Last Wednesday, Sept. 20, a research team led by two NYU College Dentistry faculty members received a $13.3 million funding award. Richard Niederman, D.M.D., and Ryan Richard Ruff, M.P.H., Ph.D., will use this money to study two methods of dental caries (cavities) prevention. The team is focusing their research on low income Hispanic and Latino communities in the Bronx.

More specifically, Niederman and Ruff will focus on children in those communities who are considered highest-need. The team hopes to discover how preventative measures affect not only cavities but also academic performance and overall quality of life.

“We will obtain educational data from the NYC Department of Education to compare changes in children over time, and collect additional data on quality of life using established instruments,”  Ruff said.

Niederman and Ruff hope to increase care in a community that faces numerous barriers, foremost among them the high cost of oral health care. According to their project summary, children with cavities and related toothaches experience a lower quality of life.  Niederman and Ruff aim to alleviate these problems by improving access to oral healthcare in general.

“The overall goal of our proposed research is to improve oral health equity by determining the most effective, patient-centered and efficient school-based caries prevention interventions,” their project summary states.

In recognition of this, the Patient-Centered Outcomes Research Institute approved their research to receive the substantial funding award. The application process for the award was extensive.

“This was a multi-year, collaborative process,”  Niederman said.  “It involved community conversations with multiple stakeholders and a pilot study.”  

“In addition to the engagement of multiple patient and stakeholder partners, PCORI has a detailed set of methodological requirements that must be included in every project proposal,” Ruff said. “This ensures that every PCORI funded project is both relevant to patients and scientifically rigorous.”

With the award, school-based simple and complex protocols for cavity prevention will be tested and their effectiveness will be compared. The participating schools will be chosen at random to decide which protocol will be used at each. Niederman and Ruff’s hypothesis is that the simple method will be just as effective as the more costly complex one in preventing dental cavities. If this holds true, access to oral health care could be increased.

“If using the simple protocol is equally effective as complex and is 1/4 the time and cost, four times more children could be provided with preventive care,” Niederman said in an email. “And, if this is true, our estimates indicate that a national school-based cavity prevention program for all children would reduce cavities by more than 50 percent and save approximately $10 billion per year in health care costs.”

In Niederman’s opinion, dentists right now have more of an incentive to provide rescue care rather than preventative care due to the disparity of compensation between each. That is, dentists are paid more to fix dental problems rather than prevent them from occurring.

“We’ve published on this conundrum, and think that the financial incentives are misaligned,” Niederman said. “I think a central problem is this inequity in access to effective preventive dental care. To increase oral health care equity, a first step is generating data on the effectiveness and cost-effectiveness of prevention and providing models for effective implementation. Ultimately, the goal is to change policy to sustainably support preventive care.”

Email Patrick Pauley at [email protected]