RESEARCH OPPORTUNITIES
AaaAbout the Implementation Plan and its Development
About the Implementation Plan and its Development
The Implementation Plan is primarily a priority setting document. With nearly 150 individual recommendations it may be difficult to discern the NIDCR priority setting since not all can be pursued at the same time with the same vigor. There are however a set of overarching programmatic priorities that link to the various goals and subgoals of the strategic plan. In addition, NIDCR’s priorities are heavily influenced by cross-cutting issues such as health disparities, research training and career development and establishment of the Practice–Based Research Networks. NIDCR also is heavily engaged in a series of NIH-wide initiatives which help shape our priorities and approaches, such as the NIH Roadmap, Bioengineering Consortium, the Pain Consortium, and the Blueprint for Neuroscience. Our leading programmatic priorities are:
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Controlled clinical intervention trials that can answer the question whether periodontal diseases in humans are responsible for systemic health effects as suggested by a series of association studies.
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Oral biofilm-mediated diseases (caries and periodontal diseases) and attendant immunologic issues.
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Tissue engineering, biomimetics, craniofacial repair and regeneration including stem cell regulation and differentiation potential.
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Craniofacial developmental biology and biomineralization, including genetic and developmental craniofacial disorders.
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Salivary diagnostics.
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Genetic and molecular changes in oral mucosa leading to premalignant and malignant lesions with one aim of identifying novel therapeutic targets.
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Mechanisms and treatment of orofacial pain.
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Research directly relevant to the practice of dentistry through Practice-Based Research Networks in order to build the evidence base for clinical dental practice.
The ultimate prioritization from year to year will be heavily influenced by the emergence of new scientific opportunities which are often unpredicted and unexpected. Consequently, the detailed prioritization remains fluid and is constantly informed and modulated by the development of the underlying science and scientific methods and approaches.
Given the importance of biomedical research in fighting disease and improving the nation's health, the enormous range of possible subjects of research, and the thousands of talented investigators who seek funding, NIH Institutes must make difficult choices about how to spend resources. This Implementation Plan and the preparatory activities described in the preamble contribute to NIDCR’s ongoing long range planning activities that chart the Institute’s future in roughly five-year cycles. However, both planning and priority setting occurs in a larger context, including areas of emphasis determined by Congress, the Department of Health and Human Services, and NIH; a highly refined peer review process; and the annual congressional appropriation. The areas NIDCR chooses to emphasize in its solicited extramural and intramural research are selected through long-term and short-term science planning. Planning activities such as the Institute’s annual process to develop research initiatives for a given fiscal year relies on information from a number of different sources and key external stakeholders. These individuals and organizations include:
- The extramural scientific community, including both individual researchers and professional societies;
- Patient organizations and voluntary health associations that may deal directly with the NIDCR or indirectly through Congress and the public media;
- The Congress and the Department of Health and Human Services;
- The National Advisory Dental and Craniofacial Research Council and the Board of Scientific Counselors;
- Other NIH Institutes, program offices, and other federal agencies;
In addition, the institute relies on input gleaned through ad hoc advisory groups and a variety of conferences and workshops. These include collaborative, trans-Institute and trans-NIH scientific conferences and workshops that constitute reviews of emerging scientific opportunities, public health concerns, or state-of-the-science assessments, many of which outline specific areas of research that should be the target of future initiatives or activities. Consensus development conferences also may be held. Finally, NIDCR uses information developed from evaluation research to identify areas that need additional resources and those which could be de-emphasized.
The format of the Implementation Plan is derived directly from the NIDCR Strategic Plan and it serves as a template for guiding the Institute in developing specific initiatives on an annual basis. The organization of the Implementation Plan is tied closely to the goals and subgoals of the NIDCR Strategic Plan and each of the following sections is organized around the goals and subgoals of the Strategic Plan. Following a statement of a goal and sub-goal we have listed the recommendations for implementation for the stated goal and sub-goal for each of the scientific areas of the Institute. The scientific basis underlying the priorities is detailed in the “Burden of Disease” section of the NIDCR Strategic Plan. Additional information on disease morbidity of oral and craniofacial diseases and disorders is detailed in the Surgeon General's Report on Oral Health.
