health; (2) training programs for clinical research linking the University of Kentucky \\ith the rural medical/dental centers; and (3) implementing 2 clinical research programs: Centering+T'" and SOKiTT'"(Save our Kids Teeth). The Centering+TM project is a prenatal general and oral health improwment program for expectant mothers, The rate of preteI'm/low birthweight (PTLBW) infants in the U.S. has not significantly decreased during the last 3 decades. These rates tend to be highest in ethnic minority and historically medically underserved (eg. rural) populations. The 2 principal oral diseases are chronic infections, and gum disease has now been implicated as a contributing factor to an increased incidence pf PTLBW. In Kentucky" >5,000 PTLBW occur annually \\ith an estimated acute care cost of nearly $40,000/birth. This negative birthing outcome, particularly in "high risk" mothers, exerts a substantial economic and long-term social impact on rural communities and health provider nehvorks. The Centering+D' program is designed to provide enhanced prenatal general and oral health education to expectant mothers, as well as prO\iding treatment of dental needs during gestation, The outcomes measured will include changes in the rate of PTLBW, and improvements in oral health quality and knowledge of mothers in rural Kentucky The SO KiP'" program \\ill focus on the substantial problem of early childhood caries (ECC) in Kentuck'y. ECC is defined as active dental decay in children up to 72 months of age, This disease has a de\'astating impact on the early dewlopment of these children, as well as providing a substantial risk for long-term dental problems, including decreases in learning potential and socialization, increased general health needs, and potentially early edentulism. The causes of ECC are clear: behavioral feeding practices of infants coupled with a specific oral bacterial infection that is exacerbated by these practices. Neyertheless, in the 2002 Kentucky Children's Oral Health Survey, it was estimated that over 40% of children in Kentucky suffered from this disease. The estimated annual cost for reactive urgent and emergency care for these children is >$15,000,000. The SOKiP'" program is composed of 2 approaches: (1) evaluate a combined behavioral and fluoride yarn ish approach for decreasing ECC incidence and severity, and (2) establish clearlv the exact magnitude of ECC in the targeted rural communities comprising approximately 20% of the counties in the Commonwealth. The outcomes \\ill define the effectiveness of the early intel"\"ention, and provide documentatIOn of intel"\'ention/treatment needs for the population,