NIDR: 50 years of Scientific Progress

By Harold C. Slavkin, DDS

The National Institute of Dental Research turns 50 this month. During those 50 years, scientific research has resulted in amazing progress in reducing the prevalence and severity of tooth decay, periodontal diseases, and tooth loss. With these successes in mind, NIDR looks to more progress in such areas as the design and fabrication of biomaterials for replacement of teeth, early detection of caries lesions, and innovative remineralization strategies to optimize and preserve the health of dental tissues.

Article copyright 1998 Journal of the California Dental Association.
Photographs copyright of the authors.

American dentistry is the finest in the world. During the last half of this remarkable 20th century, our nation increased its investment in science with the goal of improving the health of the American people. The investment has paid off and continues to pay off as we prepare for the next millennium.

Just reflect on 1940's life expectancy; patterns of morbidity and mortality; and prevalence and severity of tooth decay, periodontal diseases, and tooth loss. Life expectancy was 55. Viral and bacterial infectious diseases were major determinants for morbidity and mortality. Tooth decay was rampant. Most people expected to be edentulous by the time they reached 45.

Access the NIDR home page on the Internet.

What a difference advances in science and technology have made to the oral health of the American people and to the effectiveness of today's clinical dentistry and medicine as the National Institute of Dental Research closes in on its 50th anniversary this June 24. Life expectancy is approaching 80. Remarkable progress has been made in the prevention and management of many infectious diseases. The etiology and pathogenesis of dental caries and periodontal diseases are now understood in the context of infectious microorganisms and host immunity; the selective use of antimicrobial drugs and routine professional prophylaxis strategies; and a number of health promotion measures including fluoridation, dental sealants, and personal oral hygiene. Today, the prevalence of dental caries has been profoundly reduced, the management of periodontal diseases has progressed, and less than 10 percent of the adult population is edentulous. More people are dentate, free of pain and discomfort, and living longer than ever before in human history.

The mission of NIDR is to improve and promote craniofacial, oral, and dental health through research. The legislation that Congress enacted and President Harry S. Truman signed into law in 1948 to create NIDR entrusted it with national leadership in dental research, granted it authority to conduct and support research and training, and mandated that it promote science transfer and dissemination of information (Table 1). And NIDR has delivered.

Since its 1948 origins, NIDR training support has benefited this nation's universities and, in particular, schools of dentistry and medicine with a faculty educated and trained in the biological, physical, chemical, behavioral, and clinical sciences (Table 2).

Clinical dentistry directly benefited from the NIDR-sponsored science that has revolutionized diagnostics, therapeutics, and dental and medical devices, and provided remarkable health promotion and disease prevention approaches to improve craniofacial, oral and dental health (Table 3).

Imagine how science and technology have changed the face of dentistry. Science has fostered enhanced knowledge and expertise regarding all aspects of the human condition in health and disease. Today, we consider not only the prevention and control of dental caries and periodontal diseases, but we also address craniofacial-oral-dental malformations; other infectious diseases (viral, bacterial, yeast, and parasitic); oral and pharyngeal cancers; temporomandibular joint diseases and disorders; acute and chronic oral-facial pain; and oral manifestations of medically compromised patients with AIDS, osteoarthritis, osteoporosis and diabetes, to mention a few.1,2 Today, we use scientific evidence to educate the general and professional public and to evaluate oral health determinants such as nutrition, lifestyle choices (tobacco cessation, alcohol reduction, and exercise), and environmental exposures.3-6

Table 3 The Top 16 Dental Schools* University of Washington University of California at San Francisco University of Alabama at Birmingham Forsyth Dental Center (a research organization that also provides training to dental hygienists) University of Texas Health Science Center, San Antonio University of Michigan State University of New York at Buffalo University of North Carolinaa University of Iowa University of Southern California University of Rochester University of Minnesota University of Florida University of Pennsylvania Boston University University of California at Los Angeles * In fiscal year 1997, each of the above schools received $2 million or more from NIDR through competitive peer-review process.

Just look around a typical dental clinic in the 1990s. Bench science has moved into mainstream clinical dentistry, often at a very rapid pace. Consider the contributions from NIDR, ADA, the National Bureau of Standards, and private industry-sponsored research and development, which have resulted in:

* The high-speed dental handpiece;
* Panorex radiography;
* Digitized radiography;
* The inorganic and organic chemistry for dental materials;
* Dental sealants;
* Improved amalgam alloys;
* The science of infection management and control (from AIDS to xerostomia);
* The science of soft- and hard-tissue wound healing;
* The science of chemo- and neurosensory processes with attendant advances in analgesia;
* The biochemistry of tissue-specific mineralization; and
* The science of steroidal and nonsteroidal anti-inflammatory drugs.7

Just look at the community-based and community-wide prevention opportunities we have and can build upon. Oral health professionals are part of a comprehensive health promotion team, helping to advance health promotion and disease prevention, which is a profound strength of our dental profession. Imagine increased public/private partnerships and collaborations designed to improve student health, science and technology literacy. To begin to address these wonderful opportunities, NIDR is planning a network of regional Centers of Discovery, each thematically and programmatically dedicated to improving the health of the American people through research that extends from the bench to the community. In addition, NIDR has been designated by Health and Human Services Secretary Donna Shalala to be the lead federal agency in the first Surgeon General's Report on the Oral Health of the American People, scheduled to be completed by the Spring of 1999 (access to which can be obtained through the Internet at www.nidr.nih.gov)

NIDR celebrates its 50th anniversary on June 24, 1998.

