Cameron L. Randall - US grants

PROJECT SUMMARY Dental Pain Sensitivity, Fear, and Avoidance: Linkages with the MC1R Gene Dental care-related fear is a significant and prevalent problem that limits the utilization of necessary treatment and ultimately impacts oral, systemic, and psychological health. Thus, work that addresses psychosocial barriers to dental care is important. The field of behavioral dentistry, which is ripe with opportunity and lacking studies focusing specifically on behavioral genetics, requires attention in order to completely answer questions related to such psychosocial barriers. Two main, long-term objectives will guide the proposed work: (1) to improve our understanding of psychosocial barriers to the utilization of dental care by elucidating mechanisms partially responsible for the development and maintenance of dental care-related fear so that they may be targeted in interventions that decrease treatment avoidance and, thus, improve oral public health; and, (2) to provide training and collaboration opportunities to the fellowship awardee in the areas of behavioral genetics and dental pain research, university teaching, and presentation of scientific results, opportunities that will add significant value to his graduate education and will promote a career of transdisciplinary scientific work. Drawing on previous work suggesting that there may be important genetic predictors of dental treatment-seeking behavior, and current theories in behavioral dentistry, this project will span the disciplines of dentistry, genetics, psychology, and public health. The proposed study aims to determine the nature of the relation(s) among the MC1R gene, and other identified genes, and factors that may be important in the development and maintenance of dental care-related fear and anxiety, such as dental pain sensitivity, fear of pain, anxiety sensitivity, and dental treatment-seeking patterns. This will be accomplished through collecting pain sensitivity and dental care-related fear data (via behavioral test and self-report means) from already- genotyped participants, and analyzing collected data with collaborators working in human genetics. The project will utilize theory-driven hypothesis testing in order to improve current conceptualizations of dental care-related fear, which ultimately will lead to the improvement of intervention strategies intended to bolster treatment utilization. The fellow's training will include collection and analysis of data, with collaboration with researchers from disciplines other than his primary area of study. Additionally, the fellow will benefit from training opportunities that would not otherwise be experienced as part of his regular graduate training, including didactic coursework in statistical genetics, one-on-one instruction in genetic data analysis, attendance of a summer institute in genetics research, pursuance of a university teaching certificate, and advanced training in conceptual and clinical issues of dental care-related fear. In all, the project seeks to provide data that will add to the current understanding of the etiology of dental care-related fear and may subsequently drive the development of interventions for such fear. It also seeks to provide additional graduate training opportunities that will promote a solid research career for the National Research Service Award fellow.

PROJECT SUMMARY Dental procedures are one of the most common sources of acute pain in children. Painful childhood dental experiences are distressing. Moreover, they are related to development of dental fear, future dental care avoidance, and associated oral health problems. Use of evidence-based pain measurement tools is an integral part of acute pain management, and such tools are available for use with children in the dental setting. These tools are recommended by professional groups as part of routine clinical practice. However, dentists are unlikely to consistently use standardized pain assessment protocols. This K23 project aims to identify the barriers to and facilitators of evidence-based pain assessment in pediatric dentistry and to develop and pilot an intervention that will increase dentists? adherence to evidence-based guidelines on pain management. The career development award will provide training to advance the candidate?s research program in behavioral dentistry. A carefully devised training plan will allow the candidate to gain expertise in implementation science, qualitative research methods, pediatric pain, and pediatric dentistry, as well as additional experience in multidisciplinary collaboration and grant writing. Training goals will be achieved through rigorous mentorship from experts, graduate-level coursework, and advanced professional development activities. The proposed research project is congruent with the training goals. The first phase will include three studies: (1) a survey of all US pediatric dentistry residency directors to determine which approaches to dental pain assessment are taught, and how; (2) a large, nationally-representative survey of dentists to identify barriers to and facilitators of use of evidence-based assessment of acute pediatric dental pain in clinical practice; and, (3) qualitative interviews with dentists to refine the understanding of these barriers and facilitators and identify final targets for intervention. The second phase will involve development of an implementation intervention targeting barriers and facilitators identified in the first phase to improve adherence to assessment recommendations. Intervention development will be informed by feedback from an advisory group of key stakeholders, and the implementation strategy will subsequently be pilot tested with dentists for appropriateness, acceptability, and feasibility. The long-term objective of this research is to improve pain management in pediatric dentistry as a means to prevent patient distress, development of dental fear, and related health consequences. The work will take place at a research-intensive public university with noteworthy strengths in behavioral dentistry, implementation science, and pediatric pain. The award will complement the candidate?s existing strengths by providing training in new domains and will prepare him for an independent research career using health psychology to improve oral health.