In 1997 the National Institute of Dental and Craniofacial Research (NIDCR) unveiled its Strategic Plan, Shaping the Future. The driving forces behind our initial plan and this updated version remain the same – to adopt needed change, to identify and prioritize new opportunities for research, and to respond to the needs of the people we serve. In the same way that we initiated Shaping the Future, we embarked on updating the Strategic Plan mindful of the remarkable pace of continuing biological discoveries, and aware that we must do all we can to keep up the momentum, encourage young people in the pursuit of science, transform health professional education, and ensure that oral health research can benefit all people.
Our commitment to respond to the changing needs of the public is evident when we consider how the NIDCR has evolved. Created in 1948 as the third component of the NIH, the NIDCR was first named the National Institute of Dental Research. The driving force that launched the new Institute was concern over the nation’s military readiness; far too many otherwise healthy young recruits were rejected for service during War World II because they lacked six opposing teeth. More than 50 years later, tooth loss of this magnitude is rare among young people in the U.S. and remarkably lower overall. Yet much work remains to be done to eliminate oral diseases that keep people from being fully healthy. Today the pressing needs include understanding the complex genetic, environmental, nutritional, and behavioral factors that result in oral diseases and conditions; addressing the persistent disparities in health status; and carrying out the health promotion and outreach efforts needed to improve health.
This Strategic Plan addresses the myriad diseases and conditions that affect the oral cavity and craniofacial structures by outlining a course for the Institute to follow in the areas of research, research training, and communication of research results.
Recognizing the need to focus our efforts in areas that offer extraordinary scientific promise, the goals and objectives of this plan are centered on:
- Advances from clinical and population-based research that are identifying risk factors and markers for the progression of disease and are stimulating new preventive, diagnostic, and treatment approaches to oral, dental and craniofacial diseases and disorders;
- New knowledge from the Human Genome Project that is leading to novel ways to prevent, diagnose, and manage oral, dental, and craniofacial diseases and conditions;
- Revolutionary advances in cell and molecular biology and in bioengineering that are enabling the growth, repair and regeneration of tissues damaged by disease, injury or malformations; and
- New knowledge from health communications research that is being used to promote healthy behaviors, improve oral health literacy and enhance the adoption of research into practice.
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These and other emerging research advances are changing how oral health research is conducted. More than ever, research is not defined or confined by the boundaries of a single scientific area but is increasingly characterized by an eclectic mix of disciplines. Computer scientists, mathematicians and biologists together have formed the new discipline of bioinformatics – the use of mathematics, statistics and computing to model biological processes and ultimately solve biological problems. Biologists, engineers and clinicians are working together to fabricate living parts for the body from cells in the laboratory, creating the new field of tissue engineering. Protein biochemists have teamed with engineers to create “labs on a chip,” small enough to begin to pursue simultaneous monitoring of multiple substances in real time. The interplay among environmental, behavioral, nutritional, and genetic factors that underlie human health and disease has led to the creation of unique multi- and inter-disciplinary research teams. Recognizing this crucial need to ensure a diverse and adequately trained research workforce, the plan sets forth an aggressive agenda to enhance multidisciplinary career training and development.
As research progress increases, so does our responsibility to ensure that scientific knowledge is communicated clearly and effectively to all who need it. Thus, NIDCR recognizes the need to increase efforts to translate research findings into tangible results that will improve clinical care and to communicate science-based information to health professionals, professional organizations, and the public.
Improving the nation’s oral health is an ambitious goal, and NIDCR recognizes the importance of partnerships in achieving that goal. We also 
recognize the need to bring new partners to the oral health research enterprise from the broader scientific community, academia, the health professions, health voluntary organizations, industry and government. The creation of multidisciplinary research teams will require that we recruit new scientific disciplines to the field. Expanding the opportunities for research training and career development will require that we work closely with medical, graduate, public health and engineering schools as well as dental schools and dental and medical professional organizations. Enhancing our partnerships with both public and private sector organizations is equally important to realize our goal of promoting the timely transfer of knowledge and its implications for health to all audiences.
Our mission has remained the same since the day the Institute was created 55 years ago. We’ve come a long way, in terms of both scientific advances and improvements in the Nation’s oral health. To achieve our ultimate goal, we must take advantage of new scientific knowledge and tools, strengthen and expand partnerships, ensure that research advances are translated into useful technologies, and above all make sure that our scientific efforts benefit people.