The Implementation Plan was developed with broad input from the extramural research community, from intramural scientists, and from NIH staff. For each programmatic area, staff initially performed an analysis of gaps and scientific opportunities in the existing portfolio. Following these analyses, ten separate working groups covering each programmatic area were convened. Participants included members of National Advisory Dental and Craniofacial Research Council, members of the Board of Scientific Counselors, scientific content experts, and NIDCR program staff. The working groups arrived at a series of recommendations and priorities that were summarized in an executive summary for each area. In addition, a separate meeting was convened with an international panel of experts to discuss scientific opportunities for NIDCR in oral mucosal immunology. Finally, a one-day meeting on research training and career development was convened featuring speakers from the National Academies, the National Science Foundation, the Howard Hughes Medical Institute and representatives from other NIH Institutes and the Office of the NIH Director. Subsequently, staff analyzed the recommendations from all of these working groups and meetings and established the priorities that ultimately gave rise to the Implementation Draft Plan. This Draft Plan was posted on the NIDCR website September 6, 2005 for a period of public comments which expired October 31, 2005. All comments were analyzed by staff and their role in shaping the Final Implementation Plan was posted on the NIDCR website February 1, 2006.
The Implementation Plan should be viewed as a living document that will be amended as new research opportunities and technologies emerge and thereby alter the current list of priorities. Moreover, although the priorities detailed in this implementation plan are important to the mission of the NIDCR at this time, NIDCR will continue to rely on the imagination, ingenuity and innovation of individual scientists in our community to bring forward exciting new scientific opportunities by communicating directly with extramural program staff (See Organization Information).
About the Institute and its Scientific Programs
The mission of the NIDCR is to support and conduct research and research training aimed at improving the oral health of the American people. The oral cavity with its teeth and supporting structures is, at the same time, located in one of the most structurally, functionally and developmentally complex regions and one of the most accessible organ systems of the body. Moreover, in addition to the diseases and disorders that affect this region, the face and the craniofacial structures play a significant role of the image of self and the relationship among human beings. For these reasons, our core mission includes a variety of disparate normal and pathological processes which often have little more in common than the same regional location. Thus research ranging from dental caries to oral and pharyngeal cancer; from chronic orofacial pain to Sjögren’s Syndrome; from herpetic and aphthous ulcers to loss of teeth; from periodontal diseases to cleft lip and palate all fall within the mission of the Institute. This diversity of disease and developmental patterns and the underlying complexity of the structures in which they develop, is reflected in the varied programmatic areas and disciplines addressed in this implementation plan.
It is becoming increasingly apparent that oral health is deeply integrated with general health; that oral diseases and conditions affect general health and that systemic diseases often display oral manifestations that require treatment or intervention. Often the approaches and specific initiatives we propose are integrated with and supported by those of other NIH Institutes and Centers either through the NIH Roadmap or through specific bi- or multi-Institute initiatives.
Goal 1. Advance the understanding of the normal and abnormal processes underlying oral, dental and craniofacial diseases and disorders through the development and application of new technology and research tools.
Genetics, Structure, and Function of Oral Tissues and Cells
Subgoal A: Support studies that address the genome, the transcriptome and the proteome of dental, oral and craniofacial diseases and disorders.
Craniofacial Developmental Biology and Mineralized Tissue Research
- Identify global and site-specific genes, transcripts and proteins of transcription factors, growth factors, cytokines, and their receptors and signaling networks in craniofacial development.
- Define the gene-gene, and protein-protein interactions that result in normal and abnormal craniofacial development, including syndromic and non-syndromic clefting.
- Develop organ culture and animal experimental models that permit a detailed assessment of craniofacial normal and abnormal development, including the function of individual genes, proteins and gene-gene and protein-protein interactions.
