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SPECIAL SUPPLEMENT TO

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SEPTEMBER 2009

150 years of progress
Highlights of America’s scientific
contribution to dentistry and
dental practice

This special supplement to The Journal of the American Dental
Association was made possible through an educational grant
from A-dec, ADA Insurance Plans from Great-West Life, ADA
Members Retirement Program, the Colgate-Palmolive Company
and the Wm. Wrigley Jr. Company.

C O N T E N T S
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Highlights of America’s Scientific Contributions
to Dentistry: 150 Years and Still Counting
B.L. Pihlstrom
The guest editor of this special supplement to JADA highlights
some of America’s scientific contributions to dentistry in the
past 150 years.

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The Evolution of America’s Scientific Advancements
in Dentistry in the Past 150 Years
J.L. Gutmann
The author examines scientific advancements in dentistry in the
United States. This article includes a sidebar about the
contributions of the ADA Foundation’s Paffenbarger Research Center.

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Science Is the Fuel for the Engine of Technology and Clinical
Practice
M.L. Snead, H.C. Slavkin
The authors highlight prominent scientific discoveries of the past 50 to 60
years that have improved the quality of life for patients.

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The Biology, Prevention, Diagnosis and Treatment of Dental Caries:
Scientific Advances in the United States
D.T. Zero, M. Fontana, E.A. Martínez-Mier, A. Ferreira-Zandoná, M. Ando,
C. González-Cabezas, S. Bayne
The authors outline major scientific advances in cariology during the past 150
years, with an emphasis on contributions made by people living and working
in the United States.

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The Biology, Prevention, Diagnosis and Treatment of Periodontal
Diseases: Scientific Advances in the United States
G.C. Armitage, P.B. Robertson
The authors provide an overview of scientific advances in periodontology
during the past 150 years.

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A View of the Future: Dentistry and Oral Health in America
I. Garcia, L.A. Tabak
The authors explore advances in modern science and technology and how
they will change oral health care in the future.

JADA, Vol. 140

http://jada.ada.org

September 2009

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PUBLISHER AND MANAGING VICE PRESIDENT

EDITOR
Michael Glick, DMD, professor of oral medicine,
Arizona School of Dentistry & Oral Health; associate
dean for oral-medical sciences, School of Osteopathic
Medicine in Arizona, A.T. Still University, Mesa

Laura A. Kosden
ASSOCIATE PUBLISHER

James H. Berry
EDITORIAL DIRECTOR

Lisbeth R. Maxwell
SENIOR EDITORS

GUEST EDITOR

Janice Snider, Amy E. Lund

Bruce L. Pihlstrom, DDS, MS, professor emeritus,
Department of Surgical and Developmental Sciences,
School of Dentistry, University of Minnesota,
Minneapolis; associate editor for research,
The Journal of the American Dental Association

EDITOR, ELECTRONIC MEDIA

ASSOCIATE EDITORS

Joe Hoyle
CREATIVE DIRECTOR

Peter Solarz
EDITORIAL ASSISTANTS
Editor’s Office (Mesa, Ariz.): Vicki Hodge
Publisher’s Office (Chicago): Karen London
LETTERS TO THE EDITOR

Dentistry and Medicine
Peter B. Lockhart, DDS

Patricia A. Lewis
REPRINTS AND PERMISSIONS

Esthetic and Restorative Dentistry
David C. Sarrett, DMD, MS

Karen London
DIRECTOR OF SALES AND MARKETING

Carol J. Krause

Evidence-Based Dental Practice
James D. Bader, DDS, MPH

ADVERTISING SALES MANAGER

Michelle Boyd
CLASSIFIED ADVERTISING COORDINATOR

EDITORIAL BOARD

Shirley Hawkins

Paul S. Casamassimo, DDS, MS

SALES AND MARKETING ASSISTANT

Lois Cohen, PhD

Angela James

Raul I. Garcia, DMD

MARKETING MANAGER

Jill Philbin

Mel L. Kantor, DDS, MPH

CIRCULATION CUSTOMER SERVICE REPRESENTATIVE

Dushanka V. Kleinman, DDS, MScD

Gwen Johnson

William G. Kohn, DDS, MPH

DIRECTOR OF PRODUCTION

Gilbert X. Muñoz

Vincent G. Kokich, DDS, MSD

ADVERTISING PRODUCTION ASSISTANT

Laura Kottemann, DMD

Liz Grace

Daniel Malamud, PhD

TECHNOLOGY MANAGER

Paul Gorski

Kevin J. McNeil, DDS

SENIOR LAYOUT AND DESIGN COORDINATOR

Terry G. O’Toole, DDS

Cindy Carstensen

Titus Schleyer, DMD, PhD

LAYOUT AND DESIGN COORDINATOR

Ann Allen

Gordon P. Trowbridge III, DMD

Cover illustration by Peter Solarz
Cover photo © 2009 Jupiterimages Corporation

EDITORIAL POLICY

ADVERTISING POLICY

All statements of opinion and of supposed fact are published
under the authority of the authors, including editorials and letters. They are not to be accepted as the views of the American
Dental Association or its subsidiaries unless such statements
have been expressly adopted by the Association. Articles are
accepted with the understanding that they have not been published previously and that they are submitted solely to The
Journal. Information on any products mentioned may be available
from the authors. Neither the American Dental Association nor
any of its subsidiaries has any financial interest in any products
mentioned in editorial content, and The Journal requires all
authors to disclose any financial or other interests they may have
in products or services described in their articles.

