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GOAL 3: Apply rigorous, multidisciplinary research approaches to overcome disparities and inequalities in dental, oral, and craniofacial health.

A group of smiling young children 

NIDCR-supported research has led to many strategies for promoting oral health and preventing oral disease, but they do not always reach people and communities who need them most. As we discover and adopt newer and better methods to prevent, diagnose, and treat disease, we must improve our ability to translate and disseminate new knowledge effectively for oral health care providers, decision makers, and people in the communities who remain underserved and are at greatest risk for poor health.

Tackling the problem of oral health disparities requires a collaborative, multilevel approach that combines mechanistic, dissemination, and implementation research with community engagement and policymaking. NIDCR’s role is to lead the effort to serve communities by funding the best research toward building a strong evidence base for sustainable, acceptable approaches. NIDCR will continue to work with the NIH community, other Federal agencies, professional societies, community organizations, and the public sector, in a determined effort to diminish and ultimately eliminate persistent oral health disparities.

Objective 3-1

Support multidisciplinary, multilevel research and research training to overcome oral health disparities.

NIDCR will continue its substantial investment in oral health disparities research. Current multidisciplinary research teams working to establish the best methods to reduce oral health disparities in their communities are building on discoveries made during the last twenty years of this research program. Beginning with the establishment of regional centers in the 1990s to the most recent funding of the Centers for Research to Reduce Disparities in Oral Health in 2008, the program was built using a team-science, multilevel approach. The Centers also have expanded the number of researchers from diverse disciplines and backgrounds by providing research training and career development opportunities for young investigators interested in health disparities-related research.

NIDCR will continue its support of research to understand how behavioral, cultural, and social factors contribute to oral health disparities and will apply clinical research strategies to develop effective interventions to prevent and manage oral diseases. NIDCR pursues basic and clinical research on determinants of behavior change, and also emphasizes training and mentoring opportunities for investigators to acquire the knowledge and skills to conduct rigorous research in this area through the use of appropriate behavioral mechanisms, theory, and methods.51 NIDCR will encourage research that identifies new outcome measures tightly linked to proposed behavioral mechanisms of action — going beyond current proxy measures such as self-reporting. Selected areas of focus include preventing childhood caries, supporting families in establishing lifelong healthy habits, optimizing tobacco cessation strategies for use by dental health care providers, promoting recovery after oral and pharyngeal cancer treatment, managing chronic orofacial pain, and enhancing the oral health of vulnerable individuals, including the elderly.

Two smiling NIDCR dental public health residents 

Given the range of personal, social, economic, and environmental factors that independently and in combination influence oral health, interventions that target these multiple determinants of health are most likely to be effective. NIDCR will encourage research to address disparities and inequalities in oral health through a comprehensive approach including the social determinants of health, health policy, and an understanding of resilience, familial and social context, and social networks and systems within communities. The insight provided by disciplines such as the social sciences, anthropology, economics, political science, health policy and health services, and communications are essential to success.

Enhanced support for training in dental public health is another strategy for expanding oral health disparities research, and NIDCR will continue to sponsor a 12-month Residency Program in Dental Public Health.54 This program also provides experience in other areas of dental public health, such as public health administration and management, and the organization and financing of dental care programs. This initiative is designed to develop the next cadre of oral public health experts steeped in the value of research-based methodologies to fill a growing need for such expertise.

Objective 3-2

Foster research to promote the translation of scientific knowledge into community-based action.

A smiling African American young boy and girl playing on a swing 

Bringing the fruits of research discovery to underserved people and communities is one of the most difficult phases of the biomedical and behavioral research continuum. NIDCR is committed to redressing this persistent problem using a full range of research approaches tested in various communities (see White House Recognizes Oral Health Researchers). NIDCR will continue supporting communication science and health literacy research that seeks to increase capacity to obtain, process, and understand oral health information and services needed to make beneficial health decisions. Oral health literacy research to date has largely focused on the development of measures and assessment of oral health literacy within populations or settings. Research must now evolve to interventions. The Institute seeks to identify effective structures and programs that may be emulated and/or enhanced and that can be embraced fully by individuals in underserved communities. NIDCR also encourages research that tests methods of health-services delivery through a wide range of potential mechanisms. Dissemination and implementation research are essential to ensure that efficacious approaches do not benefit only the most advantaged in society. NIDCR supports research that seeks to identify, develop, and refine effective and efficient strategies to disseminate and implement evidence-based health promotion, prevention, early detection, diagnostic, and treatment services into public health programs, clinical settings, and to the public.

NIDCR will continue to support communitybased participatory research. In this context, the Institute will partner with patient advocates and community organizations to identify factors, both positive and negative, that influence the acceptance of pertinent research-based approaches that promise improved health outcomes community-wide.

Objective 3-3

Provide science-based information about oral health and disease to health care providers, patients and caregivers, policy makers, and the general public.

Two smiling young girls 

An important facet of the NIDCR mission is disseminating knowledge gained through research and its implications for health, to all segments of the American public. This task is particularly relevant for members of underserved populations who have uneven access to understandable information about maintaining health.

