Mr. Chairman and Members of the Subcommittee: I am pleased to present the President’s fiscal year (FY) 2016 budget request for the National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH). The FY 2016 budget request for NIDCR is $406,746,000, which is $9,046,000 more than the FY 2015 level.
NIDCR’s mission is to improve the Nation’s dental, oral, and craniofacial health through its support of vigorous comprehensive and transformative research in basic, translational, clinical, and population sciences thereby generating new knowledge, tools, and approaches to prevent, detect, diagnose, and treat dental, oral, and craniofacial diseases and conditions.
PRECISION MEDICINE AND ORAL HEALTH
The dental profession has been an early adopter of personalized medicine, tailoring treatment to each individual based upon dental and medical history, environmental exposures, and behavioral characteristics that shape a person’s oral health. However, until the last decade, treatment has been based largely on individual clinicians’ own experiences. NIDCR recognizes that a far more effective approach requires a precise scientific evidence base to support, validate, and implement more effective personalized health care. Therefore, NIDCR launched a major initiative establishing the National Dental Practice-Based Research Network that now includes more than five thousand dentists and dental hygienists from practices across the United States. The project, now in its third year, is generating extensive evidence underlying a range of treatment protocols. In addition, NIDCR funds research focused on the development of new tools, technologies, and strategies in the field of precision oral medicine. This research focuses on oral cancer detection and treatment, and managing common diseases, such as dental caries and periodontal disease. NIDCR-supported research is applying advances in genetic research to improve clinical practices. Propranolol is a drug used to treat high blood pressure. An upcoming large, randomized clinical trial will determine whether doctors can tailor propranolol treatment to individuals with temporomandibular joint disorder (TMD) based on their genetic differences. This trial will investigate whether a variation in a gene encoding an enzyme (catechol-O-methyltransferase) responsible for breaking down molecules that transmit pain signals can alter a person’s response to propranolol used as a pain reliever. In addition to personalizing treatment of TMD, the trial’s results could also apply to those with other chronic pain conditions.
Another key step toward advancing precision medicine is NIDCR’s investment in salivary diagnostics. Saliva is an easy, safe, fast, and inexpensive fluid to collect and test. NIDCR has supported development of a miniaturized, portable biochip that can analyze small volumes of saliva to identify promising predictive markers for oral cancer and heart disease. Other exciting diagnostic research is examining whether salivary oxytocin, a hormone involved in a number of social behaviors, could be a biomarker for susceptibility to autism spectrum disorder. Another early-stage study is investigating whether salivary biomarkers could be predictive for maladaptive stress reactions such as post-traumatic stress disorder. NIDCR will continue to support innovative research to unlock the tremendous potential of salivary diagnostics as a powerful tool for precision medicine. A separate diagnostic approach under way by NIDCR intramural scientists combines state-of-the-art three-dimensional facial imaging with genetic information to help identify the genetic changes underlying facial development. Armed with such a tool, physicians could use precision data to diagnose and treat craniofacial disorders.
PATHWAYS TO INNOVATION
NIDCR is committed to translating scientific advances from basic research into cutting-edge commercial products that enhance people’s lives. For example, NIDCR-supported research to define wound healing mechanisms led to development of a new drug to reduce scarring in children who have undergone cleft lip and palate surgery. This innovative drug has the far-reaching potential to treat people with scarring from burns and injuries from military service or accidents. The investigators expect to begin patient recruitment for the clinical trial next year.
NIDCR has a history of supporting foundational research on the materials that are used to restore damaged and diseased teeth. Dental restorations made with tooth-colored resin composite materials, while esthetically pleasing, can fail after about eight years and need to be replaced. NIDCR supports multidisciplinary teams of scientists who are developing ways to increase the service life and functionality of restorations and take advantage of new technologies to incorporate antimicrobials, adhesives, and substances that remineralize teeth.
DEVELOPING NOVEL CLINICAL TREATMENTS
NIDCR supports a comprehensive portfolio in fundamental research that continues to lead to advancements in risk assessment, prevention, diagnosis, and treatment of dental, oral, and craniofacial diseases. Inflammation is now recognized as the foundation of many diseases, and NIDCR has responded to this by funding studies to combat inflammation and tissue destruction. Researchers funded by the Institute have identified a class of molecules called lipoxins that function to naturally reduce inflammation and the resulting destructive effects on oral tissue, and at the same time, stimulate tissue healing. From this groundbreaking discovery, a drug with similar dual effects has been developed and is in a proof-of-principle clinical trial as a mouthwash to treat inflammation of the gums (gingivitis). If the drug is effective, it could be used to prevent and treat periodontal disease, as well as other inflammatory diseases and conditions; furthermore, it may help decrease the overuse of antibiotic therapies, which is linked to the development of antibiotic-resistant bacteria.
NIDCR supports research on the microbial communities that live inside the mouth, and the roles they play in human health and disease. Because progress is hindered by the fact that some microbial species are difficult or impossible to grow and study in the laboratory, NIDCR launched an initiative to develop methods to overcome this technical challenge. Identifying and characterizing these uncultivable species provides potential therapeutic advantages. For example, recent research identified a new class of antibiotics in uncultivable bacteria from soil that may be effective against the bacterium MRSA (methicillin-resistant Staphylococcus aureus).
Through six decades of leadership, NIDCR has established a strong base to address research questions, train the next generation of oral health scientists, and most importantly, translate these discoveries into effective, personalized patient care to improve the Nation’s dental, oral, and craniofacial health.