All advertising appearing in ADA publications must comply with
official published advertising standards of the American Dental
Association. The publication of an advertisement is not to be construed as an endorsement or approval by the American Dental
Association or any of its subsidiaries, councils, commissions or
bureaus of the product or service being offered in the advertisement unless the advertisement specifically includes an authorized
statement that such approval or endorsement has been granted.
A copy of the advertising standards of the American Dental Association is available on request.

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JADA, Vol. 140

http://jada.ada.org

September 2009

Copyright © 2009 American Dental Association. All rights
reserved. For inquiries regarding reprints and permissions,
contact Karen London at 1-312-440-2787.

most dentists at that time were self-taught or had received training as apprentices.1 Although it has been reported that relatively few men actually were rejected owing to a lack of teeth. the authors emphasize contributions of scientists who lived and worked in the United States. dscientific advances in the biological understanding. we now are on the brink of a remarkable transformation that promises to expand dramatically the role of dental professionals and improve the oral health of people throughout the world. this supplement focuses on selected topics. and numerous advances in the dental specialties. at the beginning of the 20th century or even just a few years ago.Highlights of America’s scientific contributions to dentistry 150 years and still counting Bruce L.3. can you imagine how dentistry was practiced and what oral health was like in America one year before Abraham Lincoln was elected president and two years before the start of the American Civil War? Although the world’s first dental school.4 but it would be many years before his observations were accepted and many more before oral disease prevention was practiced widely. However. it is impossible to include in this supplement all of the developments that occurred during the 150-year period. diagnosis and treatment of dental caries and periodontal disease. Dentistry was an empirical endeavor when the ADA was founded. because they transcend all areas of dentistry. Willoughby Miller recognized the role of bacteria in caries and periodontal disease. It describes the evolution of oral health science in the United States and the transformative role of basic science in technology and dental practice. the Baltimore College of Dentistry. high-speed dental instrumentation.2 Near the beginning of the 20th cen- A 4S JADA. including discoveries such as safe and effective pain control. However. advances in the diagnosis and treatment of oral cancer. when Sherman reached Savannah. 140 http://jada. because these diseases are responsible for the vast majority of oral disease and tooth loss. Ga. and they sought to improve the standards and quality of the profession through scientific investigation. Many scientific advances have led to better oral health and improved dental care since the founding of the ADA. dthe role of basic science in transforming technology and dental practice. These topics include the following: dthe evolution of oral health science in the United States. their records were designated “4F.”1 This supplement to The Journal of the American Dental Association celebrates America’s truly amazing scientific contributions to dental practice and oral health since the founding of the ADA. it includes discussion of scientific advances in dental caries and periodontal disease. Scientific advances have changed society and dentistry in ways that no one could have imagined during the Civil War.org September 2009 tury. its originators were aware of the lack of a scientific basis. and we recognize that investigators outside the United States have made many seminal discoveries and contributions to dentistry. with no geopolitical boundaries.” an abbreviation that later came to signify any medical reason for draft deferral. MS s we celebrate the 150th anniversary of the American Dental Association (ADA). the Union Army classified recruits and draftees as being handicapped if they lacked four incisors. had opened in 1840. Pihlstrom. dental implants. because this supplement specifically commemorates the 150th anniversary of the ADA. . with an emphasis on developments in the last 50 to 60 years. Science is an international endeavor. prevention. Vol. many troops sought dental care and one dentist reported that “the emergency need alone would have required 100 dentists to work 6 months on these troops. in no small part. This supplement also includes a view of the exciting future that science likely will bring to dentistry and oral health care. In addition. Owing to. Instead.. DDS. America’s scientific contributions to dentistry.ada. Because soldiers in the Civil War needed anterior teeth to open paper cartridges for their guns.

