Dr. KRESHOVER. Exactly, in that area of basic science. Mr. FARNUM. What programs in computer sciences are going to be taught? Dr. KRESHOVER. The computer sciences are just now getting underway as far as our dental applications are concerned. These programs are mostly, I would say, on the horizon rather than anything that I can refer to specifically today. The utilization, so far as dental programs are concerned, will be largely related to applications to dental problems for the storage and the retrieval and the analysis of data that are important in hospital settings which could ultimately relate, we hope, to assisting the practicing dentist in diagnosis. Mr. FOGARTY. Thank you very much, Dr. Kreshover. 1. Annualization of positions new in 1966-. 2. Annualization of general schedule pay increase_ 3. Annualization of commissioner officers' pay increase_ Program: Subtotal, mandatory increases_. 1. Research grants- 2. Fellowships__. 3. Training grants 4. Direct research (10 positions). 5. Review and approval of grants (1 position). 6. Program direction (1 position). Subtotal, program increases. Payment to "National Institutes of Health management fund" for centrally furnished services: Research__ Review and approval of grants. 20, 000 21,000 42,000 8,000 91, 000 685,000 59, 000 92,000 283,000 22, 000 14,000 1, 155, 000 70,000 14, 000 2,000 Program direction_. Subtotal__ Gross increases_. Decreases: Nonrecurring items of research equipment and other objects (gross decreases). Total net change requested---- 86, 000 1,332, 000 125, 000 1, 207, 000 Program increases EXPLANATION OF CHANGES Research grants.-The increase of $685,000 includes $147,000 for general research support grants, $2,000 for scientific evaluation grants, and $1,215,000 for noncompeting requirements of the regular program. These increases are offset by a decrease of $679,000 in competing projects. Fellowships.-The increase of $59,000 will provide funds for four additional awards. Training. The increase of $92,000 will provide funds for 1 additional grant in the dental graduate program to support 10 additional trainees. Direct research. The increase of $283,000 and 10 new positions will allow for expansion of research in dental caries and oral and related diseases. Review and approval of grants.-The increase of $22,000 provides support for one additional position for analysis and programing essential to the management of extramural programs. Program direction.-The increases of $14,000 and one new position will provide additional support for the Office of the Director in the area of program analysis and review. SIGNIFICANT ITEMS IN HOUSE AND SENATE APPROPRIATIONS COMMITTEE REPORTS ITEM The 1966 House report (1) The committee feels that a greater effort should be made to develop the field of dental biomaterials and to draw on the skills of metallurgists, polymer chemists, ceramic engineers, and other specialists. (P. 40.) The 1966 Senate report (1) The committee recommends that $1 million more than has been requested be allocated to this Institute for regular research grants, $200,000 more for collaborative research, and an additional $300,000 for fellowships. (P. 53.) ACTION TAKEN OR TO BE TAKEN (1) During the last year, two new contracts involving research into the mechanism of adhesion to teeth were awarded. One, to a nationally prominent industrial company, covers studies on the mechanism of wetting characteristics of selected liquids, and of the adhesion of selected polymers to tooth substance. The other, to a well-respected nonprofit research institute, provides for research on the application of infrared spectrophotometry and the study and preparation of synthetic crystalline compounds similar to tooth enamel. Also, an agreement was made with the National Bureau of Standards whereby the Institute will support NBS work in two areas important to dental biomaterials: (a) the transfer of materials in and out of the tooth structure by diffusion and ion exchange and (b) the identification and measurement of the forces that act upon dental restorative materials in the tooth. In addition to new contractual arrangements, the Institute has increased its research grants program in this important field. A number of these grants involve research by persons skilled in such areas as materials science, polymer chemistry, metallurgy, and engineering, working in collaboration with dental biomedical researchers. (1) These funds are being used to support high quality research grants. new contracts related to the development of adhesive dental restorative materials, and additional career development fellowship awards. The funds were allocated in accordance with the committee's recommendation. The National Institute of Dental Research grants program is the chief source of support for research in the cause, prevention, and treatment of oral diseases. These disorders are the most prevalent of all the physical diseases of man. PROGRAM PLANS FOR 1966 AND 1967 Drawing on diversified scientific competencies throughout the United States, the research grant program effectively extends the research endeavor in areas of vital importance to the oral health of our Nation. This program will support approximately 300 research projects in well over 100 institutions in both of these years. In the regular program, an increase of $1,215,000 is requested for noncompeting projects, offset by a decrease of $679,000 for competing projects. Although requirements for noncompeting continuation grants in 1967 will approximate $1 million over 1966, the number of such grants will be approximately the same because of increasing support to larger multidisciplinary projects. The budget for 1966 and 1967 reflects the application of the newly authorized cost-sharing arrangements to competing research grant projects (new and renewal). This cost-sharing plan considers the full indirect cost of the research project in arriving at the Federal and non-Federal share. For continuation of previously approved projects, the earlier limitation of 20 percent or less for indirect cost is applied with an assurance of some sponsor cost participation. In the special grants area, increases of $147,000 for general research support grants and $2,000 for scientific evaluation are