New open-source software tool, known as GatorpH, helps expose hidden cavity risks

When the Food and Drug Administration issued a safety warning in 2022 about severe tooth decay associated with a commonly prescribed, orally dissolving opioid use disorder medication called buprenorphine, University of Florida researchers asked the question: How could scientists better measure the oral conditions that put teeth at risk?

Their efforts have culminated in the invention of GatorpH — a free, open-source software tool designed to help scientists analyze dynamic changes in oral pH and estimate factors associated with cavity risk. 

The team, led by UF College of Dentistry D.M.D./Ph.D. program candidate Kyle Kasparian, is now poised to use GatorpH for its ultimate objective: reformulating a version of buprenorphine that retains its important therapeutic benefits but does not cause cavities. 

“It [buprenorphine] will still be used to treat opioid use disorder,” Kasparian said. “However, we are designing the formulation so that it won’t have these associated cavity risks ... With more than 15 million prescriptions written for this medication each year, that will be a huge benefit.”

A mathematical blind spot 

Tooth decay begins within dental plaque, a sticky biofilm that traps bacterial acids against tooth enamel. Because plaque limits saliva’s ability to neutralize those acids, acidity can remain at harmful levels long after the rest of the mouth returns to normal, leading to tooth mineral loss. 

Accurately capturing what happens to pH over time presents researchers with a practical challenge. Continuous plaque pH monitoring can provide detailed information about the rise and fall of acid levels, but the methodology is demanding. Reliant on a wire telemetry device, the approach requires patients to wear custom sensor-equipped mouthpieces while allowing plaque to accumulate — undisturbed by brushing — for multiple days. Historically, this has made studies expensive and time-consuming.

“Few studies have implemented this since the 2000s,” Kasparian said. 

The alternative approach, and the method Kasparian set out to refine, is “sparse” pH sampling: taking occasional test-strip or probe readings every few minutes. He found that medications or foods evaluated via sparse pH sampling could easily appear benign on paper while causing true tooth decay in real-world use. Determining whether buprenorphine’s original pH testing had fallen into this mathematical trap became a central focus of his research.

Pharmacy and dentistry combine forces

As Kasparian launched a pilot cross-sectional study investigating oral pH changes among patients taking sublingual buprenorphine, the limitations of traditional modeling became increasingly apparent.

The breakthrough occurred in a synchronistic collision of expertise. It started among members in the lab of one of Kasparian’s faculty mentors, Abhisheak Sharma, Ph.D., M.Pharm., associate chair of the UF College of Pharmacy’s Department of Pharmaceutics and co-director of the Translational Drug Development Core at UF. 

Kasparian broached the subject of calculation inefficiencies in his study with Omar Elashkar, a UF College of Pharmacy graduate student with a background in quantitative modeling and computer science.

“They complemented each other,” Sharma said. “None of them could have done this alone.”

The GatorpH model accounts for biological factors such as bacterial acid production and saliva buffering, eliminating the guesswork of traditional calculations. This advance allows researchers to accurately reconstruct acid changes with greater ease.

A free public oral health tool

GatorpH reconstructs the curved trajectory of oral pH changes rather than relying on straight-line estimates between measurements.

“This software will not just solve Kyle’s problem with analyzing this clinical study data; it will also solve the problem for anybody doing this kind of study around the world,” Sharma said.

Others involved in the study include Christopher McCurdy, Ph.D., FAAPS, a distinguished professor of medicinal chemistry in the UF College of Pharmacy and director of the UF Translational Drug Development Core; Jacqueline Abranches, Ph.D., an associate professor in the UF College of Dentistry’s Department of Oral Biology; and John Abernethy, M.D., a courtesy faculty member in the UF College of Medicine and CEO of a Gainesville-based biopharmaceutical startup.

To support the work, the team has applied for National Institutes of Health funding. The decision to make the tool free to everyone for noncommercial use was an easy one, Sharma said.

“If something was developed using taxpayers’ money, it should be available to taxpayers,” he said. “Dental problems are the most prevalent problems around the globe. And if we can quantify that problem in terms of mathematics, if they can improve their life with one of our software tools, that’s the best way we could achieve impact in a public university.”