Zero and colleagues13 describe scientific advances in cariology during the past 150 years that have led to our understanding of dental caries as a chronic. we are able to remineralize early carious lesions. Today. 140 http://jada. SCIENTIFIC ADVANCES IN CARIOLOGY Dr. it promises to establish the foundation for new diagnostic tests. dthe development of scientific dental journals and the publication of scientific findings in mainstream scientific and medical journals. migrants. The contributions of Horace Wells. Genomics and proteomics continue to progress at a rapid pace. As basic science gives us the knowledge and tools to understand clinical conditions. industry and government. dietomicrobial. We also have learned that salivary factors and genetic-environmental interactions are important in the etiology of caries. They provide three fascinating examples of dentists who transformed medicine in the last 50 to 60 years: dNorman Simmons refined the techniques of isolating DNA.ada.THE SCIENTIFIC EVOLUTION OF DENTISTRY Dr. dRobert Ledley pioneered computerized tomographic scanning in the early 1950s. dthe role of immigrant dental scientists and the development of oral biology as a discipline. making it likely that dental implants. Edward Angle and others were important. Personalized medicine and dentistry are becoming a reality. associationbased and governmental scientists. we have come to better understand the central role of fluoride in preventing caries and the importance of caries risk assessment. Black. Gies and the 1926 Carnegie Foundation report6 regarding dental education. which Rosalind Franklin used to create the first x-ray crystallography images from DNA and which led James Watson. clinicians. Relatively recent advances in periodontology have changed fundamentally how clinicians detect JADA. oral health research could not have flourished in this country. dental caries remains a significant problem for many Americans. making it possible for researchers to determine the full complement of genes and proteins that make us who we are. children with disabilities. Stem cell biology holds the promise of regenerating lost tissues and organs.V.9. dental caries changed in the last century and now is unequally distributed.org September 2009 5S . Minorities. and we look forward to the day when people of all ages and backgrounds will view dental caries as a disease of the past. will become obsolete. William Morton. SCIENTIFIC ADVANCES IN PERIODONTOLOGY Drs. G. Once a ubiquitous disease.11. enabling clinicians to make diagnostic. despite the gains made during the last 150 years. academia. Drs. Francis Crick and Maurice Wilkins to predict the structure of DNA in 19538. Many novel restorative materials and treatment methods for caries have resulted from strong partnerships between academic. Vol. Without these critical developments. but the seminal events that led to the scientific basis of dentistry in the United States include the following: dthe vision of William J. Unfortunately. Snead and Slavkin7 discuss how science fuels the engine of innovation and discovery. and new diagnostic imaging methods may enhance our ability to identify and treat early lesions without the use of a handpiece or surgical intervention. prognostic and therapeutic decisions on the basis of a patient’s genetic makeup and environmental exposures. Willoughby Miller. corporate. We have learned much about the microbial etiology of caries and the role of carbohydrates in its pathogenesis. THE ROLE OF BASIC SCIENCE In their review of the role of basic science in technology development and dentistry. homeless people. During the last 60 years. Snead and Slavkin also discuss recent breakthroughs in the digital revolution that have given us the new field of bioinformatics and the amazing capacity for diagnostic imaging. Armitage and Robertson14 note that most significant scientific advances in periodontology have come about as a result of the collective efforts of visionary pioneers and through multidisciplinary collaborations between scientists. and socioeconomically disadvantaged people experience the highest prevalence and severity of caries. Gutmann5 describes how the stage was set in the early 20th century for the scientific evolution of dentistry. as used today. dRussell Ross and colleagues first proposed that atherosclerosis is an inflammatory lesion caused by localized injury to the lining of the arterial wall. site-specific disease caused by a shift from protective factors favoring tooth remineralization to destructive factors leading to demineralization. methods of prevention and therapies that improve the quality of life for our patients. dthe establishment of the National Institute of Dental Research in 1948.10 a remarkable achievement that led to modern diagnostic imaging in both dentistry and medicine. organized dentistry.12 Drs.

Advances in molecular biology. Innovation and creativeness in scientific research: my experiences in developing computerized axial tomography.140(9 suppl):8S-15S. White Dental Mfg. Nature 1993.edu”. Future of Dentistry. American Dental Association. Zero DT. Gies WJ. Garcia I. are effective in controlling or eliminating these diseases.180(93):1332-1339. Dammann G. human genetics. 16. Drs. Pihlstrom did not report any disclosures. Martinez-Mier EA. The financial support of the sponsors that made this supplement a reality is gratefully acknowledged. Dental Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. JADA 2009. Address reprint requests to Dr. JADA 2009. However. 2. 13. Tabak LA.108(4):483. diabetes and genetic influences. Drs. The pathogenesis of atherosclerosis: a perspective for the 1990s. policymakers and dental educators must make a substantive and concerted effort to apply these new discoveries in ways that improve the oral health of all those who live in our nation. tobacco use. 1859-1880: the early years. Wilkins MHF. Bethesda. Chicago: American Dental Association. We know that prominent risk factors for periodontal disease include socioeconomic status. They envision a time when dental handpieces will be obsolete and when dentists use molecular methods to predict and prevent oral disease.edu. 1926.4(2):133-136. They also look forward to the day when patients who suffer from chronic orofacial pain will be treated with new patient-specific nonaddictive pain medications that maximize efficacy and safety while avoiding dangerous side effects. 2008:41-42.140(9 suppl):36S-43S. 11.362(6423):801-809. Ross R. Accessed July 17. The future dental office likely will be a place where visual and tactile methods of diagnosing disease will be augmented by technologies such as smart imaging systems. December 11. The evolution of America’s scientific advancements in dentistry in the past 150 years. We now know that these diseases are biofilm-induced infections and that the host response plays a major role in determining the damaging effects of these diseases. Fontana M. 2009. Original Investigations Concerning Pyorrhea Alveolaris: The Micro-Organisms of the Human Mouth. Bollet AJ. The molecular configuration of nucleic acids. prevention. For the first time in human history.org The vision of the ADA Future of Dentistry report— to achieve “improved health and quality of life for all through optimal oral health”16—remains a worthy goal for our profession. 1. prevention. preventing and treating oral and craniofacial diseases and disorders. the ADA Department of Library Services. proteomics and stem cell biology have set the stage for the predictable regeneration of periodontal tissues. Ledley RS. “http://cmbi.S. A view of the future: dentistry and oral health in America. 3. Science is the fuel for the engine of technology and clinical practice. Md. e-mail “bpihls@umn. 6S CONCLUSION September 2009 Many thanks are due to the authors and anonymous peer reviewers of the articles in this supplement and to the staff of The Journal of the American Dental Association. 15. Atherosclerosis and the arterial smooth muscle cell: proliferation of smooth muscle is a key event in the genesis of the lesions of atherosclerosis. combined with posttreatment maintenance programs. Ledley RS. Images of Civil War Medicine: A Photographic History. Health Policy Resources Center. 140 http://jada.140(9 suppl):25S-34S. Failing to do so could lead to persistent or even increased disparities in oral health in America.pdf”. Ayers WR. 9. Ross R. Drs. Dent Cosmos 1902. Pihlstrom.140(9 suppl):17S-24S. diagnosis and treatment of periodontal diseases: scientific advances in the United States.bjmu. Co. 1962. All unselfishly shared their time and expertise to make this supplement possible. JADA 2009. Glomset JA. 7. He also is the guest editor of this supplement. 4. Gutmann JL. Moreover. the Paffenbarger Research Center and the National Institute of Dental and Craniofacial Research. ■ Dr. JADA 2009.. There is no question that science will lead to new technologies for diagnosing. Comput Biol Med 1974. there is the real possibility that we will be able to alter the course of disease by manipulating defective genes and using targeted drugs and therapies to tailor treatment on an individual basis rather than using the “one-treatmentfits-all” approach that is common today. 2001. et al.and treat gingivitis and periodontitis. Randomized controlled trials have shown that most conventional forms of periodontal therapy. New York City: The Carnegie Foundation for the Advancement of Teaching. The biology. Vol.140(9 suppl):44S-48S. genome scans. practitioners. Snead ML. However exciting these new technologies may be. 14.44:425. Minneapolis. Dr. Disclosure. A VIEW OF THE FUTURE JADA. New York City: Demos Medical Publishing. 10. Garcia and Tabak emphasize that we must continue to improve the translation and dissemination of new discoveries into tools for communities and people at greatest risk of developing disease. Philadelphia: The S. Department of Surgical and Developmental Sciences. 125th anniversary commemoration. 20814. Nobel Lecture. biological knowledge gained from research regarding periodontal tissue repair and regeneration has been translated from the laboratory into clinical practice. The presence of bacterial plaques on the surface of teeth and their significance. Slavkin HC. Pihlstrom is a professor emeritus.. American Dental Association JADA 1984. molecularly based diagnostics and integrated electronic risk management systems. 6. . JADA 2009. Miller WD.12(1):v-xviii. Comput Med Imaging Graph 1988.cn/news/report/2003/ DNA50/source/wilkinslecture. Computerized medical imaging and graphics evolves from computerized tomography. diagnosis and treatment of dental caries: scientific advances in the United States. Garcia and Tabak also predict that dentists of the future likely will rely on diagnostic and treatment tools that rapidly and reliably process a patient’s biological information— from their genes to their proteins and metabolites. 1890.ada. #902. University of Minnesota. Robertson PB. given the complexities of our health care delivery system and the economic and cultural differences in our society. The biology. Lastly. School of Dentistry. Garcia and Tabak15 describe their view of the future of dentistry and oral health. Science 1973. 4801 Fairmont Ave. 12. Miller W. 8. Armitage GC. 5.

dentistry in the United States faced many challenges as it developed its scientific foundation. The scientific evolution of America’s contribution to dental practice and science occurred because of many factors. Dallas.G. clinical practice was driven by empirical evidence.) Black in operative dentistry 8S JADA. Texas A&M University Health Science Center. and the first few decades of the 20th century set the stage for America’s scientific evolution of dentistry. M THE EARLY YEARS In the mid-19th century. a development that often has been attributed to William T. we are at the brink of a transformation that may expand the role of the dental profession dramatically and improve the oral health of people throughout the world. Conclusions. history of dental science. Edmund Kells. high-speed instrumentation. Gies. new dental materials and dental implants. Morton. and the establishment of the National Institute of Dental Research in 1948. Gutmann at 1416 Spenwick Terrace. the development of innovative oral surgical methods by Simon Hullihen. the role of immigrant dental scientists from Europe and oral biology as a discipline. the classification of malocclusion and treatment by Edward Angle. the characterization of oral deformities and procedures for their correction by Norman Kingsley. however. Address reprint requests to Dr.ada. Dallas. It was not until the last 50 years. Dallas. During the last 150 years. Gutmann. These included the 1926 Carnegie Foundation for the Advancement of Teaching report1 and the vision of William J. dental practice. the development of scientific dental journals. JADA 2009. Gutmann is a professor emeritus. and the establishment of the National Institute of Dental Research in 1948. radiographs. which flourished in Europe. Dental science. Gies. and the major contributions of Greene Vardiman (G.3 Other notable examples of applied research were the discovery of the welding property of annealed gold foil by Robert Arthur. Vol. and the subsequent introduction of ether as another way to induce anesthesia. but the innovations were based on applied research as opposed to more basic science. e-mail “jlgutmann@earthlink. Due in large part to America’s contribution to dental science and practice. and maintains a private practice limited to endodontics. Seminal developments in America’s contribution to science in dentistry and oral health included the 1926 Carnegie Foundation for the Advancement of Teaching report and the vision of William J.The evolution of America’s scientific advancements in dentistry in the past 150 years James L. Baylor College of Dentistry. Dr.140(9 suppl):8S-15S. who administered nitrous oxide to patients so that they would experience little or no pain during tooth extractions. the formation of scientific journals. that science became a prominent component of dental education and an integral part of dental practice. the use of radiographs to reveal anatomical and pathological conditions of the teeth and jaws by C. Department of Restorative Sciences. surgical procedures for closure of clefts by Truman Brophy. Key Words.V. the United States was viewed globally as the geographical center of innovation in dentistry. Clinical Implications. 140 http://jada. the role of immigrant dental scientists from Europe and oral biology as a discipline. DDS ajor advances in dentistry during the past 150 years include the use of safe and effective local anesthetic. . In the latter part of the 19th century. but four major events had a significant effect on bringing science to dentistry.2 Early examples of innovations in dentistry in America include the development of the use of general anesthetic by Horace Wells.net”. Texas 75204-5529.org September 2009 AB STRACT Background.

JADA: The Journal of the American Dental Association. that encouraged faculty to conduct research in dental schools and include a scientific basis for dentistry in the curriculum. for more complete dental libraries. however. The development of science that would define the essence of dentistry as a whole. presented various proposals regarding the role of bacteria in oral disease and proposed that saliva could be used for research. His seminal 1890 publication. College of Dentistry.D.8 The North American Division of IADR first met in 1952. THE CARNEGIE FOUNDATION FOR THE ADVANCEMENT OF TEACHING REPORT AND THE VISION OF WILLIAM J. “The Micro-Organisms of the Human Mouth: The Local and General Diseases Which Are Caused by Them. and Canadian dental schools to improve their curricula by employing well-trained and full-time teachers.4. and dental school graduates began taking examinations in the basic sciences and the mechanical aspects of dentistry. PRC: Paffenbarger Research Center.1 The report urged U. for better cooperation between dentistry and medicine. In 1970. NIH: National Institutes of Health.ada. skeptics such as Alton Howard Thompson from Topeka. the following deserve special mention: G. was one of the first true American dental scientists. they generated lactic acid that could decalcify an entire tooth crown. and major benchmarks that affected contemporary dentistry in the third to the fifth decades of the 20th century were set. had its roots in the late 1800s and early 1900s. NIST: National Institute of Standards and Technology. Many of these people were associated with schools in the Chicago area.8 He also called for increased financial support for dental education and for dental educators to have a greater appreciation for the biological and medical aspects of dentistry.1 In 1928.102 members from the United ABBREVIATION KEY.6 Willoughby D. Before the late 1800s and early 1900s. however. Perhaps most importantly. in 1879.and oral pathology. Black. Gies. 140 http://jada. the Carnegie Foundation for the Advancement of Teaching published a report by William J. IADR: International Association for Dental Research. challenged the empirical basis of dentistry as it was practiced in the 19th century. FDI: Fédération Dentaire Internationale. a professor of biological chemistry at Columbia University. Johnson. Hatton and S. JADA. beyond that of a technical or empirical profession. Tylman. Balint Orban.” 7 reported that when carbohydrates are mixed with saliva and incubated at 37°C. for the elimination of independent or proprietary dental schools. GIES In 1926. New York City. Truman Brophy. Moorehead. NIDR: National Institute of Dental Research. Miller. Edward H. NIDCR: National Institute of Dental and Craniofacial Research. Skillen. and for the affiliation of dental schools with private or statesupported universities. it was not until 1937 that prospective dental students were required to have two years of college.org September 2009 9S . Coolidge. by encouraging and conducting research and by providing adequate libraries.3 Furthermore. he attempted to reorient the dental profession from focusing on treatment to focusing on disease prevention.3 Gies proposed that predental and dental educational requirements should include a minimum of two years of college before entry into dental school..S.4. JDR: Journal of Dental Research. Thomas Gilmer. Although many people were at the forefront of dentistry as an evolving science in the United States. Gies Noyes. On Dec. Kan. who received his Doctor of Dental Surgery degree from the University of Pennsylvania. and the University of Illinois. dentistry in the United States was recognized throughout the Western world for its technical excellence.V. Northwestern University Dental School. W. Edgar D. Philadelphia. Frederick B. Charles N. 1920—two years after the formation of the Journal of Dental Research (JDR)—Gies and 24 colleagues organized the International Association for Dental Research (IADR) to bring together dentists and scientists to enhance dental research. Vol. the North American Division had 2. including the Chicago College of Dental Surgery at Loyola University.G. but it was not recognized generally as having a scientific basis. William J. 20. Gies envisioned an organization in which all research-oriented people could promote interest in dental research. Gies called for dentists to receive graduatelevel instruction after graduating from dental school. NDA: National Dental Association. Edmund Dr.5 Even in light of these developments. the American Dental Association (ADA) created the National Board of Dental Examiners. He also identified several bacteria that created acids during their metabolism.

Sicher and Joseph Peter Weinmann. the Official Bulletin of the National Dental Association (NDA) was introduced. The first dental periodical. THE DEVELOPMENT OF SCIENTIFIC DENTAL JOURNALS Dental journals had a significant influence on the advancement of dental science. The Dental Review. but it was not known for having a scientific basis. 140 http://jada. In 1934. providing evidence that the science of dentistry had matured into a discipline that was accepted widely by the broader scientific community. A turning point occurred in the mid-1920s when the dean of dentistry at Chicago College of Dental Surgery at Loyola University. In the latter part of the 20th century.S. Balint Orban. dentists’ technical expertise in restorative dentistry. Since its inception. major biological and medical journals began to publish articles that described the results of dental and craniofacial research. and in 1912 their quarterly journal became known as The Journal of the Allied Societies. and.G. Among these immigrants were Bernhard Gottlieb. governmental funding of oral and craniofacial research through the National Institute of Dental and Craniofacial Research (NIDCR). The journals of the New York Institute of Stomatology. Logan. under the auspices of the S. Harvard Odontological Society and Metropolitan District (Massachusetts State Dental Society) combined in 1906. the journal became an IADR publication. a group of scientists from the University of Vienna were linked to dentistry in the United States through their participation in Fédération Dentaire Internationale (FDI) World Dental Federation. Southern Dental Journal. yet emerging. In 1936. White Manufacturing Company.S. dental research effort in the United States a sound and credible foundation that enabled the profession to take advantage of the development of IADR and federal funding of research that would take place after World War II. In the early to middle 1920s. and The Journal of the Allied Dental Societies was discon10S JADA. JDR and JADA have served as vehicles for disseminating research findings and explaining the scientific basis of dentistry to the profession. The scientists in the Vienna group had biological expertise that complemented the U.”4 Gies was listed as the executive officer of JDR and was its editor from 1919 through 1935. Much of its content was empirical. Canada and Mexico.4 This division consisted of 37 sections with councilors to IADR. JADA merged with Dental Cosmos. Other early dental publications were Stockton’s Dental Intelligencer. Rudolf Kronfeld. sought the advice of Bernhard Gottlieb2.9 on how to . IADR has played a critical role in the scientific evolution of dentistry in the United States and has been a staunch advocate for U. along with many other journals with a focus on oral health research. JDR was a quarterly publication and “a journal of stomatology. The New York Dental Recorder. African American dentists formed a national association called the National Dental Association.4 Helmut Zander.3 Dental Cosmos. was introduced in 1839. the American Journal of Dental Science. When the name of the NDA was changed to the American Dental Association in 1922. devoted to the advancement and dissemination of knowledge pertaining to the mouth and teeth. Vol.States. In 1913.org September 2009 tinued and replaced in March 1919 by JDR. it was renamed the American Journal and Library of Dental Science in its second volume. The division existed only on paper until it was formally activated in 1972. American Academy of Dental Science. was the first president of the North American Division. Dental Items of Interest and the Dental News Letter. an immigrant dental scientist from Germany who was one of the leaders in the transformation of American dentistry into a science. During this time. dentistry in the United States was attempting to rise to the challenges and dictates set forth by the Gies report of 1926. The Dental Register of the West. and the first joint edition was published in 1937. including historical accounts. They were welcomed into academia in the United States despite the Great Depression and the resistance of the National Association of Dental Examiners and most state dental boards. Philadelphia. which was renamed Dental Cosmos in 1859. William H. which helped give the struggling. and to their relation to the body as a whole.ada. In 1932. published a wide range of subject matter. the journal’s name was changed to The Journal of the American Dental Association (JADA). practitioners’ techniques and opinions. and it was renamed The Journal of the National Dental Association in 1915. By late 1918. which resulted in JDR’s becoming a bimonthly publication in 1928. Harry D. William J. THE ROLE OF IMMIGRANT EUROPEAN DENTAL SCIENTISTS AND ORAL BIOLOGY American dentistry was recognized widely for its technical excellence in the first few decades of the 20th century. Gies made plans for publishing JDR as a journal for dental investigators.S. His initiative and vision spearheaded a significant increase in dental research.

