Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes.

Importance: A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. Objective: To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. Design, Setting, and Participants: This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. Exposures: All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. Main Outcomes and Measures: Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. Results: Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. Conclusions and Relevance: This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.

Malocclusion-Related Quality of Life Questionnaire (MRQoLQ): Development and validation of a new psychometric tool for older adolescents with malocclusion

ABSTRACT Objective: To develop and validate a new psychometric tool for assessing malocclusion-related quality of life among older Indian adolescents. Methods: Item generation involved analysis of existing validated tools, followed by development of new items using various qualitative steps. A draft item pool of 41 questions was initially generated and subjected to item reduction through sequential steps involving two clinical studies to ensure reliability and validity. 431 subjects aged between 15 to 18 years took part in the validation study. Principal component analysis with varimax rotation was performed to get a psychometric tool with good factorial structure and maximum variance. Results: Rotated component matrix resulted in a 20 item psychometric tool containing 4 domains with a total variance of 61.57%. Inter item, item total correlation and Cronbach α (α = 0.88) ensured good reliability. A positive correlation of the scale with global question ensured convergent validity. Independent t test showed statistically significant difference (p< 0.05) between mean score of IOTN-DHC and DAI with MRQoLQ, ensuring good construct validity. Conclusions: The newly developed psychometric tool is named as Malocclusion-Related Quality of Life Questionnaire (MRQoLQ) having 20 questions, including 2 socioeconomic items. The scale showed good reliability and initial validity, hence can be used among older adolescents with malocclusion to assess their malocclusion-related quality of life.

RESUMO Objetivo: desenvolver e validar uma nova ferramenta psicométrica para avaliar o impacto da má oclusão na qualidade de vida em pacientes indianos ao final da adolescência. Método: o delineamento do conjunto de itens desse questionário envolveu a análise de ferramentas existentes já validadas, seguida da criação de novos itens, usando vários passos qualitativos. Um conjunto provisório de itens, com 41 perguntas, foi inicialmente formulado e submetido à redução de itens por meio de passos sequenciais envolvendo dois estudos clínicos, para garantir sua validade e confiabilidade. Nesse estudo de validação, participaram 431 pacientes com idades entre 15 e 18 anos. Foi realizada uma análise do componente principal pelo método Varimax, para se obter uma ferramenta psicométrica com boa estrutura fatorial e variância máxima. Resultados: a matriz, após as rotações dos fatores, resultou em uma ferramenta psicométrica com 20 itens, contendo 4 domínios, com uma variância total de 61,57%. As correlações interitens e item-total e o alfa de Cronbach (α = 0,88) confirmaram uma boa confiabilidade. Uma correlação positiva da escala com a questão global assegurou validade convergente. O teste t independente demonstrou diferença estatisticamente significativa (p< 0,05) entre a pontuação média do IOTN-DHC e do DAI com o MRQoLQ, assegurando uma validade bem construída. Conclusões: essa nova ferramenta psicométrica desenvolvida, denominada Questionário "Impacto da Má Oclusão na Qualidade de Vida" (MRQoLQ, do inglês Malocclusion-Related Quality of Life Questionnaire), com 20 perguntas, incluindo 2 itens socioeconômicos, demonstrou boa confiabilidade e validade inicial. Assim, pode ser utilizado em pacientes no final da adolescência, para avaliar o impacto da má oclusão em sua qualidade de vida.

Prevalence and predictors of early periodontal disease among adolescents.

BACKGROUND: Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala. MATERIALS AND METHODS: A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15-18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets. RESULTS: The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene. CONCLUSION: The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.

Malocclusion-Related Quality of Life Questionnaire (MRQoLQ): Development and validation of a new psychometric tool for older adolescents with malocclusion.

