NIDR Turns 50, Gets New Name

The National Institute of Dental Research (NIDR), which turned 50 this year, has received a birthday present in the form of a name change. The new name, National Institute of Dental and Craniofacial Research (NIDCR), more accurately reflects the broad research base supported by the Institute. NIDCR became official on October 21, 1998 when President Clinton signed the Congressionally approved Omnibus Consolidated and Emergency Supplemental Appropriations Act, H.R. 4328. The bill provides NIDCR with a Fiscal Year 1999 budget of $234,338,000-representing the largest single year increase in the history of the Institute.

"For half a century, the Institute has been the driving force in oral health research and training in the United States, but our name has not been representative of the breadth of the Institute's activities and accomplishments " said Dr. Harold Slavkin, the Institute's sixth Director. "As the National Institute of Dental and Craniofacial Research, the Institute will preserve its identity with public and professional constituents, yet communicate the diversity of our basic, translational, patient-oriented, and community-based studies."

Although a single word "craniofacial" is the focus of the name change, it is a word of great impact. Craniofacial refers to the head, face, and neck, and NIDCR research in this area covers the developmental processes that form the human face and the plethora of diseases and disorders that involve dental, oral, and craniofacial tissues and structures. The human face and the human smile are remarkably important throughout the life span. Birth defects of the human face are particularly devastating and have become an area of increased attention. Every hour a baby is born with a craniofacial birth defect, translating into more than 7,500 new patients every year. The habilitation of these infants and children costs almost $1 billion each year.

Investigators began studying the most common craniofacial birth defect, cleft lip and cleft palate, in the early days of the Institute. Over the following decades, the Institute fostered improvements in diagnosis, treatment, and prevention, and supported the development of craniofacial "teams" to address the special needs of children and their parents. Today, several hundred genetic conditions are known to produce craniofacial syndromes, and scientists have identified more than 100 associated regulatory and structural genes. Additionally, it is now known that certain genes involved in craniofacial development have far-reaching effects, also directing the formation of distant parts of the body, including the limbs and heart. Further, emerging scientific evidence is beginning to unravel the complexities of gene-gene and gene-environment interactions that result in human birth defects. The Institute has had a long history in the field of craniofacial research, and it is an area of current and future emphasis.

The National Dental Research Act was signed into law by President Harry Truman on June 24, 1948 making the Institute the third oldest at NIH. The Institute came into being as a result of the appalling state of the Nation's oral health that existed at the beginning of World War II. Almost 10 percent of military-age American males were ineligible for the draft because they had less than six opposing teeth in each jaw.

Fifty years later, the Nation's oral health has improved dramatically, much to the credit of NIDCR research and health promotion efforts. The Institute's first major public health contribution was the discovery that fluoride added to drinking water significantly reduced dental caries. The subsequent development of dental sealants provided another strategy to reduce dental caries. Today, the combination of improved prevention and treatment methods is enabling many more Americans to keep their teeth for a lifetime.

From the beginning, the tone of the Institute's research agenda was set by the philosophy of first Director, Dr. H. Trendley Dean, a dental epidemiologist. He felt that basic research was the best approach for attacking oral disease. Dean was also a proponent of the philosophy "we can't divorce the mouth from the rest of the body." He believed that studies of oral soft and hard tissues could provide information applicable to connective tissue, bone, and disease processes in other areas of the body.

Initial research focus was on gaining a fundamental understanding of microbiology and immunology and their relationship to dental caries and periodontal diseases. One of the early research milestones was the discovery that dental caries was an infectious and transmissible disease. By 1949, a year after its founding, the Institute had forged into the field craniofacial research. The institute's first extramural clinical program began examining postnatal growth of head and facial skeletal tissues and treatment outcomes for cleft lip and palate. Intramural scientists soon began their pioneering research in extracellular matrix biology, bone and mineralized tissue formation, and salivary gland function. It was an NIDR grantee who first discovered that a soluble bone component could grow new bone. NIDR also moved to the forefront of research on acute and chronic pain management and is now the lead Institute for NIH's pain research clinic.

Today, improvements in technology coupled with changing patterns of disease have ushered the Institute into still other areas well beyond dentistry's traditional focus on caries and periodontal disease. Research programs are examining the genetic, behavioral, and environmental factors that underlie the many complex diseases and disorders of the craniofacial complex. Research now encompasses areas as diverse as arthritis, diabetes, oral and pharyngeal cancers, osteoporosis, temporomandibular disorders, and the link between oral and systemic diseases.

The NIDCR is supporting projects to sequence the genomes of the major pathogens responsible for dental caries, periodontal disease, and oral candidiasis. Gene transfer technology has been used in animals to restore function to damaged salivary glands. Studies in field of molecular epidemiology are honing in on susceptibility genes for complex disorders like periodontal disease, cleft lip and palate, and oral cancer. Work is also underway to produce plants that may function as a type of edible caries vaccine. NIDCR-supported scientists are genetically engineering alfalfa plants to make antibodies, aptly named plantibodies, which are directed against decay-causing bacteria.

More innovative research is taking place in the area of biomimetics, or tissue engineering. Stem cells and growth factors have been incorporated into biodegradable "scaffolds" that are being used experimentally to grow craniofacial tissues like bone, cartilage, tooth pulp, periodontal ligaments, and salivary glands. Genes for the major enamel-forming proteins have also been cloned, so that it will someday be possible to fill decayed teeth with cultured enamel indistinguishable from the original.

The complexity of the Institute's research portfolio has grown considerably from the formative years of the Institute, when the remarkable efforts of a dental epidemiologist, a water chemist, and a biochemist established the landmark link between fluoride and caries prevention. Today, research supported by NIDCR can require interdisciplinary collaborations that bring together molecular biologists, epidemiologists, materials engineers, computer scientists, and clinicians. The new name will better represent the Institute's mission to the public, the biomedical community, and the diverse group of talented investigators that are needed to carry on NIDCR's research agenda.

As NIDCR Director Slavkin sums it up, "The Institute continues our historic efforts to improve the health of all Americans through dental and craniofacial research and training. I am very pleased with our previous accomplishments and now look to the future with even higher expectations."