NIDCR Director's Statement for the Senate Appropriations Subcommittee Regarding the FY 2017 Budget Request

Mr. Chairman and Members of the Committee:  I am pleased to present the President’s Fiscal Year (FY) 2017 budget request for the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH).

The mission of NIDCR is to improve dental, oral, and craniofacial health through research, research training, and the dissemination of health information.  In keeping with this mission, NIDCR’s research spans multiple disciplines, scientific approaches, and research directions.  Today, I will highlight selected areas of NIDCR-supported research that hold particular promise to improve oral health.  These include efforts to understand the role of the oral microbiome, develop innovative tools and technologies, address emerging public health challenges, and strategies to cultivate and sustain future oral health researchers.

Foundational discoveries

The community of bacteria and other microbes that live in our mouths (the oral microbiome) not only has the potential to cause disease, but also plays a critical role in maintaining our health.  Although we have learned much about the oral microbiome, one of the most important unexplored questions is how health-promoting and disease-causing bacterial communities are acquired at birth and how the balance between the two is developed and maintained over time.  To answer this question, NIDCR-supported researchers are studying the oral microbiomes of children from birth to adolescence to determine what happens to bacterial communities during different stages of childhood.  Scientists are using genetic techniques as well as considering specific environmental factors such as the delivery method at birth, the use of antibiotics in the hospital, and whether the infant was fed breast milk or formula.  More knowledge about how individuals acquire their own unique oral microbiome could result in new strategies to help keep our mouths and bodies healthy.

We have made tremendous progress in developing new approaches to catalogue the oral microbiome.  However, understanding the types of bacteria present isn’t enough.  We also need to understand how the microbiome community in the mouth is organized and how its complex structure helps to maintain health and contributes to disease.  NIDCR-funded scientists have developed a new imaging technique to visualize the multiple layers of bacteria that live on each surface of the oral cavity.  They have observed that some microbial communities gather and form distinctive three-dimensional structures on teeth that look like spiny hedgehogs and cauliflowers.  These structures create the foundation upon which other bacteria attach and grow and eventually become the plaque that causes dental caries (tooth decay) and periodontal disease (an inflammation of the tissues supporting the teeth).  This new imaging technique will also be a valuable tool for researchers exploring potential drug therapies to change the structure of the microbial community and treat oral infections.​

Innovative tools and technologies

Early detection and diagnosis of oral cancer is essential for successful treatment.  Because most people are not diagnosed until after a tumor has spread to other tissues, the survival rate for people with oral cancer – especially for African American males – is among the lowest for the major cancers.  The current procedure for detecting oral cancer starts with inspecting the oral cavity for suspicious lesions.  If a suspicious lesion is identified, a sample of the tissue is typically removed (i.e., a biopsy) and sent to a lab to check for cancer cells.  To increase the likelihood that oral cancer will be detected earlier and more accurately, NIDCR-supported researchers have developed a handheld microscope to screen for oral cancer in the dental office.  Roughly the size of a pen, the microscope uses an innovative technology called ‘dual-axis confocal microscopy’ to make it easier to discriminate between healthy and potentially cancerous tissue.  Using this tool, clinicians will be able to make more informed decisions about whether or not to remove suspicious-looking lesions for analysis – thus reducing the need for unnecessary invasive procedures.  This novel technology will help meet a critical need for more effective tools to screen individuals at risk for oral cancer and could also be used to detect the recurrence of cancer following treatment.

Mobile health, or mHealth, is an exciting technology that encourages people to make healthy lifestyle changes.  For example, many of us wear wrist bands to count the number of steps we take every day or we use mobile applications to keep records of what we eat and drink.  NIDCR-supported researchers are taking a lead in developing mHealth tools to easily and accurately track oral health behaviors, such as tooth brushing.  In collaboration with engineers at Oral-B, NIDCR-supported researchers have developed an electronic toothbrush with a built-in sensor that collects precise data about tooth brushing frequency and duration.  By collecting real-time data, this mHealth sensor is helping investigators bypass the need for research participants to remember and accurately report their tooth brushing habits.  The objective data gained from this innovative device will increase our understanding about actual tooth brushing behavior and potentially lead to new approaches to increase motivation for improved oral health behavior.

Emerging public health concerns

After years of declining cigarette sales in the United States, spurred in part by awareness of the adverse health effects of tobacco use, a new form of nicotine delivery has emerged – the electronic cigarette, commonly called the e-cigarette.  The use of e-cigarettes is increasing dramatically among young adults.  In fact, according to the Centers for Disease Control and Prevention, e-cigarette use by middle and high school students in the United States tripled between 2013 and 2014.  However, very little is known about the chemicals in the aerosol mixtures released by e-cigarettes or the impact those chemicals might have on health.  NIDCR recently developed an initiative that funded a number of grants to investigate the effects of e-cigarette chemicals on oral health.  A broad range of studies are being supported that include human participants, as well as cell and animal model systems.  This research will offer valuable insights into the safety of e-cigarettes and how they affect the oral microbiome, the immune system, and the ability of damaged tissues in the oral cavity to heal.

Many people visit their dentist regularly, which puts dental practitioners in a prime position to address public health issues.  Currently, one particularly pressing public health concern is prescription opioid abuse.  Because dentists prescribe opioids to treat acute dental and oral pain following dental procedures, it is important to understand the opioid prescribing practices of dentists.  NIDCR invests in a valuable resource for conducting these types of clinical studies in real world settings, called the National Dental Practice-Based Research Network (NDPBRN).  The Network consists of more than 6,000 dental practitioners in the United States who see patients on a regular basis and are interested in conducting research in their practices.  Dental practitioners will participate in a study to assess dentists’ knowledge of opioids and the decision making processes and behaviors related to opioid prescription.  The findings from this NDPBRN study will increase our understanding about how and why opioids are prescribed by dentists in order to develop strategies to help halt opioid abuse in the United States.

Recognizing outstanding oral health researchers

NIDCR is proud to support three scientists who have been recognized for their innovative research.  Two of these scientists are recipients of the Presidential Early Career Award for Scientists and Engineers (PECASE), the highest honor bestowed by the Federal Government upon outstanding scientists and engineers beginning their independent careers.  The success of NIDCR-funded scientists in receiving this award is a testament to our commitment to support research training and career development.  The third scientist is a longtime NIDCR-supported investigator who recently received recognition as part of the NIH Common Fund’s Gabriella Miller Kids First Research program.  The program is named for a brave girl who raised funds to support research on childhood illnesses before she died of cancer at age ten.  This investigator is identifying the genetic basis for orofacial clefting using DNA sequencing to identify common genes in a large cohort of families.  These honors recognize exceptional NIDCR researchers who are striving to improve the lives of children like Gabriella Miller and the oral health of all Americans.