Date: September 18, 2015
Place: Conference Room 10
National Institutes of Health
The 210th meeting of the National Advisory Dental and Craniofacial Research Council (NADCRC) was convened on September 18, 2015, at 8:30 a.m., in Building 31, Conference Room 10, National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 8:30 a.m. to 12:56 p.m.; it was followed by the closed session for Council business and consideration of grant applications from 2:06 p.m. until adjournment at 2:39¬ p.m. Dr. Martha Somerman presided as Chair.
Dr. Hector G. Balcazar
Dr. Yang Chai
Dr. Richard Peters Darveau
Dr. Teresa Ann Dolan
Ms. Tracy Hart
Dr. Yvonne L. Kapila
Dr. Jane B. Lian
Dr. Mary L. Marazita
Dr. Anne Louise Oaklander
Dr. Anne C. R. Tanner
Dr. Jane A. Weintraub (by phone)
Dr. J. Leslie Winston
Ad Hoc Members
Dr. Shenda Baker
Dr. Daniel Malamud
Dr. Phillip Messersmith
Dr. Sanjay Shete
Members of the Public
Dr. Floyd E. Dewhirst, Senior Member of the Staff, Department of Microbiology, The Forsyth Institute, Cambridge, MA
Dr. Slava S. Epstein, Distinguished Professor, Department of Biology, College of Science, Northeastern University, Boston, MA
Dr. Raul Garcia, Professor and Chair, Department of Health Policy and Health Services Research, and Director, Northeast Center for Research to Evaluate and Eliminate Dental Disparities, Boston University School of Dental Medicine, Boston, MA, and Vice President, American Association for Dental Research (AADR), Alexandria, VA
Dr. Ann L. Griffen, Professor, Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, OH
Ms. Stacy L. Hawkins, Pediatric Nurse Practitioner and School of Nursing Instructor, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN
Mr. B. Timothy Leeth, Senior Director for Federal Relations, ADEA Policy Center - Advocacy and Governmental Relations, American Dental Education Association (ADEA), Washington, D.C.
Dr. Evelyn Lucas-Perry, Director of Public Policy Research, ADEA Policy Center - Advocacy and Governmental Relations, ADEA, Washington, D.C.
Mrs. Carolyn Mullen, Director of Government Affairs, AADR, Alexandria, VA
Dr. Gregory Olson, ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellow, ADEA Policy Center – Advocacy and Governmental Relations, ADEA, Washington, D.C., and Assistant Professor, Loma Linda University School of Dentistry, California
Dr. Robert Palmer, Dentist, Salt Lake City, UT
Dr. Jessica Scoffield, Postdoctoral Scholar, Institute of Oral Health Research, School of Dentistry, University of Alabama at Birmingham, AL
Federal Employees Present
National Institute of Dental and Craniofacial Research
Dr. Martha J. Somerman, Director
Dr. Alicia Dombroski, Executive Secretary, and Director, Division of Extramural Activities (DEA)
Dr. Lillian Shum, Director, Division of Extramural Research (DER)
Dr. Robert Angerer, Scientific Director, Division of Intramural Research (DIR)
Dr. John W. Kusiak, Office of the Director (OD), Acting Deputy Director
Dr. Margo Adesanya, OD, Office of Science Policy and Analysis (OSPA)
Dr. Jane Atkinson, DER, Center for Clinical Research (CCR)
Dr. Karina Boehm, OD, Office of Communications and Health Education (OCHE)
Dr. Steffany Chamut, OD, OSPA, Program Analysis and Reporting Branch (PARB)
Dr. Preethi Chander, DER, Integrative Biology and Infectious Diseases Branch (IBIDB)
Dr. Rebecca Coca, NIH Management Intern, Office of Administrative Management (OAM)
Ms. Mary A. Cutting, DER, CCR
Ms. Mary Daum, OD, OCHE
Mr. Bret Dean, OAM, Financial Management Branch (FMB)
Dr. James L. Drummond, DER, IBIDB
Dr. Bruce Dye, OD, OSPA
Dr. Olga Epifano, DEA
Dr. Dena Fischer, DER, CCR
Dr. Leslie Frieden, DEA, Research Training and Career Development Branch (RTCDB)
Dr. Crina Frincu, DEA, Scientific Review Branch (SRB)
Mr. Joel Guzman, DER
Ms. Jeannine Helm, DER
Dr. Victor Henriquez, DEA, SRB
Dr. Jonathan Horsford, OD, OSPA
Dr. Laura Hsu, DER, CCR
Dr. Lynn King, DEA, RTCDB
Ms. Carol Loose, OAM, FMB
Dr. Nadya Lumelsky, DER, IBIDB
Dr. R. Dwayne Lunsford, DER, IBIDB
Ms. Jayne Lura-Brown, DER
Dr. Amanda Melillo, DER, IBIDB
Dr. Marilyn Moore-Hoon, DEA, SRB
Dr. Dawn Morales, DER, Behavioral and Social Sciences Research Branch (BSSRB)
Dr. Niki Moutsopoulos, DIR, Oral Immunity and Infection Unit (OIIU)
Dr. Amrita Mukherjee, OD, OSPA, PARB
Dr. Ruth Nowjack-Raymer, DER, CCR
Ms. Lisa Peng, OD, Office of Information Technology (OIT)
Dr. Deborah Philp, DIR, Office of Education (OE)
Mr. John Prue, OD, OIT
Dr. Melissa Riddle, DER, BSSRB
Ms. Delores Robinson, DEA
Dr. Isaac Rodriguez-Chavez, DER, IBIDB
Ms. Diana Rutberg, DEA, Grants Management Branch (GMB)
Dr. Steven Scholnick, DER, Translational Genomics Research Branch (TGRB)
Dr. Yasaman Shirazi, DEA, SRB
Ms. Kathleen Stephan, OD
Ms. Loan Ta, OD, OSPA
Dr. Yolanda Vallejo-Estrada, DER, IBIDB
Dr. David Vannier, OD, OCHE
Dr. Jason Wan, DER, IBIDB
Ms. Delores Wells, OD, OSPA
Dr. Guo Zhang, DEA, SRB
Dr. Lois K. Cohen, Consultant
Other Federal Employees
Dr. Gail Cherry-Peppers, Public Health Analyst, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
Dr. Rajiv Kumar, Center for Scientific Review (CSR), NIH
Dr. Yi-Hsin Liu, CSR, NIH
I. WELCOME AND INTRODUCTIONS
Dr. Martha Somerman, Director, NIDCR, called the 210th meeting of the Council to order. She welcomed Council members, guests, and attendees participating via the NIH videocast (http://videocast.nih.gov). She invited guests at the meeting to introduce themselves.