- Identify and clarify the individual and coordinate function of genes, gene products, minerals and other factors that orchestrate the formation and biomineralization of bone, dentin, enamel and cementum.
- Identify embryonic and post-natal stem cells, their normal cell fate in craniofacial developmental biology, and the range and limit of their differentiation potential (“stemness”).
Oral and Pharyngeal Cancer
- Define the genetic changes and alterations in molecular networks and signaling pathways that lead to pre-malignancy and to the transition between pre-malignant and malignant lesions both in individuals with known risk factors and in individuals without any known risk factors.
- Explore the role played by human papilloma virus in the development of oral and pharyngeal cancers.
- Support research aimed at defining the molecular mechanisms and pathological processes underlying treatment complications such as mucositis and osteoradionecrosis, and devise preventive and therapeutic approaches to ameliorate the severity of these side effects.
Salivary Gland Research
Complete the Salivary Proteome Project that will identify all proteins secreted by salivary glands, thus providing a base line for proteins normally present in saliva.
Determine the function of newly discovered salivary proteins as an extension of the Salivary Proteome Project.
Identify the quantity, location, and function of salivary gland stem cells.
Determine whether salivary gland stem cells are among the first to be destroyed in the process of disease or radiation, and if not, whether they can be stimulated to regenerate ductal or acinar cells, or indeed the entire gland.
Support genetic studies on Sjögren’s Syndrome using the cohort of pre-Sjögren’s Syndrome patients being enrolled in the international Sjögren’s registry as well as other clinical trials.
Develop new animal models of Sjögren’s Syndrome. Explore the possibility of generating new strains of mice by transplantation of human salivary tissues, both normal and diseased, into immunodeficient strains.
Communication Within, Between and Among Cells
Subgoal B: Support research to understand the molecular mechanisms of cell signaling related to the development and progression of oral, dental and craniofacial diseases and disorders.
Craniofacial Developmental Biology and Mineralized Tissue Research
- Define and describe in molecular details the functional and mechanistic relationships and communication patterns among neural crest cells, mesodermal and epithelial cells in forming the tissues of the craniofacial region.
Characterize the mechanisms by which craniofacial bones undergo repair and regeneration following craniofacial injury, trauma, and reconstruction.
Identify and characterize the factors which modulate the rate, extent and quality of craniofacial bone repair.
Characterize the molecular and cellular mechanisms of osseointegration and bone augmentation.
Pain and Neuroscience Research
NIDCR pain and neuroscience research interfaces with two important NIH-wide initiatives. One is the NIH Pain Consortium composed of representatives of NIH Institutes and Centers that support pain research and is under the leadership of NIDCR, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute for Nursing Research (NINR). A second program, the NIH Blueprint for Neuroscience Research, is a new initiative formed by 15 Institutes and Centers that will fund large neuroscience research projects at NIH.
Identify the genetic basis of human orofacial pain conditions.
- Identify the organizing principles that govern the behavior of neurons as well as glial cells and associated sensory and muscle cells.
- Determine where in the nervous system the body’s unique endogenous anti-nociceptive systems are located (characterization of neuromodulatory circuits). Establish where and by what mechanisms the endogenous systems of orofacial pain control are facilitated, activated, or inhibited.
- Support research into specific drug target genes employing pharmacologic or gene therapeutic approaches that target various modalities in the nociceptive cascade.
- Explore cortical-behavioral mechanisms that operate in response to the orofacial pain experience. Explore thalamo-cortical interactions to learn more about facial movements and alterations in movements associated with orofacial pain.
- Study motor activity in association with orofacial pain and cortical-behavioral mechanisms in humans and in animals.
Microbial-Microbial Communication Within Biofilms
- Characterize microbial-microbial signaling and identify those that are important for assembly and disassembly of oral biofilms.
- Support studies that exploit quorum sensing and related mechanisms through development of small molecule reagents such a homoserine lactones, competence-stimulating peptides and related compounds to turn off of expression of pathogenic genes.
