PROJECT SUMMARY The recent NIDCR Oral Health in America report highlighted adolescence as a largely neglected life stage in oral health research and practice, with persistent and largely unchanged high caries experience, and called for strong actions to address this age cohort’s needs.1 Our team has been following a diverse cohort of children from age 1-9.5 years, and proposes now to follow them into early adolescence, providing a unique opportunity to assess U.S. children longitudinally culminating with much needed access and focus on adolescence. Given the large persistent disparities in caries rates and inequities in access to care for adolescents, targeted, risk-based healthcare delivery could be an important strategy to reduce disparities in adolescent health, while containing costs. The problem is that there have been almost no U.S. studies following the life-course progression of caries in children through adolescence to assess and predict caries patterns and disease trajectories over time, and relationships between these and changing oral and systemic health patterns in risk factors and behaviors. This is critical for targeting preventive, person-centered care in interprofessional settings that can adapt to changes in the life-course. The aims of this innovative U.S. study renewal are: 1) To define dental caries patterns (teeth and surfaces affected, e.g., pit-and-fissure vs. proximal, anterior vs. posterior) in early adolescence, including the trajectories of changes in caries patterns and counts (e.g., dmfs/DMFS) across the age-span (ages 1-15 years) (sub-aim 1a), in both primary and permanent teeth. 2) To identify patterns of caries risk factors and behaviors in the cohort when they were preschoolers (ages 1- 4), school-age (ages 6.5-9.5) and early adolescents (ages 12-15), and changes over time (sub-aim 2a). 3) To characterize the interplay among longitudinal caries patterns and risk factor/behavior patterns that lead to future caries development, we aim to develop risk screening tools to predict caries patterns, and predict caries incidence (sub-aim 3a), in early adolescence. This will be accomplished by following a diverse cohort of 500 primary caregiver (PCG)-child pairs enrolled in our ongoing U01 study. The PCGs will provide medical history and socio-demographic family information, while the adolescents will complete risk behavior questionnaires, and will have caries examinations at 12, 13.5 and 15 years of age to determine caries incidence, patterns, and trajectories. A great strength of this proposal is that it involves experienced medical/nursing and dental research groups, who have successfully worked together for the past 11 years and can facilitate follow-up of the cohort, while bringing new expertise in adolescent and behavioral health, and clinical decision-making. The overall impact and significance of this interdisciplinary project is that accurate risk stratification can optimize cost-effectiveness of personalized care...