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METHODS article

Front. Public Health
Sec. Public Health Education and Promotion
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1488910
This article is part of the Research Topic Oral Health Strategies to Achieve Health Equity and Improve Public Health in the U.S. View all articles

Testing a Multi-behavioral Intervention to Improve Oral Health Behaviors in the Pediatric Dental Surgery Population: Protocol for the PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment) Trial

Provisionally accepted
Joanna Buscemi Joanna Buscemi 1*Teresa G Borowski Teresa G Borowski 2David M. Avenetti David M. Avenetti 2Lisa Tussing-Humphreys Lisa Tussing-Humphreys 2Molly Martin Molly Martin 2Marc Atkins Marc Atkins 2Teresa Marshall Teresa Marshall 3Michael Berbaum Michael Berbaum 2Helen Lee Helen Lee 2
  • 1 DePaul University, Chicago, United States
  • 2 University of Illinois Chicago, Chicago, Illinois, United States
  • 3 The University of Iowa, Iowa City, Iowa, United States

The final, formatted version of the article will be published soon.

    Severe early childhood caries (S-ECC) is a common disease within marginalized pediatric populations. S-ECC is often treated under general anesthesia to facilitate extensive treatment in young children, but treatment does not address etiology of an infectious disease that is rooted in health behaviors. Without behavior changes related to toothbrushing and sugar consumption, many children experience recurrent disease, and some require subsequent surgeries. To improve postsurgery oral health, we developed PROTECT (Preventing Recurrent Operations Targeting Early Childhood Caries Treatment), a community health worker (CHW)-delivered behavioral intervention for caregivers that focuses on children's oral health behaviors. This study aims to test the efficacy of the PROTECT intervention compared to Usual Care (UC), to improve behavioral oral health outcomes. We will conduct a randomized clinical trial to test the efficacy of PROTECT (n = 210) compared to UC (n = 210) in the pediatric DGA (dental surgery under general anesthesia) population. We developed PROTECT through an iterative process, incorporating feedback from caregivers, dentists, and community health workers and through a small pilot trial. Caregivers will be recruited at their dental clinic and then will engage in a 10-session intervention with a community health worker. Topics covered will include education about toothbrushing and sugar consumption, behavioral strategies (e.g., goal setting, problem solving, self-monitoring), positive parenting and stress management and maintenance. Our two primary outcomes are parental assisted toothbrushing (twice/day, two minutes each time) and reduced added sugar consumption (less than 10% of overall daily caloric intake). Proposed mechanisms of change are self-efficacy and positive parenting. The ultimate goal of PROTECT is to prevent subsequent surgical events for children presenting with S- ECC to prevent further chronic disease and reduce costs and stress for families who already experience high levels of systemic barriers to their health.

    Keywords: Severe early childhood caries, community health worker, behavioral intervention, Parenting intervention, Oral Health

    Received: 30 Aug 2024; Accepted: 02 Jan 2025.

    Copyright: © 2025 Buscemi, Borowski, Avenetti, Tussing-Humphreys, Martin, Atkins, Marshall, Berbaum and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Joanna Buscemi, DePaul University, Chicago, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.