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2003 ADA RESEARCH AGENDA

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 (ADAHF), the National Institute of Dental and Craniofacial Research (NIDCR), the Agency for Healthcare Research and Quality (AHRQ), 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 and International Associations for Dental Research (AADR, IADR), the American Dental Education Association (ADEA), professional specialty groups, government agencies, and industry.

The ADA should maintain scientific expertise on its staff and in the Research Institute (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 (PRC) serve as models of effective public and private collaboration, and should continue their research on technologies and materials of greatest benefit to the public and the profession. As needed, other research should be conducted through extramural contractual arrangements.

It is the consensus of the Council on Scientific Affairs that the Association’s most vital role and important responsibilities are in the area of knowledge and technology transfer, and in ensuring that the profession is continuously kept abreast of scientific and technological advancements. With this in mind, the Council has performed its annual review of 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 Research Agenda enumerates specific procedures for enhancing the process by which science is transferred into clinical application.

The Council acknowledges that the following list of critical research issues is not exhaustive, and will continue to review 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.

RESEARCH OF IMPORTANCE TO THE PRACTICING DENTIST

(adopted by the ADA Board of Trustees at its December, 2002, meeting; adopted by the ADA Council on Scientific Affairs, September, 2002)

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.

1. Issues Related to the Science of Dentistry
   • Dental Biomaterials
     1. *Promote systematic evaluation of the technique sensitivity of restorative materials.
        
     2. Promote research and development on sealants, adhesives, and effective mercury-free biocompatible dental materials for posterior restorations.
        
     3. Promote research on biomimetic materials and other novel materials that minimize tooth loss or replace missing tissues.
        
     4. Promote research on biocompatible root canal and root-end filling materials.
        
     5. Study the application of novel biologics in dental practice. This includes:
        • diagnostics and
          
        • smart materials with diagnostic, restorative, and controlled-release capabilities.
          
        
        
     6. Create collaborative partnerships to enhance the development and evaluation of engineered tissues.
        
     
     
   • Oral Care Management
     1. *Study the use of antibiotics, the development of antibiotic resistance, and promote the development of guidelines for the use of antibiotics in dentistry, including identification of appropriate and inappropriate drug regimens and indications for antibiotic prophylaxis.
        
     2. *Promote research into the causes and management of xerostomia, especially regarding autoimmune disease and medications that induce hyposalivation.
        
     3. *Continue research on the mechanisms of action of fluorides, the pro- and posteruptive effects of fluoride on caries, and total fluoride exposure, including dietary and environmental sources.
        
     4. *Promote research on dental remineralization.
        
     5. Study the issue of tooth wear, especially with regard to what rate is considered to be pathologic.
        
     6. Expand the research on pain and anxiety control, alternative approaches to local anesthesia, as well as approaches to intra-oral and parenteral sedation and anesthesia.
        
     7. Promote research on regenerative procedures to maintain the natural dentition that has compromised periodontal support.
        
     8. Promote research in pulp biology and endodontic diagnosis and treatment to develop optimal means for maintaining the natural dentition.
        
     9. Promote research on the development of optimal methods for the replacement of missing teeth.
        
     10. Develop evidence-based indications for the placement, replacement, or repair of dental restorations.
         
     11. Promote research on the cost-effectiveness of current dental treatment.
         
     
     
   • Oral Disease
     1. *Expand research on the transmission of caries and periodontal disease.
        
     2. *Promote research on the prevention and detection of root-surface caries.
        
     3. *Promote research on the early detection, diagnosis, prevention, and treatment of oral and pharyngeal cancer.
        
     4. *Promote research for the prevention and management of oral mucosal viral disorders, such as recurrent herpetic infections.
        
     5. Promote research into the biology of dental plaque.
        
     6. Encourage research on the diagnosis, classification, and effectiveness of treatment of TMDs and orofacial pain.
        
     7. Promote research into the early detection and management of "hidden" caries.
        
     8. Encourage surveillance of the prevalence of caries in all segments of the population.
        
     9. Promote research on the etiology and treatment of pulp and periradicular disease.
        
     10. Expand research on the etiology, diagnosis, and classification of oral mucosal disorders, such as recurrent aphthous stomatitis and lichen planus.
         
