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impressed with what the U.S. Institute of Peace proposes to do in this difficult but critically important area in 1991 and 1992.

We devoutly hope you will approve this full appropriation request for this proposed program, and for the other programs with activities of the Institute. The Institute's role is more important than ever, its capacity is stronger than ever. With your approval of their request for $11,918,000 for Fiscal Year 1992, the Institute will be able to do more and better work for the good of our nation and the world.

THE NATIONAL PEACE INSTITUTE FOUNDATION

Mission

All people share a vision of a peaceful, just and secure world. The National Peace Institute Foundation links this vision with the growing knowledge and practice of the peaceful resolution of conflict.

The

We take pride in the fact that our National Peace Academy Campaign mobilized 45,000 citizens to secure the establishment of the United States Institute of Peace. Campaign affirmed our belief in the power of concerned citizens working together to make a difference. We have a special commitment to the further growth of the Institute.

The Foundation's wider purpose is to promote peacebuilding and peacemaking throughout our own country and in the world. We seek to empower citizens and governments with the perspectives and skills required to avoid violent conflict and to convert potentially destructive tensions into positive energies for progress. Our objective is to integrate conflict resolution into the mainstream of national and international life.

Program

Through the network of our Regional Councils, we work cooperatively with local groups to promote the United States Institute of Peace and to sponsor events on peacemaking and conflict resolution. Our newsletter, the Peace Reporter, serves as a national forum for peace educators and institutions. As a non-governmental member of the United nations and in other ways, we participate in a global community of peacemakers.

Membership

An active, involved membership is key to the

Foundation's past and future achievements. We welcome as members both individuals and institutions who share this vision for our common future.

Senator HARKIN. Thank you very much, Dr. Strickland. And this subcommittee has been a strong supporter of the Peace_Institute and the work that it has been doing, and especially the fine work, as you said, that the Ambassador has done.

Dr. STRICKLAND. Yes, sir.

Senator HARKIN. The request this year is much too low, and we will see what we can do about some substantial support for the Peace Institute next year.

Dr. STRICKLAND. That is a welcome word, sir. Thank you very much.

Senator HARKIN. Thank you very much, Dr. Strickland.

STATEMENT OF DR. JAMES N. CLARK, TRUSTEE, AMERICAN DENTAL ASSOCIATION

Senator HARKIN. I am going to go out of order. I understand someone has a bit of a medical problem here, and I wanted to bring Dr. Jim Clark of the American Dental Association forward at this time. We will proceed a bit out of order here.

Dr. CLARK. Mr. Chairman and members of the subcommittee, I am Dr. James Clark, a trustee of the American Dental Association and a private practitioner in Dubuque, IA. On behalf of the 150,000 association members, thank you for this opportunity to testify in support of Federal funding for dental research, education, and disease prevention.

DENTAL RESEARCH

While research into the treatment and prevention of tooth decay and gum disease continues, the successes at the National Institute of Dental Research over the past four decades, now allows NIDR to expand its focus. It has embarked on two major initiatives: research addressing the oral health needs and treatment of special care patients such as victims of lupus, cystic fibrosis, birth defects, and oral cancers; the research and action program for improving oral health of adults and older Americans, whose goal include eliminating toothlessness in future generations.

To continue NIDR's traditional disease research, and to advance these two initiatives, the association recommends that $126,500,000 be appropriated for research grants. To accelerate the transfer of new technology to dental practice, seven additional research centers are needed. To fund their establishment and the 23 centers currently studying such areas as Carries periodontal disease, and aging research, an appropriation of $30 million is requested.

The association strongly supports additional research into the safety and ethicacy of water fluoridation as recommended by a special public health committee and by NIDR. For this purpose, an appropriation of $5 million is requested.

The recent controversy over the possible harmful effects of dental amalgam fillings heightens the need for the acceleration of NIDR's research on this subject. Such research would concentrate on neurological effects of amalgams, the effects on kidney function and metabolism of elemental mercury, as well as the safety and ethicacy of new alternative materials. The association recommends

that $6 million in additional contract funds be appropriated for this end.

DENTAL EDUCATION

The needs of special care patients, including those affected with AIDS and the elderly will be met only if enough dentists develop the necessary clinical and management skills to treat them in the coming decades. General practice residencies, geriatric training, and the geriatric education center programs are critical to the training of faculty and the development of curriculum that will prepare dentists to meet the needs of these patients. The association recommends that general dentist residencies be funded at $8 million for fiscal year 1992, and the geriatric training and education programs be funded at $26 million.

DISEASE PREVENTION

Disease prevention activity at the Centers for Disease Control focuses on the control and the prevention of oral diseases. As you know, DDPA has become the national leader in water fluoridation, the most effective means for preventing tooth decay. However, its most recent efforts have also addressed infectious control in dentistry. DDPA is responsible for investigating the transmission of infectious diseases such as AIDS and hepatitis B in dental settings.