Dr. Somerman noted that the terms of four members of the Council will expire after the meeting. She thanked these Council members—Dr. Teresa Ann Dolan, Dr. Jane B. Lian, Dr. Mary L. Marazita, and Dr. J. Leslie Winston—for their many contributions, and she presented each with a gift mug. Each will also receive a signed certificate of service in the mail.
Dr. Somerman welcomed and introduced four new Council members whose appointments are pending and who attended the current meeting as ad hoc members. These four are Dr. Shenda Baker, President, Chief Operating Officer, Treasurer, and Co-founder, Synedgen, Inc., Claremont, California; Dr. Daniel Malamud, Professor, Department of Basic Science and Craniofacial Biology, and Director of HIV/AIDS Research Program, New York University College of Dentistry, New York; Dr. Phillip B. Messersmith, Endowed Class of 1941 WWII Memorial Chair, and Professor, Departments of Materials Science and Engineering and Bioengineering, University of California, Berkeley; and Dr. Sanjay S. Shete, Professor, and Chief, Behavioral and Social Statistics, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, and Director, Program in Biostatistics, Bioinformatics, and Systems Biology, Houston, Texas.
Dr. Alicia Dombroski, Director, Division of Extramural Activities (DEA), invited NIDCR staff to introduce new personnel. Dr. Somerman reported first on three recent personnel changes: Dr. Karina Boehm was selected as director of NIDCR’s Office of Communications and Health Education (OCHE); Dr. Jonathan Horsford was named acting director of the Office of Science Planning and Analysis (OSPA); and Dr. Margo Adesanya became chief of OSPA’s Science Policy and Planning Branch. Dr. Somerman extended special thanks to Dr. Adesanya for her commitment and achievements while serving as acting director of OSPA.
Dr. Horsford introduced Dr. Chantelle Ferland-Beckham, who joined OSPA as a AAAS Science and Technology Policy Fellow. Dr. Boehm introduced Dr. David Vannier, who was appointed chief of OCHE’s new Science Communication and Digital Outreach Branch.
Ms. Kathleen Stephan, Executor Officer, Office of Administrative Management (OAM), reported that Ms. Carol Loose was appointed as NIDCR’s budget officer and chief of the Financial Management Branch (FMB), OAM. Ms. Stephan also introduced Dr. Rebecca Coca, who is on rotation to the NIDCR as an NIH Management Intern.
Dr. Bruce Dye, director of the NIDCR Dental Public Health Residency Program, OSPA, introduced NIDCR’s two Dental Public Health Residents for 2015‒2016: Dr. Amrita Mukherjee, who completed her dental education and training in Kolkata, India, in 2011 and has an M.P.H. from the University of Alabama at Birmingham, and Dr. Steffany Chamut, who received a D.D.S. in 2006 from the Universidad Autonoma de Coahuila in Torreon, Coahuila, Mexico, completed postgraduate studies at the University of Texas Health Science Center at San Antonio, and has an M.P.H. from A. T. Still University of Health Sciences, in Kirksville, Missouri.
Dr. Nadya Lumelsky, acting chief of the Integrative Biology and Infectious Diseases Branch (IBIDB), Division of Extramural Research (DER), introduced Dr. Yolanda Vallejo-Estrada, who joined the NIDCR as director of the Molecular and Cellular Neuroscience Program with the IBIDB. Dr. Yasaman Shirazi, chief of the Scientific Review Branch (SRB), DEA, introduced Dr. Guo Zhang, who returned to the NIDCR to join the SRB.
II. FUTURE MEETING DATES
January 22, 2016
May 24, 2016
September 20, 2016
January 24, 2017
May 23, 2017
September 15, 2017
III. APPROVAL OF MINUTES FROM PREVIOUS MEETING
Dr. Alicia Dombroski, Executive Secretary, NADCRC, welcomed the Council members, guests, and virtual participants. She invited the Council to consider and approve the minutes of the May 20, 2015, Council meeting. The Council unanimously approved the minutes.
IV. REPORT OF THE DIRECTOR, NIDCR
Dr. Somerman invited Council’s questions on the written Director’s Report to Council: September 2015, which was provided to the Council members and is available on the NIDCR website (http://www.nidcr.nih.gov). In her presentation, she addressed the NIH Common Rule, NIDCR initiatives, and the NIH Common fund. She noted that the NIDCR budget for FY 2017 is not yet known.
NIH Common Rule
Dr. Somerman reported that the NIH has released for comment a proposed revision of the Common Rule, a policy that relates to the rights and privacy of human subjects in research and was originally published in 1991. The goals in the proposed revision, which was issued in the Federal Register, are to enhance safeguards and respect for research participants and to increase the efficiency of the oversight process. In addition, the scope is being expanded to cover all clinical trials conducted at institutions in the United States and/or receiving Federal funding (i.e., approximately 1,400 trials in FY 2016). Dr. Somerman encouraged the Council members to provide comment.
Dr. Somerman showed the timeline for development of NIDCR initiatives for Fiscal Year (FY) 2017. This process began with staff development of initiatives in spring 2015 and proceeded to public comment on the initiatives and Council’s review (at the present meeting) of the fully developed concepts. After the meeting, NIDCR staff will prepare and publish the funding opportunity announcements in March/April 2016. Applications will receive primary peer review (in study sections) in November 2016‒March 2017 and secondary review (by the Council) in May 2017. Dr. Somerman emphasized that initiatives are driven by investigator-initiated research and suggestions from the NADCRC and research community. The aim is to catalyze the translation of research into practice to fulfill the NIH mission of advancing public health. The NIDCR staff is heavily involved at all stages, and the entire process—from ideas to funding—can take 2‒2.5 years.
Dr. Somerman described, as examples, the development of two past initiatives: (a) the Dental, Oral, and Craniofacial Tissue Regeneration Consortium and (b) Novel Dental Materials. The Council approved the concept of the consortium in May 2015, and funding will begin in September 2015. The Council approved the concept of novel dental materials in May 2012, and six awards were made in FY 2013.