- Explore biomimetic principles to construct antimicrobial and self-cleaning coatings that disrupt or prevent biofilm formation. As an example these technologies will be used to manage or eliminate biofilms in water lines in dental offices.
Microbial Pathogenesis and Immunology
Subgoal C: Support research on the structural and functional properties of biofilms and biofilm-mediated diseases.
Creating an Atlas of Oral Biofilms
- Identify the entire oral microbiota including novel species and strains that have never been identified by classical culture techniques. Generate a complete inventory of microbial genomes in the oral cavity and identify new or novel genes whose function can subsequently be explored.
- Conduct a comprehensive comparison of the microorganisms and complex groups of microorganisms that are associated with health and disease and generate site-specific topographic maps of oral biofilms at healthy and disease sites.
- Generate a comprehensive library of probes, antibodies and small molecule reagents to identify in situ the microbial species of biofilms at various locations, the genes they express and the proteins they synthesize.
- Support real time in vivo imaging research in humans of oral microorganisms to identify specific genes and gene products to resolve in time and space the interactions between various species that lead to biofilm formation.
HIV/AIDS Research
- Elucidate the anti-HIV defense mechanisms in the oral cavity, including factors in saliva, in the resident microflora, and in host cells that enhance defenses against viral pathogens.
- Explore the routing of HIV in the oral cavity in newborns and throughout life and capture the fate of the virus in the oral cavity prior to seroconversion; describe how healthy tissues and the microflora respond to the virus.
- Determine the range of oral factors that might influence maternal child transmission during lactation.
- Study the pathogenesis and natural history of oral complications of HIV infection as well as oral lesions that may be related to HIV therapy.
Innate and Adaptive Immunity; Oral Mucosal and Systemic Immunity
Identify the protective or destructive responses of each arm of the immune system in oral health and disease, and determine the underlying mechanisms.
- Explore whether there are common microbial genes, or clusters of genes, that distinguish commensals from pathogens.
Determine the factors in saliva that facilitate or limit microbial colonization and disease development.
Identify, define and characterize the genetic, cellular and molecular components of the oral mucosal immune system, and its relationship to global mucosal and systemic immune responses.
Define and describe the ontogeny of human mucosal immunity and its evolution throughout human lifespan.
Define the molecular basis for the systemic immunosuppressive effects of oral and pharyngeal carcinomas.
Develop immunotherapies that are effective in preventing or treating oral and pharyngeal cancers in high-risk groups.
Identify in humans the specific destructive autoimmune mechanisms in oral and craniofacial diseases such as Sjögren’s Syndrome.
Gene and Environment Interactions
Subgoal D: Support research to understand gene-disease associations, genes, and gene products in normal craniofacial development, and gene-environment interactions in oral, dental and craniofacial diseases and disorders and birth defects.
- Identify environmental factors that raise or lower the risk of clefting and develop improved methods for diagnosis and prevention of clefting in human populations.
- Identify in molecular terms the roles of environmental and behavioral factors, and tumor-environment interactions, that increase or decrease the risk for oral and pharyngeal cancer.
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Determine how stem cell phenotypes are regulated and controlled by the diverse environments of the craniofacial region and how these cells interact with other cells in the region.
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Describe in molecular detail the interactions between cells and extracellular matrix that result in embryonic and postnatal morphogenesis of the craniofacial regions, its tissues and teeth.
Pharmacogenetics
Subgoal E: Understand individual variability of responses to drugs that are used for the treatment of dental, oral, and craniofacial diseases and disorders to develop highly effective, low-toxicity drugs or agents.
- Support research that addresses chronic orofacial pain particularly treatments for temporomandibular joint and muscle diseases and disorders.
Support research on genetic differences in pain sensitivity and response to analgesics in man and animals, and gender differences in response to opiate-based drugs.
Support pharmacogenetic studies on xerostomia that often accompanies use of anti-depressants and some heart medications that need to be taken for long periods or over the lifetime.
