Basic dental science often helps ease health disparities, a panel of leading oral health experts said at the first town hall meeting of the Friends of the National Institute of Dental and Craniofacial Research (FNIDCR), held at the University of Maryland Dental School on April 25.
The event "Bringing Oral Health Research Home" featured speaker Isabel Garcia, DDS, MPH, acting director of the National Institute of Dental and Craniofacial Research (NIDCR).
"For the majority of the infectious dental diseases, we know how to prevent them," Garcia said. "We know their cost to health. Now, affecting behavior change, to enable people to do the right thing, is needed to get people healthier."
Jay A. Perman, MD, president of the University of Maryland in Baltimore and a practicing pediatric gastroenterologist, said, "Those of us who are engaged in health care are deeply troubled, and may I say, embarrassed, by the inequities and inequalities that are based on background, on gender, on race, and on social status."
According to the National Institutes of Health, disparities according to patients' race, ethnicity, gender, income, and disability exist regarding how frequently the patients get sick and how often the disease causes death.
Christian S. Stohler, DMD, DrMedDent, dean of the Dental School, introduced three faculty scientists from the School who illustrated how their current laboratory research is positioned to help reduce health disparities. Huakun Xu, PhD, MS, professor and director of the Biomaterials and Tissue Engineering Division, talked about the use of nanotechnology compounds to prevent cavities; Ronald Dubner, PhD, DDS, professor, addressed new understanding of persistent head and jaw pain; and Mary Ann Rizk, PhD, assistant professor, spoke about microbial "biofilms" in the oral cavity.
"This isn't esoteric basic microbiology," Garcia said after the meeting, "Just like Dr. Rizk explained, we are beginning to understand all the bugs in the oral community, the microbiom as we call it, and the interaction with one another."
Garcia said NIDCR funds research to create new tools and approaches to improve health. An NIDCR-funded team, she said, recently used molecular biology to implicate for the first time a bacterium, Scardovia wiggsiae, in severe cases of early childhood caries.
"That is an example of a tangible finding that might provide avenues for better identification of problems," she said. "We knew it was in the oral cavity but it was never implicated as a pathogen. The reason we were able to identify it is that we have better tools and better technology to identify [pathogens]."
Another example of research impacting patients quickly, Garcia said, is NIDCR-funded research in California demonstrating that it is "highly efficacious to use fluoride varnish once or twice yearly on very young children." The study is credited with changing the reimbursement for physicians to apply fluoride varnish in "many, many states across the country."
NIDCR is the largest public funder of oral health research.
"We are playing a pivotal role in providing knowledge that improves clinical care," Garcia said. "NIDCR takes those questions that are most important and pivotal for dental practitioners in their everyday encounters with patients and brings them together to work as part of a dental practice research network, where the questions are often generated by the dentists themselves."
The network includes 700 practices across the nation and more than 30 studies representing more than 30,000 patients.
"There is a particular kind of power in this kind of research which is engaging from the bottom up," Garcia said, "and often where those answers cannot be found in the traditional ways in which we conduct research in academic health centers. We put the research into the environment where it is real and provide answers to important questions in the practicing community."
Garcia said the University of Maryland Dental School is "a fabulous example of a dental institution that draws strength by spanning many areas of research." She continued, "The research we heard about this afternoon provides examples of the breadth of the kinds of problems in research that we have to undertake to take care of oral problems."
The Dental School is ranked third among all U.S. dental schools in terms of NIH support.
Oral health leaders at the town hall also discussed ideas to promote dentists as primary care givers. "In our own minds, dental care is primary care," said moderator Dushanka Kleinman, DDS, MScD, associate dean for research and academic affairs, School of Public Health, University of Maryland, College Park.
Unlike many physicians who are affiliated with hospitals and large clinics, most dentists have fully independent practices. Kleinman said, however, that dentists are "extensions of hospitals," similar to ambulatory surgery centers. "This is one of the issues regarded as a hot button issue," she said.