For the past three years, Viacheslav “Slava” Fofanov and other Northern Arizona University researchers have been studying tooth decay in 350 preschoolers in northern Arizona to see if they are affected by the acidic bacteria in their oral “microbiome.” They will soon begin working both in southern Arizona in Yuma County and on the Big Island of Hawaii through a SHERC project to expand their research.
The long-term goal of the researchers is to reduce tooth decay, particularly in youth who are from ethnic minorities in the United States. In the U.S., early childhood caries (EEC), or tooth decay, is the most prevalent chronic disease in children, occurring five times as frequently as asthma.
Nationally, tooth decay rates of Hispanic, American Indian, Native Hawaiian and other Pacific Islander children are almost double those of white children, with approximately 52% of pre-school Hispanic children in Yuma County and 50% of Native Hawaiian and Other Pacific Islander children having untreated tooth decay.
The researchers are working to prove that biological components combine with socioeconomic factors, which include poverty and access to dental care, to increase tooth decay. Fofanov, who is an assistant professor and also the associate director for Research and Graduate Programs in the School of Informatics, Computing and Cyber Systems (SICCS), and his colleagues have found that the strains, S. mutans and S. sobrinus, are the bacteria that most contribute to childhood tooth decay, according to their research.
In the study, the researchers have been collecting and analyzing saliva samples from pre-school children, ages 1 to 5 years old. The researchers use plush hand puppets, specifically a friendly shark with human-like teeth, to make swab sampling fun and to assist them with educating the students on the importance of oral hygiene.
“Part of the choice to examine children in preschool is that they are a lot more isolated (as a group) than elementary school students,” Fofanov said. “We know that the problems that start in the preschool are continuing beyond there.”
Titled “Defining Microbiological Drivers of Early Childhood Caries in Preschoolers in Southern Arizona,” the main study includes investigators, Julie Baldwin, Regents’ Professor and director of the Center for Health Equity Research, Talima Pearson, associate research professor in the Department of Biological Sciences, and Denise Helm, professor of NAU Department of Dental Hygiene.
Fofanov said that the bacteria, which are from the S. mutans group, metabolize carbohydrates and produce highly acidic byproducts that change the pH in a person’s mouth, which leads to demineralization of tooth enamel. Fofanov said that preschools and family households are ideal environments for the bacteria to spread.
“The problem is that these types of cavities are caused by bacteria that like to live in your mouth and that process sugars and project an acid byproduct,” Fofanov said.
He said that through their research, they hope to discover the best interventions to eliminate the bacteria and improve dental health, especially in minority groups, to not only save the teeth of the students and their families, but also to reduce dental costs nationally. In 2012 alone, early childhood tooth decay cost $1.6 billion in emergency dental care in the U.S.
Study extended to the Big Island
The researchers are expanding their existing study to include a supplemental study with Misty Pacheco, associate professor of kinesiology and exercise sciences at the University of Hawaii at Hilo, under principal investigator Baldwin. The university is located on the Big Island, where similar social determinants of health exist as in rural populations on the continental United States. Fofanov and Baldwin said they decided to partner with Pacheco because the main study does not include youth who are Native Hawaiian or Pacific Islander.
“Throughout the United States, Native Hawaiians and Pacific Islanders are lumped in the Asian category and they are not––it is a completely different population,” Fofanov said. “We would not be able to disambiguate them from the wider population (with the incorrect classification).”
In both the original and the supplemental studies, the goals for researchers are to determine the impact of classroom-based microbiome and bacterial transmission on tooth decay rates.
According to the researchers, the supplemental study is the first large-scale effort to understand the biological factors that drive tooth decay both at home and at school in students who are Native Hawaiian or Other Pacific Islander.
“We are targeting the family––the home––and dentist,” Fofanov said. “But when these kids go into the classrooms (from their homes), for better or worse, the more acidic microbiome (in the classroom) may win out.”