Faculty Bibliography

Oral potentially malignant disorders (OPMDs) such as leukoplakia and erythroplakia may harbor dysplasia or progress to oral squamous cell carcinoma (OSCC), yet visual inspection alone is unreliable for risk assessment. Cytology offers a minimally invasive adjunct, but conventional approaches depend on manual feature extraction and subjective review. Herein we report a deep learning (DL) object detection model that directly classifies four cell phenotypes: differentiated squamous epithelial (DSE) cells, small round (SR) cells, leukocytes, and lone nuclei. The DL model produced cytology-derived parameters that correlated strongly with histopathologic diagnoses across 692 subjects with OPMDs, OSCC, and healthy controls, including declining DSE cell proportion and increasing SR cells and leukocytes with disease severity (p < 0.0001). The oral cancer numerical index (OCNI) achieved AUROC values up to 0.99 for malignant versus healthy lesions, with excellent reliability (intra-class correlation coefficient ≥ 0.96). This reproducible, minimally invasive test provides a robust platform for early detection and surveillance of OPMDs.

OBJECTIVES/OBJECTIVE:This study aimed to develop and validate the Knowledge Related to Oral Health Literacy Spanish (KROHL- S) instrument to assess oral health knowledge among Spanish-speaking adults in the United States, a population facing significant oral health disparities. DESIGN/METHODS:A cross-sectional study was conducted at NYU College of Dentistry. A convenience sample of 175 self-identified Spanish-speaking adults (70% female, mean age 49. 79 years) completed the orally administered KROHL- S questionnaire. Participants, mainly born outside the US (91. 9%), also completed the Comprehensive Measure of Oral Health Knowledge (CMOHK) and a single-item literacy screening tool in Spanish (SILS). Psychometric properties of the KROHL- S, including internal consistency (Cronbach's alpha), discriminant validity (correlation with CMOHK), and known-group validity (comparison across education levels), were evaluated. Confirmatory factor analysis was used to test the original factor structure. RESULTS:The mean KROHL- S score was 8.34 (SD = 5.82), indicating a low level of oral health knowledge in the sample. Internal consistency for the overall KROHL- S was good (Cronbach's alpha = 0.75), and interrater agreement was high. A moderate positive correlation was found between KROHL- S and CMOHK scores (r = 0.49, p < .0001). Participants with higher education levels showed significantly greater oral health knowledge on the KROHL- S. Confirmatory factor analysis suggested an average fit to the data (RMSEA = 0.064, CFI = 0.86, TLI = 0.83). CONCLUSION/CONCLUSIONS:The KROHL- S could be used to assess oral health knowledge among Spanish-speaking adults and incorporates cultural and linguistic aspects, making it suitable for a wider range of individuals. KROHL-S offers a valuable tool for healthcare providers by not only helping identify individuals' knowledge gaps to guide customized educational interventions but also helping enhance patient-provider communications.

BACKGROUND:School-based caries prevention programs are clinically and cost-effective public health approaches to increase access to essential oral healthcare for high-risk children. However, approximately 1 in 4 children participating in school caries prevention fail to respond to care, remaining at risk for dental caries and related sequela. METHODS:The Building Adaptive School-based Interventions for Caries study (BASICS) will develop and test adaptive preventive interventions using a Sequential, Multiple Assignment, Randomized Trial (SMART) design, reducing treatment nonresponse by incorporating personalized medicine into school caries prevention. Children will receive a first-stage treatment of either silver diamine fluoride or glass ionomer dental sealants and atraumatic restorations. At subsequent observations, the primary outcome of reoccurrence or new presentation of dental caries will be used as a tailoring variable for treatment nonresponse. Nonresponsive participants in either first-stage pathway will subsequently receive either (1) reapplication of initial treatment plus fluoride varnish and receipt of an electronic toothbrush or (2) an intensified Silver Modified Atraumatic Restorative Technique. The targeted enrollment is 1200 children from primarily low-income rural families enrolled in kindergarten through third grades in public primary schools. DISCUSSION/CONCLUSIONS:Primary study objectives of BASICS include determining the most effective initial treatment for caries prevention and sequence of treatments to reduce nonresponse, identifying the optimal dynamic treatment regime given patient attributes, and estimating the most cost-efficient allocation of resources for adaptive school-based caries prevention. If successful, BASICS will result in a resource-efficient approach to school dental care that optimizes resources matched to patient needs. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov #NCT07265830, Registered on 12/4/25. https://www. CLINICALTRIALS/RESULTS:gov/study/NCT07265830.

