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NCT03385629: PACT

Providers Against Cavities in Children's Teeth

Completed NA Results posted Last updated 17 April 2025
What this trial tests

NA trial testing CSM theory-based didactic education and skills training in Dental Caries in 2,108 participants. Completed in 31 December 2022.

Timeline
15 November 2017
Primary endpoint
31 December 2022
31 December 2022

Quick facts

Lead sponsorCase Western Reserve University
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingdouble
Primary purposeprevention
Enrollment2,108
Start date15 November 2017
Primary completion31 December 2022
Estimated completion31 December 2022
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Case Western Reserve University

Who can join

Adults 3 to 6, any sex, with Dental Caries. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Dental Attendance Primary · Data will be abstracted from Clinical Exams and Medicaid Claims data at baseline and the exit visit at the 24 month follow-up visit.

Receipt of any dental care (preventive and/or restorative) at approximately 24 months from baseline to the exit visit. Any dental care was defined as yes or no visit.

Medicaid Claims Data
GroupValue95% CI
CSM Theory-based Arm330
AAP-based Arm332
Clinical Examination Data
GroupValue95% CI
CSM Theory-based Arm170
AAP-based Arm150
Change in Primary Decayed and Filled Teeth Secondary · Dental exams will assess change in dft between baseline well-child visit (WCV#1) and 24 month follow-up exit visit (well-child visit: WCV#3)

dft: number of decayed, missing and filled teeth (dft) at WCV#3 minus the number at WCV#1.

GroupValue95% CI
CSM Theory-based Arm1.14± 2.45
AAP-based Arm1.16± 2.34
Change in Oral Hygiene-brushing Secondary · Assessed as change between baseline well-child visit (WCV #1) and 24 month follow-up exit visit (well-child visit: WCV#3)

Change in mean number of times per day a child in the study brushed.

GroupValue95% CI
CSM Theory-based Arm-0.01± 0.63
AAP-based Arm-0.04± 0.62
Change in Diet Secondary · Assessed as change between baseline well-child visit (WCV #1) and 24 month follow-up exit visit (well-child visit:WCV#3)

Number of sugar-sweetened drinks consumed per day

GroupValue95% CI
CSM Theory-based Arm0.01± 0.88
AAP-based Arm0.04± 0.94
Change in Oral Health-related Quality of Life for Child Secondary · Assessed as change between baseline well-child visit (WCV #1) and 24 month follow-up exit visit (well-child visit: WCV#3)

Overall score on Early Childhood Oral Health Impact (ECOHIS) Scale with 13 items. Each item is on a Likert scale from 0 through 4. The overall score ranges from 0 to 52. An overall score was calculated for each child, and then a mean calculated for each arm of the study. Lower scores indicate a better oral health quality of life.

GroupValue95% CI
CSM Theory-based Arm0.56± 3.38
AAP-based Arm0.50± 3.42

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse event data was collected from baseline (WCV1) through the exit visit (WCV3).. Reporting threshold: 1%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

CSM Theory-based Arm Children
Serious: 0/517 (0%)
Deaths: 0/517
CSM Theory-based Arm Parents/Caregivers
Serious: 2/517 (0%)
Deaths: 2/517
CSM Theory-based Arm Providers
Serious: 0/27 (0%)
Deaths: 0/27
AAP-based Arm Children
Serious: 0/506 (0%)
Deaths: 0/506
AAP-based Arm Parents/Caregivers
Serious: 0/506 (0%)
Deaths: 0/506
AAP-based Arm Providers
Serious: 0/35 (0%)
Deaths: 0/35

Serious adverse events (1 terms)

ReactionSystemCSM Theory-based Arm Child…CSM Theory-based Arm Paren…CSM Theory-based Arm Provi…AAP-based Arm ChildrenAAP-based Arm Parents/Care…AAP-based Arm Providers
DeathGeneral disorders

Most-reported serious reactions: Death.

Data from ClinicalTrials.gov NCT03385629 adverse events section.