NIH Common Fund
Dr. Somerman noted that the origins of the NIH Common Fund began with the launching of the NIH Roadmap in FY 2004, which encouraged trans-NIH research. Subsequently, the NIH reauthorization in December 2006 provided the NIH a dedicated source of funding for the Common Fund, to enable this research, and established the Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI) in the Office of the Director (OD), NIH, to provide oversight. Dr. Somerman noted that the criteria for Common Fund programs are that they be transformative; synergistic and enabling; catalytic, short-term, and goal-driven; cross-cutting with a high level of trans-NIH coordination; and unique and novel.
Dr. Somerman reported that, for FY 2015, the Common Fund has a budget of $545 million, which supports activities in four program areas: data/tools/methods, new paradigms, transformative work force support, and new types of clinical partnerships. There is a trans-NIH working group for each area, chaired by two to three institute and center (IC) directors or senior staff, and NIDCR staff are actively involved in each area. Dr. Somerman highlighted three research programs in which the NIDCR participates: the Human Microbiome Project (FY 2007‒FY 2015), in which the oral cavity is one of five body regions being studied; the Science of Behavior Change program (FY 2009‒FY 2019), which is intended to capitalize on emerging basic science to accelerate investigation of common mechanisms of behavior change applicable across a broad range of health-related behaviors; and the Glycoscience Program (FY 2015‒FY2021), which Dr. Somerman and Dr. Jon Lorsch, Director, National Institute of General Medical Sciences (NIGMS), co-chair and which just funded 23 projects to create new, accessible methodologies and resources for studying glycans.
Dr. Somerman encouraged the Council members to peruse the Common Fund website and to encourage their colleagues to participate in Common Fund activities. She noted that the NIDCR is involved in strategically planning new initiatives for the Common Fund to launch in FY 2018.
V. NIH STRATEGIC PLAN
Dr. Lawrence Tabak, Principal Deputy Director, NIH, thanked the NIDCR for the opportunity to address the Council. He described the goals, process, timeline, and draft framework for development of the NIH-wide Strategic Plan. Development of this plan is mandated by CROmnibus H.R. 83-346, which was enacted on December 16, 2014, and states that the NIH shall submit to the Congress an NIH-wide, 5-year scientific strategic plan no later than December 16, 2015. Dr. Tabak said that the plan will include the priority areas (rare and pediatric diseases, maintaining the biomedical workforce) outlined in the Congress’s pending 21st Century Cures Act, Section 1021.
Dr. Tabak noted several goals in developing the NIH-wide Strategic Plan: It should be an iterative, living document that will help guide the NIH in fulfilling its mission over the next 5 years; it should articulate approaches and opportunities that are forward-looking and inspirational; and it should identify major trans-NIH themes that will advance biomedical research. In addition, the plan should be short, concise, and focused, and it should complement, but not substitute for, strategic plans of the institute, centers, and offices (ICOs).
The planning process began in April/May 2015 with the assembling of a subgroup of IC Directors, to develop the plan utilizing a framework provided by the DPCPSI. Dr. Tabak noted that the subgroup received feedback from a working group of ICO representatives, which included five NIDCR representatives, who met weekly and have been critical in developing the content and research examples for the plan. In June, the draft plan was discussed with all IC Directors, and in June and July, the Advisory Committee of the Director, NIH (ACD) met twice to review the overall plan and framework. Dr. Tabak said that the ACD has commented favorably on the framework and advocated for additional emphasis on the interconnected nature of research and the inclusion of clinical methodologies, data science, and workforce retention. He noted that the NIH Director is monitoring progress carefully and will oversee development of the final document.
In July and August, the NIH published a Request for Input and held Webinars to solicit feedback from the public, which yielded comments from approximately 1,000 participants. Dr. Tabak said that during September and October, he is meeting with all NIH advisory councils to gather their feedback. He noted that, thus far, the NIH advisory councils have emphasized implementation science, interdisciplinary science, peer review, workforce training, systems approaches, more explicit inclusion of behavioral and social sciences, and partnerships with patients. They specifically have urged use of big data, population health, and a greater focus on mental illness. In October and November, all feedback, including that from the Department of Health and Human Services (HHS), which will provide clearance on the draft, will be incorporated into the plan; members of Congress and their staff will be briefed; and the plan will be distributed to the ACD. In mid-December 2015, the final plan will be presented to the ACD and sent to the Congress.
Dr. Tabak elaborated on the overall framework of the NIH-wide Strategic Plan. He noted that, in an overview, the plan will relay the mission of the NIH, capture this unique moment of opportunity in biomedical research, address the current NIH-supported research landscape, and outline constraints confronting the research community in the face of lost purchasing power. The plan will focus on three, interdependent areas of opportunity: fundamental science, health promotion/disease prevention, and treatments/cures. For each area, the plan will describe emergent opportunities, highlight examples of recent research breakthroughs (“research call-outs”), and convey its alignment with the HHS Strategic Plan and the unique role of the NIH within the HHS. The plan also will highlight unifying principles in setting priorities (e.g., in relation to disease burden, nimbleness of research, rare diseases, and eradication of pandemics) and enhancing stewardship (e.g., maintaining the research workforce, optimizing funding decisions, enhancing partnerships), and it will present examples of recent breakthroughs (“stewardship call-outs”).
Dr. Tabak invited the Council to ask questions and comment on the draft plan. He also encouraged the members to communicate any feedback directly to him at www.Lawrence.Tabak@nih.gov.
The Council thanked Dr. Tabak for his presentation. The Council noted the complexity of levels of science currently and the challenge of bringing together researchers with different expertise to focus on strategic areas of opportunity. In response to a question about research on aging, Dr. Tabak noted the importance of this area and agreed with the need to balance research in basic biology with studies of diseases and cures. He noted that the strategic plan will emphasize the study of health, including during aging, and that the NIH hopes that this emphasis will broaden research, as driven by investigator-initiated imagination and work. The Council suggested that the growing number of U.S. immigrants presents the NIH with a strategic opportunity to focus on pediatric diseases. Dr. Tabak noted that consideration is being given to broadening the context of rare diseases studied at the NIH Clinical Center to include rare diseases among foreign nationals and to studies of the effects of trauma and inflammation in past generations on the burden of disease in current generations.