IMPORTANCE/UNASSIGNED:Pediatric dental-related emergency department visits have drastically increased in recent years. School-based caries prevention programs (SCPPs) aim to address unmet dental needs, yet it is unclear whether they effectively reach high-risk populations. OBJECTIVE/UNASSIGNED:To determine whether children with prior dental care utilization are more likely than children without prior utilization to participate in SCPPs. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study, conducted between June 2023 and October 2025, linked 2019 SCPP clinical trial data and 2016 to 2019 Medicaid claims data to examine disparities in sociodemographic characteristics and dental and dental-related medical care utilization prior to SCPP implementation between participants and nonparticipants. SCPPs were implemented in 47 primary schools in New York, New York, primarily in the Bronx, which was deemed to have the highest risk of tooth decay in the city. Participants included children aged 5 to 13 years in 2019 residing in the Bronx and continuously enrolled in Medicaid between 2018 and 2019. EXPOSURES/UNASSIGNED:Dental and dental-related medical care utilization in 2018, the year prior to SCPP implementation, demographic factors, individual-level clinical dental needs, and health system factors. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was SCPP participation in 2019. Adjusted logistic regression was used to assess whether prior dental care use was independently associated with participation. RESULTS/UNASSIGNED:The study included 63 217 children in total (62 187 nonparticipants and 1030 participants), with a mean age of 7.7 years (95% CI, 7.6-7.7 years). There were 30 590 female children (48.4%), 1852 Asian children (2.9%), 13 926 Black children (22.0%), 31 620 Hispanic children (50.0%), and 1988 White children (3.2%). In multivariable analysis, compared with any dental visits, having no dental visits prior to SCPP implementation was associated with 17% lower odds of participating (adjusted odds ratio, 0.83; 95% CI, 0.71-0.96). Compared with having any dental emergencies, having no dental emergencies was associated with 32% increased odds of participating (adjusted odds ratio, 1.32; 95% CI, 1.08-1.62). Mitigating selection from a statewide SCPP rollout was estimated to save up to $2.4 million in nontraumatic dental-related emergency department visits. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study of NY Medicaid claims data linked to SCPP participation data, there was evidence that children at high risk of tooth decay who are most in need of dental preventive services have a lower likelihood of participating in school-based prevention programs. More evidence is needed to identify successful strategies for recruitment of high-need children.

Silver diamine fluoride (SDF) can effectively prevent and control dental caries, the world's most pervasive noncommunicable disease. This study estimated the transition probabilities for caries in children receiving SDF. The CariedAway study was a community-based cluster-randomized trial of SDF, glass ionomer sealants, and atraumatic restorations conducted in 48 primary schools enrolling predominately low-income minority children in New York, USA. For enrolled children receiving SDF, probabilities were computed for transitions between healthy (sound), diseased (carious), and disease-controlled (arrested) states for 6-year molars using multistate Markov models. Subject-level transition probabilities over one- and two-year periods were then calculated by aggregating states of all 6-year molars and first and second bicuspids. Tooth state progression was treated as a relapsing-remitting condition. A total of 7418 children were enrolled in CariedAway, of which 1352 received SDF and completed at least three study observations. Among eligible participants, the baseline prevalence of untreated decay was 29% and the prevalence of preexisting dental sealants was 8%. The probability of transitioning between sound and carious states in 6-year molars ranged from 0.0022 to 0.0074. At the subject-level, the sound to carious transition probabilities were 0.07 and 0.12 after one and two years, respectively. Once in a fully arrested state, the probability of remaining arrested was 0.72 and 0.60 after 1 and 2 years. While the overall probabilities of teeth remaining in disease-free or arrested states was high after receiving SDF, multiple applications might be needed for consistent caries control.

