NIDCR Director's Statement for the Senate Appropriations Subcommittee Regarding the FY 2015 Budget Request

Mr. Chairman and Members of the Committee: I am pleased to present the President’s Budget request for the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH).  The fiscal year (FY) 2015 NIDCR budget of $397,131,000 includes an increase of $29,000 over the enacted FY 2014 level of $397,102,000.

In keeping with its mission to improve the nation’s oral health, the breadth of NIDCR’s research touches the lives of nearly all Americans.  Our research spans multiple disciplines, scientific approaches, and research directions, all focused on the goal of improving people’s lives.  Today, I will highlight selected areas of particular promise in our efforts to understand the development of tissues of the face and head, conquer oral infectious diseases through better understanding of the body’s own defenses, help people facing chronic orofacial pain conditions, and develop new approaches to improve oral cancer survival.

DEVELOPMENT AND REGENERATION

The human face is among the body’s most distinctive structures.  NIDCR is the leading supporter of research on the development of the human face and skull, collectively known as the craniofacial region.  By defining the complex web of environmental and genetic instructions that drive craniofacial development, the hope is that scientists one day will learn to repair damaged or malformed facial structures such as cleft lip and palate by harnessing the body’s ability to heal itself.

Five years ago, NIDCR began assembling information on the genetic code that instructs facial development with the launch of its FaceBase Consortium.  Through this endeavor, scientists have assembled nearly 500 publicly available datasets involving the biological instructions for the middle region of the human face, which includes the nose, upper lip, and palate, or roof of the mouth.  FaceBase begins a second phase this year, as it expands its focus to include studies on additional regions of the face.  This new phase will add to our knowledge about the genetics that underlie craniosynostosis, a birth skull defect that may result in severe and permanent problems if not corrected.

NIDCR is also translating knowledge about craniofacial development into tools to re-grow bone and cartilage damaged by disease or injury.  Ongoing studies are using the power of stem cells to regenerate tissues, improve wound healing, and help control inflammatory-associated diseases of the mouth.  Related research uses specially designed stable small molecules modified from naturally occurring molecules called resolvins that control inflammation in a wide range of conditions to target oral inflammatory diseases such as periodontitis.  We envision a future where natural tool kits are used to regenerate and repair damaged teeth, diseased gums, and broken or defective bones by utilizing stem cells and adapting natural molecules and processes.

ORAL INFECTIONS, IMMUNITY AND THE MICROBIOME

The NIH’s human microbiome project has reinforced that no man is an island.  Although human beings coexist with a plethora of microorganisms, microbial cells outnumber human cells by ten to one, living on surfaces of our body in sticky layers of polymicrobial communities called biofilms.  Under normal circumstances, these microbial guests coexist with us and even contribute to sustaining human health.  But, if conditions in some part of the body are altered, the balance is disrupted, and the disease-causing organisms that live on our gums and teeth can overwhelm our natural immune defense systems causing oral infectious diseases such as tooth decay and periodontal diseases.  NIDCR-supported scientists are beginning to assemble the precise molecular details of how select oral pathogens destabilize the immune system to cause oral diseases.  For example, individuals with leukocyte adhesion deficiency (a rare genetic disorder affecting the body’s immune system) suffer from frequent bacterial infections, including severe periodontitis.  New research has demonstrated that blocking certain molecules that are part of the individual’s own immune system can reverse this inflammation and resulting bone loss.

In combination with these discoveries, we have made great strides in understanding how an individual’s own microbiome affects his or her health and disease.  NIDCR continues to invest in microbiome research, supporting a database of information on oral microbes that will one day allow dentists to visualize the microbes within a patient’s oral biofilm in real time – offering new tools to diagnose and treat oral disease.  For example, a dentist might observe an overgrowth of a particular type of bacteria that uniquely predisposes a patient to tooth decay, and could treat that bacterial imbalance to prevent the individual from developing cavities.  These emerging leads will not only guide future personalized dental treatment for millions of Americans; they will help scientists throughout biomedical research to inform better treatment approaches for other microbe-host diseases such as colitis.

TEMPOROMANDIBULAR JOINT DISORDERS

Thousands of Americans this year will be diagnosed with a painful and debilitating disorder of the jaw called temporomandibular joint and muscle disorder (TMD).  Some of these individuals will recover after a single bout of TMD, while others will go on to develop chronic disease – and their healthcare providers, currently, are unable to predict the likely outcome for any individual patient.  NIDCR-supported research is providing key insights that could identify people at risk for developing TMD, and predict the likelihood of progression to chronic disease.  In 2006, NIDCR launched the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study.  The study’s latest findings present the most in-depth picture to date of the factors that may contribute to a person’s developing an initial bout of painful TMD.  Among the many interesting findings is that there is almost no difference in the rate at which men and women develop TMD for the first time.  And yet, females are far more likely to progress to chronic TMD than males.  Researchers will continue to examine potential causes of this difference, such as hormonal regulatory factors, leading to more targeted strategies for detecting and managing TMD in the future. 

Although TMD specifically afflicts the jaw, OPPERA researchers found only about 15 percent of OPPERA participants diagnosed with chronic TMD have orofacial pain only.   The other 85 percent have additional ailments, many of which are painful in nature, including chronic fatigue syndrome, fibromyalgia headache, and low back pain.  This finding demonstrates that first-onset and chronic TMD are complex disorders that must be understood within a biological, psychological, and social model of illness.  NIDCR will continue to help lead the way for all those battling these chronic conditions to find relief through a more accurate diagnosis and more personalized care.

ORAL CANCER AND HUMAM PAPILLOMAVIRUS (HPV)

When many people hear the acronym HPV, they think of its association with cervical cancer.  But over the last decade, various types of this virus also have been shown to contribute to head and neck cancers.  In fact, the incidence of HPV-related head and neck cancer has risen steadily over the last decade and if the pace continues, it will soon surpass the incidence of cervical cancer.  This trend is particularly alarming because no effective diagnostic test currently exists to detect early HPV-related head and neck cancer.  Tools are needed to screen those at increased risk of the condition and to test for possible persistence of the condition following therapy.

NIDCR will help to fill this public health need by launching an initiative to develop a viable diagnostic test.  The initiative will identify DNA markers associated with HPV-related head and neck cancer, develop and validate saliva and plasma-based diagnostic tests, and evaluate and test the biomarkers in humans.  Clinical studies are also ongoing to establish the safety and feasibility of administration of a DNA vaccine in certain HPV-associated head and neck cancer patients.  NIDCR scientists recognize the urgency of developing innovative approaches to detect oral cancer early, when personalized treatment can be more successful, leading to better patient outcomes. 

There has never been a better time to take advantage of the remarkable opportunities in science and technology waiting at our doorstep.  Seizing this moment brings us closer to preventing and treating dental, oral, and craniofacial conditions as well as other diseases that share risk factors and therapeutic strategies.