Sponsor's own description

The study is a multi-site, multi-level, and multi-component cluster randomized clinical trial (RCT) to address poor dental utilization (attendance) and untreated caries among 3-6 year old Medicaid-enrolled children attending well-child visits (WCV) in primary care settings. The focus is on addressing factors (determinants) at the socio-ecological levels of the child's environment: provider (pediatrician and nurse practitioner), practice/organization level, and parent/caregiver level. Eighteen practices will be randomized to 2 arms: A) bundled multi-level intervention consisting of: 1. training medical providers in the Common-Sense Model of Self-Regulation theory-based education so that the provider delivers to the parent/caregiver the following: i) Core oral health facts about dental caries, and ii) prescription to visit the dentist and a list of dentists accepting Medicaid; 2. Integration of oral health assessments into EMR for the provider to document in the child's medical record; versus B) Control arm of medical providers receiving the American Academy of Pediatrics (AAP) based oral health education and providing usual AAP-based care for oral health. Each arm will consist of 9 practices. Children will be followed for 24 months to determine dental utilization and changes in oral health status. The primary aim is to examine the effectiveness of theory-based behavioral (provider-level) and implementation (practice-level) bundled interventions versus enhanced usual care (AAP based oral health education) delivered by providers at WCVs in increasing dental attendance among 3-6 year old Medicaid-enrolled children. The secondary aims are to 1) assess the effectiveness of interventions on secondary outcomes (e.g. development of new caries, changes in oral hygiene, oral health quality of life, frequency of sweet snacks and beverages, cost), 2) assess potential mediators and moderators to investigate the pathways through which the multi-level interventions affect child primary and secondary outcomes, and 3) assess the adoption, reach, fidelity, and maintenance of providers and practices that affect child primary and secondary outcomes. The hypothesis is that theory-based behavioral (provider-level) and implementation (practice-level) bundled interventions delivered by providers at WCVs will increase dental attendance among 3-6 year old Medicaid-enrolled children versus enhanced usual care (AAP based oral health education) delivered by providers at WCVs.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits.
    Nelson S, Slusar MB, Curtan S, Selvaraj D, et al · · 2020 · cited 9× · PMID 32882958 · DOI 10.3390/dj8030101
  2. Recruitment strategies for a pragmatic cluster randomized oral health trial in pediatric primary care settings.
    Curtan S, Copeland T, McNamee E, Debelnogich J, et al · · 2021 · cited 7× · PMID 33665473 · DOI 10.1016/j.conctc.2021.100748
  3. Dental Caries in Medicaid-Insured Preschool Children With or Without Special Health Care Needs in Northeast Ohio.
    Ronis SD, Selvaraj D, Albert JM, Koroukian SM, et al · · 2023 · cited 3× · PMID 36853605 · DOI 10.1001/jamanetworkopen.2023.0999
  4. Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial.
    Nelson S, Albert JM, Selvaraj D, Curtan S, et al · · 2024 · cited 2× · PMID 38980678 · DOI 10.1001/jamanetworkopen.2024.18217
  5. Adoption of New Oral Health Interventions in Primary Care: Qualitative Findings.
    Bales GC, Curtan S, Agarwal N, Ronis SD, et al · · 2024 · cited 2× · PMID 38586824 · DOI 10.1016/j.focus.2024.100214
  6. COVID-19 Impact on Community-Based Participatory Randomized Controlled Trials-Lessons From the Oral Health Disparities in Children Consortium.
    Ramos-Gomez FJ, Martin MA, Nelson SS, Borrelli B, et al · · 2021 · cited 1× · PMID 35669970 · DOI 10.3389/fdmed.2021.671911
  7. Cost and Workflow Impact of a Primary Care Based Multi-Level Pediatric Oral Health Intervention.
    Rose J, Selvaraj D, Ronis SD, Curtan S, et al · · 2025 · PMID 41122957 · DOI 10.1177/21501319251369991
  8. Cost-effectiveness analysis design for interventions to prevent children's oral disease.
    Spetz J, Rose J, Kahn JG, Lin T, et al · · 2024 · PMID 39092198 · DOI 10.3389/froh.2024.1428638

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Other recruiting trials for Dental Caries

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