Employing Powerful Tools
The completion of the draft of the human genome sequence in 2001 was heralded as one of the most important scientific milestones of all time. Understanding how the 40,000 or so human genes function and how they interact with one another is a major challenge to be overcome to translate genetic knowledge into improved health. Ultimately, it is not only the genes that must be understood, but how they instruct cells to produce proteins, how and where these proteins function normally and interact with one another, and how faulty proteins or protein complexes can lead to disease. To date, the genome sequences of numerous oral microbes are being deciphered, and major ones implicated in caries and periodontal diseases have been completed. But how is genomics — the analysis of the entire genetic makeup of a species — adding to our understanding of oral diseases? How is proteomics, or the study of the tens of thousands of proteins expressed by a cell type, changing oral health research? And how will the availability of genetic information and powerful technologies to analyze it change the way dentistry is practiced and help to improve the public’s oral health?
Using genomic and proteomic approaches, researchers are unraveling the mysteries of how oral bacterial cells attach to a surface and become established in a “biofilm,” which oral health researchers and practitioners know as dental plaque. Such knowledge provides a brand new set of tactics for disease prevention. We can envision dental health professionals in the near future using a therapeutic substance to block or weaken the function of cell enzymes that enable caries-causing bacteria to anchor to enamel and form biofilm. Alternatively, they might apply products to render certain oral bacteria harmless by lessening their virulence, or they may give their patients products that short circuit communication among bacteria and host cells. Proteomic discovery of the patterns of salivary expression will lead to early identification of individuals most at risk of oral diseases as well as systemic conditions and diseases. These potential tools would not be possible without the knowledge gained from sequencing of human and oral microbial genomes, and from proteomic studies that reveal how changes in human and microbial protein expression contribute to normal and abnormal function.
In the struggle against oral and pharyngeal cancer, we can foresee a new way of diagnosing and treating disease by using molecular techniques to help identify which lesions are likely to undergo malignant conversion. Earlier detection might be afforded by finding a “signature” pattern of substances in oral fluids — ranging from alterations in salivary proteins to abnormalities detected in the DNA of pre-cancerous cheek cells. Before long, surgeons could be using molecular markers to identify genetically abnormal cells at the margin of a tumor whose removal would reduce the chance of its recurrence. Using molecular information, clinicians may be able to tailor a patient’s treatment to deal with the specific molecular defects that caused the malignancy.
Chronic pain is a common feature of temporomandibular muscle and joint disorders (TMJDs). Functional deficits and joint degeneration are also characteristic of TMJDs. Genomic approaches will offer valuable insights to understand why some individuals are more susceptible to TMJDs than others and to explain the wide variations in sensitivity to pain and responses to analgesic drugs used to treat chronic pain. Proteomic approaches will have a role in predicting risk, diagnosing TMJDs, and understanding how individuals process painful stimuli. These powerful tools will be useful in uncovering the reasons for the predominance of these disorders among women of childbearing age.
A genetic test to predict a person’s response to a particular drug — a far-fetched idea less than a decade ago — is now being used to 
identify patients who metabolize certain drugs poorly. This emerging field of pharmacogenetics offers great promise for improving drug effectiveness, preventing severe adverse drug reactions, and improving patient compliance. Pharmacogenetics will also benefit dental research. Genetic screening may improve drug development and testing by identifying and eliminating the number of participants in clinical trials who will not respond to, or may be harmed by a new drug being tested, thereby making clinical trials smaller, faster and less costly.
Genomics and proteomics are powerful tools that will revolutionize the practice of dentistry and the public's perception of oral health care. We can now anticipate a day when no patient will experience pain, loss of function, or disfigurement from late-stage oral diseases. Instead, they will be treated by oral health professionals who use drugs instead of drills, regenerate damaged oral and craniofacial tissues, identify problems before they manifest clinically, and stop or reverse disease instead of practicing damage control.
Benefiting from Our Investments
The NIDCR is uniquely positioned to remain a key player in genomics, proteomics, and the growing field of tissue engineering. For more than four decades, dental researchers have studied the basic biological, chemical, and molecular structure of bone and have worked to identify proteins that stimulate bone growth and repair. The NIDCR was a pioneer in the study of the chemical properties and molecular structure of collagen, which is an integral part of bones, teeth, and the periodontium — the connective tissues surrounding the teeth. The Institute’s world-class research program in matrix and developmental biology has led to a basic understanding of how cells organize to form the hard and soft tissues of the craniofacial complex. This basic knowledge is pivotal to the new discipline of bioengineering because it provides the key three elements needed for its success: a) the scaffold or matrices on which to grow tissues such as collagen or bone mineral; b) the cells to form cartilage, collagen, or bone; and c) the biologic molecules (e.g. growth factors from bone matrix) that signal the cells to differentiate into specific tissue types.
The orofacial tissues pose particularly interesting challenges to 
tissue engineering research because of their complex nerve supply, finely-tuned muscle function, unique organs, multiple cell types that must be integrated with one another, and the ubiquitous presence of millions of microorganisms that influence tissue response. Information emerging from the human genome project, advances in our understanding of cell adhesion, and the availability of human adult and embryonic stem cells provide a wealth of potential approaches to designing bioinspired materials that can be used to engineer tissues (biomimetics). Researchers have discovered that third molars, which are often extracted and discarded, contain adult stem cells that when cultured and expanded are capable of producing dentin in animal models. This and other approaches to regenerate dentin and other dental tissues may transform the way endodontic, or root canal therapy is performed.
