Mr. Chairman and Members of the Committee:
I
am pleased to present the President’s budget request for the National
Institute of Dental and Craniofacial Research (NIDCR) for Fiscal Year
(FY) 2006. The FY 2006 budget includes
$393,269,000, an increase of $1,440,000 over the FY 2005 level of
$391,829,000 comparable for transfers proposed in the President’s
Request.
THE ROAD AHEAD: MERGING SCIENTIFIC VISION AND TECHNOLOGY DEVELOPMENT
Many
of the opportunities that now face our nation’s oral health researchers
have never been more exciting or scientifically challenging. For
the first time, we can envision a day when early stage tooth decay will
be reversible with remineralizing solutions that patch the tooth and
halt the disease process before a filling is required. Researchers
will soon begin to learn how to engineer teeth and their constituent
parts in the laboratory and transplant them into the mouth to replace a
missing tooth or damaged tissue. The day also is
approaching when saliva will be a reliable diagnostic fluid to detect
systemic diseases, providing a rapid, non-invasive alternative to
blood-based tests. These are but a few of the many opportunities that await us. And
yet, as important as these visions of the future are in setting the
course toward improved public health, it is abundantly clear that the
road ahead will be blocked unless we develop new tools and technologies
for working within the complex microenvironments of the human body. It
is this merging of scientific vision with technology development that
the NIDCR is fostering within our nation’s oral research community and
which I would like to highlight.
EARLY DIAGNOSIS TO PREVENT DENTAL CARIES
Let me begin with one of the examples just mentioned. Despite
dramatic reductions in tooth decay in the United States over the last
half century, dental caries remains a significant public health
problem, particularly among disadvantaged population groups. Dental decay also is an unexpected impediment to timely deployment of military personnel. At
a time when our nation remains at war, dental readiness has been cited
in testimony by the Reserve Officers Association as the number one
deployment problem for National Guard and Reserve members. In
a 2002 Department of Defense study, 34 percent of military personnel
required dental care before they could be deployed, compared to only 16
percent in 1998.
The
NIDCR will soon launch an initiative to evaluate the ability of
emerging technologies to accurately and reproducibly measure extremely
subtle changes in dental enamel that signal the earliest phases of
dental caries. While this initiative may sound highly technical, its outcome could play an essential role in transforming dental care. Treatments
with the potential to remineralize tooth surfaces in the very earliest
stages of decay, long before a filling is needed, are emerging. In
anticipation of the required clinical trials to rigorously evaluate
these treatments, NIDCR will soon launch an initiative to ensure that
microscopic changes in a tooth’s mineral content can be measured
accurately and reproducibly. Through this
enabling research, the evaluation of these treatments will be firmly
grounded in science, ensuring the greatest possible benefit to the
public.
BIOENGINEERING: BUILDING A TOOTH
Tooth loss has been a public health problem in the United States since the days of George Washington and Thomas Jefferson. Despite
revolutionary advances in oral health over the last half century, tooth
loss remains a problem, particularly among disadvantaged groups. In addition, tooth agenesis - the lack of one or more permanent teeth - is the most common congenital malformation in humans. While
dental implants or dentures are often effective replacements, science
has progressed to the point that it may be possible to generate
replacement teeth from scratch, which would mark a truly historic
advance in oral healthcare and in our understanding of human biology.
Whereas just a few years ago tooth regeneration was far beyond the reach of science, which is no longer the case. An
historic opportunity now awaits dental science to learn to seed and
reproducibly control the complex, tightly orchestrated cellular and
molecular interactions involved in producing a tooth and its supporting
structures. The crucial first steps will be to: identify
existing gaps in our knowledge of tooth formation; pursue viable
solutions from throughout the biological and physical sciences to
bridge these gaps; and, based on these comprehensive analyses,
formulate blueprints for a complete tooth. Relying
on the best of these blueprints, interdisciplinary teams of scientists
will begin the process of engineering replacement teeth. It
is likely that these investigations will initially yield viable
replacement parts, such as enamel, dentin or periodontal ligament, but
the ultimate goal is complete tooth regeneration.
LAB ON A CHIP: SALIVARY DIAGNOSTICS
Another particularly exciting area of research is salivary diagnostics. 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 molecular substances that are frequently measured
in standard blood tests to monitor health and disease. Saliva is easy to collect and poses none of the risks, fears, or “invasiveness” of blood tests. The problem has been that the needed technologies have not existed to adequately develop salivary diagnostics on a large scale.
