GOAL FOUR: Apply rigorous, multidisciplinary research approaches to eliminate disparities in oral, dental and craniofacial health.
As the NIDCR moves closer to unlocking the secrets of biology that will benefit the oral health of millions of Americans, the Institute is also keenly aware that many scientific discoveries do not reach all people. This leads to disparities in the health and health care among various groups in the U.S. due to a complicated array of reasons that are still poorly understood and deserving of research. The NIDCR will continue to support studies that will provide a better understanding of the basis of health disparities; to develop and test interventions tailored to underserved populations; and to foster dissemination and implementation research to assure that research findings are translated into practice, policy and action in communities.
Objective IV-1: Identify the full range of factors that contribute to oral health inequality.
The NIDCR will prioritize research that seeks to understand the determinants of inequality in oral health status and quality of life. Studies that explore the root causes of inequality at individual, community and societal levels—as well as those that explore genetic, behavioral, psychosocial and environmental interactions—will serve as the underpinnings for future health disparities interventional research.
The Institute will tackle these problems by funding multidisciplinary teams that include a range of expertise including anthropologists, behavioral and social scientists, economists, health policy analysts, health services researchers, and others, to develop prevention and treatment approaches that are effective and practical in populations with health disparities. The Institute will continue its commitment to enrolling and retaining women, children, racial and ethnic minorities and other underrepresented groups in NIDCR-funded clinical research, and emphasize clinical research that meets the needs of specific, vulnerable or underserved populations. These efforts will be enhanced by community-based partnerships.
Objective IV-2: Support interventional, dissemination and implementation research to eliminate oral health disparities.
The NIDCR will support interventional research that will have a meaningful impact on caries, oral and pharyngeal cancer, and periodontal disease, and that will influence clinical practice, health policy, community and individual action and ultimately improve the oral health of individuals with poor oral health. The Institute has catalyzed the conduct of interventional health disparities research through its Centers for Research to Reduce Disparities in Oral Health program, which provides a venue for the interaction among scientists from a wide array of disciplines. These multidisciplinary teams target oral health issues in underserved communities, integrating the expertise of oral health professionals, sociologists, economists, anthropologists, psychologists, communications specialists and other health practitioners and researchers. The NIDCR will also fund health disparities interventional research beyond that conducted through the Centers for Research to Reduce Disparities in Oral Health program.
The NIDCR will prioritize research that seeks to understand the determinants of inequality in oral health status and quality of life.
One significant return from the NIDCR's investment in interventional health disparities research comes from a randomized clinical trial conducted by the NIDCR-supported Center at the University of California, San Francisco. This trial demonstrated that as little as one fluoride varnish treatment a year, in addition to parental oral health counseling, can cut the cavity rate in half for young children at high risk for developing tooth decay21. The results of this study have contributed to policy changes at the state level: As of November, 2008, 29 states reimburse physicians for fluoride varnish application to young children22.
Dissemination and implementation research are essential to assure that oral health advancements are appropriately and effectively translated to underserved and vulnerable populations. The NIDCR will support the development of new technologies that are culturally appropriate and affordable, and that can be delivered by workers readily available in communities.
The NIDCR also recognizes a critical need to consider research outcomes in their proper economic and societal contexts. Thus, the Institute will conduct systems-level research to assess the effectiveness of oral health interventions including vulnerable subgroups of the U.S. population. Comparative effectiveness studies will evaluate innovations and determine which represent added value, which offer minimal enhancements to current choices, which fail to reach their potential, and which work for some patients and not for others. The need to develop better evidence about the benefits, risks, and costs of alternative choices is imperative to practical and effective oral health care.
Objective IV-3: Provide science-based information about oral health and disease to health care providers, patients and caregivers, policy makers and the general public.
Many oral diseases and conditions can be prevented or controlled. However, due in part to the challenge of producing lasting behavioral change, significant gaps continue to persist in oral health. The NIDCR ensures that the American public has access to science-based, unbiased, accessible information that all individuals can use to make wise decisions about their oral health.
The NIDCR Office of Communications and Health Education produces and disseminates informational materials on a wide variety of topics, ranging from children's oral health, oral cancer, and periodontal disease, to oral health care for people with disabilities. Some materials are geared toward patients or the general public; others are targeted to health care professionals, teachers or caregivers for special needs patients. The Institute also disseminates information about significant research advances to the media, patient support organizations, professional organizations and the research community. The Institute will continue to support vital communication efforts that can help translate scientific research into bettering people's lives.
Objective IV-4: Monitor the oral health status of the nation, through periodic epidemiologic and other sentinel surveys.
Documenting the nation's prevalence of the full range of oral, dental and craniofacial diseases is an important element of a strategic investment in basic and clinical research. The NIDCR uses this information to guide its planning efforts, as well as to assess the value of research investments. These tracking efforts are particularly important given the extent of co-morbidities that accompany oral diseases.
In partnership with the Centers for Disease Control and Prevention and other agencies, the NIDCR will seek and validate new methods to measure and document oral, dental and craniofacial diseases, disorders and conditions; as well as risk factors and determinants of health disparities at the individual, community and societal levels. Companion to these activities will be an assessment of the social, educational, quality of life, and economic impact of problems related to oral, dental and craniofacial health.
As part of this effort, the NIDCR will enhance its in-house epidemiological expertise to enable a more thorough monitoring of changes in disease status, oral health determinants, access to care, and the use of professional, community and oral health services.