Develop and validate new animal models for use in pharmacogenetic studies.
Develop cooperation with scientists in pharmaceutical companies to study the oral effects of new drugs.
Support research into the pharmacogenetics of dental fluorosis and any possible adverse effects of local or systemic use of fluorides in caries prevention.
Biocompatible Materials
Subgoal F: Support and encourage research for the design and development of "living" materials for the repair and regeneration of orofacial tissues and organs based on advances made in biological systems research.
Conventional Restorative Materials
- Develop and validate new technologies and analytical techniques that permit refinement of the assessment of any adverse health effects of dental amalgam.
Determine the possible neurotoxic effect of low levels of mercury vapor (Hg0) in general and the effect of low levels of Hg0 in utero on brain development in particular.
Evaluate reproductive and pregnancy outcomes in large groups of oral health professionals with well-defined Hg0 exposure.
Support research that can better assess any adverse health effects of other restorative materials used in the oral cavity such as composites, nanocomposites, ceramics, and titanium.
Novel Restorative Materials and Tissue Engineering
- Design and develop new dental
restorative materials with superior bio-compatibility and function.
Design and develop "smart" polymers that mimic the extracellular matrix in serving as scaffolds for parenchymal and stem cell transplantation.
Develop biomimetic polymers with specific, selective biologic functions in adhesion, signaling, and growth factor activity to enable creation of inductive, permissive or restrictive local environments.
Develop engineering approaches for elucidation of design principles of cellular systems (nanotubes, nanoparticles that provide “synthetic stem cell niches” for controlling stem cell differentiation).
Develop delivery vehicles (nanoparticles, artificial matrices) capable of on-demand local delivery of precise amounts or regulatory molecules (growth factors, cytokines, pharmacologic agents).
Link the Temporomandibular Joint Disorders Registry to the development of biological materials that can restore/regenerate the functional mechanical and anatomical properties of the tissues of the temporomandibular joint.
Industrial Relations to Accelerate Translation of New Paradigms in the Clinic
- Develop strategic initiatives to focus on translation and commercialization of projects and technologies in areas of greatest commercial impact and public health need.
- Establish consultation and liaisons with experts in the dental and biotechnology industries, investment community, academicians with credentials in inter- and multi-disciplinary projects.
Goal 2: Develop new or improved approaches and methods for preventing, diagnosing, treatment and eventually eliminating oral, dental and craniofacial diseases and disorders.
Development and Validation of Biomarkers
Subgoal A: Develop and validate biochemical, cellular, physiologic or genetic biomarkers that can be used to predict risk, aid in early diagnosis, and assess disease progression and response to treatment of chronic and disabling oral diseases and disorders.
Develop and validate biosensors for salivary diagnostics (“laboratory on a chip”) to measure molecular concentrations, and associations and extend these technologies to the measurement of reactions in living cells.
- Identify and validate biomarkers for dental caries and periodontal diseases with predictive accuracy to identify high-risk teeth, high-risk individuals and high-risk populations, and effective treatment outcomes.
- Develop and validate improved diagnostic criteria and biomarkers (e.g. genetic, neuroinflammatory, neuropathic) for temporomandibular joint and muscle disorders, other chronic orofacial pain conditions, and treatment outcomes.
- Develop and validate screening methodologies for premalignant and malignant lesions that can be applied in dental and medical practice settings on a population basis in the general population and in selected high-risk populations.
Clinical Research and Clinical Trials
Subgoal B: Expand and enhance the Institute's clinical research and clinical trials program to identify effective preventive, diagnostic and treatment approaches for oral, dental and craniofacial diseases and disorders.
Caries and Periodontal Diseases
Conduct human clinical intervention trials that will answer the question whether periodontal treatment and prevention significantly lowers the risk of developing any or all of the systemic complications reported in association studies (low-birth weight, preterm birth, cardiovascular disease, pulmonary disease, stroke, diabetes).
Determine the contribution of genetic factors to the susceptibility and resistance to dental caries and periodontal diseases.