Investments in science have served as the fuel for the engine of technology that improves clinical dentistry and oral health. And as we approach the 21st century, what should we anticipate for the next 50 years? How should we prepare for the new millennium? Consider preparation in the context of major changes in demography, disease patterns, management of health care, international immigrations, and the global economy. By the year 2020,

Understanding gene testing for human dental, oral and craniofacial diseases and disorders.

the U.S. population will reach 300 million people, and one in every five Americans will be 65 or older. In this context, the goal of the NIDR will continue to be to reduce or eliminate inherited, infectious, neoplastic, and chronic craniofacial-oral-dental diseases and disorders.8

To help realize these goals, scientists will complete the sequencing of the entire human genome as well as a number of microbial and animal genomes by the year 2005.9 Essentially every gene in the genetic lexicon of significant organisms will be identified and available in hard copy or through the Internet.

Bioinformatics will enable the rapid discovery of more sensitive and specific drugs for the treatment and management of human diseases and disorders. Bioinformatics will also enable dental and medical records to be readily accessible anywhere on the planet Earth. Biomimetics will enable the design and fabrication of novel biomaterials for body part replacements, including teeth, salivary glands, muscle, cartilage, bone and joints. Novel imaging techniques will enable detection of early caries lesions, and innovative remineralization strategies will be used to optimize and preserve the health of dental tissues. Increased knowledge and technology will enable improved oral diagnostics for inherited and acquired systemic diseases using saliva, buccal epithelial cells, and gingival crevicular fluids. During the first half of the 21st century, we envision oral health professionals addressing the challenges of chronic diseases and disorders coupled with medically compromised patients using gene-mediated diagnostics and therapeutics. All of these changes will require increased efforts in the dental and medical school curriculum and continuing education in the areas of epidemiology, genetics, biostatistics, bioinformatics, pharmacology, and physiology and a thorough understanding of the connection between oral and systemic health and diseases.

Our nation's decision to invest in the biomedical and behavioral scientific enterprise has reaped enormous health, social, and economic benefits for the American people as we celebrate this golden anniversary of NIDR. And as we anticipate the next millennium, it becomes very useful to consider the rates and magnitude of changes that have taken place in the demography and patterns of disease in our nation. Further, this is a time to evaluate our goals, where we have been, and where we plan to go as a profession. The future seems bright when we consider the enormous progress of biomedical and behavioral research, the advances in our understandings from the principles of oral infectious diseases, the promise of the microbial and human genomic era, and the emerging opportunities for oral health professionals to address health promotion and disease prevention. Virtually everything important to health care professionals, patients and society -- diagnostic techniques, understanding the etiology and pathogenesis of diseases, methods of treatment, approaches to prevention, health care management, dental and medical education, legal and ethical issues -- will change through information technology, biotechnology, genetic dentistry and medicine, and our nation's expanding partnerships among federal, state, local governments, and the private sector as we enter the 21st century.

Author

Harold C. Slavkin, DDS, is the director of the National Institute of Dental Research.

References

1. Slavkin HC, Craniofacial-oral-dental research in the 21st century. J Dent Res 76:628-30, 1997.
2. Slavkin HC, Clinical dentistry in the 21st century. Compendium 18(3):212-8, 1997.
3. Kaste LM, Selwitz RH, et al, Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res 75:631-41, 1996.
4. Winn DM, Brunelle JA, et al, Coronal and root caries in the dentition of adults in the United States, 1988-1991. J Dent Res 75:642-51, 1996.
5. Brown LJ, Brunelle JA, and Kingman A, Periodontal status in the United States, 1988-1991: prevalence, extent, and demographic variation. J Dent Res 75:672-83, 1996.
6. Drury TF, Brown LJ, and Zion GR, Tooth retention and tooth loss in the permanent dentition of adults: United Stated, 1988-1991. J Dent Res 75:684-95, 1996.
7. Harris RR, Dental Science in a New Age: A History of the National Institute of Dental Research. Montrose Press, Rockville, Md, 1989.
8. Shaping the Future, NIDR Strategic Plan. Department of Human Health Services, US Public Health Service, NIH Publication No 97-4174, 1997.
9. Rowen L, Mahairas G and Hood L, Sequencing the human genome. Science 278:605-7, 1997.

To request a printed copy of this article, please contact/Harold C. Slavkin, Office of the Director, National Institute of Dental Research, National Institutes of Health, 32 Center Drive, Bldg. 31C, Room 2C-39, Bethesda, MD 20892.