In the section that follows, the Strategic Plan identifies three major areas to achieve the NIDCR mission: 1) research opportunities, 2) research capacity, and 3) communications. Two crosscutting areas -- health disparities and data acquisition and analysis — are also identified. The initiatives, goals, and objectives described are interrelated and in some cases inextricably linked. However, they are presented under discrete categories for ease of planning and developing the action steps needed to implement them, and for tracking and evaluating our success in achieving them.

Clearly, these goals and objectives do not encompass the entire range of NIDCR-supported research that collectively contributes to our overall mission. Nonetheless they capture the areas that offer the most significant scientific promise in the near-term.

RESEARCH OPPORTUNITIES

  Advance the understanding of the normal and abnormal processes underlying oral, dental and craniofacial diseases and disorders through the development and application of new technology and research tools.

Genetics, Structure and Function of Oral Tissues and Cells

Subgoal A: Support studies that address the genome, the transcriptome and the proteome of dental, oral and craniofacial diseases and disorders.

• Objective 1: Identify genes, genetic and protein variations and molecular pathways associated with susceptibility to craniofacial disorders, malignancies and oral infectious diseases.
  
  
• Objective 2: Further the understanding of gene and protein networks and signaling mechanisms associated with oral, dental and craniofacial diseases and disorders.
  
  
• Objective 3: Identify human genetic variations for possible genetic contributions to complex disease in populations experiencing oral health disparities.

Communication Between and Within Cells

Subgoal B: Support research to understand the molecular mechanisms of oral cell cycle regulation related to the development and progression of oral, dental and craniofacial diseases and disorders.

• Objective 4: Use biochemical, genomic and proteomic approaches to study cell signaling systems and pathways in the oral cells, tissues and organs of the developing and growing craniofacial complex.
  
  
• Objective 5: Use biochemical, genomic and proteomic approaches to study prokaryotic-eukaryotic cell signaling systems and pathways, as well as prokaryotic-prokaryotic signaling within maturing microbial biofilms (dental plaque).
  
  
• Objective 6: Examine the molecular alterations responsible for head and neck cancer development, including alteration of genes and proteins involved in cell cycle regulation, and regulatory networks controlling cell cycle progression and cell survival or death.

Microbial Pathogenesis and Immunology

Subgoal C: Support research on the structural and functional properties of biofilms and biofilm-mediated diseases.

• Objective 7: Support research to further understand the normal microbial ecology of biofilms in the oral environment, including biochemistry, physiology and taxonomy of oral bacteria.
  
  
• Objective 8: Identify and characterize microbial products involved in virulence and disease pathogenesis and interactions in mixed microbial infections.
  
  
• Objective 9: Encourage research on the immunobiology of oral infectious diseases, cancer, autoimmunity, inflammation and microbial commensalism.

Gene and Environment Interactions

Subgoal D: Support research to understand gene-disease associations, genes and gene products in normal craniofacial development, and gene-environment interactions in oral, dental and craniofacial diseases and disorders and birth defects.

• Objective 10: Investigate complex multifactorial disorders of the oral and craniofacial structures that arise from the interaction of several genes and environmental components.
  
  
• Objective 11: Identify genetic, nutritional, and environmental risk factors that influence susceptibility, severity or progression of oral, dental and craniofacial diseases and disorders and that affect the response to treatment.
  
  
• Objective 12: Foster studies to identify environmental triggers that precipitate diseases with a specific genetic context.

Pharmacogenetics

Subgoal E: Understand individual variability of responses to drugs that are used for the treatment of dental, oral, and craniofacial diseases and disorders to develop highly effective, low-toxicity drugs or agents.

• Objective 13: Establish gene expression profiles that control or regulate drug metabolism and response in different populations to predict and optimize efficacy of agents used in the treatment of oral and craniofacial diseases and disorders.
  
  
• Objective 14: Identify biomarkers for both phenotype and genotype of different subgroups of the population that have various drug responses.
  
  
• Objective 15: Use biomarkers to monitor and direct clinical treatment including predicting drug response, optimizing efficacy, and preventing or reducing side effects and toxicity.

Biocompatible Materials

Subgoal F: Support and encourage research for the design and development of “living” materials for the repair and regeneration of orofacial tissues and organs based on advances made in biological systems research.

• Objective 16: Elucidate the mechanism leading to the formation of mineralized structures through the support of biomimetic studies.
  
  
• Objective 17: Encourage the use of human adult and embryonic stem cells and tissue engineering approaches for the repair and replacement of orofacial tissues and organs.
  
  
• Objective 18: Enhance research on the interface between materials and tissues, including the development of methods to access biocompatibility and prevent rejection.

  Develop new or improved approaches and methods for preventing, diagnosing, treating and eventually eliminating oral, dental and craniofacial diseases and disorders.

Development and Validation of Biomarkers

Subgoal A: Develop and validate biochemical, cellular, physiologic, or genetic biomarkers that can be used to predict risk, aid in early diagnosis, and assess disease progression and response to treatment of chronic and disabling oral diseases and disorders.