     
     
   • Technology
     1. 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
          
        • Endodontic rotary file systems
          
        • Information management
          
        
        
     2. Promote research to enhance imaging for determining the precise placement of implants.
        
     
     
   • Patient and Provider Safety
     1. *Promote studies on ergonomics as it relates to dental instruments, products, materials, and dental procedures to help ensure the health of practitioners and allied dental personnel.
        
     2. *Promote research on the use of safety devices to prevent percutaneous injuries in the dental setting.
        
     3. *Promote research on the health implications from exposure to aerosols generated during dental procedures.
        
     4. *Investigate the acceptable and attainable levels of nitrous oxide in the dental office.
        
     5. *Promote research on the health implications from exposure to dental materials such as dental amalgam, resins, latex, and other chemicals in the dental workplace.
        
     6. Continue research to improve procedures for the protection of patients, practitioners, and allied dental personnel against contact, air-, and blood-borne pathogens (such as TB, HIV, HBV, HCV, and HPV).
        
     7. *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.
        
     8. Study the quality of water in waterlines in dental equipment and develop methodologies to ensure acceptable purity levels in coolant and irrigant systems.
        
     9. Study the potential adverse interactions between drugs used in dentistry and those used in medicine, and develop appropriate recommendations for the prevention and management of these interactions.
        
     
     
   • Development of Standards and Guidelines
     1. Develop in vitro test methodologies predictive of clinical behavior to evaluate dental biomaterials and assist in standards development.
        
     2. Standardize protocol for clinical evaluations of dental biomaterials in both university-based and private-practice-based research.
        
     
     
   • Systemic Health Considerations
     1. *Promote research on 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
          
        • Pre/peri-natal care patients
          
        
        
     2. Promote research on the relationship between oral (periodontal and endodontic) disease and systemic health and on clinical management as it relates to:
        • Cardiovascular disease
          
        • Preterm, low-birthweight babies
          
        • Osteoporosis
          
        • Diabetes
          
        
        
     3. Study the effects of the use of different fluorosis indices on the reported prevalence of dental fluorosis over time.
        
     
     
   
   
2. Economic, Environmental, Social, and Management Issues Related to the Practice of Dentistry
   • Access Barriers
     1. Promote research on the socio-economic, geographic, and cultural barriers to oral health care and develop strategies for extending quality care to all Americans.
        
     2. Develop further research on the clinical management of patients who may have particular problems in obtaining access to oral health care.
        
     3. Promote research on the links between oral disease and general health outcomes, specifically regarding chronic conditions encountered in an aging population and disabilities in children, and concomitant barriers to oral health care in those special populations.
        
     4. Promote research on 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.
     
   • Practice Management Modalities
     1. Develop simulation models to compare various oral health care delivery systems such as solo practice, multi-specialty, and institution and hospital practices, as well as utilizing various combinations of allied dental personnel, for assessment of long-term efficacy.
        
     2. Evaluate the electronic patient record and other aspects of oral health informatics, and their application to dental practice.
        
     3. Promote research to optimize the ethical practice of dentistry.
        
     
     
   • Environmental Issues
     1. *Develop protocols for evaluating technologies and systems designed to reduce amalgam waste and mercury in dental wastewater.
        
     2. *Promote studies aimed at determining the effect of the release of amalgam waste on the environment.
        
     
     
   
   
3. Issues of Information Transfer
   • Interagency and Intraprofessional Transfer: *Explore methods by which the ADA can disseminate research findings and other information available from the ADA, ADEA, NIDCR, AADR, CDC, and other relevant agencies/organizations.
     
   • Intraprofessional Transfer
     1. *Develop effective methods to disseminate currently existing protocols for various regimens for the prevention of oral diseases.
        
     2. Develop process(es) through which oral health care practitioners gain new knowledge to support life-long learning.
        
     3. Develop 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
     1. *Develop methods to disseminate pertinent information on dental issues to the public.
        
     2. Develop effective oral health promotion strategies employed by organized dentistry to reach various public audiences.
        
     
     
   
   
4. Research Models
   1. *Promote the concept of evidence-based research models.
      
   2. *Support the continued need for animal-based research models.
      
   
   

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