Center for Clinical Research, DER, NIDCR
The goal of this initiative is to accelerate research that will improve the oral health of older adults living in the United States by addressing knowledge gaps in the etiology and management of dental, oral and craniofacial diseases associated with aging. Research proposals that involve interdisciplinary multi-PI collaborations with researchers studying dental, oral and/or craniofacial diseases and researchers with a background in aging research will be strongly encouraged.
Older adults comprise a rapidly growing segment of our population due to longer life spans and the aging of baby boomers. In the United States, the 65-and-older population is projected to more than double over the next four decades, from 46 million to 98 million by 2060. Racial and ethnic minorities, who comprised 22% of older adults in 2014, are projected to increase to 28% of all older adults by 2030. The prevalence of chronic diseases and conditions increases with age, and these conditions as well as their comorbidities, treatments, and psychosocial factors can negatively affect oral health. Further, well-recognized oral conditions such as periodontal disease, root caries and salivary hypofunction are more common in older adults, and the risk of developing certain craniofacial diseases such as head and neck cancer increases with age. For example, analysis of 2009-2012 National Health and Nutrition Examination Survey (NHANES) data found that total periodontitis is highly prevalent among US adults ≥ 65 years, affecting 70-80% of all socioeconomic groups. In NHANES 2011-2012, almost 20% of adults ≥ 65 years had untreated dental caries, and Surveillance, Epidemiology, and End Results (SEER) 2009-2013 data indicated that incidence and mortality rates of oral and pharyngeal cancer increased with age across racial groups, particularly in adults ≥ 55 years. Certain segments of the older adult population may be disproportionately affected by poor oral health outcomes, due to low socioeconomic status, limited access to oral care, and/or racial/ethnic inequities.
Through advances in preventive oral care, many older adults are retaining their natural dentitions throughout life, presenting new challenges to the oral health community. In parallel, a recent study has shown that aged compared to young mice exhibit a greater adaptive immune response to oral infection and reduced bacterial diversity, which may contribute to an increased susceptibility to oral disease. Although there may have been some limitations in experimental design due to control selection, the findings suggest that further study is warranted. It is essential to address knowledge gaps that exist in the basic biology of aging in dental, oral and/or craniofacial (DOC) tissues and to contrast aging of DOC tissues with aging tissues in other regions of the body. It is also important to improve our understanding about the impact of age-related changes in the oral environment upon the development of dental, oral, and craniofacial disease. Clinical care guidelines for older adults and research identifying effective approaches to support oral health throughout the later years of life are also needed.
Alignment with Institute Goals and Strategic Plan
The objective of this initiative is consistent with the NIDCR Strategic Plan 2014-2019: Objective 1-1: Enable basic research to advance knowledge of dental, oral, and craniofacial health; Objective 1-3: Conduct translational and clinical investigations to improve dental, oral, and craniofacial health; and Objective 2-1: Support research toward precise classification, prevention, and treatment of dental, oral, and craniofacial health and disease. This initiative would encourage researchers in the aging and oral health disciplines to explore partnerships and form interdisciplinary research collaborations to address knowledge gaps in dental, oral and craniofacial diseases that increase with aging and to contrast factors associated with aging in DOC cells/tissues with aging cells/tissues in other regions of the body. Longitudinal cohort studies of older adult populations with chronic disease could untangle relationships between aging, disease and oral conditions that are commonly observed in older adults. Future research directions may identify factors related to prevention and quality treatment earlier in the lifespan to offset the cumulative effects of dental, oral and craniofacial disease and aging over the life course.
Across NIH, it has been recognized that there is an increasing need to support research to address issues around aging, from the basic biology of aging, to clinical studies focused on developing the best clinical care guidelines for older adults, to behavioral and social sciences research identifying effective approaches to support oral health throughout aging.
Complex dental, oral and craniofacial problems in the context of aging typically require collaborative and interdisciplinary research approaches for their solution. To stimulate scientific advances, this initiative aims to identify and support interdisciplinary multi-PI collaborative opportunities for researchers focused on aging and researchers focused on dental, oral and/or craniofacial health.
Research supported by this initiative could include, but is not limited to:
- Identifying age-related genetic/genomic, molecular and cellular mechanisms of healthy aging, wound healing/tissue regeneration capacity, and responses to treatment in DOC tissues; and to compare these age-related changes with the aging of other tissues in the body;
- Developing improved animal model systems to study DOC tissues in aging and compare to the aging of other tissues/organs in the body;
- Identifying age-related changes in salivary gland structure, salivary composition, and/or gingival crevicular fluid and the relationship of these changes to the development of dental/oral disease;
- Identifying the impact of age-related biological changes in the oral microbiota and/or oral immune function upon the development and management of dental, oral and/or craniofacial diseases; and to contrast these age-related changes with the aging of comparable tissues elsewhere in the body;
- Analysis of existing data/biospecimens to explore causal associations between dental, oral and/or craniofacial diseases and diseases of aging, including genomic analyses; or to assess the impact of aging diseases upon the development of dental, oral and/or craniofacial diseases that increase with age and to contrast with aging diseases in other regions of the body;
- Collection and analyses of oral health clinical data or DOC biospecimens from participants enrolled in existing studies;
- Activities that test putative mechanisms of action of one or more oral health behavior change interventions for older adults as implemented in experimental, clinical, community, or population-level settings; explore whether such mechanisms of action affect total health issues in aging;
- Assessment of best methods to improve oral health in frail elders, such as applying organizational change in assisted living communities to improve oral health outcomes of the older adult residents; assess the value of adding such methods to total health care routines applied to elder individuals.
Current Portfolio Overview
The NIDCR currently supports a small cluster of projects addressing: a) bony changes in osteoarthritis and other aspects of bone biology in aging, b) the oral microbiome and periodontitis in postmenopausal women, c) developing a measure of illness perception for dental use in older adults, and d) an intervention to improve the oral health of institutionalized older adults. The current portfolio of primarily observational and association studies is insufficient to address the many remaining knowledge gaps stated above. The NIDCR portfolio would benefit from robust research to identify the basic biology and underlying mechanisms of aging in DOC tissues, appropriate oral care for older adults, and oral health support throughout the life course.
- Eke PI, Wei L, Borgnakke WS, Thornton-Evans G, Zhang X, Lu H, et al. Periodontitis prevalence in adults >/= 65 years of age, in the USA. Periodontol 2000 2016;72(1):76-95.
- Dye B, Thornton-Evans G, Li X, Iafolla T. Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief 2015(197):197.
- Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2013, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER web site, April 2016.
- U.S. Department of Health and Human Services; U.S. Administration on Aging; Administration for Community Living. A profile of older Americans: 2015; 2015. Available at: http://www.aoa.acl.gov/aging_statistics/profile/2015/docs/2015-Profile.pdf.
- Wu Y, Dong G, Xiao W, Xiao E, Miao F, Syverson A, Missighian N, et al. Effect of aging on periodontal inflammation, microbial colonization, and disease susceptibility. J Dent Res 2016;95(4): 460-6.