• Objective 1: Utilize genomic and proteomic approaches to screen for novel biochemical, cellular or genetic markers associated with disease susceptibility, disease progression or treatment efficacy.
  
  
• Objective 2: Conduct early clinical and epidemiologic studies to evaluate the predictive accuracy, sensitivity and specificity of known and newly identified potential biomarkers.

Clinical Research and Clinical Trials

Subgoal B: Expand and enhance the Institute’s clinical research and clinical trials program to identify effective preventive, diagnostic and treatment approaches for oral, dental and craniofacial diseases and disorders.

• Objective 3: Identify and validate novel and existing methods for early diagnosis and the identification of risk factors for diseases such as dental caries, periodontal diseases, oral cancer, and conditions such as chronic orofacial pain
  
  
• Objective 4: Identify and evaluate the efficacy of novel and existing strategies for the prevention, management and treatment of oral infectious diseases such as dental caries and periodontal diseases, and oral and pharyngeal cancer, particularly in populations that are at high-risk.
  
  
• Objective 5: Define the relationship between oral infectious diseases and systemic diseases and conditions such as cardiovascular disease, preterm birth, diabetes, and pulmonary disease.
  
  
• Objective 6: Identify and evaluate the efficacy of existing and new prevention, management and treatment strategies for chronic conditions including orofacial pain resulting from temporomandibular muscle and joint disorders.
  
  
• Objective 7: Identify and evaluate the efficacy of novel and existing methods for preventing, managing and treating mucosal infections such as oral candidiasis, herpes simplex, and conditions such as mucositis and aphthous ulcers, especially in patients with AIDS or immune dysfunction secondary to cancer therapy.
  
  
• Objective 8: Develop and evaluate new technologies including gene transfer therapy, drugs and biologics for treating or alleviating the oral symptoms of xerostomia and Sjögren’s syndrome.
  
  
• Objective 9: Determine the relative safety, efficacy and effectiveness of new and commonly used dental restorative materials.

Population-Based, Genetics, Social and Behavioral Research

Subgoal C: Support studies that expand and enhance the integration of population-based, genetic, social, and behavioral research.

• Objective 10: Further the understanding of how genetic, biologic, social, behavioral and environmental factors interact to contribute to disease susceptibility or resistance in diseases such as head and neck cancer, caries, periodontal diseases, and conditions such as craniofacial defects or syndromes, birth defects, and chronic and disabling pain.
  
  
• Objective 11: Elucidate the mechanisms involved in the regulation of gene expression by other variables such as other genes, lifestyle, nutrition and the environment.
  
  
• Objective 12: Assess and bridge gaps in the knowledge, opinions and practices of the public, educators and health care professionals about oral diseases and their prevention.

RESEARCH CAPACITY

  Ensure an adequate and well-trained research workforce that reflects the current and emerging needs of science and includes sufficient numbers of investigators from diverse disciplines and from underrepresented groups.

• Objective 1: Increase and diversify the number of individuals engaged in oral, dental, and craniofacial research through innovative and flexible research training and career development programs at all stages of career development.
  
  
• Objective 2: Increase the number of investigators from groups that are underrepresented in oral, dental and craniofacial research, including individuals from racial and ethnic minorities or from disadvantaged backgrounds.
  
  
• Objective 3: Increase the number of researchers from disciplines such as bioengineering, chemistry, computer science, informatics, imaging, biostatistics, genomics, neuroscience, behavioral sciences and epidemiology working in areas that are relevant to the NIDCR mission.
  
  
• Objective 4: Increase the number of investigators having specialized skills and knowledge in the design, conduct, and evaluation of clinical research and clinical trials in areas that are relevant to the NIDCR mission.
  
  
• Objective 5: Increase the number of oral health professionals working in oral health research and interdisciplinary research relevant to the NIDCR mission.

  Support research infrastructure and enhance the development of new approaches for conducting inter- and cross-disciplinary research.

• Objective 1: Expand NIDCR’s collaborations with public and private research organizations, academia and industry to maximize resources and develop needed technology both nationally and internationally.
  
  
• Objective 2: Enhance the research capacity of U.S. academic dental institutions and their ability to address changing scientific needs through improvements in the research infrastructure, including research personnel and equipment.

COMMUNICATION

As defined in Healthy People 2010, health communication “encompasses the study and use of communication strategies to inform and influence individual and community decisions to enhance health.”⁷ Consistent with that definition, NIDCR’s communication efforts are meant to ensure that target audiences become informed, change behavior, and make decisions in a manner that will improve clinical care and health outcomes. Target audiences are broadly defined to include health care providers, consumers, the research community, and other groups such as educators, policymakers, industry, and the media. One of the main challenges of our health communication efforts is to find the most effective ways to communicate and disseminate health information, clinical information, and research findings to target audiences.

  Enhance the translation of research results into clinical practice and communicate science-based health information to ensure that NIDCR-supported research leads to improved health.

