terol levels, reducing elevated blood pressure, and eliminating smoking. This trial is scheduled for completion in 1982. We anticipate that the findings of these two trials will help us immeasurably in understanding the association between cholesterol and heart disease. However, when one realizes that there remain today a few scientists who still challenge the link between smoking and heart disease and smoking and lung cancer, we cannot give assurances that any new data provided by these clinical trials will resolve the cholesterol controversy completely. Cholesterol and its impact on heart disease is a relatively complicated issue and one which prohibits a general public educational approach on a national scale. We do not know what is a desirable level for cholesterol as we know with blood pressure. We cannot assure people, at this time, that lowering their cholesterol level will help prevent a heart attack. Our approach to countering confusion and giving perspective to the issue is to make available to the health professions and the public information based on what we know, what is suggested, and what we don't know. We do this in a number of ways. Let us give you some examples. For the physician, we have the Dietary Management of Hyperlipoproteinemia, a series of patient education pamphlets and a physician manual which have been distributed in the millions and are used widely in daily practice. These guides deal with specific lipid disorders. For those engaged in nutrition counselling, we, together with the American Heart Association, have staged a series of workshops around the country which will result in a "workshop package" to be further used by many others involved in training nutrition counselors. For the public, we have developed a number of projects and have disseminated a variety of informational materials. Together with Giant Foods, we developed the "Foods for Health" program which provided consumers with basic nutritional information at the point of purchase. The American Heart Association is developing a model based on this experimental project for national distribution through its chapters. Other food chains and businesses have adapted the program for community or employee educational purposes. Our widely distributed booklet on heart attacks, being promoted by tennis star Arthur Ashe, carries a section on cholesterol as one of the risk factors associated with heart attacks, and we have just completed a project with U.S. Air, whereby we provided a column on nutrition and heart disease each month for their inflight magazine. We are hopeful that in the not too distant future we will have the scientific base upon which to aggresively build a more comprehensive educational program directed at altering dietary behavior and extending life among our citizens. On the basis of available data, we cannot yet aggressively pursue that course of action. BEHAVIORAL MEDICINE Question: The Committee would appreciate learning of the extent of the NHLBI "behavioral medicine" budget projected for FY 1982? Answer: The funding for the Behavioral Medicine Branch will be approximately $9 million in both 1981 and 1982 for grant-supported extramural research. NATIONAL INSTITUTE OF DENTAL RESEARCH STATEMENT OF DR. DAVID B. SCOTT, DIRECTOR ACCOMPANIED BY: DR. DONALD S. FREDRICKSON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH DR. RICHARD L. CHRISTIANSEN, ASSOCIATE DIRECTOR, EXTRAMURAL PROGRAMS GILBERT D. PRESS, BUDGET OFFICER NORMAL D. MANSFIELD, DIRECTOR, DIVISION OF FINANCIAL MAN BUDGET ITTEILAG, ACTING DEPUTY ASSISTANT SECRETARY, DENTAL RESEARCH Senator SCHMITT. Our next witness is Dr. David B. Scott, Director the National Institute of Dental Research. NIDR, as it is called, is the Nation's focal point for dental research and related training, aimed at the oral diseases, probably the most universal afflictions of mankind. Dr. Scott, welcome. And if you'll introduce your colleagues, I would appreciate it, and then summarize your testimony. The entire testimony will be included in the record. Dr. Scort. Thank you, Mr. Chairman. To my immediate left is Mr. Gilbert Press, our Budget Officer. Next to him is Dr. Richard Christiansen, our Associate Director for Extramural Programs. As you heard Dr. Fredrickson mention, our Institute is responsible for about 80 percent of the dental research that is done in this country. There was essentially none done at the time the Institute was founded some 30 years ago. So, starting from ground zero, we had to stimulate the growth in research and the training of scientists to carry it out. Last year, before this committee, I mentioned that we have finally reached the point at which we are beginning to make clinical applications in almost all of our problem areas. This year, I am indeed pleased to tell you that we have important new information. The prevalence of one of our most devastating diseases, tooth decay, is on the decline. CARIES PREVENTION Over the years, quite a large number of preventive methods have been developed, and they have really been quite well accepted by the profession and by the community. During the last year we have conducted a large survey of 6- to 18-year-old individuals in a population. (423) sample which permits a comparison to be made with data from the national health and nutrition survey of about 10 years ago. It appears abundantly safe to say that during the last decade the overall dental caries prevalence has been reduced by at least 25 percent, which I think is a long step in the right direction, considering that there already had been some changes in the pattern before this. We shall, of course, continue to refine the data, to learn the subtle messages that can be derived, such as regional differences and the like. We still have farther to go in our research on various chemopreventive agents, vaccines, diet modification, and behavioral science. This will all continue. PERIODONTAL DISEASE We are also making progress in our efforts to develop some means of controlling periodontal disease, which is the major problem in adults. We estimate that some 94 million people are afflicted with this group of diseases. They are the principal cause of tooth loss in adults. In this case, we have not advanced as far with caries prevention, but we are getting together the required base of information and moving into clinical investigation. One of the main advances in the last 1 or 2 years is an increase in our potential to see if and when periodontal disease is actually active. These diseases are slow and insidious, and turn on and off, so that it is very difficult to tell activity. The four new techniques that have been worked out are all quite sophisticated, but we think they will give us the information we need. One involves analysis of minute samples of fluid from the periodontal pockets around the teeth for the presence of prostaglandin, a molecule which indicates tissue breakdown. Another involves assaying the same fluid for antibodies against a major causative microorganism which bespeak infection. A third system utilizes, in the dental office, a phase microscopic survey of the bacterial population of the pockets. The fourth involves an ingenious system of computer reproduction and enhancement of extremely minute differences in X-ray pictures of bone around teeth at intervals during attacks of the disease or during treat ment. So, contributions are being made at all levels of science. This bears a little bit on what you have been asking. Recently, from benefits of the space age in computer science, and from areas of medical science, such as the immune response, we have been quick to exploit any means at hand to improve our information. ORAL HEALTH RESEARCH We are moving along in most of the other fields of oral health research similarly, including craniofacial anomalies, development of restorative materials. and in the soft tissue diseases, such as the ulcerative diseases that plague a large number of our population at any one time, mainly fever blisters and canker sores. We are into the clinical stages in those investigations. Still, time will be required for definitive information. I think this gives you a thumbnail sketch of where we are. Certainly a most exciting development is in the fight against dental caries, because this is an extremely costly disease. To see a reduction like this is really quite rewarding. I should add there are a couple of other studies available which show that the effect has been seen in adults as well as in children. I shall be happy to answer any questions. [The statement follows:] |