Addressing Multiple Complex Diseases
The mouth is a complex and unique environment. It contains exquisitely sensitive tissues that are used for taste, chewing, swallowing, 
speech, facial expression and fighting off diseases. It has one of the highest concentrations of sensory and motor nerves in the body, four different types of calcified tissue, and contains nearly 500 species of microbes (only about half of which have been cultivated thus far) that maintain a delicate balance between health and disease. Not surprisingly, there are a multitude of diseases and conditions that affect the oral cavity and related dental and craniofacial structures, including the teeth, soft tissues, salivary glands, the temporomandibular joint, jaws, and facial bones, muscles and nerves. Our challenges extend from the continued struggle against two of the most common infectious diseases –dental caries and periodontal diseases – to eliminating life-threatening oral and pharyngeal malignancies, craniofacial birth defects and developmental disorders, acute and chronic orofacial pain and other conditions that compromise oral health. We must not only understand the factors that increase the risk for and contribute to oral diseases, but also find the causes of oral diseases, seek new ways to improve quality of life for persons who suffer from them, and at the same time be prepared to face the unforeseen challenges that lie ahead.
Attracting Researchers with Required Competencies
With the remarkable advances in science and technology have come increased responsibilities to assure an adequate and diverse supply of highly competent investigators in the years to come. A variety of flexible and innovative research training and career development programs are needed to recruit and retain researchers with the right mix of skills. Specifically, future researchers will need to be familiar with a broad range of scientific areas, manage complex studies, and learn to create and work successfully in teams and with individuals from new disciplines. Specific competencies that will be required include knowledge of cellular and molecular biology, human genetics, human nutrition, structural biology, molecular epidemiology, bioengineering, computational biology, behavioral and social sciences, and informatics among others. In addition, there is a critical need for researchers who are rigorously trained in the design and conduct of clinical trials and clinical research. Research aimed at eliminating oral health disparities will require investigators who can integrate knowledge from diverse fields and perspectives including biology, behavioral research, psychology, sociology, health economics, and health services research. The 1997 NIDCR Blue Ribbon Panel on Research Training and Career Development 
(56KB) emphasized the need to diversify the NIDCR research and training portfolio, expand the mix of disciplines in oral, dental and craniofacial research and adopt new strategies to promote diversity in the scientific workforce. Many challenges remain ahead to realize the full potential of the scientific opportunities that are unfolding before us today.
Adopting and Applying New Technologies
Against the backdrop of the extraordinary developments in biomedical science, there is a pressing need to ensure that tools emanating from new technologies are adopted and used. This is no easy task. It has been estimated that on average, it takes approximately 20 years for a new technology to be fully adopted and implemented into the health care system. Efforts will have to be devoted to increasing the awareness of NIDCR research results among providers, policy makers and the public and to enhance the Institute’s capacity to translate research results into practice. Promoting technology transfer as well as the integration of oral health-related research findings into both the undergraduate and postgraduate curricula in academic health science centers will be important to ensure that the clinicians, researchers and educators of the future can fully apply science to benefit the public.
Closing the Knowledge Gap
Many oral diseases and conditions can be prevented and controlled; yet significant gaps exist in the public’s oral health knowledge, attitudes and behaviors. For instance, only 62 percent of U.S. adults recognize that the primary purpose of water fluoridation is to prevent dental caries; fewer than one-quarter of U.S. adults know that dental sealants prevent dental decay. Overall, U.S. adults are ill informed about signs and symptoms and risk factors for oral cancers — only 25 percent of adults can identify even one sign of this disease. The dental knowledge gap, while greater among individuals with lower educational attainment, also exists among racial and ethnic groups and is as prevalent among persons who make frequent dental/medical visits as it is among those who do not. Ensuring that target audiences become informed, make appropriate decisions about their health, and adopt behaviors that will improve their oral health, requires further advancement of our tools to communicate with audiences effectively. We also must enhance the public’s access to and use of the most current science-based health information.
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