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Dr. Lawrence Tabak:
I am Larry Tabak. I am the seventh director of the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, and it has been my true privilege to be part of the NIH over these past eight years now. I trained for my dental degree at Columbia University and Ph.D. at the State University of New York in Buffalo. What most don’t know about me is I also am a board eligible endodontist.
Interviewer:
Larry, what do you think are the most important current developments in oral health research?
Dr. Lawrence Tabak:
I’d say that there are three that I would highlight. The first is the emergence of using saliva as a diagnostic fluid. The second is the emerging field in pharmacogenomics, which I think will have a tremendous impact on dentistry. Finally, and perhaps the one that will have the most practical impact long term, is the field of tissue engineering, which has so many applications to restoration of form and function.
Interviewer:
Where would those three areas have developed to in ten years time, and will dentists in practice be applying them?
Dr. Lawrence Tabak:
Your latter point is the key. Somebody will be applying them, and so the question is, will dentistry as a profession embrace these new developments, or will they leave them for others, particularly physicians, to adopt and implement? So with regard to salivary diagnostics, we already have saliva-based tests for things like HIV/AIDS and there are many, many others in the pipeline. So there the question becomes, does the dentist as a health professional become part of the primary healthcare network, where you are helping to survey your patients, not only for oral diseases but indeed for more general diseases and conditions? With regard to pharmacogenomics, I have no doubt that this is going to have a major impact because third-party payers are going to drive this because they want to cut down on the number of untoward reactions to pharmaceuticals. With the advent of tissue engineering principles, I think our profession is going to become increasingly preventive biologically-based, as opposed to preventive surgically-based. Taken together, I think all three of these things really will impact, in a very positive way I feel, the profession over the next decade.
Interviewer:
Do you think we are educating the right type of professionals to carry out these therapies in the future, or do we need different types of professionals?
Dr. Lawrence Tabak:
I think the report card there is mixed. I think there is much more to be done, particularly for those practitioners who are already out there in the communities, who have not had the benefit of these newer advances and approaches. But I must say, at least in the United States, I plead ignorance of the specifics in the Canadian schools of dentistry, but at least in the United States, I’ve had an opportunity to visit many of the schools, there is a certain unevenness in how they approach teaching these newer things. We will have to do a better job as a profession to make sure everybody is up to speed.
Interviewer:
How will tissue engineering be applied in the dental practice in ten years time?
Dr. Lawrence Tabak:
I think now everybody understands one of the hallmark principles of dentistry, and that is, to restore function and form. We do that now with clever materials. In the future we are going to do that with biologicals. No doubt it will be a combination of growth factors and stem cells, and perhaps chemically derived scaffolds that are smart in nature because they will help inform the cells that you deposit in an oral wound, in a cavitation, in an infected pulp, and so forth. But we will not be using the traditional ceramal, metallic, and plastic kinds of things that we use today. Now, ultimately you want to be able to engineer a tooth for example, that is a whole living tooth that would be used instead of the current implant technology. That is a ways away and in the ten year horizon I suspect it won’t be accomplished. But certainly within a twenty year horizon it will be. But along the way there is a tremendous amount of repair and restoration that will be done biologically. We are already seeing evidence of that in terms of repaired bony defects and things of that nature.
Interviewer:
Beyond the research sector, what do you think are the most important developments that will have an impact on the future of our profession?
Dr. Lawrence Tabak:
I think that there are three areas that I would highlight. One is the demographic of North America. Both in the U.S. and in Canada, the population continues to age. I think the trend is that as the population ages there is an increased need for dental service. The other part of the demographic, and again I do plead a little ignorance as to how it is in Canada, but I suspect it’s not dissimilar, at least in the United States there is a tremendous disequilibrium as to where dentists want to practice. In the U.S., there is so much emphasis on practicing in the cities and insufficient draw to practice in the rural part of the country. And so you have this odd disequilibrium and you have many underserved persons. Finally, and I think that it really is tied into this second point that I made about dentists’ professional distribution, is this growing discussion about the need for some sort of a mid-level provider, as perhaps a way of reaching those who are presently underserved. I think those three developments, which are not research driven, will have profound impact on our profession.
Interviewer:
Could this type of mid-level provider be providing the non-surgical care that you talked about earlier?
Dr. Lawrence Tabak:
That is certainly one model that people at least are thinking about out loud. Of course if you combine that with tremendous advantages in telemedicine, or in this case teledentistry, you could at least envision a circumstance where a mid-level provider doing biological-based intervention under this provision of coordination of a dentist via teledentistry for example, potentially would be a model that would be very effective.
Interviewer:
Do you see opportunities for organized dentistry to lead our professions to greater heights?
Dr. Lawrence Tabak:
Oh my, indeed. Dentistry has so very, very much to be proud of, and I think that we can continue to build on the enormous success that the profession enjoys. I think our physician colleagues are envious of the profession in terms of, for example, prevention. Dentists had that figured out way before many of our physician colleagues did. We have so much to be proud of, so I would hope that organized dentistry takes leadership in preparing, not only the emerging generation of practitioners but those who are already out and practice some of these newer research developments that I think will have a profound impact, and embrace technology in ways that allow us to provide more care to the subset of people who currently, for a variety of different reasons, have difficulty accessing it.
Interviewer:
You would say that the care for the underserved should be one of our priorities and we should be showing leadership there?
Dr. Lawrence Tabak:
I certainly believe that organized dentistry has been doing this but certainly I think more can be done. It is our hope that research advances will help inform new and creative ways of being able to do this in a very efficient way.
Interviewer:
In the macroclimate, could you see any surprise developments?
Dr. Lawrence Tabak:
The thing that I worry about is that we really give up our place at the table. Right now the practice of dentistry is a very lucrative thing, and I think there are some who would prefer that we not get involved in things like using salivary diagnostics and so forth. If we give up our place at the table and become enamored with things like aesthetic dentistry and things of this nature, I fear that we could go the way of eye care, at least in the United States. As you know, in the United States there are ophthalmologists who are physicians; There are optometrists who are sort of the middle level providers; and then there are opticians who dispense what eyeglass frame looks well on you. We want to be the ophthalmologists of the mouth. We want to remain as part of medicine. I am concerned that in some ways we are becoming more like optometrists, and I never, ever, ever want to see us become like opticians. So that’s the thing that I really worry about.
Interviewer:
Larry, thank you very much for this interview.
Dr. Lawrence Tabak:
My great pleasure.