• Objective 1: Communicate information to dentists, dental hygienists, educators and researchers that could be used to improve the prevention, diagnosis, management, and treatment of craniofacial, oral and dental diseases.
  
  
• Objective 2: Communicate information to health care providers and researchers in other disciplines that could be used to improve the prevention, diagnosis, management and treatment of craniofacial, oral and dental diseases.
  
  
• Objective 3: Increase the general public’s knowledge of research findings with implications for improving oral health, in particular among parents, and high-risk, special needs and underserved populations.
  
  
• Objective 4: Ensure that science-based information is integrated into health communication and education programs for high-risk and underserved populations as well as the general public.
  
  
• Objective 5: Expand outreach efforts to populations with limited oral health literacy and disseminate information that is in plain language and is culturally sensitive, including languages other than English.
  
  
• Objective 6: Support communications research to identify optimal strategies and tools for reaching various audiences and for disseminating research findings so they can be adopted widely by all who need it.

Crosscutting Areas

Most NIDCR research areas and programs are complementary, interdependent and cut across programmatic and organizational boundaries. Indeed, it would be difficult to identify many scientific areas within NIDCR’s mission that are not interrelated in some fashion. We have singled out health disparities and data acquisition and analysis as major crosscutting areas because of their far-reaching implications and contribution to NIDCR’s mission:

HEALTH DISPARITIES

To address the persistent inequalities in oral health status among U.S. population subgroups, NIDCR has developed a Plan to Eliminate Oral, Dental and Craniofacial Health Disparities. The objectives related to health disparities in this Strategic Plan, stated below, provide the foundation for the initiatives and detailed implementation strategies to address the persistent inequalities in the oral health of the Nation within the NIDCR Health Disparities Plan.

We are interpreting health disparities to refer to the diminished oral health status of population subgroups defined by demographic factors such as age and socioeconomic status, geography, disability status, behavioral lifestyles, gender, racial or ethnic identity. There are at least four interdependent and interacting variables that are key determinants of health, namely, the unique biology of an individual, behavioral lifestyles, environment, and the organization and financing of health care. Accordingly, addressing health disparities requires more than an understanding of the biology and lifestyle of an individual. We also must take into account the environment where the individual lives, works, and plays as well as the larger social and cultural environment. Critical to the development of effective interventions to reduce health disparities across the lifespan is the inclusion of individuals from all racial/ethnic, gender, and age groups in clinical trials. In addition, using evidence-based approaches for translating science into practice is key to ensure that NIDCR research benefits the people with the greatest needs.

  Eliminate health disparities in oral, dental and craniofacial diseases and conditions among underserved populations and groups.

• Objective 1: Encourage interdisciplinary research to understand and address the multiple factors underlying oral health disparities among U.S. subgroups.
  
  
• Objective 2: Increase the enrollment and retention of women, children, racial and ethnic minorities and other underrepresented groups in studies conducted at NIDCR and in NIDCR-funded clinical research.
  
  
• Objective 3: Ensure the integration of science-based oral health information into health communication and education programs for populations with high needs (racial/ethnic minorities, individuals with disabilities, and other susceptible populations.

DATA ACQUISITION AND ANALYSIS

Documenting the full extent and magnitude of the many oral, dental and craniofacial diseases and conditions is critically important. Given the wide implications and significant impact of the many oral and craniofacial conditions and diseases, we must continue to determine their prevalence, incidence, and co-morbidity and their effect on physical health, quality of life, and social and economic impact. However, reliable measures and data are lacking for common diseases in selected populations and for many less widespread conditions in the U.S. population in general. Baseline and trend data are needed for demonstrating progress in improving the nation’s oral health and to provide a key foundation for research efforts to improve oral health.

The changing U.S. demographic profile brings additional responsibility to collect information on the oral health of many more and increasingly diverse population subgroups. Adequate and reliable national data are lacking for common conditions for many racial and ethnic minority groups and other vulnerable populations, and for less prevalent oral, dental and craniofacial conditions in the U.S. population. At the same time, there is a need for continued assessment and revision of survey methods and designs, enhancing the capacity for longitudinal follow-up of participants while maintaining privacy, and increasing the inter-relationship among surveys. Data acquisition and analysis, particularly among unique population subgroups, will benefit from collaborations with other Federal agencies as well as with patient and community groups, state and local-based organizations, foundations, industry and others in the private sector.

  Ensure the adequacy of systems to document and monitor the extent and impact of oral, dental and craniofacial diseases, disorders and conditions.

• Objective 1: Identify and validate new methods to measure and document oral, dental and craniofacial diseases, disorders, conditions, risk factors and markers in population-based studies.
  
  
• Objective 2: Assess the social, educational and economic impact of oral, dental and craniofacial diseases, disorders, conditions, and birth defects.
  
  
• Objective 3: Assess and monitor changes in disease status, access to care, and the utilization of professional, community and self-care oral health services.

⁷http://www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm