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Dear Editor: We have read with interest Kettlekamp et al. that empirically assessed the survival outcomes of the Silver Diamine Fluoride (SDF) treatment among older adults [1]. Using a retrospective cohort analysis of electronic health records (EHRs) over 24 months, Kettlekamp et al. revealed that multiple reapplications at the site receiving SDF application prolonged survival time while shorter survival time was noted with higher baseline restorative treatment needs [1]. As Mitchell et al., [2] noted and Kettlekamp et al., [1] also reiterated that to assess the success rate of SDF treatment among older adults, analyzing small sized samples (n = 169 in Kettlekamp et al.,; n = 62 in Mitchell et al.,) is a methodological challenge. Missing values of more than 10% occurred among the variables of eating disorder, tobacco, alcohol, dental fear, dry mouth, brux clench, and osteoarthritis in Table 3 of Kettlekamp et al., [1] These values across various variables in Kettlekamp et al., [1] might have impacted statistical power and Type-II error rates [3, 4]. In Kettlekamp et al., randomness of missing values has not been fully assessed [1]. To confirm the absence of missing values-related randomness, it is highly recommended to apply multiple imputation methods by emerging approaches, multiple imputation using chained equations, and a visualization of Monte Carlo simulation results [3, 4]. As demonstrated in Table 4 of Kettlekamp et al., [1], any pre-existing medical condition did not contribute to the survival rate of SDF treatment. From geriatrics clinical perspectives, ‘self-care deficits (known as impaired activities of daily living)’ variable is the most powerful predictor of oral health outcomes including edentulousness and denture sores related to poorly fitting dentures [5]. Self-care deficits due to any medical condition reflect someone's assistance to achieve appropriate access to care and self-management of any health conditions [5]. Thus, it can be speculated that self-care deficits due to Alzheimer's disease and other dementias, not assessed in the analysis of Kettlekamp et al., [1] might be associated with lower survival probability of SDF treatment. It is quite challenging to assess the most updated health information related to medical conditions at dental clinics. Moreover, at the organizational level, the integration of EHRs between dental and medical clinics usually does not exist even under the same academic institution umbrella. To obtain the most updated health information related to medical conditions at dental clinics, the utilization of “After Visit Summary (AVS)” is one of the practical approaches. The “AVS” is automatically generated documents that provide health information related to medical clinic and hospital visits, including active medical diagnosis, medications and pharmacies, test results and orders, multispecialty next appointments, and follow-up instructions. As a quality improvement project, patients and caregivers receiving the University of Nevada, Las Vegas (UNLV) Health (medical service health system) were instructed to bring “AVS” to their dental providers in order to update AVS information in their dental EHRs. The UNLV Institutional Review Board determined exempt for review as it is not a human research subject (1613064-1). It was necessary for training gateway dental workforce, particularly, dental assistants (DAs) to enhance their capacities of managing data interoperability. UNLV Dental Practice (dental service health system) trained DAs for data interoperability between July 2021 and June 2022 and randomly reviewed charts of age ≥ 65 years (n = 40). This chart review revealed that self-care deficits (or impaired activities of daily living) documentation rate increased from 7.5% (3/40) to 25.0% (10/40, χ2 = 4.5, p = 0.03). UNLV Dental Practice's self-care deficits rate of 25.0% at the end of DA training period was equivalent to the self-care deficits rate, 30.0% (12/40) of UNLV Health (medical services)’s random chart reviews of age ≥ 65 years (n = 40) [6]. Vice versa, medical assistants (MAs) at UNLV Health were trained about documenting dental caries sites and numbers information in EHRs during the same period. UNLV Health's dental caries documentation rates increased from 5.0% (2/40) to 17.5% (7/40) in random charts review of age ≥ 65 years (n = 40, χ2 = 4.1, p = 0.04). Health information symmetry resulting from dental-medical data interoperability might foster the mutual insights of acknowledging the need for SDF treatment among older adults from dental and medical providers. The benefits of SDF treatment among older adults were well documented by arresting and preventing caries, reducing plaque, and managing hypersensitivity [7, 8]. The enhancement of access to SDF treatment applications is prioritized to enhance the benefits of SDF treatment among older adults. Most U.S. state governmental and commercial payors acknowledge evidence-based benefits of SDF treatment and recently expanded the coverage of SDF treatment among older adults as core preventive services in the past five years [5]. Medical providers, particularly, primary care providers, are training about the necessity of SDF treatment among older adults can gear up timely referrals to dental providers and reassures the semi-annual dental continuity of care if carious lesions [9].