116 FUTURE OFDENTISTRY

Dental and Craniofacial

Research

CHAPTER

7

Research is the process by which new information is obtained and existing tenets are modified. Research involves

experimentation and observation, and through this mechanism information is converted to practical application.

Research has enabled advances in diagnosis, disease treatment and management and in the prevention of

oral diseases and conditions. Through research, the preventive effects of fluoride for dental caries and spe-

cific risk factors for periodontal disease were identified. These findings led to improved interventions and a

reduction in the oral disease burden. Ongoing and future research concerning the fundamental mechanisms

of oral disease will continue to drive change in dental practice.

Through epidemiological and behavioral research, the dental profession has made advances in understanding the

causes and progression of dental disease. Epidemiological research, through national surveys of oral health such as

the National Health and Nutrition Examination Survey, has been invaluable in improving the understanding of the

extent, distribution, and determinants of most dental diseases and their relationships to general health.

Epidemiological research demonstrates that underserved populations shoulder a disproportionate burden

of disease. For example, the death rate from oral cancer for African American males is double that for White

males despite only a 20% higher incidence rate of oral cancer among African Americans. This disparity

reflects the fact that African Americans have more advanced disease at the time of diagnosis and initiation

of treatment. Additional epidemiological research is needed to characterize disease patterns in specific pop-

ulation groups, to understand why diagnoses are not made earlier, to develop new strategies for reaching

people who are at risk for oral diseases, and to evaluate treatment outcomes.

Research has shown that behaviors that are under the direct control of the individual can influence the develop-

ment of many dental conditions. Examples include the relationship between sucrose consumption and caries, poor

oral hygiene and periodontal diseases, and smoking and oral cancer. More behavioral research is needed to design

effective interventions to deter individuals from harmful personal habits and to promote preventive behaviors.

The transfer of research-based knowledge and technology to practicing dental professionals has lagged

behind the expansion of the knowledge base on the etiology of dental diseases and methods of treatment.

Hence, there is a need to evaluate and improve the speed and quality of information and technology trans-

ferred from the laboratory and other research settings to the public domain.

This chapter discusses the current state of knowledge about nine defined categories of oral diseases and

conditions, and identifies research directions for the future with respect to these diseases and conditions.

The chapter is not inclusive of all dental diseases; rather, these disorders are intended to illustrate the direc-

tions and challenges for dentistry in the future. The discussions underscore the fundamental importance of

research to dentistry's future and demonstrate the value of research to all aspects of dentistry, including:

u Diagnosis, treatment and prevention of oral health problems;

u Education and student training opportunities;

u Adaptation of medical versus surgical models in the treatment of oral disease;

u Identification of the relationships of oral infection to many systemic diseases; and,

u Incorporation of non-dental health care personnel into programs that promote early identification of oral disease.

Progress through research will challenge dentists and students with a need to become familiar with the molecular and

genetic basis of oral diseases. This process will help to assure that dentistry continues as a vital and progressive profession.

As the relationships between oral and systemic diseases are clarified, issues will arise about which profes-

sionals have the responsibility for diagnosing and managing oral disease and who will pay for treatment.

These questions will impact dentistry's future role in the health care system.

CHAPTER OVERVIEW