STRUCTURED ABSTRACT Background We examined the correlates of root caries experience for middle-aged (ages 45–64 years) and older adults (ages 65+ years) to test the hypothesis that the factors related to root caries are different for middle-aged versus older adults. Methods This observational cross-sectional study focused on adult patients ages 45–97 years recruited from the Northwest PRECEDENT (N=775 adults). The outcome variable was any root caries experience (no/yes). Sociodemographic, intraoral, and behavioral factors were hypothesized as potential root caries correlates. We used Poisson regression models to generate overall and age-stratified prevalence ratios (PR) of root caries and Generalized Estimating Equations to account for practice-level clustering of participants. Results About 20% of adults had any root caries. Dentists’ assessment that the patient was at high risk for any caries was associated with greater prevalence of root caries experience in both middle-aged adults (PR=2.70, 95% CI: 1.63,4.46) and older adults (PR=1.87, 95% CI: 1.19,2.95). The following factors were significantly associated with increased root caries prevalence, but only for middle-aged adults: male sex (P=.02), self-reported dry mouth (P<.0001), exposed roots (P=.03), and increased frequency of eating or drinking between meals (P=.03). No other covariates were related to root caries experience for older adults. Conclusions Within a practice-based research network, the factors associated with root caries experience were different for middle-aged and older adults. Future work should identify relevant root caries correlates for adults ages 65+ years. Clinical Implications Interventions aimed at preventing root caries are likely to be different for middle-aged and older adults. Root caries prevention programs should address the appropriate aged-based risk factors.

The prevalence of dental caries (tooth decay) among preschool children is increasing, driven partially by an earlier age of onset of carious lesions. The American Academy of Pediatrics recommends application of 5% sodium fluoride varnish at intervals increasing with caries risk status, as soon as teeth are present. However, the varnishes are marketed for treatment of tooth sensitivity and are regulated as medical devices rather than approved by the US Food and Drug Administration for prevention of dental caries (tooth decay). The objective of this research is to examine the safety of use in toddlers by characterizing the absorption and distribution profile of a currently marketed fluoride varnish. We measured urinary fluoride for 5 hours after application of fluoride varnish to teeth in 6 toddlers aged 12 to 15 months. Baseline levels were measured on a separate day. The urine was extracted from disposable diapers, measured by rapid diffusion, and extrapolated to plasma levels. The mean estimated plasma fluoride concentration was 13 mg/L (SD, 9 mg/L) during the baseline visit and 21 mg/L (SD, 8 mg/L) during the 5 hours after treatment. Mean estimated peak plasma fluoride after treatment was 57 mg/L (SD, 22 mg/L), and 20 mg/kg (SD, 4 mg/L) was retained on average. Retained fluoride was 253 times lower than the acute toxic dose of 5 mg/kg. Mean plasma fluoride after placement of varnish was within an SD of control levels. Occasional application of fluoride varnish following American Academy of Pediatrics guidance is safe for toddlers. Pediatrics 2014;134:e870-e874 AUTHORS:

Abstract. There is currently a need for a safe and effective way to detect and diagnose early stages of childhood caries. A multimodal optical clinical prototype for diagnosing caries demineralization in vivo has been developed. The device can be used to quickly image and screen for any signs of demineralized enamel by obtaining highresolution and high-contrast surface images using a 405-nm laser as the illumination source, as well as obtaining autofluorescence and bacterial fluorescence images. When a suspicious region of demineralization is located, the device also performs dual laser fluorescence spectroscopy using 405-and 532-nm laser excitation. An autofluorescence ratio of the two excitation lasers is computed and used to quantitatively diagnose enamel health. The device was tested on five patients in vivo as well as on 28 extracted teeth with clinically diagnosed carious lesions. The device was able to provide detailed images that highlighted the lesions identified by the clinicians. The autofluorescence spectroscopic ratios obtained from the extracted teeth successfully quantitatively discriminated between sound and demineralized enamel.

An ultrathin scanning fiber endoscope, originally developed for cancer diagnosis, was used in a case study to locate plaque and caries. The imaging system incorporated software mitigation of background autofluorescence (AF). In conventional fluorescence imaging, varying AF across a tooth surface can mask low-level porphyrin signals. Laserinduced autofluorescence signals of dental tissue excited using a 405-nm laser typically produce fluorescence over a wavelength range extending from 440-nm to 750-nm. Anaerobic bacterial metabolism produces various porphyrin species (eg. protoporphyrin IX) that are located in carious enamel, dentin, gingivitis sites, and plaque. In our case study, these porphyrin deposits remained as long as one day after prophylaxis. Imaging the tooth surface using 405-nm excitation and subtracting the natural AF enhances the image contrast of low-level porphyrin deposits, which would otherwise be masked by the high background AF. In a case study, healthy tissues as well as sites of early and advanced caries formations were scanned for visual and quantitative signs of red fluorescence associated with porphyrin species using a background mitigation algorithm. Initial findings show increasing amplitudes of red fluorescence as caries severity increases from early to late stages. Sites of plaque accumulation also displayed red fluorescence similar to that found in carious dental tissue. The use of real-time background mitigation of natural dental AF can enhance the detection of low porphyrin concentrations that are indicators of early stage caries formation.

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