Response to the Letter to the Editor: Preventing Caries in American IndianChildren: Lost Battle or New Hope?

摘要

have offeredimportant and thoughtful remarks in their letter commenting on our Invited Commentary,“Preventing Caries in American Indian Children: Lost Battle or New Hope?” ( ). Several of theexcellent points they have made are valid, including their characterization of early childhoodcaries (ECC) as an endemic infectious disease and the suggestion that there may be moreeffective biochemical interventions with which to manage ECC in American Indian children thanthe fluoride varnish that we used in one of our studies. These points do not negate thecritical points we have attempted to make in describing the challenge of preventing ECC inhigh-risk populations, however. That challenge has less to do with the efficacy of variousagents for eliminating than it does with the individualand social acceptability of various strategies that actual children and their parents arelikely to engage in this fight. To wit, the 2 studies that we reported were clinical trials ofcommunity-based participatory approaches to prevention, not evaluations of biochemical agents.This means that they involved approaches that had been approved by the tribes as strategiesthat were likely to be well understood and accepted and, therefore, actually put into use bythe parents of children who are highly susceptible to ECC. The behavioral aspects of thetrials were the central focus—and in fact, the focus of the second studythat we described (in which no biochemical agents were involved at all). Herein lies the pointthat we find ourselves needing to make time and time again—that is, the most highly effectivetherapeutic agent available will be utterly useless if people do not want it, do not acceptit, or do not use it. This, of course, is where behavioral strategies come in.