The
Institute continues to support a major research effort that will
further develop these needed technologies and create the first
comprehensive baseline catalogue of all proteins found normally in oral
fluids. This is the initial step in building the needed scientific infrastructure required to expand salivary diagnostics. Already, scientists have begun to evaluate which of the myriad gene products in saliva correlate with various disease processes.
The
NIDCR envisions that this basic research could one day translate into
miniature, hi-tech tests, or so-called “labs” on a silicon chip, which
rapidly scan oral fluids for the presence or absence of multiple
proteins linked to various systemic diseases and conditions. Given
the ease of sample collection and the breadth of protein markers that
could be arrayed on the silicon chip, salivary tests have the potential
to revolutionize how diseases are diagnosed. Physicians and dentists would continue to diagnose diseases. But
they would be in the position for the first time to monitor a patient’s
health, producing a comprehensive molecular printout of that
individual’s health status that can be assessed over time.
Salivary diagnostics will have benefits far beyond medicine and dentistry as well. Law
enforcement agencies could employ saliva tests in the field to
determine rapidly whether a person is intoxicated or has recently used
illegal drugs. These tests may also be
beneficial in determining exposures to environmental, occupational, and
biological substances, such as anthrax.
ORAL CANCER: EARLY DETECTION IS KEY TO SAVING LIVES
The field of salivary diagnostics recently yielded exciting early findings related to oral cancer detection. According
to the American Cancer Society and the Centers for Disease Control and
Prevention, oral cancer is the seventh most common cancer among U.S.
males and ranks fourth among African American men. Unfortunately, survival rates have not improved significantly in decades. A patient’s chance of survival is improved significantly with early detection and treatment. A
team of NIDCR-supported scientists at the University of California at
Los Angeles recently reported that they could measure elevated levels
of four distinct cancer-associated molecules in saliva and distinguish
within 91 percent accuracy between healthy people and those diagnosed
with oral squamous cell carcinoma. This
“proof-of-principle” study marks the first report in the scientific
literature that distinct patterns of “messenger RNA” are not only
measurable in saliva, but can indicate a developing tumor. These
initial results highlight the potential clinical value of saliva and
hold out exciting possibilities for development of commercially
available tests capable of delivering early, reliable, non-invasive
detection of developing tumors.
PAIN: TRANSLATING TARGETS INTO TREATMENTS
Sizeable gaps exist in our understanding of some of the most basic cells involved in the pain process. Prime examples are the glial cells. For
decades, scientists assumed that glial cells primarily played a
supportive role in the central nervous system and had no direct
influence on the transmission of sensory signals to the brain. But,
as more powerful analytical molecular tools have emerged in recent
years, scientists now realize that glial cells play a far more
important role in pain than was previously appreciated. With
this new awareness, it becomes imperative to better define the biology
of these cells and their roles in regulating certain aspects of nervous
system function.
The
NIDCR will launch an initiative that will stimulate needed research
into the basic biology of glial cells and their interactions with
neurons in causing orofacial pain disorders, such as temporomandibular
joint disorders. The initiative will encourage
multidisciplinary studies in a variety of areas to define more broadly
than ever important aspects of the pain process. Based
on this broad investigative approach, key aspects of the pain process
will be more clearly defined, pointing the way to unique and highly
specific molecular targets for drug development. Without
identifying these additional targets, it will be impossible to ever
adequately control or treat pain, particularly among the estimated 10
percent of Americans who suffer from chronic pain.
NIH ROADMAP
The
NIH Roadmap themes are synergistic with NIDCR research initiatives and
provide added impetus to the efforts of oral health researchers. For example, the theme Re-engineering the Clinical Research Enterprise is particularly relevant to the development of NIDCR-sponsored dental Practice Based Research Networks. Similarly, the goals of the initiative Building Blocks, Biological Pathways and Networks are closely linked to NIDCR’s own bioengineering initiative, “Building a Tooth.” Research Teams of the Future
provides an opportunity to further integrate dentists into the new
clinical research structure, and highlights NIDCR’s longstanding
efforts to encourage multi- and interdisciplinary approaches to
research questions.
With
the above-mentioned examples and other research progress, such as in
salivary gene transfer, defining the oral biofilm, and the molecular
targeting of oral cancer, NIDCR has never faced more exciting
opportunities. By merging our vision of the
future with technology development, the road ahead will lead this
nation to a new generation of progress and improved oral health.
Thank you, Mr. Chairman. I would be pleased to answer any questions that the Committee may have.