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Question: Certain groups, such as the National Health
Federation, continue to maintain that fluoridation of public water supplies is damaging to public health. Is resistance to fluoridation of public water supplies growing or declining?
Answer: Although opinion polls indicate that 50 to 70 percent of the American public continues to approve of fluoridation, the small minority that actively opposes fluoridation has become increasingly visible and vocal. Opponents have, in the last few years, filed lawsuits against the initiation or continuation of fluoridation in several areas. Although no court of last resort has ever ruled against fluoridation, the multiple lawsuits have delayed the implement at ion of some administrative decisions for fluoridation, discouraged some local governments from making such decisions, and created negative publicity. Organizations opposed to water fluoridation have become more active in lobbying Congress by mass mail and personal contacts to eliminate Federal budget support of fluoridation programs and are attempting to reverse the positions of proponent organizations.
Question: Is there any new evidence to implicate fluoridation as a cause of cancer?
Answer: New evidence continues to support the safety of water fluoridation in that there is no association indicated between fluorides in water and the incidence of cancer. In 1980, publications from the National Health Statistics Center of New Zealand and a Committee of Inquiry appointed by the Premier of the Australian State of Victoria reported their negative findings, which are in full agreement with previous evaluations by the National Cancer Institute; National Heart, Lung, and Blood Institute; the U.S. National Academy of Sciences; National Health and Welfare of Canada; the Royal Statistical Society (London); and other similar organizations in the U.S. and overseas.
Question: Is there any new information that indicates that fluoridation is beneficial to the general health of the public?
Answer: The benefits to dental health provided by fluoridation include: (1) as much as two-thirds less tooth decay in children; (2) a six-fold increase in the number of decay-free teenagers; (3) fewer extractions of primary and permanent teeth; (4) fewer and less complex restorative dental service needs; and (5) fewer decay-related treatment needs and decreased loss of teeth in adults. The latest reconfirmation of these benefits has come from several U.S. and foreign studies during 1980 (Omaha, Nebraska; East Germany; England; and Australia).
Question: What new developments have there been in the development and application of fluoridated mouth rinses?
Answer: An important development has been the over-the-counter marketing of fluoride mouthrinses for home use. These mouthrinses, based on either sodium or stannous fluoride and intended for daily use, are now widely available and, we believe, will become widely used. Conscientious daily rinsing should achieve about a 35 percent
reduction in caries prevalence of children.
This is a particularly important mode of prevention for children residing in non-fluoridated areas and attending schools without self-applied fluoride programs for older children graduating from such programs, and, of course, for adults with teeth at high risk for caries.
Question: Your Institute continues to search for substitute sweeteners that are acceptable and noncariogenic. Last year, you did not sound very hopeful about short-term solution and said it would take 5-7 years for a new substance to meet regulatory requirements. Are there any sweeteners that are good substitutes for sugar?
Answer: Several sweeteners appear to be good substitutes for limited use. These include the sugar alcohols, sorbitol and xylitol, which are now being used to sweeten dietetic candies and much of the chewing gum consumed in the U.S. Neohesperidine dihydrochalcone, derived from citrus rind, also may be in this category and is being studied by the FDA. A number of other sweeteners, about which information is incomplete, have potential for fairly widespread use as sugar substitutes. For example, an extremely sweet protein, monellin, and an equally sweet protein glycoside, thaumatin, both found in berries of African plants, have attracted some commercial interest. In addition, a very sweet terpene glycoside, stevioside, can be isolated from leaves of a Paraguayan plant. This plant is now being cultivated extensively in Japan for the sweetener. Food chemists, particularly in Japan, have developed several starch derivatives that are highly sweet and reputedly non-cariogenic. Aspartame and saccharin are still being reviewed by the FDA.
Question: How much are you spending on this effort?
Answer: In FY 81, the NIDR will spend approximtely $400,000 in contracts for research on substitute sweeteners.
DISSEMINATION OF INFORMATION
Question: Last year you provided some very encouraging indications that the dissemination of information from the Institute was being expanded. In view of recent developments such as the new dental vaccine, we would hope this trend would continue. What new initiatives in information dissemination will you undertake in Fiscal Year 1981?
Answer: The Institute plans to expand its efforts to inform the dental and medical professions, as well as the public, about our new research findings on diet and caries. We are preparing two films on this subject--one for health professionals and one for the general public.
New publications are also planned to advise health professionals and cancer patients of the adverse effects of radiation therapy and chemotherapy on the teeth and the soft tissues of the mouth, and to outline steps to prevent and alleviate these effects.
Question: How wide is the dissemination of dental care
information to the nation's school system?
Answer: The National Caries Program recently produced three films describing self-applied fluoride tablet and mouthrinse programs in schools. Last year, these films were seen by over 16,000 viewers. Almost 140,000 pamphlets on the same subject were distributed to school children. In addition, the NCP has distributed more
than 200,000 posters designed to emphasize the importance of fluorides in caries prevention.