requested. In 1967, the following areas of research will receive emphasis. Periodontal disease There is no universally accepted course of effective therapy for periodontal disease because the agents or events which lead to and influence this condition have not been fully ascertained. Due to the complex etiology of these disorders, which represent the chief cause of loss of teeth after age 35, research on a broad front is desirable. Knowledge of the anatomy and physiology of normal periodontal structures is basic to a better understanding of disease-induced changes in these tissues. Additional information will be sought from studies on normal collagen metabolism, the formation of the ligament which supports the tooth in its socket, the tooth structure to which it is attached and the surrounding hard and soft tissues. Promising leads on possible contributory factors will also be pursued. Studies will be encouraged on the relationship between partial blockage of blood flow by biting forces and the resorption of bone, the effects of tartar formation upon gum tissues, and the effect of the chemical reactions induced by oral microorganisms. Studies on pathologic changes will focus on the mechanisins of bone loss and collagen destruction, the influence of bacterial products on supporting tissues, and any mitigating effects of antibacterial substances in the saliva. The prophylactic effect of dental hygiene, orthodontic treatments, and antimicrobial substances will similarly be explored. Current therapy requires further evaluation and new techniques must be developed. In 1967 an effort will be made to develop studies leading to an earlier recognition by the clinician of the incipient disease state, so that therapy can begin before severe damage has resulted. The newly proposed therapeutic use of hormones must be investigated more thoroughly, and techniques of bone and soft tissue surgery require further study and refinement. Efforts will be made to initiate interdisciplinary research on the role of hormone imbalance, nutritional inadequacies, oral microorganisms, and oral hygiene upon the supporting structures of the teeth. Cleft palate Many interrelated factors play a part in the growth and development of cleft lip and palate which each year afflict 6,000 newborn. These influences must be identified and their precise role defined as a prerequisite to restoring normality of function and appearance and to providing a basis for new therapeutic concepts. Afflicted individuals present not only the cleft lips and palates but also a wide range of associated problems involving speech, breathing, chewing, social and psychological maladjustments, and orthodontic treatment. Continued studies are needed leading to a more specific classification of the various types of clefts with a more precise indication of the surgical procedure of choice in each type. The indications and contraindications for surgery, the age most favoring surgical procedures, and the proper sequence of the various rehabilitative measures need further refinement. The effects of orofacial anomalies on the speech process suggest many areas for investigations. Among these, the criteria and techniques used for evaluating speech adequacy and the potential for speech in individuals with cleft palate, call for further research. Because of the plurality of conditions characteristic of affected individuals, a major emphasis in 1967 will be to support additional multidisciplinary programs. Such programs bring together the skills and knowledge of embryologists, geneticists, plastic surgeons, speech pathologists, audiologists, and other basic and clinical scientists. Dental caries Further research will be encouraged on the etiology of dental caries, with particular emphasis on prevention through the use of antimicrobial agents and those agents which increase tooth resistance. Additional fundamental studies on the physical and chemical properties of tooth structure as related to dental caries will be supported. Examples are studies of the mineral portion of the enamel, ultramicroscopic structure of these tissues, and the further delineation of the processes involved in their formation. Also, the mechanisms of the chemical processes related to the breakdown of the organic part of the dental hard tissues must be further elucidated. Projects in this area of research will be encouraged. Investigations on the worldwide incidence of both dental caries and periodontal disease afford a unique opportunity to evaluate factors affecting their prevalence. Such studies will be expanded both in this country and abroad. Dental materials The practice of dentistry would be literally revolutionized by the development of an adequate adhesive restorative dental material, and the Institute is supporting the quest for new and improved filling materials and techniques for applying them. Still to be resolved, however, are various problems inherent in making dental restorations. A major difficulty concerns the use of different materials (metals, ceramics, plastics) that must be compatible with the particular biology of the tooth. Other perplexing questions involve the nature of the tooth itself (enamel, dentin) and the constantly changing chemical, thermal, and biological characteristics of the mouth fluids. More information is also needed about the physical nature of a cavity surface after it is prepared for filling. In view of the need for intensified efforts in this area, the Institute proposes to accelerate studies in 1967 and to stimulate a broader research interest in adhesive restorative dental materials both through the grants program and by contractural arrangements with industry. Other areas To facilitate communication of dental research knowledge, support will be given to the use of computer facilities for the storage and dissemination of information. Conferences in areas of Institute program interest will also be supported to further interchange of information. Encouragement will be given to studies on the use of lasers and ultrasonics in dental research. Investigations in the fields of neurophysiology, biochemistry, endocrinology, and anesthesiology will be supported with a high priority given to those bridging basic research and clinical application. |