The Council applauded the plan’s emphasis on health and asked how this emphasis will impact investigators who are preparing research grant applications. Dr. Tabak noted that the NIH hopes that the new emphasis on health will encourage investigators to shift their focus to tackle truly intractable questions of health and disease and to increase their cross-NIH collaborations. The NIH also hopes the strategic plan will resonate with other stakeholders, such as the Congress, in their decision-making. Dr. Tabak further noted that the NIH views potential partners in the broadest sense, to include other HHS components, other Federal agencies, the private sector, and not-for-profit organizations. He said that the plan will articulate the unique role of the NIH within the HHS and illuminate areas of synergy with other HHS components.
The Council raised the issue of retention of the research workforce, particularly among junior scientists. The Council suggested that funds could be set aside in certain programs [e.g., the Small Business Innovation in Research (SBIR) program] specifically for junior scientists, who would compete only among themselves for these funds. Dr. Tabak noted that other NIH advisory councils have commented on this issue and that various strategies could be employed. The Council also suggested that the NIH could do more to capture the experience of researchers who are retiring or coming to the end of their careers, by for example, enlisting them in senior mentoring roles. Dr. Tabak said that the NIH is considering initiating a “last” or “emeritus” award for such individuals and will be discussing this topic at its next Leadership Forum.
The Council asked about the “fit” between the NIH Strategic Plan and the President’s Precision Medicine Initiative announced on September 17. Dr. Tabak said that the two efforts fit well together, and he encouraged the Council to follow this initiative, which is exciting, important, and strongly supported by the President.
Dr. Somerman encouraged the Council to keep up with the NIH’s Precision Medicine Initiative website: https://www.nih.gov/research-training/precision-medicine-initiative. She noted that the NIDCR participated in the strategic planning for this initiative and that it is a very important effort for the NIDCR, especially as the emphasis is on medicine while dentistry has been left out. She noted that the NIDCR is seeking inclusion of dentistry’s electronic health records (EHRs) in this initiative, as well as a more robust focus on dental health problems. She emphasized the need for greater collaboration between medical and dental schools. Council member Dr. Yang Chai commented that the University of Southern California’s EHR data warehouse involves the university’s medical, dental, and pharmacy schools. Dr. Somerman encouraged dissemination of this “best practice” to other universities.
VI. CONCEPT CLEARANCES
Dr. Dombroski noted that the NIDCR is required to present to the Council the scope, purpose, and objectives of staff-developed concepts for NIDCR initiatives and to give the public an opportunity to provide comment. The NIDCR staff presented six concepts for the Council’s review. Two or three members of Council led the discussion of each concept.
Glycoprofiling HIV and Persisting AIDS-Related Oral Pathogens under Antiretroviral Therapy
Dr. Isaac R. Rodriguez-Chavez, program director of the AIDS and Immunosuppression Program, IBIDB, DER, presented a proposed concept to glycoprofile HIV and persisting AIDS-related oral pathogens in patients receiving antiretroviral therapy. The goals are (i) to elucidate the structure, abundance, and distribution of glycans in HIV and persisting AIDS-related oral pathogens under antiretroviral therapy (HIV-OP/ART), and (ii) to annotate glycans for HIV-OP/ART in a new electronic AIDS-related database, which will be developed, implemented, and publicly shared by investigator-initiated, coordinated plans. As background, Dr. Rodriguez-Chavez noted that there is a global health need for more effective therapies to halt the AIDS pandemic and to clinically manage HIV-OP/ART; that the structure of glycans on glycoconjugates of infectious pathogens plays an important role in determining the balance between health and disease; and that elucidation of the structure, abundance, and distribution of glycans on glycoconjugates of HIV-OP/ART could yield a new class of biomarkers and therapeutic targets.
Dr. Rodriguez-Chavez said that the concept is both feasible and timely. The NIH Common Fund’s Glycoscience Program has attracted investigators from outside the field to catalyze the development of technologies, reagents, and databases that allow the linking of glycosylation profiles of glycoconjugates with systemic diseases. It is timely for the NIDCR to leverage the resources and infrastructure of the Glycoscience Program to determine and annotate in a database the glycans in HIV-OP/ART. The AIDS-related, reference electronic data and database that are produced and implemented publicly will serve as a resource of persistent oral pathogens for future biological studies.
The Council’s lead discussants, Dr. J. Leslie Winston and Dr. Richard Peters Darveau, supported the concept. Dr. Winston said that the concept is a great example of how the NIDCR can participate in the Common Fund’s Glycoscience Program. She noted that there is substantial evidence that glycans play an important role in oral pathogens of HIV/AIDS and the oral mucosa and that there is great potential for translating the knowledge gained into dentistry and other fields. Dr. Darveau said that the time is ripe, as this initiative would match with the NIH Strategic Plan and Common Fund priorities and would utilize the new technologies available. In discussion, the Council asked whether there is a corollary effort to study glycan changes in the oral mucosa. Dr. Rodriguez-Chavez said the concept focuses more broadly on oral pathogens, though there is hope that it would yield information on intrinsic and complex glycan‒host interactions and help to build glycan libraries that would allow investigators to pinpoint areas of interest.
The Council unanimously approved the concept.
NIDCR Mentoring Network
Dr. Lynn King, chief of the RTCDB, DEA, presented a proposed concept for a mentoring network for underrepresented minority early-career-stage investigators. The goals of the proposed program are to develop a mentoring network and to provide structured mentoring activities for investigators who are underrepresented in the biomedical, clinical, behavioral, and social science research workforce. The network is expected to ensure high-quality mentorship that will enhance participants’ career development and their professional success as independent researchers and members of the dental, oral, and craniofacial research community. Dr. King noted that NIDCR currently lacks programs designed to develop a community of researchers dedicated to the mentorship, career progression, retention, and success of individuals who are members of groups that are underrepresented in the biomedical research community. The proposed mentoring network and structured and unstructured activities would help to guide the development of professional skills of early-career, underrepresented investigators and would enhance the investigators’ scientific career trajectories and potential for career advancement.