Develop and validate new technologies for the early detection of enamel demineralization before cavitation to facilitate new paradigms for the reversal and repair of early demineralization (RFA-DE-06-008).
Understand the human pharmacokinetics of fluoride relative to caries prevention and to dental fluorosis.
Assess whether the multiple sources of fluoride available today (water fluoridation, dentifrices, mouth washes, food chain, soft drinks) merit a reevaluation of the current modalities of fluoride usage in caries prevention.
Determine the role of specific microbial virulence factors, host microbial communication, and host immune responses in gingivitis. Conduct clinical studies in humans to identify factors that govern and regulate the host response to microbial colonization.
Develop and test effective community and population-based methods of preventing dental caries and periodontal diseases.
Develop and test innovative treatment strategies in humans for periodontal diseases and dental caries that are minimally invasive and take advantage of the increased understanding of tissue regeneration and repair at the molecular level.
Investigate outcomes of various treatment protocols for osseointegrated dental implants (RFA-DE-06-007).
Pain and Neuroscience Research
- Compare orofacial pain with pain elsewhere in the body to determine if there are, specific “orofacial pain” genes.
Conduct genetic/molecular epidemiology cohort studies of temporomandibular joint and muscle disorders patients to identify subgroups of patients within the temporomandibular joint and muscle disorders population.
Supplement existing prospective studies of female populations with orofacial pain studies to determine the characteristics of individuals who progress to develop temporomandibular joint and muscle disorders.
Determine, in cases where orofacial pain occurs in common with other comorbidities (such as temporomandibular joint disorders with fibromyalgia or irritable bowel syndrome, chronic fatigue syndrome), whether a common mechanism underlies these comorbidities.
Develop and validate objective outcome measures to judge the efficacy of orofacial pain therapies in clinical studies and clinical trials.
Determine the mechanisms of ablating dorsal root and trigeminal ganglion neurons and explore the therapeutic value of this approach for long-term pain control.
Salivary Gland Research
- Develop and validate approaches to restore impaired salivary gland function in humans through gene transfer approaches.
- Develop and validate approaches to utilize salivary glands as bioreactors in humans to restore deficiencies of certain proteins by secretion to the systemic circulation (insulin, human growth hormone).
- Develop and validate the next generation of improved vectors suitable for gene transfer to human salivary glands.
Population-Based, Genetics, Social and Behavioral Research
Subgoal C: Support studies that expand and enhance the integration of population-based, genetic, social, and behavioral research.
- Explore in depth the behavior of humans and animals affected by chronic orofacial pain for a more comprehensive understanding of the experience of pain.
- Conduct behavioral research to understand and enhance translation and adoption of new clinical research findings in oral health into oral disease prevention and routine health care delivery, including such issues as the public’s acceptability of new interventions.
- Explore how behavioral and social scientists studying oral, dental and craniofacial health and disease can contribute to the NIH Roadmap initiative: Patient Reported Outcome Measurement and Information Systems (PROMIS).
RESEARCH CAPACITY
Goal 3. Ensure an adequate and well-trained research workforce that reflects the current and emerging needs of science and includes sufficient numbers of investigators from diverse disciplines and from underrepresented groups.
Goal 4. Support research infrastructure and enhance the development of new approaches for conducting inter- and cross-disciplinary research.
RESEARCH TRAINING AND CAREER DEVELOPMENT
- The NIDCR will maintain a diverse portfolio of individual and institutional research training and career development programs that address the needs of the community and guarantee optimal training conditions for those who wish to enter biomedical research as a career in academia or industry (see NIDCR training website: http://www.nidcr.nih.gov/CareersAndTraining/).
In addition to these ongoing support mechanisms, the NIDCR views it as a priority to explore innovative and imaginative new approaches in training wherever possible.
Develop and support programs that enable dental schools to attract and recruit students from a scientific undergraduate field that already have exposure to and a continued interest in research.
