Applying Science to Prevent Childhood Cavities

Ling Zhan, DDS, PhD, in the lab; she is isolating cavity causing bacteria.
Ling Zhan, DDS, PhD, in the lab; she is isolating cavity-causing bacteria.

By Kate Rauch

Study by study, UCSF assistant professor and pediatric dentist Ling Zhan, DDS, PhD, is building a path to something children and parents the world over welcome: fewer cavities.

Cavities are the number one infectious disease in children in the U.S. Every year, nearly $4.5 billion is spent to treat them and about 1.6 million school days are missed annually related to dental decay. The prevalence of this disease is five times higher than asthma.

Cavities can be readily prevented, and I want to see if there’s anything I can apply from basic science to fix this.
Ling Zhan, DDS, PhD, UCSF assistant professor and pediatric dentist

Zhan is an emerging leader in the use of xylitol, a naturally occurring sugar alcohol, to prevent tooth decay in children. Research shows that the sweet-tasting substance, which is extracted from the fibers of fruits, vegetables and other vegetation, has the potential to prevent cavities. Xylitol, commercially used as a sugar substitute, is lower in calories than sucrose and appears to diminish the negative dental effects of oral bacteria.

Many of the children Zhan sees in her research and clinic are suffering from significant tooth decay. “In the traditional dental clinic, we’re normally only fixing the cavities, but not treating the cause,” Zhan said. “I’m a dentist, but also a dental scientist. Cavities can be readily prevented, and I want to see if there’s anything I can apply from basic science to fix this.”

In a recent study, Zhan and her team found that xylitol can prevent cavities in infants. In the findings, which Zhan presented in the 2nd International Conference on Novel Anticaries and Remineralizing Agents, infants whose gums were wiped daily with xylitol by their parents had nearly eight times fewer dental carries after one year than those who used wipes without xylitol. The study will be published in the Journal of Dental Research later this year.

In another study, Zhan is working to shed light on the potential benefits of xylitol in 5-9 year old children. She is comparing the dental health of children who engage in regular cavity prevention measures including a combination of xylitol mints, fluoride treatments and nutritional advice, to those who don’t. The children are first assessed for their risk to get cavities, looking at risk factors such as diet, oral hygiene, and the presence of decaying oral bacteria as well as protective factors such as drinking tap water containing fluoride, regular dental visits, and office fluoride treatments. The research is being carried out at a school-based dental clinic in San Francisco’s Tenderloin community, and final results are due in March, 2012. 

This approach, which matches prevention to risk, is called CAMBRA for Caries Management by Risk Assessment, and  has proven to be successful with adults. It was developed by John Featherstone, MSc, PhD, the Dean of UCSF’s School of Dentistry and a mentor to Zhan. 

“We want to better understand the risk factors for cavities, and balance these with proven prevention measures,” Zhan said. In her work, she sees the perfect opportunity for translational research—to use science for direct patient benefit—and feels some urgency in this.

Each step of the way, she has partnered with UCSF’s Clinical and Translational Science Institute (CTSI) for assistance. In particular, she has taken two of CTSI’s Designing Clinical Research courses to help her first develop the xylitol wipe infant study, and then to eventually expand it to multi-centers. Zhan also received $30,000 Strategic Opportunities Support (SOS) funds to support her Tenderloin study.

CTSI’s Community Engagement and Health Policy program plays an active role in the San Francisco Health Improvement Partnerships (SF HIP) initiative, which is also working to address children’s oral health issues in the Bay Area.

CTSI at UCSF is a member of the National Institutes of Health-funded Clinical and Translational Science Awards network focusing on accelerating research to improve health. The Institute provides services for researchers at every stage, and promotes online collaboration and networking through UCSF Profiles.