An important role of the American Dental Association in scientific research is to serve as a facilitator of the national dental research effort, including promotion of adequate funding for the research, research training and science transfer programs conducted by the ADA Health Foundation; the National Institute of Dental and Craniofacial Research, or NIDCR; the Agency for Health Care Research and Quality; and other national foundations and institutions that support or conduct research related to the oral health sciences. In fulfilling this function, it is essential that the ADA work closely with the American Association for Dental Research, or AADR; the International Association for Dental Research; the American Dental Education Association, or ADEA; professional specialty groups; government agencies and industry.
The ADA should maintain scientific expertise on its staff and in the Research Institute, or RI, to conduct, evaluate and anticipate new research of importance to the practitioner; to test new methodologies, develop standards and establish guidelines for acceptance of various dental products; to resolve issues relative to acceptance and safety; and to address other critical issues. The RI and the Paffenbarger Research Center, or PRC, serve as models of effective public and private collaboration and should continue their research into technologies and materials of the greatest benefit to the public and the profession. As needed, other research should be carried out through extramural contractual arrangements.
It is the consensus of the Council on Scientific Affairs that the most vital role and important responsibilities of the ADA are in the area of knowledge and technology transfer, as well as in ensuring that the profession is continuously kept abreast of scientific and technological advancements. With this in mind, the Council has reviewed patient and provider safety issues, including governmental alerts and ethical/legal topics; health services research, including social/ behavioral issues; and treatment-oriented research of immediate and emerging importance in the management of oral diseases. The Council believes that these issues have short- and long-term impact on the quality of patient care, "best practice" guidelines and the continuing development of dental practice. Finally, the 2001 ADA Research Agenda enumerates specific procedures for enhancing the process by which science is transferred into clinical application.
In the year 2000, the Council broadened the annual review process for the Research Agenda to include all Association councils and requested their proposed revisions, additions and feedback on the draft Mission Statement and the categorical headings of research priorities. The revisions proposed by various Association councils are incorporated in the revised 2001 ADA Research Agenda.
As the following list of critical research issues is not exhaustive, the Council will continue to review the Association’s Research Agenda, solicit feedback from other ADA councils and forward suggested changes annually to the Board of Trustees. While the Council feels that all of the issues listed are important, certain items are marked with an asterisk (*) to indicate greater urgency.
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RESEARCH OF IMPORTANCE TO THE PRACTICING DENTIST1
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Mission Statement
A major objective of the Association is to promote a good quality of life by improving the oral health of the public and encouraging optimal health behaviors. To achieve this objective, it is imperative that the Association take a leading role in promoting, conducting and critically reviewing research on topics related to dentistry and its relationship to the overall health of the individual. The Association should serve as a facilitator of the national dental research effort, help determine the priority of topics for research and ensure the timely dissemination of information to the profession.
I. Issues Related to the Science of Dentistry
Dental Biomaterials
- *Promote systematic evaluation of the technique sensitivity of restorative materials.
- Promote research and development on sealants, adhesives and effective mercury-free bio-compatible dental materials for posterior restorations.
- Promote research on biomimetic materials and other novel materials that minimize tooth loss or replace missing tissues.
- Study the application of novel biologics in dental practice. This includes:
- diagnostics;
- smart materials with diagnostic, restorative and controlled release capabilities.
- Create collaborative partnership to enhance the development and evaluation of engineered tissues.
Oral Care Management
- *Study the use of antibiotics and the development of antibiotic resistance, and promote the development of guidelines for the use of antibiotics in dental practice.
- *Continue research on the mechanisms of action of fluorides and the total fluoride exposure.
- Expand the research on pain and anxiety control and alternative approaches to local anesthesia, as well as approaches to intraoral and parenteral sedation and anesthesia.
- Promote research on regenerative procedures to maintain the natural dentition that has compromised periodontal support.
- Promote research on the development of optimal methods for the replacement of missing teeth.
- Develop evidence-based indications for the placement, replacement or repair of dental restorations.
- Promote research on the cost-effectiveness of current dental treatment.
- Study the pre- and posteruptive effects of fluoride on caries.
Oral Disease
- *Expand research on the infectious nature of caries and periodontal disease.
- *Promote research on the early detection, diagnosis, prevention and treatment of oral and pharyngeal cancer.
- Encourage research on the diagnosis, classification and effectiveness of treatment of temporomandibular joint disorders and orofacial pain.
- Promote studies into the detection and treatment of early and "hidden" caries.