and remineralyou pick up a front-surface dental mirror or highizing pulp-capping therapies. American Dental burg. earlier this year science-based specifications for media reports raised concerns about Dr. you are taking advantage of alties from patents are a significant source of advances developed by scientists at PRC. Every time effective in treating sensitive teeth. procedures or use of ultrasonic scalers and producdcalcium phosphate remineralization.ada. Royor dental sealant. senior work at the NIST campus in Gaithersvice president. “Proresearchers on dental product specifijects that are currently under way cations. safely and effectively. PRC scientists developed new test Research Unit in Dr. Food and Drug played a key role in dentistry—identifying Administration. as well as new technologies. Md. George lead in crowns. Other PRC projects in the pipeline that promise dorthodontic bracket bonding. that might be present in dental materials. scientists at PRC developed the first ishing of resin-based composites. will help revolutionize how dental creating a robust research environdiseases are treated in the future. Vol. ADA Foundation’s calcium-phosphate bone cements whose use in Paffenbarger Research Center (PRC) has humans was approved by the U. equipment from fired porcelain-fused-to-metal crowns. In 1985. During and therapies. ders from standard commercial sources and finUnder his guidance. PRC scientists obtained porcelain powUnit and rapidly became the unit’s lead scientist.ADAF Paffenbarger Research Center Where many new ideas for dentistry start or more than 80 years. As soon as the issue Paffenbarger joined the scientists at the Research emerged. In 1929. revenue for the ADA Foundation. Technology [NIST]) to develop For example. the PRC has a staff of 27 people who sible. More recent developments have the needs of dental practitioners and translating included amorphous calcium phosphate. PRC researchers also in technologies that are hallmarks in dentistry: are looking into other high-profile issues such as dhigh-speed handpieces. F JADA.S. He also in an acidic solution. ddental sealants.” ment that has an international repuPRC was established in 1928 as tation for excellence. the Research Unit continued ished crowns produced by both domestic and fordeveloping standards to ensure that products pereign dental laboratories. PRC research has resulted as this arise in the future. the ADA renamed the the process. 140 http://jada. ated the tools that make modern dentistry posToday. Dr.org September 2009 11S . After storing the samples form predictably. the risk of developing dental erosion from sports drhodium-coated front-surface dental mirrors. scientists detected no lead in expanded the scope of Research Unit projects to the solution. important rewards for the dental profession dtooth-colored resin-based composite restorative include materials.” says Dr. Paffenbarger’s honor. The presence of the Research Unit of the ADA to colwell-equipped laboratories and highly laborate with the National Bureau skilled researchers is invaluable to of Standards (now called the Napracticing dentists when they need tional Institute of Standards and timely answers to critical questions. Daniel Meyer. More than 200 prodspeed handpiece or place a composite restoration ucts on the market are based on PRC patents. drinks and the bioavailability of any bisphenol A dpanoramic radiography. The scientists at PRC conAssociation (ADA) tinue to collaborate with NIST Science/Professional Affairs. tion of ultrafine particles during finishing and polIn addition.5 million during the past six years. George Paffenbarger dental products. amounting to “Technological breakthroughs at PRC have cre$5. indicating that lead does not leach further advances in dental materials. methods that will be useful when questions such Thanks to his vision. danalysis of aerosol production during restorative ddental bonding adhesives. which is those needs into improved products.

It offered practitioners the opportunity to acquire knowledge in allied clinical fields.16 The American Institute of Oral Biology was founded in 1943 to encourage basic and clinical research for the prevention and treatment of oral disease.”15 The development of oral biology as a discipline has been an integral factor in America’s contribution to dental science and practice. colleagues. He then joined the faculty at the Chicago College of Dental Surgery at Loyola University. For more information about PRC and its current research projects. one month before he was to become president of IADR.S. 140 http://jada.9 A tremendous debt is owed to the dentists and dental scientists who emigrated from Europe to the United States in the 1930s and 1940s.9 Gottlieb moved to the United States in 1940. he returned to the University of Illinois. then dean of the University of Michigan School of Dentistry stated that the dental schools making up the American Association of Dental Schools “are faced with a decision as to what they will do to orient the stranger dentists within our gates to become useful citizens and respected practitioners. before moving to Baylor University.11 During his career. Rudolf Kronfeld was another protégé of Bernhard Gottlieb. came to the United States from Vienna in 1927 to establish a research program at the Chicago College of Dental Surgery at Loyola University.S. Ann Arbor. the Department of Dental Research (renamed the Center for Oral Biology) joined five other research centers to form the Aab Institute of Biomedical Sciences. He later joined the faculty at the University of Illinois College of Dentistry.. and some who had lost their academic positions in Europe received help from their U. Under these conditions. Joseph Peter Weinmann began his U.org/goto/prc”. Rochester. ddental materials that are indistinguishable from tooth structure. as his colleague Edgar D.ada. as well as in .”14 Harry D. Dallas. histology. American Dental Association Division of Science. followed by one year at Columbia University.dcariostatic delivery devices (chewing gum. damorphous calcium phosphate–containing composites that can remineralize tooth structure. visit “www. His message to clinical dentists was expressed in an article in which he delineated the crucial connection between the techniques of restorative dentistry and the biological foundation on which those techniques rested. In 1946. anti-Semitism and war. and those who viewed it as an economic threat. This created a struggle between the members of the dental profession in the United States who viewed the emigration of foreigntrained scientists as an opportunity for the dental profession and as a moral responsibility. Its origins can be traced back to 1928. bone physiology and oral pathology.org September 2009 dtissue engineering scaffolds for bone repair.12 Balint Orban. Kronfeld died. N. Scientific Information. Bunting. when the University of Rochester Medical Center. Gottlieb wrote numerous scientific articles and four textbooks and is responsible for founding the study of oral histology. significant grant funding from the National Institutes of Health (NIH). ■ Anita Mark. and then he moved to the Chicago College of Dental Surgery at Loyola University. The program eventually became the Department of Dental Research in the School of Medicine and Dentistry. Weinmann received 12S JADA. fluoride therapies). many dentists and medical scientists— primarily from the University of Vienna—sought refuge in the United States. establish a research endeavor in an academic environment.13 In 1939. Some practicing dentists in Austria and Germany were able to emigrate to the United States. Vol. career in 1938 at the University of Illinois College of Dentistry. In 1998. cements.ada. Sicher began his career in the United States at the Chicago Medical College. He has been acknowledged as being the first dentist to integrate basic science information with clinical treatment. Coolidge put it. Europe was experiencing political upheaval. During this period. a protégé of Bernhard Gottlieb. Chicago. his histological material and his work in progress for the coming season. His short career at Loyola University was marked by many research advancements that helped place science into the practice of dentistry.9 Russell W. Both scientists undertook significant research endeavors in oral anatomy.10. He was associated briefly with Columbia University and the University of Michigan. manager. they were instrumental in nourishing dental research and incorporating it into the dental school curriculum. established the first oral biology research and training program in the United States. where he was a professor and the chair of the Department of Pathology and Research in the School of Dentistry until his death in 1950.Y. “surrounded by his library.