Continue to include targeted recruitment efforts toward women and underrepresented minorities (African Americans, Hispanics, Native Americans) and provide support mechanisms for innovative programs that attract these groups both to research and to dentistry.
Support and encourage development of concurrent dual degree (DMD/DDS and PhD) Dentist Scientist Training Programs (DSTP) in the nation’s dental schools.
Support, encourage and further develop programs that allow science-interested dental students an opportunity to commit one full year for mentored clinical or basic research before returning and finishing their dental education. Work with individual dental schools and dental professional, educational and research organizations (ADA, ADEA, AADR) to facilitate such arrangements.
Continue funding and support for clinical research training for dentists under a variety of institutional and individual award mechanisms (http://grants1.nih.gov/grants/guide/rfa-files/RFA-DE-05-008.html).
The NIDCR proposes, on an experimental basis, to build a program modeled after the Robert Wood Johnson Foundation Physicians Scholars Program and successfully implemented with the “Native Investigator Development Program” at University of Colorado Health Science Center’s Resource Center for Minority Aging Research (RCMAR). The program, termed “Distributive” Training Program for Junior Dental School Faculty,” is based on a distributive approach where the trainees stay at their home institutions and receive training by a customized team of local or national mentors who guide and monitor trainee progress, so that their time away from the home institution is minimized. The didactic program is taught through a number of short 2-3 day mini-courses at a central location where all trainees and mentors have an opportunity to meet and interact.
Evaluation and Tracking of Training and Career Development Programs
- While the success of individual training programs cannot be ascertained in the short term, it is imperative that the NIDCR work with the NIH to establish a detailed database on all trainees from institutional, as well as individual training and career development support mechanisms, including information about the future career path and success of each trainee.
Infrastructure Improvement of US Dental Schools
COMMUNICATION
Goal 5. Enhance the translation of research results into clinical practice and communicate science-based health information to ensure that NIDCR-supported research leads to improved health.
- Define the factors and strategies to increase the timely dissemination and implementation of research findings to all members of the oral health care team and the rapid transfer of such research findings into the practice of dentistry.
- Determine the most effective means to translate new and existing knowledge of disease prevention and health promotion into public health practice and use by the public.
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xplore novel methods of disseminating information and skills to clinicians, patients and others in geographically isolated areas and those with ambulation problems through telehealth and teledentistry approaches.
Improve the awareness and knowledge base in the population in general, and in high-risk populations in particular, of oral diseases and disorders and their risk factors.
Provide dental health professionals with information to help them care for patients with systemic conditions that affect oral health, including developmental disabilities, cancer treatment, and diabetes.
Increase medical professionals’ awareness that prevention and management of oral complications of cancer treatment can enhance both patient survival and quality of life.
Provide parents and caregivers practical, easy-to-understand information for preventing dental disease in children. Focus particularly on populations with oral health disparities and limited oral health literacy. Build new marketing partnerships with intermediaries such as community organizations, government programs, health care providers and others to reach parents and caregivers.
Provide researchers, educators, professional and scientific organizations and patient advocacy organizations with regular updates about the latest advances in oral health research and funding opportunities.
HEALTH DISPARITIES
Goal 6. Eliminate health disparities in oral, dental and craniofacial diseases and conditions among underserved populations and groups.
- Work with other Institutes and Centers and relevant Federal Agencies to develop scientifically based approaches to conceptualize race/ethnicity for health disparities research purposes to more accurately reflect the growing diversity in the U.S. population.
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onduct epidemiological surveys of well-defined subpopulations to determine their oral and general health status in order to specify and address the nature of the health disparities found.
Support novel and innovative interdisciplinary approaches to understand and address the diverse factors underlying oral health disparities among U.S. subgroups, including issues relating to patient, provider and reimbursement system characteristics.
Document the determinants of health and disease within new waves of immigrants.
Utilize existing or develop new networks as vehicles for health disparities data collection, analyses and interventions as appropriate for accessing vulnerable populations including those with special needs. The Clinical Directors Network of Federally Qualified Health Centers and the NIDCR Practice Based Research Networks are two examples of existing networks.