- *Promote research for the prevention and management of oral mucosal viral disorders, such as recurrent herpetic infections.
- Expand research on the etiology, diagnosis and classification of oral mucosal disorders, such as recurrent aphthous stomatitis and lichen planus.
Technology
- Study the application of emerging technologies in dental practice and laboratories. This includes:
- diagnostic devices and methods;
- lasers;
- CAD/CAM;
- technology/genetic engineering;
- imaging devices and methods.
- Promote research to enhance imaging for determining the precise placement of implants.
Patient and Provider Safety
- *Promote studies on the use of safety devices to prevent percutaneous injuries in the dental setting.
- *Promote studies aimed at determining what are the health implications from exposure to aerosols generated during dental procedures.
- *Investigate the acceptable and attainable levels of nitrous oxide in the dental office.
- *Promote studies on the health implications from exposure to dental materials such as dental amalgam, resins, latex and other chemicals in the dental workplace.
- Continue research to improve procedures for the protection of patients, practitioners and allied health personnel against contact with airborne and bloodborne pathogens (such as tuberculosis, human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human papillomavirus).
- *Study the need for and the cost-effectiveness of chemical collection devices (such as amalgam separators) and other aspects of waste management in dental practice.
- Promote studies on ergonomics as it relates to the health of practitioners and allied health personnel.
- Study the quality of water in waterlines in dental equipment and develop methodologies to ensure acceptable purity levels in coolant and irrigant systems.
- *Promote studies aimed at determining the effect of the release of amalgam waste on the environment.
Development of Standards and Guidelines
- Develop in vitro test methodologies predictive of clinical behavior to evaluate dental biomaterials and assist in standards development.
- Standardize protocol for clinical evaluations of dental biomaterials in both university-based and private practice–based research.
Systemic Health Considerations
- *Promote studies of the interrelationship between oral and systemic health and on clinical management as it relates to:
- acutely ill patients;
- chronically ill patients;
- cancer patients;
- female patients;
- pediatric patients;
- geriatric patients;
- saliva diagnostics.
- Promote studies of the relationship between periodontal disease and systemic health and of clinical management as it relates to:
- cardiovascular disease;
- preterm, low-birthweight babies;
- osteoporosis;
- diabetes.
- Study the effect the use of different fluorosis indexes has had on the reported prevalence of dental fluorosis over time.
II. Economic, Environmental, Social and Management Issues Related to the Practice of Dentistry
Access Barriers
- Study the socioeconomic, geographic and cultural barriers to health care and develop strategies for extending quality care to all Americans.
- Develop further research on the clinical management of patients who may have particular problems in obtaining access to appropriate regular care.
- Study the links between oral disease and general health outcomes specifically regarding chronic conditions encountered in an aging population and handicapping conditions in children, and concomitant barriers to oral health care in those special populations.
- Study the cost-effectiveness of community water fluoridation and other preventive modalities, particularly with respect to barriers to access to care.
Impact of Oral Health on Quality of Life
- Study the social and economic impacts of oral diseases and treatments with special reference to quality-of-life functions.
- Study the causes of and treatments for xerostomia.
Practice Management Modalities
- Develop simulation models to compare various oral health care delivery systems such as solo, multispecialty, institution and hospital practices, as well as utilizing various combinations of auxiliary personnel, for assessment of long-term efficacy.
- Evaluate the electronic patient record and other aspects of oral health informatics and their application to dental practice.
Environmental Issues
- *Develop protocols for evaluating technologies and systems designed to reduce amalgam waste and mercury in dental wastewater.
III. Issues of Information Transfer
Interagency and Interprofessional Transfer
- *Explore methods by which the ADA can disseminate research findings and other information available from the ADA, ADEA, NIDCR, AADR, Centers for Disease Control and Prevention and other relevant agencies/organizations.
Intraprofessional Transfer
- *Identify most effective methods to disseminate currently existing protocols for various regimens for the prevention of oral diseases.
- Initiate research to determine the process(es) through which oral health care practitioners gain new knowledge to support lifelong learning.
- Explore methods by which the ADA can expeditiously disseminate research findings and other information to the profession:
- ergonomics;
- emerging infectious diseases;
- evidence-based dentistry;
- oral-systemic health interactions;
- prevention and early detection of oral cancer;
- waste management technologies.
Public Transfer
- *Explore methods to disseminate pertinent information on dental issues to the public.
- Explore the development of effective oral health promotion strategies employed by organized dentistry to reach various public audiences.
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RESEARCH OF IMPORTANCE TO...
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