FOR RELEASE:
Tuesday, June 24, 2008
CONTACT:
Bob Kuska, (301) 594-7560
kuskar@nidcr.nih.gov
Sixty years ago today, President Harry Truman signed into law a bill that most Americans probably are unfamiliar with but which continues to have a profound effect on our everyday lives.
The law is the National Dental Research Act of 1948. It established what is now known as the National Institute of Dental and Craniofacial Research (NIDCR) as the third of the National Institutes of Health and set in motion one of the most ambitious - and successful – American public health pushes of the last century.
The expanded research produced community water fluoridation and the fluoride-containing products that now reside in virtually all American households. Because of this NIDCR research and continued progress in dental care, more Americans than ever enjoy a lifetime of good oral health.
President Truman’s signature also allowed NIDCR to begin a broader scientific quest to explore the biology of the mouth, jaw, and cranium for clues to prevent and treat disease. Today, NIDCR stands on the threshold of major scientific advances that could be as revolutionary as fluoride and preventive dentistry were sixty years ago.
“Congratulations, NIDCR, on sixty years well done,” said NIH director Elias Zerhouni, M.D. “The institute has much to celebrate for the betterment of American public health.”
Turning Back the Clock
December 7, 1941. Pearl Harbour. A day which will live in infamy. In the months that followed, tens of thousands of young Americans passed through military recruitment centers en route to boot camp and a special place in history.
But as the physical examiners soon reported up the chain of command, they had to reject about one in every 10 recruits for dental reasons. These young men and women lacked the six opposing teeth mandated for military service.
The examiners also reported that the military spent a great deal of time and money repairing the badly decayed and failing teeth of recruits who passed their physicals. So bad would the situation become, the armed forces later enlisted 20,000 dentists- or more than a quarter of the nation’s practicing civilian dentists- and sent them overseas to treat soldiers for all variety of dental problems.
When World War II ended, many dentists, military officers, political leaders, and others vowed to solve the Nation’s rampant dental problems. On June 24, 1948, President Harry Truman signed the National Dental Research Act “to improve the dental health of the people of the United States.” Leading the research effort would be the newly established National Institute of Dental Research, (NIDR), known today by the acronym NIDCR.
By 1954, the NIDR had laid the foundation for a new era of preventive dentistry. Following up on earlier observations that low levels of water-borne fluoride might protect against tooth decay, the NIDR scientifically validated this observation in a multi-year study of 30,000 school children in Grand Rapids, Michigan.
“The results of water fluoridation studies enable us to predict that the over-all reduction in dental caries in the general population can be as much as 65 percent,” wrote Dr. Francis A. Arnold, Jr., the institute director at the time.
Arnold’s prediction has largely come true. According to the most recent figures from the National Health and Nutrition Survey (NHANES), 41 percent of American children had one or more decayed teeth in 2002. In 1954, roughly 98 percent of American children had at least one decayed tooth, and most had rampant decay and tooth loss.
Looking to the Future
When the NIDR was established in 1948, dental research was poorly funded and thus attracted relatively few scientists. But the potential benefits of dental research were clear to many dentists. “American dentistry may be said to occupy an unchallenged position of world leadership,” stated Dr. H. Trendley Dean, the institute’s founding director. “Much of the preeminence, however, is due to the high level of clinical practice and technological development and too little of it is due to proficiency in research into fundamental aspects of diseases of the mouth.”
Dean and the other early NIDR directors carved out the first national programs to develop this research proficiency. As a philosophical cornerstone of NIDR supported research, Dean emphasized, “We can’t divorce the mouth from the rest of the body.” Dean explained that human biology represents a continuum from head to toe. Discoveries in the mouth and surrounding face and cranium are highly exportable to understanding disease elsewhere in the body.
Today, many scientists say this fundamental philosophy has placed oral and craniofacial research on the threshold of unprecedented advances that were well beyond the reach of Dean and his contemporaries just three generations ago. “Scientists today have assembled an array of powerful research tools that are allowing them to develop more quantitative models of craniofacial development,” said NIDCR director Dr. Lawrence Tabak. “Why is this so exciting? By understanding the molecular and physical processes at work to form the human head and face, scientists also can glean more detailed developmental models of the sub systems therein, from a salivary gland in the mouth to the frontal bone in the skull.”
Tabak said that by knowing how bones, cartilage, and soft tissues assemble to produce the unique composite structure that is the human head, researchers can take better aim at the causes of disease. “Rather than saturate an inflamed tissue with a non-specific drug and its exhausting list of potential side effects, we’re seeking to pinpoint care,” said Tabak. “As these targeted diagnostic tests and therapies come online in the coming years, they will transform medicine and dentistry.”
Among the many promising areas of study that are now unfolding are:
- Salivary diagnostics - using saliva to diagnose oral and general disease;
- Oral biofilm - defining in comprehensive detail the microbial community that forms on our teeth and targeting the bacterial dynamics to prevent oral disease;
- Oral cancer – validating various molecular and optical tools to diagnose oral cancer earlier and thereafter learning to characterize the precise disease-causing changes to improve treatment;
- Orofacial pain – mapping the multiple pathways of pain, with their various feedback loops, processing points, and underlying genetic components, is rapidly becoming more realistic and promises to benefit many;
- Tissue engineering – merging the principles of biology, chemistry, and engineering to reproducibly replace damaged bone and enamel;
- Inflammation – designing new and complementary approaches to control the immune response before it causes chronic disease;
- Imaging - improved optics will enable practitioners to detect the initial signs of demineralization, or early decay, in the mouth and ultimately characterize those that will likely progress and need to be remineralized.
“We owe a great debt of gratitude to Dr. Dean and the other former NIDCR directors for collectively guiding the institute to this critical point in its research mission,” said Tabak. “Our past successes also remind us that the benefits of research can be slow to reach all Americans. On its 60th anniversary, NIDCR remains committed to uncovering new knowledge and finding novel new ways to improve the oral health of all Americans.”