OBJECTIVE: To develop and validate a new psychometric tool for assessing malocclusion-related quality of life among older Indian adolescents. METHODS: Item generation involved analysis of existing validated tools, followed by development of new items using various qualitative steps. A draft item pool of 41 questions was initially generated and subjected to item reduction through sequential steps involving two clinical studies to ensure reliability and validity. 431 subjects aged between 15 to 18 years took part in the validation study. Principal component analysis with varimax rotation was performed to get a psychometric tool with good factorial structure and maximum variance. RESULTS: Rotated component matrix resulted in a 20 item psychometric tool containing 4 domains with a total variance of 61.57%. Inter item, item total correlation and Cronbach α (α = 0.88) ensured good reliability. A positive correlation of the scale with global question ensured convergent validity. Independent t test showed statistically significant difference (p< 0.05) between mean score of IOTN-DHC and DAI with MRQoLQ, ensuring good construct validity. CONCLUSIONS: The newly developed psychometric tool is named as Malocclusion-Related Quality of Life Questionnaire (MRQoLQ) having 20 questions, including 2 socioeconomic items. The scale showed good reliability and initial validity, hence can be used among older adolescents with malocclusion to assess their malocclusion-related quality of life.

Development and initial validation of an oral health-related quality of life scale for older adolescents.

BACKGROUND: Oral health-related quality of life (OHRQoL) perception is age-dependent and therefore different for children, adolescents, and adults. Adolescents are a critical age group with specific oral health needs. Oral health needs assessment is not complete without the estimation of OHRQoL. OBJECTIVE: To develop and validate an OHRQoL scale for older adolescents considering their functional, social, emotional, academic, and economic situation. METHODS: All steps in psychometric tool development including face, content, and translational validity, pretesting, piloting, and factor analysis were followed. Construct validity was further tested using a cross-sectional study on 400 senior secondary students. Sociodemographic data, Decayed Missing Filled Teeth, Dental Aesthetic Index, and Community Periodontal Index were used to test construct validity. RESULTS: A 20-item tool with five domains (intraclass correlation of 0.857, Cronbach's alpha of 0.811, variance of 64.25%) was developed. Convergent validity was established with a single-item global question and discriminant validity with clinical indices. In the multivariate logistic regression model, malocclusion emerged as the most significant predictor for poor OHRQoL adjusting for socioeconomic status, dental caries, gingival bleeding, and last dental visit. Dental caries and last dental visit also significantly predicted poor OHRQoL in the adjusted regression model. CONCLUSION: The new tool has sound psychometric properties, is relatively short, culturally equivalent, age-specific, and can assess both positive and negative aspects of adolescent oral health. Further testing in longitudinal studies is required to determine its usefulness as an outcome measure.

A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: An in vitro study.

BACKGROUND: Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis. MATERIALS AND METHODS: In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal-Wallis test was performed as the parametric test to compare different groups. Student's t-test was used to compare mean values between groups before and after treatment with test agents (P < 0.001). RESULTS: NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect. CONCLUSION: The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl.

Do Children of Working Mothers Experience More Dental Caries?

BACKGROUND: Pain and discomfort due to untreated dental caries lead to eating and sleep disruptions, behavioral changes, and poor quality of life. Among adolescents, severe dental caries may lead to activity restriction, school absenteeism, and poor academic performance. Dietary factors, parent's socioeconomic status, and family income have been associated with dental caries experience. The employment status of the mother is a measure of socioeconomic status of the family. AIMS: This study aims to estimate the prevalence of dental caries and to find out its sociodemographic, oral health behavioral, and clinical determinants among older adolescent (15-18 years) students in Kerala. SETTINGS AND DESIGN: This was a cross-sectional study conducted at higher secondary schools. METHODS: Oral examination and sociodemographic and oral health behavioral data collection were done among 1065 older adolescent students in the age group 15-18 across five districts of Kerala by a multistage cluster sampling design. Decayed, missing, and filled teeth (DMFT) and Significant Caries (SiC) index were taken. STATISTICAL ANALYSIS USED: SPSS version 16 software was employed. Multiple regression analysis was done to estimate adjusted odds ratios (OR) of predictors of dental caries experience. RESULTS: The overall dental caries experience for the group was 59.8% (95% confidence interval [CI]: 56.9-62.7). About 40% of students had no caries experience, 43% had DMFT score 1-3, and only 16.8% had DMFT score 4 and more. Mean DMFT was 1.67 (95% CI: 1.56-1.79). Diet preference, timing of sugar intake, and sugar form were not significantly associated with caries. Mean SiC index was 3.90 (95% CI, 3.75-4.05). In the unadjusted analysis, age, gender, place of residence, mother's employment status, school type, frequency of sugar intake, oral hygiene status, and timing of last dental visit were significant. In the adjusted analysis, however, age, male gender, government schools, timing of last dental visit, and employed mothers were significant predictors for higher dental caries experience. CONCLUSIONS: Mother's employment was the strongest predictor (OR 2.82, 95% CI: 2.15-3.69) for dental caries experience among adolescents when adjusted to other variables in the final multivariate model.