IMPORTANCE/UNASSIGNED:Dental caries is a pervasive and inequitable chronic disease stemming from a lack of access to preventive and therapeutic care. Minimally invasive interventions may be provided in schools to treat caries in children. OBJECTIVE/UNASSIGNED:To compare the effectiveness of silver diamine fluoride (SDF) with atraumatic restorative treatment (ART) in the control of dental caries among US schoolchildren. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The CariedAway study was a cluster randomized clinical trial conducted from February 1, 2019, to June 1, 2023, in 48 primary schools in New York City. Participants were followed up for up to 4 years. Schools with a student population of at least 50% Black and/or Hispanic or Latino students and 80% receiving free or reduced-cost lunch were eligible. Within enrolled schools, any child with parental informed consent was eligible. Treatment was provided biannually. Analysis was restricted to children aged 5 to 13 years who completed at least 1 follow-up observation and had at least 1 tooth surface with dental caries. INTERVENTIONS/UNASSIGNED:Participants were randomized at the school level to receive SDF or ART. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Any surface lesion with an International Caries Detection and Assessment System score of 5 or 6 was recorded as caries. The primary outcome was the number of carious surfaces that had a recurrence of caries. Analysis was performed on an intent-to-treat basis. RESULTS/UNASSIGNED:Of the 17 741 children eligible, 7418 were randomized (mean [SD] age at baseline, 7.6 [1.9] years; 4006 girls [54.0%]), and 1668 were analyzed (mean [SD] age at baseline, 6.8 [1.5] years; 881 girls [52.8%]; 861 in the SDF group and 807 in the ART group). The total surface-level failure in the SDF group was 38.3% (2167 of 5651 carious surfaces) compared with 45.5% (2116 of 4647) in the ART group. There were 2167 surface failures observed among SDF participants over 1372 person-years compared with 2116 ART surface failures over 1291 person-years (incidence rate ratio, 0.96 [95% CI, 0.91-1.02]). At the person level, 45.5% of SDF recipients (392 of 861) experienced at least 1 surface failure compared with 53.3% of ART recipients (430 of 807; odds ratio, 0.51 [95% CI, 0.39-0.66]). There were no significant differences in the risk of recurrent surface failure between treatments (hazard ratio, 0.92 [95% CI, 0.82-1.04]). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study of treatments for caries, similar failures in surface control were observed among children receiving SDF or ART. These results support the use of secondary preventive therapies for caries in schools. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03442309.

INTRODUCTION/BACKGROUND:Teledentistry, also known as "virtual" dental examinations, is an innovative approach to increasing access to care. The objective of this study was to evaluate the diagnostic inter-rater reliability between virtual and in-person examinations for patients seeking emergency dental care (sick call) at a military dental treatment facility. MATERIALS AND METHODS/METHODS:One hundred subjects received both virtual and in-person examinations on the same day, in random order. The virtual examiner and subject were stationed in separate rooms and used only a laptop equipped with a camera, microphone, and speaker to complete the virtual exam. In contrast, the in-person examiner had access to all standard care modalities in a dental treatment room. After the first encounter, the subject proceeded to the corresponding virtual or in-person exam, and both examiners determined a diagnosis. Inter-rater agreement was determined between the two encounters for both diagnosis specialty category and diagnostic code using the Kappa coefficient. RESULTS:The results of the inter-rater analyses showed a Kappa score of 0.644 for the diagnosis specialty category (P < .001) and a Kappa score of 0.714 for diagnostic codes (P < .001). Both analyses indicated "substantial" agreement. CONCLUSIONS:We conclude that teledentistry can be an effective tool for determining a diagnosis and improving access to care for dental emergencies at military dental treatment facilities.

