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Answer. The Institute signed an interagency agreement with the Department of Education. Several of the materials and programs currently being developed for the school environment are a result of this agreement. The products will display the seals of both Departments. Initially, the materials will be targeted to school principals and outline the role that school personnel can play in managing asthma. A "Directory of Asthma Resources," which outlines a variety of asthma education resources, is also under development. Another product will be developed for school coaches. The NHLBI will work with the Department of Education to select schools to pilot test materials.


BUDGET REQUEST Senator HARKIN. Dr. Löe, we have your budget request for $160.9 million, which is about 8 percent more than last year. I am aware of your Institute's successful effort to complete its new long-range research plan, and we look forward to hearing about that and your statement. Welcome, and again, please proceed, Dr. Löe.

Dr. LOE. Thank you, Mr. Chairman. .

Last year at this time, a committee of experts convened by the Assistant Secretary for Health had engaged in the most comprehensive review of water fluoridation ever conducted by the Federal Government. As you recall, their review was prompted by studies in which four male rats, of those several hundred male and female rats and mice given high dosages of fluoride in drinking water, developed a rare bone cancer. The findings at that time were considered equivocal, which means that the results could have happened by chance alone.

The expert committee reviewed those experiments, along with other animal data, and more than 50 human demographic studies worldwide, and has now completed its report. Their conclusion is that optimal fluoridation of drinking water does not pose a detectable cancer risk to humans. The committee also confirmed that fluoride in water plays a central role in preventing tooth decay, providing improved oral health to all, rich and poor alike.

We at the NIDR are pleased that fluoride, which has been a cornerstone in dental disease prevention for the past 40 years, has received a clean bill of health. We hope that the new report will clear up some of the confusion on the part of the public, and we are eager to get on with the additional research that the committee has recommended.

This year NIDR is participating in a new and equally comprehensive review of the benefits or risks of dental amalgam, the mercury-containing silver fillings that have been in common use in dentistry for more than 150 years. The issue here is the possibility of mercury being toxic and that mercury is released from these restorations. Only a few years ago were we able to provide the technology to detect this small amount of mercury vapor from fillings. Actually, we believe that the amounts are too small to pose a threat, and that there is no need for panic at this time.

However, we are actively pursuing studies and tests to clarify this problem, and a report can be expected by the end of this year.

Senator HARKIN. On the mercury issue.

Dr. LÖE. Yes, sir. Meanwhile, we are moving ahead in the development of new and improved materials which one day will substitute for both silver and gold.

The NIDR also has moved ahead with its new Research and Action Program. As you know, this program is aimed at eliminating toothlessness in this country and improving the oral health of adults, the elderly, and others at high risk, including members of minority populations. The program has grown to include several other Federal agencies, and we are now working with a private foundation which is about to set up a consortium of industry, academia, and the general public to mount a major oral disease prevention and oral health promotion program for the Nation.

PREPARED STATEMENT Finally, our past successes with the prevention of disease in children and our current aspirations have led us to expand our agenda, as described in our new long-range plan for the 1990's which we have called broadening the scope. The plan speaks to finishing the job on periodontal diseases as well as getting on with all the diseases and disorders affecting the mouth, the face, and the jaws.

Mr. Chairman, for fiscal year 1992, the request for NIDR is $160,939,000. I would be pleased to answer any questions that you may have. [The statement follows:)


Mr. Chairman, the publication of Broadening the Scope, the new NIDR Long

Range Research Plan for the Nineties, marks a turning point in the history of

the institute.

During our earliest years, research emphasized dental caries

and periodontal diseases--the costly, painful, and highly prevalent conditions

that were responsible for the widespread toothlessness of our parents' and

grandparents' generations.

Four decades of NIDR-funded research have changed

the epidemiological picture.

We learned what caused these diseases and how to

prevent them -- knowledge that has been translated into public and professional


Our surveys now indicate that 50 percent of schoolchildren have no

cavities in their permanent teeth.

Periodontal diseases remain common, but

are generally mild and no longer considered a major cause of tooth loss in


The resulting gains in oral health translated into savings of $5

billion in the nation's dental bill in 1989.

These advances have allowed us to evolve from an Institute with a two

disease focus to one with a broadened mission.

We will continue to work to

reduce the burden of caries and periodontal diseases, but our plan for the

nineties establishes priorities for research that emphasize other serious and

debilitating diseases that affect the mouth, the face, and the jaws.

Oral cancers constitute one of the deadliest forms of cancer known, with

30,000 new cases occurring every year and 10,000 deaths. Those who survive

may face disfigurement from surgery, destruction of the salivary glands from

radiation, and impairments in speaking, chewing, and swallowing.

We have

expanded research on oral cancers to include studies of the basic mechanisms

Involved in transforming the normal cells lining the mouth into aggressive and

rapidly dividing malignant cells.

We are exploring the role of herpes and

papillomaviruses in initiating the cancer process, as well as behavioral

factors that greatly heighten the risk, such as the combined use of tobacco

and alcohol.

Our investigators have evidence that alcohol increases the

permeability of the oral tissues, making it easier for carcinogenic substances

in tobacco to penetrate cells.

To facilitate this research, NIDR Intramural scientists have developed a

novel method for growing human cancers in' nice--traditionally, an extremely

difficult task.

The method should greatly benefit the study of all human

cancers, enabling observation of the growth and spread of human tumor cells in

the living animal, and making it possible to test new methods of diagnosis,

treatment, and prevention.

A second high priority research area concerns birth defects.

We have

long supported research on treatment of cleft lip and cleft palate-- the most

common facial birth defects.

Now that we can apply molecular biology methods

to the study of craniofacial development, we are increasing research on the

genetic and environmental factors that cause facial clefting and other

developmental disorders, including the abnormalities of bone seen in

osteogenesis imperfecta, the painful skin and oral ulcers that occur in

epidermolysis bullosa, and the multiple defects in the development of teeth,

skin, and hair that occur in the ectodermal dysplasias.

The children affected

by ectodermal dysplasias must be repeatedly fitted with removable dentures as

they grow, a costly and hardly ideal solution considering that these are

normal, active children who like to play games and participate in sports 11ke

most children their age.

We are currently conducting a clinical trial of dental implants in

children with ectodermal dysplasias.

The implants are small titanium screw

11ke devices that are surgically placed in the jawbone and allowed to heal for

several months, during which time they become integrated into the natural


At the second stage of treatment, artificial teeth are attached to the

implants and the patients learn to clean the teeth just as they would natural


We feel that this more physiological approach--along with improvements

in esthetics, efficiency, and patient satisfaction--will make implants the

treatment of choice in the future.

Not only will implants essentially replace

dentures for patients missing all their teeth, but they will be used also for

single tooth replacements.

The advantage in that case is that there is no

need to cap the adjacent teeth--the normal procedure in making a bridge.

The Institute's emphasis on oral cancers and birth defects underscores

the priority we are placing on people at high risk for oral health problems.

We think of this as a natural progression from our earlier overall concern for

the oral health of the nation's schoolchildren to a concern for the special

needs of people of any age whose oral health is compromised because of

systemic diseases, because of age, or because of limited resources.

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