Milk yield response of cows supplemented with sorghum stover and Tithonia diversifolia leaf hay diets during the dry season in northern Uganda.

Five primiparous cows (Friesians crossed with undefined breeds and in early lactation) were used to assess the milk yield response of dairy cows offered a basal feed of Panicum maximum hay and supplemented with diets based on sorghum stover and Tithonia diversifolia leaf hay during the dry season. The cows were assigned to five experimental diets in a 5 × 5 Latin square design of 21-day experimental periods. The experimental diets consisted of a control (Panicum hay alone), and four experimental diets whereby Panicum hay was supplemented with diets based on sorghum stover, Tithonia leaf hay, maize bran, sunflower cake, and sugar cane molasses as follows: stover/Tithonia/bran/molasses (STBM), stover/Tithonia/bran (STB), stover/Tithonia/bran/cake (STBC), and stover/bran/cake (SBC). The supplements were formulated and offered to meet the crude protein and energy recommendations of a 350-kg cow producing about 10 kg milk/day. Average milk yield significantly increased (P < 0.05) from 6.49 kg/cow/day (control) to 7.25, 7.29, 7.50, and 7.52 kg/cow/day (SBC, STBM, STB, and STBC, respectively). There was no significant difference (P > 0.05) in the amounts consumed across the supplements. A similar trend was observed for milk returned/kg supplement consumed. On average, each kilogram of STB, STBC, STBM, and SBC returned 0.48, 0.37, 0.29, and 0.29 kg milk/day, respectively. Thus, the results of the present study revealed that supplements based on sorghum stover and Tithonia leaf hay are a viable option as dry season feed supplements for dairy cows. However, only two supplements, namely STB and STBC, had positive net financial benefits.

Periapical tissue reaction to calcium phosphate root canal sealer in porcine model.

BACKGROUND: Calcium phosphate cements (CPC) are a group of biomaterials possessing wide scope of use in various branches of medical science. These materials have been proposed to be highly biocompatible and osteoconductive. This study is based on a newly developed CPC formulation (Chitra-CPC) and is aimed at the evaluation of its biocompatibility through an Endodontic Usage Test in a porcine study model. OBJECTIVE: To evaluate the periapical tissue reaction to Chitra-CPC when used as a root canal sealer/filler material in comparison with a resin sealer, AH Plus (Dentsply). MATERIALS AND METHODS: The procedure was done on porcine animal model following the ISO 7405 criteria. The material was implanted intentionally into the periapical area of 36 teeth through a root canal procedure carried out in six animals which were divided equally among 1-month and 3-month time periods. Results were based on the histological evaluation of the autopsied specimens after the prescribed time periods. RESULTS: Mild to moderate periapical tissue reaction was found in Chitra-CPC samples belonging to the 1-month time period, whereas majority of the 3-month CPC samples showed an absence of inflammation. Samples of AH Plus in 1-month period showed severe to moderate inflammation, whereas 3-month AH Plus samples had a mild to moderate inflammation. CONCLUSIONS: Chitra-CPC is a biocompatible material.