OBJECTIVE/UNASSIGNED:Current approaches to school-based caries prevention can increase access to oral healthcare, but are often limited by costs and other logistical challenges. Evidence from large pragmatic trials support the use of silver diamine fluoride (SDF) to prevent and control caries in school dental programs. In this pilot, we developed implementation strategies and integrated SDF into an existing school-based dental program, Smiles For Students (SFS). METHODS/UNASSIGNED:This was a single-group observational pilot. Using a school-based SDF implementation toolkit, SFS clinicians received training in clinical protocols as well as ongoing interactive technical assistance to support SDF integration. SDF was then implemented into existing clinical workflows. RESULTS/UNASSIGNED:Following training and implementation, the Smiles For Students program saw a 23 % increase in the number of patients served, a 53 % decrease in the per-child treatment time, a 45 % decrease in labor costs despite increased enrollment, and a 24 % decrease in supply costs. Qualitative feedback indicated strong support for simplified clinical protocols, reduction in cumbersome supplies and materials, and increased flexibility with space and resources. CONCLUSIONS/UNASSIGNED:In a pilot implementation project in which SDF was integrated into an existing school-based dental program serving 16 schools, multiple logistical and economic challenges were mitigated and program clinicians utilized both sealants and SDF to meet the needs of participating children.

Sodium-glucose transporter-2 inhibitor (SGLT2i) drugs are widely used for lowering blood glucose levels independent of insulin. Beyond this, these drugs induce various metabolic changes, including weight loss and impaired bone integrity. There is a significant gap in understanding SGLT2i-induced skeletal changes, as SGLT2 is not expressed in osteoblasts or osteocytes, which use glucose to remodel the bone matrix. We studied the impact of 1, 3, or 6 months of canagliflozin (CANA), an SGLT2i treatment, on the skeleton of 6-month-old genetically heterogeneous UM-HET3 mice. Significant metabolic adaptations to CANA were evident as early as 1.5 months post-treatment, specifically in male mice. CANA-treated male mice exhibited notable reductions in body weight and decreased proinflammatory and bone remodeling markers associated with reduced cortical bone remodeling indices. Bone tissue metabolome indicated enrichment in metabolites related to amino acid transport and tryptophan catabolism in CANA-treated male mice. In contrast, CANA-treated female mice showed increases in nucleic acid metabolism. An integrOmics approach of source-matched bone tissue metabolome and bone marrow RNAseq indicated a positive correlation between the two omics data sets in male mice. Three clusters of transcripts and metabolites involved in energy metabolism, oxidative stress response, and cellular proliferation and differentiation were reduced in CANA-treated male mice. In conclusion, CANA affects bone metabolism mainly via the 'glucose restriction state' it induces and impacts bone cell proliferation and differentiation. These findings underline the effects of SGLT2i on bone health and highlight the need to consider sex-specific responses when developing clinical treatments that alter substrate availability.

Several mouse lines with congenital growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis disruption have shown improved health and extended lifespan. The current study investigated how inactivating this axis, specifically during aging, impacts the healthspan. We used a tamoxifen-inducible global GH receptor (GHR) knockout mouse model starting at 12 months and followed the mice until 24 months of age (iGHRKO_12-24 mice). We found sex- and tissue-specific effects, with some being pro-aging and others anti-aging. Measuring an array of cytokines in serum revealed that inactivation of the GH/IGF-1 axis at 12 months did not affect systemic inflammation during aging. On the other hand, hypothalamic inflammation was significantly reduced in iGHRKO_12-24 mice, evidenced by GFAP⁺ (glial fibrillary acidic protein, a marker of astrocytes) and Iba-1⁺ (a marker for microglia). Liver RNAseq analysis indicated feminization of the male transcriptome, with significant changes in the expression of monooxygenase, sulfotransferase, and solute-carrier-transporter gene clusters. Finally, we found impaired bone morphology, more pronounced in male iGHRKO_12-24 mice and correlated with GH/IGF-1 inactivation onset age. We conclude that inhibiting the GH/IGF-1 axis during aging only partially preserves the beneficial healthspan effects observed with congenital GH deficiency.