The Council’s lead discussants, Drs. Hector G. Balcazar, Teresa Ann Dolan, and Benjamin Alexander White, Jr., enthusiastically supported the concept. Dr. Balcazar noted the importance of understanding the complexities of mentoring underrepresented early-career investigators. Dr. Dolan commented that development and retention of the research workforce are critical. She noted that increasing the number of underrepresented investigators is necessary to improve public health and that previous efforts have not been successful. She further noted that structured mentoring programs are likely to produce successful outcomes and would be an important initiative for the NIDCR. Dr. White said that the concept was appropriate in scope and consistent with the NIDCR’s strategic plan. He cautioned that “the devil is in the details” and that making the network work is critical.
The Council members agreed on the importance of fostering a supportive environment for mentor‒mentee relationships and for cohorts of mentees (e.g., workshops to bring mentees together). The Council encouraged the NIDCR to consider lessons learned by other ICs (e.g., the National Heart, Lung, and Blood Institute) and universities (e.g., the University of North Carolina at Chapel Hill) which support similar programs. Dr. King suggested that the lessons learned and best practices may be translatable to all NIDCR-supported trainees.
The Council unanimously approved the concept.
Biosensors in the Oral Cavity
Dr. James L. Drummond, program director of the Dental and Biomaterials Program, IBIDB, DER, presented a proposed concept to develop biosensors for the oral cavity. The goal is to develop new biosensor prototypes for noninvasive, dynamic, real-time monitoring of physiological processes in the human body using the oral cavity as the sensing site. The biosensors would be able to assess health and disease states and to receive signals from oral fluids, cells, and microorganisms, as well as other compounds that are found in or pass through the oral cavity. Dr. Drummond noted that the concept is both feasible and timely owing to recent advances in technology—wireless technologies, dissolvable nanotechnology-based electronics, and improved sensing—and the accessibility of the oral cavity as an entryway into the body (e.g., for bacteria, viruses, medications, dietary and toxic substances). The advances make it possible now to design effective biosensors, composed of a power source, antenna, sensor, and signal, that can be used by trained dental professionals to examine any soft, firm, and hard tissues in the oral cavity (e.g., cheeks, gingiva, teeth) and to monitor them over the short or long term. Dr. Drummond noted that the NIH has convened conferences on wireless technologies and biosensors and that thousands of biosensors and wireless devices are being developed.
The Council’s lead discussants, Dr. J. Leslie Winston, and Dr. Anne C. Tanner, noted that tremendous advances have been made and that while they are very exciting and could elevate research on biosensors in the oral cavity, this research will be challenging. Dr. Winston suggested that the proposed concept include endpoints relevant not only to the oral cavity, but also to other systems, as well as other ways of monitoring the oral cavity (e.g., imaging). Dr. Tanner noted that a number of tools (e.g., saliva kits) are already available for measuring dental caries and periodontal disease and could be useful for monitoring processes in the oral cavity. She suggested that a simpler, more direct (e.g., non-wireless) device for use in the oral cavity might be more clinically useful and that clinical practitioners would prefer having one test for all measurements.
The Council noted that the concept has merit and that key indicators of oral health are ultimately needed for prevention of disease and maintenance of health in the oral cavity. The Council commented on the complexity of the oral environment. Members noted researchers’ ability to sample breath in the oral cavity, the need for monitoring of host‒environment interfaces (e.g., biofilms), and the requirement to test specific biological questions in animal models. Dr. Drummond noted that testing anything in the mouth is difficult, that measures need to be constantly reassessed, and that the many devices and data that could be developed have to be weighed for their reliability, validity, predictability, and applicability. He also noted the need for balance between basic science and applied research. The Council emphasized the necessity of having a clear understanding of the future clinical translatability of the research. Members urged the NIDCR to guard against spending resources on development of devices that clinicians will not adopt and suggested that the NIDCR apply a standard rule-of-thumb: that is, do not pursue research or development of new technology that will not change dental care.
The Council unanimously approved the concept.
Dental, Oral, and Craniofacial 3D Tissue/Organ Models to Mimic Health and Disease
Dr. Nadya Lumelsky, acting chief of IBIDB, DER, presented a proposed concept for development of three-dimensional (3D) models of tissues and organs to mimic health and disease. The goal is to develop tools and technologies that will allow for robust, precise, and predictable in vitro assembly and functional morphogenesis of human 3D Dental, Oral, and Craniofacial (DOC) micro tissues and organs (tissue/organ chips) that can mimic human physiological and pathophysiological responses. The expected outcomes are (i) derivation of unique model systems for elucidating human DOC tissue and organ development, (ii) addressing mechanistic questions of health and disease of human DOC tissues and organs, (iii) identification of new therapeutic targets for DOC diseases, and (iv) development of approaches for testing the efficacy and toxicity of drugs targeting DOC diseases.
Dr. Lumelsky mentioned that traditional model systems offer different types of technical capabilities at increasing degrees of structural and functional complexity, from 2D cell monolayers to 3D organoids, tissue/organ chips, and animal models. Development of tissue/organ chips would bridge the gap between partial recapitulation of tissue complexity, as available with 3D organoids, and animal models, the gold standard for recapitulation of systemic tissue and organ responses. Dr. Lumelsky said that among current in vitro systems, tissue/organ chips potentially offer superior recapitulation, though the research is still in the discovery phase and extensive functional validation studies are needed. She noted that continued research on tissue/organ chips would leverage advances in microfabrication and microfluidic technologies with advances in developmental and stem cell biology.
Dr. Lumelsky said that, in 2012, the NIH, the Defense Advanced Research Projects Agency (DARPA), and the Food and Drug Administration (FDA) launched a 5-year partnership to advance derivation of human tissue/organ chip platforms (i.e., to devise a “human-on-a-chip” for studying systemic responses across cell types). Extensive validation of the newly derived systems is under way, and Phase II research for this high-visibility project is being planned. Dr. Lumelsky noted that this effort does not include DOC chips and that the proposed concept would fill this gap. Examples of DOC chips of interest to the NIDCR include craniofacial bone‒skeletal muscle, craniofacial bone‒cranial suture, periodontium‒tooth, dentin‒dental pulp, salivary gland and oral mucosa. Dr. Lumelsky suggested that this research could create unprecedented opportunities for basic and translational research within the NIDCR mission and would facilitate incorporation of DOC tissues into other emerging platforms so as to study reciprocal interactions between DOC and other tissues in the body.