The Institute supports an in-house program that serves as a resource for science-based information about dental, oral, and craniofacial health. Its Office of Communications and Health Education will continue to produce and disseminate informational materials in expanded ways to take advantage of various new-media formats on a wide variety of topics. These include children’s oral health, oral cancer, periodontal disease, and oral health care for Americans with disabilities. NIDCR also provides materials in print and online to the media, health care professionals, educators and students, patient support organizations, caregivers for individuals with special needs, and the research community.

Oral Health Research Across the Globe

a globe 

NIDCR supports research in a number of countries throughout the world, and a significant focus area is orofacial clefting — birth defects that occur during early pregnancy when an infant’s lip or mouth does not form properly. The result can be cleft lip, cleft palate, or both, and these malformations create problems for feeding, speech, hearing, and dental development. Children with cleft lip and/or palate often endure multiple corrective surgeries, incurring a high emotional and financial toll on their families.

Orofacial clefting is a major public health problem, affecting one in every 500-1,000 births worldwide.52,53 International clefting studies yield new understanding about disease causes and progression, and they can lead to new therapies that U.S.-based studies alone might not achieve. For example, research with populations that have a higher birth prevalence of cleft lip/cleft palate enables researchers to identify important relationships between genetic and environmental factors that may be hard to identify in lower risk populations.

Collectively, NIDCR-supported studies related to orofacial clefting include research partnerships or scientists from Singapore, Taiwan, China, South Korea, India, Germany, Denmark, Norway, Finland, Sweden, Hungary, the United Kingdom, the Philippines, Argentina, Brazil, Guatemala, Nigeria, Ethiopia, and Tanzania, as well as within the United States with research participants from specific ethnic groups, such as those of African ancestry, that have been underrepresented in cleft lip/cleft palate research. Multidisciplinary teams participate in this research. Selected areas currently under investigation include:

  • Genetic variants for both diagnostic purposes and understanding disease formation
  • Environmental contributors, such as maternal behaviors and other factors
  • Other phenotypes that may be related to orofacial clefting (such as defects in lip muscles)
  • Epigenetics and metabolism in clefting
  • The optimal timing of corrective surgery for cleft palate

White House Recognizes Two NIDCR Grantees Advancing Oral Health in Children

The Presidential Early Career Award for Scientists and Engineers, or PECASE, is the highest honor bestowed by the U.S. government on outstanding scientists and engineers beginning their independent careers. In recent years, two NIDCR-funded scientists won this prestigious honor. Both women are investigating issues related to oral health in children.

Margherita R. Fontana, D.D.S., Ph.D. 

Margherita R. Fontana, D.D.S., Ph.D., of the University of Michigan School of Dentistry, received a 2011 PECASE award for her research to develop a screening tool for use in primary health care settings to identify underserved young children at higher risk for developing caries. This work focuses on addressing oral health inequities among preschool-aged children. A key motivator for Fontana’s research is the troubling increase in dental caries within children aged two to five years, especially in underserved and minority population groups. She views targeted prevention and care as a promising strategy for improved oral health in this age group.

Candidate risk and prevention factors related to caries development in preschool-aged children include transmission of cariogenic bacteria from mother to child, a diet high in sugar and/or starch, oral hygiene practices, and dental care. Also important, Fontana predicts, are those risks stemming from culturally derived eating and behavior patterns. She believes that an objective, easy-to-implement, and validated risk-assessment tool that can be used widely would be extremely useful to identify those at greatest risk so they can be referred for dental care. In particular, she sees the need for such a prevention resource in non-dental settings such as schools, clinics, and physicians’ offices. Her caries-risk work is part of a larger prospective longitudinal study that will track the natural history of dental caries in underserved toddlers over a period of three years, in which she will look for other ways to prevent caries in vulnerable populations at the earliest stage possible.

Jessica Y. Lee, D.D.S., M.P.H., Ph.D., 

Jessica Y. Lee, D.D.S., M.P.H., Ph.D., of the University of North Carolina at Chapel Hill, received a 2010 PECASE award for defining the role of health literacy in the development of dental caries, particularly in young children. She discovered that very young children that had received services from the Special Supplemental Feeding Program for Women, Infants, & Children (WIC) had significantly less dentally related expenditures than those who had not received this support. Lee concluded that the WIC program has the potential to decrease dentally related costs to Medicaid, while increasing use of dental services.

Lee has also studied how oral diseases in children, if untreated, can lead to serious health problems and significant pain, interference with eating, overuse of emergency rooms, and lost school time. Her research is examining how a low dental literacy population interprets dental health prevention information and navigates the dental health system. Lee’s other research foci include health services research, cost effectiveness research, and studies examining access to oral health care and health disparities of young children. One example is a study of pediatric dentists’ views on providing nutritional counseling to prevent childhood obesity, and the perceptions of Early Head Start staff regarding their role in providing preventive dental services.

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This page last updated: July 29, 2014