ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY 117

Dental and Craniofacial Research

I. DENTAL AND CRANIOFACIAL RESEARCH TODAY

THE ROLE OF RESEARCH IN THE IMPROVEMENT
OF ORAL HEALTH

Dentistry evolves and is continuously becoming a
stronger and more capable health profession
because of its commitment to research. The dental
profession’s recognition of the value of a constantly
expanding scientific base is clear. It was largely due
to the efforts of the ADA that the National Institute
of Dental Research (later to become the National
Institute of Dental and Craniofacial Research
[NIDCR]) was established in 1948 as one of the first
three institutes of the National Institutes of Health.
Since then, dental research has contributed to
major improvements in the nation's oral health.
Approximately $4 billion dollars are saved each
year as a result of the nation's investment in dental
research (Brown et al, 1994).
The ultimate objective of research is to improve
oral health, eliminate health disparities and enhance
quality of life. Dental research has led to develop-
ments in disease prevention, diagnosis and treat-
ment modalities. During the past century, there has
been a shift from an approach based on treatment of
disease to prevention of disease. The caries-preven-
tive modalities of fluoride and of dental sealants
have had a major impact on the dental health of
Americans.
Community water fluoridation, the country's
mainstay caries preventive measure, is one of ten top
public health achievements of the past century
(Centers for Disease Control [CDC], 1999).
Uncovering the harmful effects of tobacco use on
oral cancer and periodontal diseases has suggested
the potential importance of tobacco control pro-
grams delivered by the dental profession. The den-
tal office, with patients returning for care on a reg-
ular basis, is an ideal location for smoking cessation
programs. In the future, members of the dental
health care team will become active providers of
smoking prevention and smoking cessation pro-
grams for dental patients. This will be equivalent to
oral hygiene programs that are now standard of care
in dental offices.
Dentistry is now among the family of health pro-
fessions addressing these and other risk factors com-
mon to many diseases and conditions that plague
our nation. For individuals who have not benefited

from the available preventive measures, the devel-

opment and refinement of restorative materials and

equipment, such as the high-speed handpiece and radi-

ography, have enhanced the capacity to manage oral

diseases for those who can avail themselves of profes-

sional care. An increased understanding of the inter-

dependent role of personal lifestyle behaviors, profes-

sional care and community-based programs has

demonstrated how oral diseases differ from some

other diseases and emphasized the importance of the

partnership among these components.

The Research Process

The behavioral and biomedical research process

generates new knowledge to promote health and

manage diseases and disorders. The research

process evolves from a stage focused upon knowl-

edge acquisition to one of knowledge validation.

Ultimately, the acquired knowledge needs to be

transferred and disseminated effectively, efficiently

and in a timely manner to those who will use it.

This includes active participation and involvement

of the dental profession.

Figure 7.1 demonstrates the research spectrum

that parallels this creation and distribution of

knowledge. Both behavioral and biomedical re-

search include basic research that pursues the fun-

damental underlying mechanisms and evolves to

applied research and development. At the applied

stage, animal studies may be involved, as well as

preliminary human studies. Patient and population-

oriented studies may include clinical, epidemiologi-

cal and health services research. Clinical studies

include a variety of experimental designs with the

design for randomized controlled trials as the gold

standard. At this stage of research, efficacy and

safety of an intervention or technology are deter-

mined. To assess the effectiveness of an intervention

demonstration, research projects are undertaken to

test the intervention. Education research is also

important to determine how best to transfer the

research findings into practice, whether it is to be

used by patients, clinicians or community programs.

As seen in Figure 7.1, the research process is not

unidirectional. As a result of information gathered,

further refinement may be necessary before pro-

ceeding to the next stage.