PREPARED STATEMENT

Following such investigations, DDPA works with State and local governments and private organizations in implementing and evaluating dental infection control programs. For fiscal year 1992 it is requested that the DDPA be funded at $2.3 million. This funding level will also allow DDPA to work with the National Institute of Dental Research on the adult oral health initiatives noted earlier. This completes my statement. Thank you, Mr. Chairman. [The statement follows:]

STATEMENT OF DR. JAMES N. CLARK

Mr. Chairman and Members of the Subcommittee:

On

I am Dr. James N. Clark, a trustee of the American Dental Association and a private practitioner in Dubuque, Iowa. behalf of the 150,000 Association members, thank you for this opportunity to testify in support of federal funding for dental research, education and disease prevention.

Dental Research: The improved oral health status of today's citizens is principally a factor of dental research. The advanced technology and expanded knowledge of disease, which have made American dentistry the world standard, derive from research research traditionally funded by the federal government through the National Institute of Dental Research.

NIDR's most significant achievements over the past four decades — in instrumentation, restorative materials development and preventative measures have been in research directed largely to the treatment and ultimate elimination of caries and periodontal diseases. Control of the incidence of caries, especially in young people, and reduction of the severity of periodontal diseases once the primary cause of tooth loss in realizes an estimated savings in treatment costs of $5 billion annually.

adults

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These successes do not obviate the need for continued research in caries and periodontal diseases, but they have allowed an expansion of the research focus of NIDR. As described to the Committee last year, NIDR has embarked on two new major initiatives:

● Research addressing the needs of special care patients, the victims of systemic diseases, and systemic treatments, that adversely affect their oral health, and

The Research and Action Program for Improving Oral Health of Adults and Older Americans.

Prominent in these initiatives is increased exploration of oral cancers, acute and chronic pain, and disorders affecting taste, smell and swallowing, as well as continued AIDS research. With respect to the latter effort, NIDR seeks identification of a factor in saliva that appears to inhibit the AIDS virus from infecting cells.

To continue NIDR's traditional disease research and to advance these two new initiatives, the Association recommends that $126,500,000 be appropriated for research grants.

To accelerate the transfer of new technology to dental practice, seven additional research centers are needed. To fund their establishment and the 23 centers currently operational, an appropriation of $30 million is requested.

The Association strongly supports the additional research into the safety and efficacy of water fluoridation recommended in the NIDR Long-Range Research Plan, and in the report of the special subcommittee of the Committee to Coordinate Environmental Health and Related Programs. For this purpose, an appropriation of $5 million is requested.

The recent controversy over the possible harmful effects of dental amalgam on health heightens the need for acceleration of NIDR's research into the neurological effects and the effects on kidney function and metabolism of elemental mercury, as well as

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the safety and efficacy of new restorative materials. The Association recommends that $6 million in additional funds be appropriated toward this end.

In summary, to fully support NIDR in FY 1992, in the efforts described, and in its essential related activities in management and support, intramural research, research and development contracts, training and career development, the Association requests that a total of $247,500,000 be appropriated.

Dental Education: The needs of special patient populations and
the elderly will be met only if sufficient dentists develop the
special clinical and management skills to treat them in the
coming decades. General practice residencies prepare dentists to
meet these needs in the immediate future. The Geriatric Training
and the Geriatric Education Centers programs assure that faculty
and appropriate curriculum will be available for education over
the long term.

The Association recommends that General Dentistry Residencies be
funded at $8 million for FY 1992 and that the Geriatric Training
and Geriatric Education Centers programs be funded at $26
million.

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Current dental education costs averaging in excess of $50,000
for four-years, exclusive of living expenses are creating
barriers that even the most determined students from low-income
families would find insurmountable in too many instances without
the programs funded under the Disadvantaged Assistance authority:
the Health Career Opportunity Program and the Financial
Assistance to Disadvantaged Health Professions Students Program.
The Association recommends funding of $40 million under the
Disadvantaged Assistance authority.

The Exceptional Financial Need (EFN) scholarship program remains critical to increasing opportunities for talented minority students to attend professional schools and especially in the disciplines that are most costly. We recommend that $18 million be appropriated for the EFN program.

Lastly, the educational institutions need to be supported through continued funding of Biomedical Research Support Grants (BRSG), severely reduced in recent years, but nonetheless essential to maintaining our most research-intensive institutions. We ask that the BRSG program be funded at $56 million.

Disease Prevention: The Dental Disease Prevention Activity, Center for Prevention Services, Centers for Disease Control, directs its national efforts toward assisting state and local governments and private organizations in planning, implementing and evaluating dental disease prevention and control programs.

Internationally, it collaborates with the World Health Organization in assessing, developing and disseminating information on infection control in dentistry and in conducting an assessment of determinants of oral health. For FY 1992, it is requested that the DDPA be funded at $2.3 million. This would permit the Activity to assist the Center for Infectious Diseases with technical expertise in investigating cases involving dental procedures and work practices. It would also support the Activity's participation with NIDR in the adult oral health initiatives.

Agency for Health Care Policy and Research: The Agency is currently engaged in studies of dental practice variations and appropriateness of care, effectiveness and efficiency of oral health care systems, statistical methods, consumer and professional evaluations of dental practice, evaluation of

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