Improving depression screening for adolescents with type 1 diabetes.

OBJECTIVE: Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. METHODS: To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children's Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. RESULTS: Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥ 16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population. CONCLUSIONS: Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions.

Endodontic management of an unusual foreign body in a maxillary central incisor.

The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth.

Inhibitory effect of yogurt extract on dental enamel demineralisation - an in vitro study.

PURPOSE: To test the effectiveness of yogurt extract as an agent to protect tooth enamel from demineralisation in vitro. MATERIALS AND METHODS: The crowns of 80 intact caries-free human premolars were selected, and standardised 5 x 3 mm2 enamel windows were isolated on the buccal and lingual surface of each tooth. The baseline weight of each specimen was recorded. Four demineralising solutions were prepared: S1: lactic acid (LA) at pH 4.8; S2: LA at pH 3.97; S3: LA + yogurt supernatant (YS) at pH 4.8; S4: LA + YS at pH 3.97. The calcium content of each solution was determined using compleximetric titration with Eriochrome black-T. The 80 teeth were randomly divided into 4 groups. Each group was incubated in its corresponding solution at 37°C for 96 h. The specimens were weighed again and the calcium content of the four solutions determined. Five samples from each group were randomly chosen, sectioned through the treatment windows, stained with rhodamine-B and viewed under a confocal laser scanning microscope (CLSM). Lesion area (LeA) and average fluorescence (AF) were calculated using Image J software. Total fluorescence (TF) values were obtained by LeA x AF. RESULTS: There was a statistically significant difference between groups in terms of LeA and TF. No statistically significant difference was found between groups in terms of difference in weight. CONCLUSION: Probiotic yogurt extract is effective in reducing demineralisation of enamel under experimental conditions.

Comprehensive evidence-based assessment and prioritization of potential antidiabetic medicinal plants: a case study from canadian eastern james bay cree traditional medicine.

Canadian Aboriginals, like others globally, suffer from disproportionately high rates of diabetes. A comprehensive evidence-based approach was therefore developed to study potential antidiabetic medicinal plants stemming from Canadian Aboriginal Traditional Medicine to provide culturally adapted complementary and alternative treatment options. Key elements of pathophysiology of diabetes and of related contemporary drug therapy are presented to highlight relevant cellular and molecular targets for medicinal plants. Potential antidiabetic plants were identified using a novel ethnobotanical method based on a set of diabetes symptoms. The most promising species were screened for primary (glucose-lowering) and secondary (toxicity, drug interactions, complications) antidiabetic activity by using a comprehensive platform of in vitro cell-based and cell-free bioassays. The most active species were studied further for their mechanism of action and their active principles identified though bioassay-guided fractionation. Biological activity of key species was confirmed in animal models of diabetes. These in vitro and in vivo findings are the basis for evidence-based prioritization of antidiabetic plants. In parallel, plants were also prioritized by Cree Elders and healers according to their Traditional Medicine paradigm. This case study highlights the convergence of modern science and Traditional Medicine while providing a model that can be adapted to other Aboriginal realities worldwide.

Prognosis of periapical surgery using bonegrafts: A clinical study.

AIM: to evaluate and compares the healing clinically and radiographically following periapical surgery with and without using hydroxyapatite graules. MATERIALS AND METHODS: Twenty patients were selected for the study & the nature of healing is compared with that of conventional periapical surgery. In the present clinical study chitra hydroxyapatite granules, a freeze-dried hydroxyapatite, is used to fill the osseous defects following periapical surgery. Following surgery all patients were assessed both clinically & radiographically for a period of nine months. RESULTS: On clinical evaluation the test group did not show any significant immediate or delayed local tissue reactions. Radiographically in the follow up period of 6 - 9 months the bone graft became indistinguishable from the surrounding bone which indicates complete bone regeneration. Where as in the control group ever after 9 months the radiographs showed inadequate bone fills. CONCLUSION: The bone regeneration following periapical surgery can be facilitated by using bone graft. Hydroxyapatite is found to be very effective alloplastic material. Based on this study it might be concluded that in large bone destruction caused by periradicular lesion bone regeneration can be facilitated by effective bone replacing materials like hydroxyapatite.

Evaluation, using extracted human teeth, of Ricetral as a storage medium for avulsions--an in vitro study.

The prognosis of teeth replanted following avulsion is determined by the extra-alveolar time and storage medium used. This study was undertaken to determine the efficacy of an oral rehydration solution 'Ricetral', in retaining the vitality of periodontal ligament cells when used as a storage medium for avulsed teeth prior to replantation. The study consisted of a comparative evaluation between Ricetral and two currently recommended solutions, Hank's balanced salt solution (HBSS) and milk. Thirty extracted teeth were dried for 30min and soaked in the respective storage media for 45min. The periodontal ligament cells were isolated by an enzyme treatment with collagenase and trypsin. The cells were evaluated for vitality by trypan blue staining and number of vital cells counted in a hemocytometer. Statistical analysis revealed that cell vitality was high with Ricetral and HBSS, but poor with milk.

Remineralization potential of fluoride and amorphous calcium phosphate-casein phospho peptide on enamel lesions: An in vitro comparative evaluation.

AIM: This in vitro study was conducted on enamel blocks of human premolars with the aim of evaluating the remineralization potential of fluoride and ACP-CPP and the combination of ACP-CPP and fluoride on early enamel lesions. MATERIALS AND METHODS: Fifteen intact carious free human premolars were selected. The coronal part of each tooth was sectioned into four parts to make 4 enamel blocks. The baseline SMH (surface microhardness) was measured for all the enamel specimens using Vickers microhardness (VHN) testing machine. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 3 consecutive days. The SMH of the demineralised specimens was evaluated. Then the four enamel sections of each tooth were subjected to various surface treatments, i.e. Group 1- Fluoride varnish, Group 2- ACP-CPP cream, Group 3- Fluoride + ACP-CPP & Group 4- Control (No surface treatment). A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3hours) and remineralization with artificial saliva (21 hours) for five consecutive days. After pH cycling again SMH of each specimen was assessed to evaluate the remineralization potential of each surface treatment agent. Then, to asses the remineralization potential of various surface treatments at the subsurface level, each enamel specimen was longitudinally sectioned through the centre to expose the subsurface enamel area. Cross-sectional microhardness (CSMH) was evaluated to assess any subsurface remineralization RESULTS: Statistical analysis using one-way ANOVA followed by multiple comparisons test was applied to detect significant differences at P

Clinical trial for detection of dental caries using laser-induced fluorescence ratio reference standard.

We present the clinical applicability of fluorescence ratio reference standard (FRRS) to discriminate different stages of dental caries. Toward this, laser-induced autofluorescence emission spectra are recorded in vivo in the 400- to 800-nm spectral range on a miniature fiber optic spectrometer from 65 patients, with a 404-nm diode laser as the excitation source. Autofluorescence spectra of sound teeth consist of a broad emission at 500 nm that is typical of natural enamel, whereas in caries teeth additional peaks are seen at 635 and 680 nm due to emission from porphyrin compounds in oral bacteria. Scatter plots are developed to differentiate sound teeth from enamel caries, sound teeth from dentinal caries, and enamel caries from dentinal caries using the mean fluorescence intensity (FI) and ratios F500F635 and F500F680 measured from 25 sites of sound teeth and 65 sites of carious teeth. The sensitivity and specificity of both the FI and FRRS are determined. It is observed that a diagnostic algorithm based on FRRS scatter plots is able to discriminate enamel caries from sound teeth, dentinal caries from sound teeth, and enamel from dentinal caries with overall sensitivities of 85, 100, and 88% and specificities of 90, 100, and 77%, respectively.