Project Summary
Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases
per year globally. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting
in harmful short- and long-term effects on health and quality of life. The current biomedical approach to control
the ECC pandemic has had limited success. It primarily focuses on restorative procedures rather than
population-wide preventive strategies. Clinical evidence shows that caries is reversible if detected and addressed
in its early stages. However, many low-income US children often have poor access to pediatric dental services.
In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment
is needed. We believe that with more than 85% of lower-income Americans owning a smartphone, mHealth tools
hold great promise to achieve patient-driven early detection and risk control of ECC. Our long-term goal is to
develop strategies that use mHealth tools to achieve early detection and prevention of ECC at a broad population
base. Our previous innovative work has led to a novel prototype of an artificial intelligence (AI) -powered
smartphone app, AICaries, to be used by children's parents/caregivers. This AICaries app prototype offers a)
AI-powered caries detection using photos of children's teeth taken by the parents' smartphones, b) interactive
caries risk assessment, and c) personalized education on reducing children's ECC risk. The preliminary AI-
powered caries detection module demonstrated a satisfactory sensitivity and specificity for front teeth caries
detection, using 6,895 annotated tooth images from 1,277 photos. We have recently built an archive of > 100,000
high-quality intra-oral photos that is ready to be used for finalizing the development of a reliable automatic
detection algorithm. The immediate objectives of the study are - AIM 1: complete the development of AICaries
smartphone app, maximize its caries detection performance, and achieve a caries detection sensitivity and
specificity that are comparable to trained dental practitioners; AIM 2: employ a community-based participatory
research strategy to conduct moderated testing and refinement of the app usability, and non-moderated field
testing of the app feasibility/acceptability. Our multidisciplinary team is well-positioned for proposal
success with needed expertise in computer science, AI imaging recognition, oral health care, mHealth,
disparity research, patient education and community engagement. The AICaries app could facilitate early
detection of ECC for many underserved US children, who often have poor access to pediatric dental
services. Using AICaries, parents can use their regular smartphones to take photo of their children’s teeth and
detect ECC aided by AICaries, so that they can actively seek treatment for their children at an early and reversible
stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries
risk. Data from this R21 will support a R01 clinical trial that evaluates the real-world impact of using this innovative
smartphone app on early detection and prevention of ECC among low-income children.