Thank you Chris, for sending this our way.

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NIDCR testifies on Capitol Hill

Witness appearing before the House Subcommittee on Labor-HHS-Education Appropriations

Dr. Lawrence A. Tabak, Director

National Institute of Dental and Craniofacial Research

March 28, 2001

Mr. Chairman and Members of the Committee:

I am pleased to testify on behalf of the National Institute of Dental and Craniofacial Research (NIDCR). Our Institute's mission is to promote the general health of the American people by improving craniofacial, oral and dental health through research. As a central part of this mission, NIDCR funds scientific research to prevent diseases and improve the quality of life for the millions of Americans who suffer from chronic diseases affecting the mouth and face. All of us at one time or another have experienced some form of oral disease -- be it dental decay, or a less common condition like SjF6gren's Syndrome, a disease that results in constant oral dryness, causing difficulty in speaking, chewing and swallowing. Many Americans are affected by other disorders, like diabetes, that often cause oral complications. Chronic diseases erode our quality of life; the insidious nature of these silent enemies sometimes makes them difficult to diagnose and treat, but associated symptoms, such as pain, confirms their presence.

The NIDCR supports research in areas as diverse as understanding the oral infections that lead to dental decay, periodontal diseases and recurrent herpes lesions; oral manifestations of osteoporosis and other bone diseases; salivary gland dysfunctions and disease; and connective tissue diseases and disorders, among others. Because one quarter of all chronic pain is associated with the face and mouth, NIDCR has become a leader in the field of pain research. It is now appreciated that chronic pain can become a disease in itself, causing long-term detrimental changes in the nervous system.

With this wealth of experience and expertise, NIDCR is uniquely positioned to fund research on chronic diseases that will make a major difference in the lives of many Americans.

Saliva is a remarkable, protective fluid whose presence most of us take for granted. Without adequate saliva, patients may experience difficulty speaking, chewing and swallowing. They may also experience rampant tooth decay, oral infections such as thrush (candidiasis), and considerable oral discomfort. An estimated one to two million individuals in the United States, most of them women, suffer from soft tissue dryness because of SjF6gren's Syndrome, an autoimmune disorder that destroys the salivary glands and lachrymal glands.1 NIDCR research has shown progress in the treatment of SjF6gren's through the use of anti-inflammatory drugs and chemical mediators.

Using the new techniques and principles of tissue engineering, NIDCR scientists are working on the development of a first-of-its-kind artificial salivary gland that offers hope for patients with SjF6gren's Syndrome and other debilitating salivary gland conditions. Initial efforts are focused on creating a small tube that can be placed into the patient's cheek. The tube, which is made of a biodegradable material, would be coated with a protein material and lined cells engineered to secrete a saliva-like substance. Scientists expect that the artificial salivary gland will be ready for clinical testing within five to seven years.

Lifesaving cancer treatments have allowed more people to survive devastating diseases, but often at the cost of side effects that seriously impair their quality of life. Oral complications resulting from cancer treatment affect more than 400,000 patients annually.2 Oral mucositis, a severe inflammation in the mouth, develops in the majority of patients undergoing chemotherapy. The effects of oral mucositis limit the ability of patients to sustain the dose and duration of cancer treatments. NIDCR initiatives are planned to conduct research on better ways to prevent and manage oral manifestations of cancer therapy, in particular mucositis. NIDCR is also leading a national media campaign, "Oral Health, Cancer Care and You," designed to raise awareness of oncologists, dentists and patients about the oral complications of cancer therapy and how these complications can be prevented and managed.

In addition, to protect head and neck cancer patients, NIDCR scientists have designed new methods to shield the salivary glands from radiation treatments, thus preventing treatments from damaging or destroying healthy tissues.

The most common oral diseases, and among the most prevalent of all chronic infectious diseases, are dental caries (tooth decay) and periodontal diseases (gum diseases). These infections affect individuals throughout their lifespan. According to the Surgeon General's report, Oral Health in America, dental caries is the most common chronic disease in childhood - five times more common than asthma and seven times more common than hay fever - but almost all Americans have experienced caries at one time in their lives. Periodontal diseases are also prevalent - a majority of people age 30 or over have experienced some form of periodontal disease. Both these diseases require life long attention by both the individual and by health providers. The Health Care Financing Administration estimates that dental expenditures by 2000 approached $60 billion, the majority of which were associated with the repair of teeth and their surrounding tissues.

Children from low-income families and from racial and ethnic minorities are at particular risk of dental caries, and these caries are more likely to go untreated. Although it is not clear why some individuals are more susceptible and others more resistant to caries, NIDCR research suggests that genetic differences, variations in the quality of saliva, exposure to environmental heavy metals, as well as preventive behavior, play a role. As a result, NIDCR is hosting an "NIH Consensus Development Conference" on the diagnosis and management of dental caries.

Like dental caries, the periodontal diseases are infections caused by bacteria that accumulate in the form of a "biofilm" on the tooth and soft tissue surfaces. Long considered localized infections, periodontal diseases are now linked to a variety of systemic diseases and conditions. For example, periodontal disease in pregnant women may contribute to the risk of delivering preterm, low-birth weight babies. The destructive inflammatory processes that define periodontal disease are also closely intertwined with diabetes. Periodontal diseases are exacerbated in individuals with uncontrolled diabetes.

Most people have experienced some form of orofacial pain. This may interfere with vital functions such as eating or speaking. Although pain is a disease in and of itself, it significantly adds to the complexity of other conditions, such as Temporomandibular Disorders (TMD). Various etiological factors, including trauma, can give rise to pain and dysfunction in the temporomandibular joints and surrounding muscles, conditions collectively called TMD. Our Institute is the primary sponsor for research on these conditions, supporting basic, translational and clinical research. We established the TMD Interagency Working Group to facilitate progress in dealing with these disorders through cooperation, communication, and collaboration among agencies that conduct or support TMD-related research and direct provision of health care services.

The multiplicity of factors that may cause or contribute to TMDs has unfortunately led to an even greater number of treatments that have not been validated. NIDCR is currently conducting clinical trials looking at the effects of conservative versus surgical interventions, with preliminary findings indicating that surgical interventions offer no increased benefits. To address the needs of individuals who require joint replacement, NIDCR is also conducting basic research on engineering more biocompatible implants.

I became Director of NIDCR eight months ago with great enthusiasm about the opportunities to make a difference in improving the nation's oral health through biomedical and behavioral research. Past advances in the prevention and treatment of oral and dental disease have been estimated to generate savings of $5 billion a year in dental expenditures alone - saving each year more than the total funding for the Institute since its inception over 50 years ago.3 Our work is not yet finished, however. Many Americans are not yet completely healthy because they suffer from the scores of chronic diseases and disorders that affect the oral, dental, and craniofacial tissues. I am also committed to address the mandate provided by the Surgeon General's report, Oral Health in America, to eliminate oral health disparities and improve the quality of life through our research efforts. Thank you for this opportunity to provide you with information on NIDCR's chronic disease research efforts. sease research efforts.

1 Talal N. Sjôgren's Syndrome: historical overview and clinical spectrum of disease. Rheumatic Diseases Clinics of North America. 1992 Aug. 18 (3): 507-15.

2 National Institutes of Health (NIH) Consensus Development Conference on Oral Complication of Cancer Therapy, Diagnoses, Prevention and Treatment. NIH monograph no. 9. Bethesda (MD) National Institutes of Health; 1990.

3 Centers of Disease Control and Prevention (CDC), fluoridation of Drinking Water to Prevent Dental Caries", Morbidity and Mortality Weekly Report 1999, 48: 933-940.