The Council’s lead discussants, Dr. Jane B. Lian and Dr. Yang Chai, agreed that the proposed concept was exciting, forward-thinking, timely, feasible, practical, and relevant to the NIDCR mission. They enthusiastically supported the use of resources for this research and emphasized the need to ensure cross-collaboration among biologists, engineers, materials scientists, and clinical scientists when designing DOC chips. They noted that the DOC complex comprises a number of distinctive tissues in the body and that this research would highlight the uniqueness of this region.
In discussion, Dr. Lumelsky said that the proposed research is highly relevant for patients, as the aim is to develop systems that are applicable for preclinical testing of the safety and efficacy of drugs and would enable more efficacious utilization of stem cell-based technologies. The Council suggested that the simplest tissue/organ model to develop may be that of taste.
The Council unanimously approved the concept.
Factors Underlying Differences in Female and Male Presentation for Dental, Oral, and Craniofacial Diseases and Conditions
Dr. Amanda A. Melillo, director of the Salivary Biology and Immunology Program, IBIDB, DER, presented a proposed concept to support research on mechanisms underlying male- and female-based differences in DOC-related diseases and conditions. The specific goal is to understand immune reactivity, genetic and environmental triggers, and hormonal changes as they relate to sex-based differences. Dr. Melillo highlighted three diseases or conditions in which significant differences are found between males and females. She noted that women comprise nine out of 10 people with Sjögren’s syndrome. Moreover, the incidence rates for autoimmune diseases are higher in females and 75 percent of Americans diagnosed with autoimmune diseases are women. Among head and neck cancers, the incidence rate of major salivary gland carcinomas (e.g., adenoid cystic, acinic cell, and muco-epidermoid cancer) is 25‒38 percent higher in females than in males, and the incidence rate of squamous cell carcinomas is 122 percent higher in males than in females, but human papilloma virus-associated oropharyngeal cancers are 3- to 5-fold more common in men. Also, orofacial pain conditions are more common among women. For example, females have a 4-fold greater risk of temporomandibular joint disorders (TMDs) than do males and are at greater risk of transitioning from acute to chronic pain status with these disorders.
Dr. Melillo said that the proposed concept would focus on five areas in which there are significant gaps in understanding sex-based differences. These are (i) identification of genetic risk/protective factors, gene polymorphisms, and gene‒environment interactions; (ii) identification of molecular pathways and cellular networks in the onset, progression, and persistence of disease and the response to treatment; (iii) elucidation of sex hormone influences on differences in plastic responses; (iv) characterization of sex-based regulation of immune reactivity that initiates and controls inflammation; and (v) study of disease-specific areas of interest. She noted that advancing the understanding of mechanisms underlying sex-based differences is likely to result in identification of new therapeutic targets and development of precision medicine-based therapies.
The Council’s lead discussants, Dr. Yvonne L. Kapila and Dr. Mary L. Marazita, strongly supported the breadth, timing, and potential impact of the proposed research. Dr. Kapila noted the dearth of studies on gender differences (e.g., in Sjögren’s syndrome), NIDCR’s ongoing support of the Sjögren’s International Collaborative Clinical Alliance (SICCA) repository, and new data emerging from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study. She suggested specifically adding behavioral triggers to the concept. Dr. Marazita agreed that gender-related differences are poorly understood and that the proposed research does link with the Precision Medicine Initiative. She emphasized the importance of cross-collaborative studies and suggested that the NIDCR clearly state that the concept is inclusive of other diseases and conditions beyond the three specifically mentioned.
The Council unanimously approved the concept.
Tailoring Dental Treatment Guidelines for Individuals with Systemic Diseases that Compromise Oral Health
Dr. Dena Fischer, program director of the Clinical Research and Epidemiology Program, Center for Clinical Research (CCR), DER, presented a proposed concept for tailoring dental treatment guidelines for individuals with systemic diseases or conditions that compromise oral health. The three goals are (i) to address knowledge gaps in the treatment of oral diseases for these individuals, (ii) to identify factors predictive of treatment outcomes within patient groups, and (iii) to generate evidence for more precise dental treatment guidelines tailored to patients’ needs. She noted that it is known that oral diseases are more prevalent and severe in patients with certain systemic diseases (e.g., diabetes) and syndromes (e.g., Sjögren’s syndrome, ectodermal dysplasia) and that affected patients are managed with more frequent and aggressive dental treatment protocols.
Dr. Fischer pointed out that current standard dental treatment guidelines are derived from clinical trials in healthy patients or studies with limited follow-up periods and that there are knowledge gaps in dental treatment guidelines for individuals with systemic diseases or conditions that impact their oral health. She said that addressing these knowledge gaps, identifying factors predictive of treatment outcomes, and generating evidence for more precise guidelines are feasible by capturing longer-term outcomes in established cohorts of individuals with a disease of interest. Dr. Fischer noted that the NIH, patient advocacy groups, and academic centers have cohorts of patients with specific diseases and conditions that could be accessed to accomplish the goals of the proposed concept.
The Council’s lead discussants, Ms. Tracy Hart and Dr. Jane A. Weintraub, supported the proposed concept, saying it clearly conveys a way to work with patients and patient advocacy groups and has meritorious objectives. Ms. Hart suggested that the NIDCR could advocate for inclusion of a dental component in NIH-supported longitudinal studies. Dr. Weintraub remarked on the dearth of studies of patient cohorts and the limited information available on dental treatment of patients. She suggested that the title of the concept be revised to emphasize research that supports development of guidelines, rather than tailoring of guidelines per se. She further suggested that the concept include support of preliminary analyses of available data, definition of “established cohorts” and establishment of new cohorts, randomized clinical trials to compare different treatment protocols, and multidisciplinary teams with medical, dental, clinical, and epidemiological research expertise. In discussion, the Council suggested that the concept mention that oral‒systemic connections are unknown for many diseases and conditions (e.g., metabolic syndrome).
The Council unanimously approved the concept.
VII. SPECIAL SESSION ON ORAL MICROBIOME
Dr. R. Dwayne Lunsford, program director of the Microbiology Program, IBIDB, DER, introduced the special session and speakers. He affirmed that the present time is truly very exciting for a microbiologist. In early 2007, the oral microbiome was chosen as one of five body regions to study in the Human Microbiome Project (HMP), and in 2012, the HMP captured the cover of Nature (vol. 486, 14 June 2012). Dr. Lunsford noted that for several decades before 2007, NIDCR-supported investigators had been studying the oral microbiome and that they are continuing to lead this research in the current “post-HMP” era. The presentations of the three speakers are summarized below.
The Human Oral Microbiome and Metagenome
Dr. Floyd E. Dewhirst, Senior Member of the Staff, Department of Microbiology, The Forsyth Institute, Cambridge, Massachusetts, thanked the NIDCR for the opportunity to speak to the Council about the human oral microbiome and metagenome. He addressed the definitions for microbiome and metagenome, the history of oral microbiology and classification of bacteria, establishment of the Human Oral Microbiome Database (HOMD), and successes in cultivating previously uncultivable organisms.
Dr. Dewhirst said that microbiome, as defined by Dr. Joshua Lederberg, is “the ecological community of commensal, symbiotic, and pathogenic microorganisms that literally share our body space and have been all but ignored as determinants of health and disease,” whereas metagenome is the DNA sequences of all genes of microorganisms in a particular environment or sample. He noted that the beginning of microbiology, with Van Leeuwenhoek’s observations in 1674, was also the beginning of oral microbiology and that the two fields have developed in tandem—from determination of phenotypes of bacteria grown in Petri dishes; to the understanding of biology based on phylogeny, put forth by Darwin in the mid-1880s; to construction of a phylogenetic tree of life, beginning with Haeckel; to the breakthrough publication by Zuckerkandl and Pauling establishing molecules as actual documents of evolutionary history, a view that has served as the framework for microbiology ever since. Dr. Dewhirst noted that Woese’s work in the 1970s, building phylogenetic trees based on 16S rRNA gene sequences, eventually led to Pace’s publication in 2001 of the currently accepted phylogenetic tree of life, which consists of bacteria, eucarya, and archaea.
Similarly, oral microbiology moved from cultivation of phenotypes, in the 1850s to the 1980s, to phylogenetic studies based on 16S rRNA gene sequences, beginning in the late 1980s, which focused on oral campylobacters, oral treponemes, and the diversity of microbes in subgingival crevice and plaque. In 1995, the first full genome of a bacteria (haemophilus influenza) was published by Venter, and subsequently, in 2002, several papers published the genomes for four specific oral bacteria—Fusobacterium nucleatum, Streptococcus mutans, Porphyromonas gingivalis, and Treponema denticola. Dr. Dewhirst noted that, by 2004, it was clear that research progress on the oral microbiome was impeded by the lack of a naming scheme for 16S rRNA phylotypes and the unavailability to researchers of isolates for unnamed oral bacteria. To move forward, the NIDCR issued a Program Announcement in 2004 to support metagenomic analyses of the oral microbiome and, following the review of applications, funded two awards, to Stanford University and The Forsyth Institute. In 2008, the NIH launched the Human Microbiome Project.
Dr. Dewhirst noted that the NIDCR aimed to secure a foundation for research on the oral microbiome and metagenome by supporting development of a taxonomic framework for unnamed taxa, the obtaining of genomes for oral bacteria, identification of isolates for unnamed and previously uncultivated bacterial species, and creation of a web-accessible database. He reported that this database, the HOMD, is publicly available now at http://www.homd.org and, as stated on the website’s homepage, the goal is “to provide the scientific community with comprehensive information on the approximately 700 prokaryote species that are present in the human oral cavity.”
Dr. Dewhirst said that approximately 50 percent of the 688 taxa of oral microbial species are named, 15 percent are cultivated but not named, and 35 percent are known as uncultivated phylotypes. He noted that the 65 percent of the species already cultivated far exceeds current knowledge of other microbial species (e.g., only about 1 percent of the microbes in the world’s oceans have been cultivated). Using the HOMD website, researchers can link to taxon descriptions, 16S rRNA gene sequences, and genomes for the species, as well as PubMed articles and information on purchasing resources for research. Dr. Dewhirst noted that with this enormous database, researchers have greater utility for studying the genomics, transcriptomics, proteomics, and metabolomics of the oral microbiome than for any other body site.
Dr. Dewhirst commented that progress is being made on cultivating previously uncultivable bacteria using an iChip, TM7, single-cell genomics, and growth of organisms in consortia. He said that researchers at The Forsyth Institute have had success moving from consortia to encouraging single organisms to grow with a feeder. They have been able to grow bacteria from lesser known phyla (synergistetes, chloroflexi); to grow the difficult-to-grow Tannerella sp. Clone BUO63, one of the most virulent pathogens in the mouth; and to cultivate 46 previously uncultured taxa over the past 5 years. Dr. Dewhirst noted that each of the oral cavity’s nine sites has distinct microbiomes and that uncultivated taxa have been identified in all sites.
In conclusion, Dr. Dewhirst said that the NIDCR leads the way in human microbiome research and that the oral cavity is the only body site for which dedicated websites have been established for microbiome data. He noted that the oral cavity, in comparison with all other body regions, offers the highest percentage of cultivated bacteria, the highest percentage of genomes sequenced, the most reference strains to work with, and nine easily sampled niches.
Taming “Uncultivable” Microbes
Dr. Slava S. Epstein, Distinguished Professor, Department of Biology, College of Science, Northeastern University, Boston, Massachusetts, elaborated on the progress being made to cultivate previously uncultivable bacteria. He asserted that there is no such thing as uncultivable bacteria, for all bacteria are potentially cultivable, though perhaps by means other than a Petri dish. He noted that scientists are finding ways to grow bacteria via other methods and can study them under laboratory conditions. Dr. Epstein emphasized that this research is necessary and important as only about 1 percent of microorganisms in the environment have been cultivated so far.
Dr. Epstein described the efforts of his research to “tame” uncultivable microbes by bringing laboratory conditions to samples, as opposed to bringing samples to the laboratory. He first illustrated the development and use of diffusion chambers, whereby agar that contains bacteria is separated from the environment by membranes that allow chemical diffusion to occur, while neither the sample nor other organisms can pass through. Dr. Epstein noted that with this technology, he and his team were able to isolate (recover) and produce (grow) microbes for study, yielding numbers far exceeding those possible with a Petri dish. From this research, he observed that (i) uncultivable microorganisms can grow in vitro in the presence of “helper” species, (ii) uncultivable microorganisms spontaneously domesticate (grow in vitro), and (iii) uncultivable microorganisms respond to what appear to be signaling molecules produced in the presence of their kin. That is, some bacteria require helper species, some do not, and some may need help initially, but not later.
Dr. Epstein noted that from experiments with diffusion chambers, his research led to development of isolation chip (iChip) technology, whereby separated cells can be loaded onto a chip and embedded into mold, and eventually miniaturization of the iChip. He reported that the performance of this technology in growing colonies of microorganisms surpasses that of diffusion chambers and far exceeds that of Petri dishes. The iChip allows for isolation and growth of more and different species, including strains from uncultivable HOMIM taxa (e.g., isolates ICM47 and ICM34 in taxon 172) and numerous novel species and genera sharing rRNA gene identity with known microorganisms. Dr. Epstein noted that this research has led to the discovery, study, and cultivation of novel antibiotics (e.g., teixobactin) from previously uncultivable microorganisms and that the results are a testament to the value of the research and the use of these technologies to gain access to microorganisms.
In summary, Dr. Epstein noted that there is an enormous biodiversity of microbes that can be accessed using various techniques and that innovative technologies are needed to access the one-third of oral microbes that have yet to be cultivated. Research concepts being explored for the future include the development of a microbial growth chamber that can sample cells by itself (e.g., when dropped into the ocean), nanosensors that can be placed in the chamber to determine and monitor conditions and to transmit data, and placement of additional chambers on top of diffusion chambers to release challenges to the microorganisms within the diffusion chamber via valves controlled by a wireless signal. Dr. Epstein said that these efforts will move science closer to studying organisms in nature.
Acquisition of the Oral Microbiome
Dr. Ann L. Griffen, Professor, Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, presented the results of three ongoing clinical studies undertaken to examine how oral microbiota are acquired. The overall question is: What does health look like? Dr. Griffen noted that this research is founded on scientists’ current understanding that the human microbiome is a super-organism in which the microbiome (composed of approximately 700 species of bacteria in the mouth alone) is an integral and essential part of the system and engages in a symbiotic relationship with the host to maintain health by, for example, priming the immune system, supporting metabolic functions, and protecting against disease. From this perspective, unfavorable shifts in the composition of microbial communities (i.e., dysbiosis) are viewed as a cause of chronic diseases (e.g., caries, periodontal diseases).
Dr. Griffen said that the three clinical studies address three separate questions: (i) Is there a common pattern and timeframe for acquisition of oral microbiota? (ii) Is this acquisition easy to disrupt? (iii) How does acquisition of microbiota in the mouth compare with that in other body sites? To address the first question, she and her team conducted a 1-year longitudinal study of nine mother‒infant pairs, from whom saliva (gingival) was sampled (at birth and monthly) to obtain microbes for 16S rDNA sequencing. Dr. Griffen noted that the study showed a steady increase in the total number and complexity of species detected among infants, toddlers, and mothers; a seemingly universal and specific convergence to core species among toddlers over time; a common order of acquisition for a majority of species shared with adults (i.e., 113 dominant core species); and substantive changes in the species as a result of diet (introduction of solid food), but not eruption of teeth. Dr. Griffen said that the researchers are continuing to follow the toddlers into adulthood to study the stability of the oral species, bacterial strains and host genetics, and potential development of dysbiosis and disease.
To address the second question, the researchers followed a cohort of 38 infants born at 34‒36 weeks’ gestational age. One-half (19) of the infants stayed in the hospital for approximately 2 days and then went home, and the other half (19) remained in a neonatal infant care unit (NICU) for approximately 2 weeks. The researchers collected samples of gingival saliva via swabs of the infants’ oral cavity (at day 1, week 2, and month 3) to establish the effects on infants’ acquisition of oral microbiota by degree of early contact, antibiotic therapy, vaginal versus Cesarean delivery, and human milk versus formula. Dr. Griffen reported that the study showed that, in both groups of infants, establishment of the oral microbiota was a robust process and assembly of the microbial ecosystem was resilient to limited exposure (contact), use of antibiotics (ampicillin), method of delivery, and feeding practices (though breastfed infants showed a marginally lower diversity of species and more Streptococcus mitis than did formula-fed infants). Dr. Griffen said that the researchers are continuing their studies, to elucidate factors (including genetics) that control the acquisition process.
To address the third question, the researchers compared data from 16S rDNA sequences of saliva (gingival) and vaginal samples obtained via swabs from 10 mother‒toddler pairs. Dr. Griffen noted that the results showed that the composition of microbial species in oral samples was similar in mothers and their toddlers, whereas the composition in vaginal samples was different between mothers and their toddlers. Further, the diversity and complexity of the species in oral samples increased from toddlers to mothers, whereas in vaginal samples, they decreased from toddlers to mothers. Dr. Griffen concluded that the body sites are distinct ecosystems which acquire microbiota differently and that acquisition of oral microbiota appears to be tightly controlled.
In closing, Dr. Griffen said that the particular pattern and specific strains of microbial species in the oral cavity are different for each individual and may reflect both genetic and environmental factors. She noted that she and her colleagues will seek to better understand these differences and the controlling factors in future studies.
The Council applauded the speakers for their presentations. In discussion, the members commented on the difficulty of cultivating microbial organisms and of distinguishing and defining microbial species and taxa. They posed several additional areas for study, including the role of fathers and siblings in the development of individuals’ oral microbiome, the acquisition of microbial species between toddler and teenage years, and a broader sampling of the oral mucosa (e.g., subgingival tissues). NIDCR staff mentioned that the “holy grail” of microbiology would be to grow microbial communities in predictable ways so as to be able to probe questions about the interaction between communities and their host.
VIII. ADJOURNMENT OF OPEN SESSION
Dr. Somerman adjourned the open session of the Council meeting at 12:56 p.m.
This portion of the meeting was closed to the public in accordance with the determination that it was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix 2).
IX. REVIEW OF APPLICATIONS
The Council considered 386 applications requesting $97,520,147 in total costs. The Council recommended 224 applications for a total cost of $57,435,060 (see Attachment II).
The meeting was adjourned at 2:39 p.m. on September 18, 2015.
I hereby certify that the foregoing minutes are accurate and complete.
Dr. Martha J. Somerman Dr. Alicia Dombroski
Chairperson Executive Secretary
National Advisory Dental and National Advisory Dental and
Craniofacial Research Council Craniofacial Research Council
I. Roster of Council Members
II. Table of Council Actions