Funded by the National Institute of Dental and Craniofacial Research, the study aims to identify key criteria for optimizing local school-based caries prevention programs scalable for nation-wide effective caries prevention programs.

Ryan Richard Ruff, PhD
Ryan Richard Ruff, PhD

Dental caries is the most common childhood disease. Untreated decay affects 20% of children ages 6-8, and caries experience can reach as high as 58% among children and adolescents. Untreated decay can lead to infection and pain, and, in rare instances, death.

“Childhood caries is a preventable epidemic,” says Ryan Richard Ruff, PhD, assistant professor and director of the Biostatistics Core in the Department of Epidemiology and Health Promotion at the NYU College of Dentistry (NYU Dentistry).   

To help tackle the problem, Dr. Ruff has been awarded a two-year, $317,000 grant from the National Institute of Dental and Craniofacial Research (NIDCR) to conduct a systematic evaluation of comprehensive caries prevention using a longitudinal dataset of students attending Title 1 (low-income) schools.

Dr. Ruff and his team will analyze a six-year dataset of 9,260 children across 55 elementary schools in Massachusetts who participated in a school-based caries prevention program conducted by the Forsyth Institute from 2003 to 2009. The new investigation aims to expand upon the scope and sequence of the original study by using secondary data analyses to identify key criteria for optimizing school-based caries prevention programs.

“There are three primary barriers to the dissemination and implementation of school-based caries prevention,” said Dr. Ruff.  “First, while efficacy trials demonstrate success in caries control, there is little evidence of effectiveness in large pragmatic (effectiveness) studies.  Second, little is known of the cumulative effects of prevention over time for students of varying ages, so optimization is difficult. Finally, previous studies of longitudinal data from prevention programs did not examine student cohorts who most needed care.”

To overcome these barriers, Dr. Ruff and his team will model nonlinear trends of untreated decay in children receiving the prevention intervention, seeking to determine the causal effects of prevention over time, and thus estimating the predicted probabilities of decay development.

“To optimize care, we need to be focusing on delivery time, targeted care for high-risk groups, and clinically relevant prevention methods,” said Dr. Ruff. “Utilizing novel statistical methods to properly account for the longitudinal research design, we can control for relevant observed and unmeasured confounders, and explore the comparative effects of multiple preventive services simultaneously.”

Incorporating oral health into the primary education system and eradicating dental disease in children, are both oral health goals of Healthy People 2020  Additionally, the CDC supports school-based caries prevention programs as a cost-effective method to increase access to and improve health. However, the effectiveness of school-based caries prevention has never been systematically studied in high-risk populations.

Dr. Ruff believes that the methods used in this project will be demonstrated to be effective and easily adaptable for use in the analysis of other large effectiveness trials.

“Our aims,” he says, “will thus serve as a roadmap for the robust analysis of complex, longitudinal datasets in oral health, which in turn will help clinicians and policymakers accomplish the Healthy People 2020 goals of incorporating oral health in education and eradicating oral diseases in children.”

NIDCR Award #: 1R03DEO25289-01A1



New York University College of Dentistry (NYU Dentistry) is the third oldest and the largest dental school in the US, educating 8 percent of all dentists. NYU Dentistry has a significant global reach and provides a level of national and international diversity among its students that is unmatched by any other dental school.

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