GOAL TWO: Strengthen the pipeline of researchers dedicated to solving problems in oral, dental and craniofacial health.
Scientific research holds great promise for targeted prevention and treatment strategies, and thus it is vital that oral health care become more science-based in the coming years. The oral health community must ready itself for fuller integration into the primary health care network. Developing and maintaining a robust and diverse pipeline of oral, dental and craniofacial researchers is the best way to assure that evidence-based oral health comes to fruition.
Objective II-1: Collaborate with schools of dentistry to create vibrant research pathways for students and faculty.
We must continue to maintain a critical mass of investigators with a unique and intimate knowledge of orofacial structures.
The oral cavity offers unique attributes for basic and clinical research, and so the dental research community can contribute to biomedical research at multiple levels. However, there is a relative scarcity of dentist-scientists who receive competitive funding from the NIH. Researchers in schools of dentistry now receive less than half of the NIDCR extramural budget, and this proportion has been steadily decreasing with time (See Figure 1).
The need to act now is urgent: While it is important to welcome, and retain, the expertise and different viewpoints of researchers outside of traditional dentistry, we must continue to maintain a critical mass of investigators with a unique and intimate knowledge of orofacial structures. The high demand for dental clinicians, coupled with the onerous level of indebtedness of many dental school graduates, has led the large majority of dental school graduates to pursue careers in private practice.
Yet, if the oral health community is to assume an authoritative position in primary health care by contributing creatively and substantially to the evidence research base, it is essential that we recruit, educate and train future scientific leaders in academic dentistry. Attracting such students requires that schools of dentistry establish research paths, and then identify and mentor students poised to pursue research career training. The NIDCR will continue to provide leadership for rigorous training and career development that promote interest in academic dentistry (see Objective II-2).
Figure 1. Proportion of NIDCR Extramural Research Grant Support by Type of Academic Institution
Figure 2. Proportion of NIDCR Extramural Training and Career Development Support by Type of Academic Institution
Figures 1 and 2 show the trends in NIDCR support to academic institutions for extramural research and training/career development. The relative percentage of NIDCR extramural research and career and training funds awarded to schools of dentistry have steadily declined since 1993. Note that total expenditures for research ($262.3 million for FY 2008 and $99.1 million for FY 1993) are substantially larger than the total NIDCR training and career grant investment ($23.6 million and $14.4 million for FY 2008 and FY 1993, respectively).
Objective II-2: Emphasize the training and career development investment of individuals.
Currently, the NIDCR offers a range of training opportunities for both individuals and institutions at the pre-doctoral and post-doctoral levels, along with combined-degree programs (D.D.S./Ph.D.). Mentored career development programs at the post-doctoral level and the recently introduced K99/R00 Pathway to Independence Award16 encourage early-stage investigators to achieve earlier scientific independence. Other NIDCR training programs encourage independent scientists to update their skills or make career changes; provide salary support; or provide protected time for research. The Institute continues to recognize and support the value of high-quality, sustained mentoring in the successful career development of trainees.
The NIDCR will continue efforts to recruit and retain new and early-career investigators in oral health disparities research to ensure future research capacity.
Recently, NIDCR staff undertook an analysis of training data to assure that the Institute's research training investment is targeted to best achieve its goals. NIDCR staff ascertained the professional outcomes of NIDCR trainees and examined data from the annual survey of U.S. schools of dentistry conducted by the American Dental Education Association. This analysis demonstrated that those trainees who are supported by an individual fellowship are more likely to obtain independent NIH research funding, particularly with respect to R01 grants, than those supported by an institutional training grant. These data revealed that a significantly higher proportion of faculty with prior NIH career development (K) awards were in full-time employment than were those who had prior NIH training grant or other NIH fellowship award support (T- and F- awards, respectively).
The NIDCR will therefore increase its emphasis on individual awards, shifting research training away from institutional awards. The Institute also will expand its pre-doctoral research training pool by reissuing the institutional training grant program as a T90/R90 mechanism that will allow support of foreign-trained, non-U.S. citizen dentists for Ph.D. degree and postdoctoral training. This pool of talented young investigators has not been tapped because of restrictions on the standard Ruth L. Kirschstein National Research Service Award17 programs; however, the Institute believes these individuals could significantly enhance the value and outcome of NIDCR institutional training programs. The NIDCR has also joined the NIH-wide solicitation to support pre-doctoral Ph.D. trainees on F31 individual fellowships, and will continue efforts to recruit and retain new and early-career investigators in oral health disparities research to ensure future research capacity.
The Institute also will partner with schools of dentistry to provide the training and mentorship that emerging clinician scientists require (see Objective III-4).
Objective II-3: Welcome new disciplines poised to expand oral, dental and craniofacial research.
As a discipline, oral health research offers a unique window of accessibility to study inflammation, microbial biofilms, bone metabolism and repair, and exocrine glands and their secretions in real time. The NIDCR strongly believes that now is the time to proactively communicate the value of oral, dental and craniofacial research as it relates to the larger biomedical construct.
Offering new programs to recruit and train Ph.D. students and postdoctoral fellows trained in other areas of biomedical research to dental and craniofacial research careers may be a fruitful approach to tap a robust source of new independent investigators. To attract these individuals to pursue research topics relevant to the mission of the NIDCR, the Institute will develop mechanisms to support non-dentist Ph.D.s to receive two years of training in an area of oral pathobiology. In addition, the NIDCR will develop a new infrastructure program designed to encourage the recruitment of new faculty into oral health research and provide much-needed, state-of-the-art equipment to conduct modern scientific research. The Institute also will explore ways to engage behavioral and social scientists in oral health research (see Objective I-2), as well as experts in bioinformatics and computer science.
Opportunities may include oral health training and mentoring for early-career investigators, oral health retraining and networking for established investigators from other fields, and funding for translational research that applies cutting-edge behavioral or social science methods or constructs toward improving oral health. Because it will always be important to retain dental expertise within scientific teams pursuing oral health issues, the current environment presents a good opportunity for cross-disciplinary training that can build the next generation of dental/non-dental research teams.
There is also an urgent need to introduce under-represented groups into the dental research pipeline, since current numbers neither reflect the U.S. population as a whole, nor the census of dentists in training across the nation. One of the NIDCR's highest priorities will be to emphasize training and career development programs for scientists from diverse backgrounds.