The National Caries Program also consults with community groups and school personnel about setting up school-based fluoride programs and works closely with other government agencies and offices involved in these efforts. A new exhibit on self-applied fluorides was shown at the annual meeting of the American School Health Association and the Association of Teacher/Educators. Other exhibits, developed for distribution on a free-loan basis, were sent on request to meetings of state PTAs and school board associations.
The Institute received requests for more that one-quarter million NIDR publications last year on tooth decay, oral hygiene, and snacking. Many of these requests were from students, their parents, and their teachers.
Question: Your Institute reported that you have been able to associate experimentally a cause and effect relationship between viruses, early-onset diabetes, and oral cancer. What follow-up has there been on this matter over the past year?
Answer: Our Institute reported an association between viruses and early onset diabetes mellitus. Over the past year, another case has been reported in the literature showing a link between coxsackie viruses and diabetes in the human. In our Institute, additional evidence has been obtained from autopsies showing that certain viruses can damage insulin-producing beta cells in the pancreas. number of important new leads also have been obtained from studies on virus-induced diabetes in animals.
Question: How good is our understanding of the relationship between viruses and diabetes or oral cancer?
Answer: A great deal of information has accumulated from experiments in animals showing that several viruses can infect and destroy beta cells in the pancreas and produce diabetes. However, at the human level, it still remains to be determined whether viruses are only a minor cause of diabetes or whether viruses are one of the more important causes of this disease. As testified last year, there is still no clear relationship between herpes viruses and oral
Question: patient care?
How will this knowledge be applied to prevention and
Answer: If a virus or viruses can be shown to be a major cause of diabetes, then it might be possible to develop a vaccine to prevent this disease.
MAINTAINING NEW RESEARCH GRANTS
Question: The Fiscal Year 1982 Budget continues to emphasize the stabilization of new, investigator-initiated research grants at 5,000. How much funding will you need in Fiscal Year 1982 to maintain your share of the NIH goal of 5,000 new and competing research grants?
Answer: The revised budget request, proposed by President Reagan provided for the funding of approximately 4,900 new and competing research project grants for $571,621,000. The NIDR share of that amount is $11,399,000 and 119 grants.
on this goal:
How is inflation impacting or how will it impact
Answer: An inflation factor of 9.5 percent was taken into account in developing the cost of funding the 4,900 new and competing research project grants.
Question: Why is it so important to stabilize new research grants regardless of other budget priorities within NIH?
Answer: While the largest proportion of scientific activity related to oral health problems is currently in the basic research domain, this prominent function is implemented primarily by means of the investigator-initiated grant mechanism. The current state-of-the-science in oral health research is still largely in the basic area, and most of the research capacity is to be found in university and other related research institutions. To lessen the support for research grants to these institutions would seriously diminish U.S. capability to pursue basic science investigations relevant to oral health. Alternative sources of support from the private sector cannot be expected because these sources focus on the more clinically relevant investigations of technologies closer to potential market development and production. Thus, stabilization of new research grants is essential to maintain a steady stream of knowledge development concerning the etiologic aspects of oral diseases and conditions which can lead to new or improved diagnosis, prevention and therapy.
Question: What happens if, in a particular year, the quality of new research proposals declines: To what extent would you then want to fund fewer new grants and put greater emphasis on research contracts or intramural research?
Answer: Never in the history of the NIDR has there been an insufficient pool of quality research proposals. It is unlikely that a decline in quality will occur in the near future since with the advent of a diminishing funding capacity, only the highest scoring applications will be supported. An extreme level of competition might ultimately precipitate a decline in ability to attract the brightest potential investigators to careers in biomedical research in general and this would limit the nation's capacity to pursue productive research through any mechanism, whether it be grants, contracts or intramural research.
Question: To what "Payline" will you fund new and competing grants in fiscal 1981 and if you can estimate it -- in FY 1982? What percent age of grants will you fund in both years?
Answer: In FY 1981 and 1982 the NIDR plans to fund to the 200 "Payline", representing 36 percent and 35 percent respectively of all approved grants.
WHERE TO CUT
Question: If faced with a major budget cutback, what are your priorities? Where could cuts be made without impairing essential research?
Answer: The Institute will continue to emphasize the importance of basic and applied research by supporting research grants in its six categorical program areas: dental caries; periodontal diseases; soft tissue stomatology and nutrition; craniofacial anomalies; restorative materials; and pain control and behavioral studies. order to accommodate to a major cut back, the Institute would need to decrease the investment in research training; decrease applied research through the contract program; decrease the effort in intramural research; and decrease information/dissemination activities in the Institute's Office of Scientific and Health Reports.
Question: How much can be saved through more efficient management, less official travel and fewer consultant contracts?
Answer: Because of the hiring freeze imposed during FY 81, savings were incurred in personnel costs. Additional reductions were made in travel, consultant services and procurement contracts. During FY 82 consultant services were cut further but reductions in other areas could not be absorbed without seriously affecting essential research activity.
Question: Please provide for the record the effects of various levels of funding reduction on your major activities.
Answer: The budget justifications recently submitted to the Congress have attempted to depict the effects of reductions made from the budget proposals submitted in January. These justifications clearly show the levels of funding reductions by budget mechanism and major disease category.