Conduct interdisciplinary studies to explore the linkages between genetics and other biological pathways including environment, culture, and behavior across the life course and develop interventions that take advantage of these linkages.
Conduct studies to elucidate why individuals from the same racial/ethnic group and cultural backgrounds have different health profiles and more or less health disparities, depending on community-specific factors and develop appropriate interventions.
Develop and validate novel approaches to understanding “culture” as an asset in improving oral health literacy, oral health practices and behaviors.
Increase the enrollment and retention of women, children, and racial and ethnic minorities and other underrepresented groups in NIDCR-funded clinical research including intervention studies specifically designed to eliminate health disparities.
Stimulate research that utilizes the community-based participatory research approach that works directly with leaders and agencies inside communities with high needs to assure that community representatives are included in all phases of research development and conduct.
Engage allied oral health professionals including those from the study communities as a source of research personnel and increase the cadre of health disparities researchers.
DATA ACQUISITION AND ANALYSIS
Goal 7. Ensure the adequacy of systems to document and monitor the extent and impact of oral, dental and craniofacial diseases, disorders and conditions.
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Periodically assess the need for surveys, and design and conduct such surveys as are required to understand the extent and impact of oral, dental, craniofacial diseases and disorders.
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Develop strategies for follow-up with the ongoing NHANES taking into account existing studies such as the Hispanic Community Study.
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Support the development of new methods for diagnosing and monitoring dental caries and periodontal diseases.
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Support the inclusion and integration of oral health activities (interview, examination, and/or self-report) in national surveys or in other longitudinal studies at the national, state, regional or community level.
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Support research that evaluates the use of new technologies and approaches for use in clinical and community trials, and population surveys.
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Conduct studies and analyses of existing data on burden of illness of oral, dental and craniofacial diseases and disorders, such as with the National Center for Health Statistics and the National Health Interview Survey, to include data on cost of services and health care utilization.
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Establish ongoing access for researchers to existing data and ready analysis to serve as a basis for hypothesis generation and for development of new surveys to address gaps in knowledge.
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Continue collaborations with and/or support of the Data Resource Center and Query System.
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Support analyses of access to care, cost of care, and utilization data in the Medical Expenditure Population Survey and other public oral health databases.
NIDCR EVALUATION
Evaluation research is an important tool to assist NIDCR with planning, management, and accountability. At the Institute, evaluation is defined as objective, systematic research that uses scientific criteria and analytical techniques to measure the effectiveness of program implementation and/or the impact of program results. As with NIDCR’s biomedical research, priority setting is needed for evaluation research due to limited resources. The results of NIDCR evaluations are used in future short- and long-term planning and management.
Comprehensive evaluations are conducted for key disease-based and crosscutting areas of NIDCR’s portfolio of research and activities. The order in which the areas are selected for evaluation is determined by applying six criteria: (1) prevalence of diseases or conditions relevant to the area; (2) the impact of the underlying condition or problem; (3) NIDCR resources devoted to the area; (4) timing—for example, whether sufficient time has passed to see the impact of a particular initiative or effort; (5) resources needed to conduct the evaluation; (6) recommendations of Council and other advisory groups.
Evaluations have been completed recently or are ongoing in the areas of dental caries, periodontal diseases, health disparities, and craniofacial anomalies. Smaller-scale analyses are also conducted. For example, publication-based reviews and analyses have been conducted in preparation for competing renewal for centers and other large-scale grants. For each evaluation, a set of research questions and objectives are developed. Some of these objectives will reflect the unique nature of each portfolio, but others are designed to permit comparisons across topic areas.
Panels of nationally and internationally known scientists often assist NIDCR in conducting these studies. For example, for the evaluation of NIDCR’s dental caries research portfolio, a technical advisory panel helped identify specific analyses needed to describe the scientific literature and NIDCR’s grant portfolio, pointed out recent interventions and discoveries in the field, and provided context to the key findings of the study.