Tissue engineering research has enormous potential to change clinical practice in other ways too. Someday it may be possible to use biomimetics to repair periodontal tissues, fill in bony defects caused by disease, craniofacial disorders or injuries, and regenerate muscle, nerves and salivary glands. Using remarkable biomimetic approaches, scientists are developing the first artificial salivary gland, a giant scientific leap that would benefit millions of Americans with salivary gland disease or dysfunction.
Contributing to Other Disciplines
Unlike the internal organs of the body, the structures of the mouth are readily visible and accessible. This unique feature has allowed using the oral cavity as a model to understand systems or diseases that occur elsewhere in the body. Only recently have scientists begun to appreciate the potential of the oral cavity to be used as a “real time” laboratory using the tools emerging from molecular and cell biology. Viewed from this perspective, it will be possible in the not-so-distant future to test, observe, measure, and understand complex processes that affect the entire human body by examining the cells, proteins, and molecules from tissues and fluids in the mouth.
Scientists have long recognized that our saliva serves as a “mirror” 
of the body’s health in that it contains the full repertoire of proteins, hormones, antibodies, and other substances that are frequently measured in standard blood tests. The Institute’s work currently includes a major research effort to identify and address major cross-cutting biomedical challenges, and will further develop needed technologies and create the first comprehensive baseline catalogue of all proteins found in oral fluids of healthy individuals. The NIDCR envisions that this basic research could one day translate into miniature, hi-tech tests, or so called "labs" on a silicon chip, that rapidly scan oral fluid for the presence or absence of multiple proteins linked to various systemic diseases and conditions. Ultimately, this approach could be used for real-time health surveillance — rapidly identifying persons most at risk at the earliest moments of detectable change in key diagnostic markers.
Oral health researchers have taken advantage of the easy access to oral tissues to make significant contributions to other scientific areas as well, such as immunology, neurobiology, and pain research. The NIDCR’s seminal work in microbiology and immunology opened new insights into the nature of the inflammatory process and defined cytokines — hormone-like factors — that participate in the body’s inflammatory and immune responses. Institute studies added to the knowledge about many conditions including Sjögren’s syndrome, cleft lip and palate, ectodermal dysplasia, cancer, chronic pain and other neurological disorders, and many infectious diseases including candidiasis, herpes, hepatitis, human papillomavirus infection and acquired immune deficiency syndrome (AIDS).
The Institute’s research efforts have not only improved the oral health of the nation, but also contributed important knowledge to understand and control systemic diseases. We remain committed to supporting research that has far-reaching implications for improving the health and well-being of people today as well as in the years to come.
Sustaining our Uniqueness
To achieve our vision of advancing the oral health of all people, we must strike a fine balance between attracting researchers from other related disciplines, and maintaining a critical number of investigators with intimate knowledge of the uniqueness of the orofacial structures and the diseases that affect them. The NIDCR has a rich tradition of working across diverse fields of basic science. These inter-disciplinary collaborations have resulted not only in generating new knowledge, but also in improving clinical care. Further improvements in the oral health of individuals and communities will require a strengthened link among basic, translational and clinical research1. Clinical research has been described as “the ‘neck of the scientific bottle’ through which all scientific developments in biomedicine must flow before they can be of real-world benefit to the public.”2 Thus, enhancing the clinical research infrastructure, expanding the capacity and skills of future clinical researchers, and maintaining their link with basic researchers are critical to sustain and exceed the achievements of more than 50-years of public investment in oral health research.
Findings from oral health research have led to the development of many successful approaches to prevent, diagnose, and manage oral, dental and craniofacial diseases. Indeed, NIDCR-supported research has led to the widespread adoption of water fluoridation and other measures to prevent tooth decay. These preventive efforts are estimated to have saved nearly $40 billion from 1979 to 1989, and continue to save money and improve the quality of life for millions of Americans3. Combining the tools of molecular and cellular biology, bioimaging, genetics, genomics, proteomics, engineering, epidemiology, social, behavioral science and clinical research will bring immense benefit to the millions of people affected by oral, dental and craniofacial diseases.
1Clinical research is defined in this document consistent with the NIH “Nathan Report” to include patient-oriented research, epidemiological and behavioral studies, and outcomes research and health services research.
2Association of American Medical Colleges; American Medical Association. Breaking the scientific bottleneck: report of the Graylyn consensus development conference. Washington, DC: AAMC, 1990.
3Brown LJ et al. Public Health Reports, 1994, Vol 109 No 2 195-203.
