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tooth

tooth is an R package for dental public health research. It computes standardised caries indices and produces publication-ready odontogram heatmaps from clinical examination data.

An odontogram is a whole-mouth dental chart that arranges every tooth in its anatomical position across the four quadrants. tooth renders each tooth as a five-surface crown diagram with optional root-surface bars, then maps your surface values onto a colour gradient — so caries patterns, treatment outcomes, or any per-tooth-surface metric are visible at a glance across the whole arch.

Crown surfaces

Abbreviation	Surface	Description
B	Buccal	Cheek-facing surface
L	Lingual	Tongue-facing surface
M	Mesial	Forward-facing interproximal surface
D	Distal	Backward-facing interproximal surface
O	Occlusal	Biting/chewing surface

Root surfaces

Abbreviation	Surface	Description
RB	Root-Buccal	Root surface on the cheek side
RL	Root-Lingual	Root surface on the tongue side
RM	Root-Mesial	Root surface on the mesial side
RD	Root-Distal	Root surface on the distal side

Why tooth?

Dental epidemiological studies routinely compute DMFT/DMFS indices and visualise caries distributions, yet there is no dedicated R package for these tasks. Researchers write ad-hoc scripts with hardcoded ICDAS thresholds and manual ggplot layouts for every new project. tooth replaces those one-off scripts with tested, documented, flexible functions that work across study designs — primary or permanent dentition, 5 to 8 teeth per quadrant, coronal and root caries, long or wide data formats.

Features

Caries indices — DMFT/dmft and DMFS/dmfs with configurable ICDAS thresholds, activity codes, and restoration codes
Root vs coronal separation — Tally root caries (RDT, RDS) independently from coronal indices
Odontogram heatmaps — Colour-coded whole-arch dental charts with up to 9 surfaces per tooth (B, L, M, D, O, RB, RL, RM, RD)
Flexible dentition — Primary (5 teeth/quadrant) or permanent (5–8 teeth/quadrant)
Stratification with statistics — Facet by treatment arm with sample size (n), mean DMFT, mean DT, and significance stars (t-test or Wilcoxon rank-sum)
Tooth numbering — Display in quadrant, FDI (ISO 3950), or Universal (ADA) notation
Manual heatmap range — min_val/max_val for consistent colour scales across multiple plots
Surface label toggle — show_labels = FALSE for clean exports
Adjustable tooth label size — tooth_label_size for readability
Custom strata titles — strata_labels to rename panel headings
Footnotes — Abbreviation keys and p-value definitions via footnote
Smart spacing — Automatically widens tooth gaps when root-mesial (RM) and root-distal (RD) surfaces are displayed
Long or wide input — Auto-pivots wide-format data to long
Tooth numbering conversion — FDI ↔︎ Universal ↔︎ quadrant

Installation

# From GitHub
devtools::install_github("ddmsel/tooth")

# From local tarball
install.packages("tooth_0.5.0.tar.gz", repos = NULL, type = "source")

Gallery

Single tooth diagram

Each tooth is a five-wedge crown (B, L, M, D, O) with optional root bars (RB, RL), labelled by surface and coloured by value.

Coronal odontogram — full arch

build_odontogram(
  data = decay_data,
  teeth_per_quadrant = 7,
  surfaces = c("buc", "lin", "mes", "dis", "occ")
)

Odontogram with root-buccal (RB) and root-lingual (RL) surfaces

build_odontogram(
  data = decay_data,
  surfaces = c("buc", "lin", "mes", "dis", "occ", "rootb", "rootl")
)

Stratified odontogram with summary statistics

stats_df <- data.frame(
  treatment = c("SDF", "ART"),
  n = c(120, 115),
  mean_DT = c(2.3, 2.8),
  mean_DMFT = c(5.1, 5.6)
)

build_odontogram(
  data = decay_by_trt,
  strata = "treatment",
  stats = stats_df,
  footnote = "B=Buccal, L=Lingual, M=Mesial, D=Distal, O=Occlusal.\n* p<0.05, ** p<0.01, *** p<0.001."
)

Odontogram with FDI numbering

build_odontogram(data = decay_data, numbering = "fdi")

Odontogram without surface labels

build_odontogram(data = decay_data, show_labels = FALSE)

Quick Start

DMFT calculation

library(tooth)
data(sim_exam)

# Basic DMFT
dmft <- calc_dmft(sim_exam)

# With stratification
dmft <- calc_dmft(sim_exam, strata = "treatment")

# Separate root caries
dmft <- calc_dmft(sim_exam, root_lesion_col = "lesion_code")
# Returns DT (coronal) + RDT (root) separately

Odontogram with all options

build_odontogram(
  data             = decay_data,
  value_col        = "prop",
  teeth_per_quadrant = 7,
  title            = "Caries Distribution",
  surfaces         = c("buc", "lin", "mes", "dis", "occ"),
  show_labels      = TRUE,
  tooth_label_size = 3,
  numbering        = "fdi",
  min_val = 0, max_val = 0.5,
  strata           = "treatment",
  strata_labels    = c("1" = "SDF", "2" = "ART + FV"),
  stats            = stats_df,
  stats_test       = "wilcox",
  stats_var        = "mean_DMFT",
  stats_raw        = raw_patient_data,
  footnote         = paste0(
    "B=Buccal, L=Lingual, M=Mesial, D=Distal, O=Occlusal.\n",
    "* p<0.05, ** p<0.01, *** p<0.001 (Wilcoxon rank-sum test)."
  )
)

Tooth numbering conversion

tooth_convert("11", from = "fdi", to = "quadrant")
#> "ur1"

tooth_convert("ur1", from = "quadrant", to = "fdi")
#> "11"

All Functions

Function	Description
`build_odontogram()`	Full-arch heatmap with stratification, stats, numbering
`draw_tooth()`	Single tooth polygon geometry (up to 9 surfaces)
`calc_dmft()`	DMFT/dmft with root/coronal separation
`calc_dmfs()`	DMFS/dmfs with root/coronal separation
`pivot_to_long()`	Wide → long format converter
`tooth_config()`	Arch layout configuration
`tooth_convert()`	FDI ↔︎ Universal ↔︎ quadrant numbering

Authors

David Selvaraj, MBA, PhD — author, maintainer Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH. dms256@case.edu · ORCID: 0000-0003-4055-9493
Suchitra Nelson, PhD — author Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH; and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.

Citation

If you use tooth in published research, please cite:

Selvaraj D, Nelson S (2026). tooth: Dental Public Health Indices and
Odontogram Visualizations. R package version 0.5.0.
https://github.com/ddmsel/tooth

License

MIT

These binaries (installable software) and packages are in development.
They may not be fully stable and should be used with caution. We make no claims about them.
Health stats visible at Monitor.