reached out to the dental profession. caries prevention through the National Caries Program (a merger of both intramural and extramural programs) and craniofacial research and cleft palate reconstruction. promoted research in developmental biology.19 fields traditionally associated with dentistry. funded first multidisciplinary cleft palate study. appointed director of Dental Research Section (1945). Lawrence A. Mich. Department of Health and Human Services. Phase III clinical trials. Slavkin 1995-2000 Engineered renaming NIDR as National Institute of Dental and Craniofacial Research (NIDCR) to reflect expanded research mission. expanded extramural dental research to include research centers in the collective fields of oral biology. established an intramural Clinical Investigations and Patient Care Branch to coordinate and integrate patient treatment with clinical research conducted elsewhere in NIDR and NIH. expanded intramural research and grants to include pain research and anesthesiology. established an intramural Diagnostic Systems Branch to study noninvasive diagnostic techniques. provided oversight for intramural building and laboratory facilities of intramural research program. and enhanced both intramural and extramural capacity to conduct clinical studies. patient groups and the public to promote communication of NIDCR research findings..org September 2009 13S .TABLE A brief history of the National Institute of Dental Research/National Institute of Dental and Craniofacial Research and its directors. DIRECTOR DATES SIGNIFICANT FOCUS/ACCOMPLISHMENTS H. autoimmune diseases and allergic disorders. enabled the formation of the intramural Laboratory of Oral Medicine. systems biology of salivary glands and diagnostic potential of saliva. the Laboratory of Microbiology. Kreshover 1966-1975 Previously served as the scientific director of the NIDR’s intramural research program. IADR and the ADA sponsored the First International Conference on Oral Biology (with a grant from the Colgate- Palmolive Company. Arnold Jr. became first director of the National Institute of Dental Research (NIDR) (1948). Trendley Dean. and expanded research investments in periodontal diseases. David B. genomics (including genome-wide association studies). pain research. the first step was taken to form a society of oral biologists as part of a section of the JADA. In 1959. human genetics and oral medicine. as well as the behavioral sciences. enhanced grants in the neurosciences. Trendley Dean 1948-1953 Provided first leadership for dental research at the National Institutes of Health (NIH) (1931). New York City) and the proceedings were published in JDR. established intramural Laboratory of Biochemistry. fluorosis. awarded first extramural dental research grants and fellowships. 2000-present Increased support for research on oral health disparities. prevention of dental caries by fluoride and water fluoridation. Tabak * Source: U. established the first Board of Scientific Counselors to provide advice to the director for intramural research program. Harold C. 1953-1966 With H. led Grand Rapids. stimulated expansion of grants in the behavioral and social sciences.ada. established intramural research units for basic and clinical science. and oral health needs of minority and vulnerable populations. helped lead NIH initiative to enhance peer review. Harald Löe 1983-1994 Established the Epidemiology and Oral Disease Prevention Program to include periodontal and other diseases of the oral cavity. fostered interdisciplinary research as cochair of the NIH Roadmap program on Research Teams of the Future. established the Dentist Scientist Award program to enhance clinical research. advocated for integration of dental health into mainstream medical research. oral complications of HIV/AIDS. Francis A. Vol. initiated programs of continuing dental education and public information to translate research findings. established World Health Organization Collaborating Center for Dental Research and Training. expanded NIDR research to dental materials. encouraged scientists outside of dentistry to focus on the structure and function of the oral and craniofacial area. effective and economical way to prevent dental caries. head and neck cancer. neuroscience of chronic pain.S. Seymour J. supported creation of a dental practice-based research network and a formal Dentist Scientist Training Program for concomitant Doctor of Dental Surgery/Doctor of Philosophy degree training. oral and pharyngeal cancer. It also served as a meeting ground for academically oriented researchers and clinicians. and minority oral health. facilitated NIDCR leadership in Oral Health in America: A Report of the Surgeon General*– the first of its kind dedicated solely to oral health. supported first consensus development conference on dental implants. 140 http://jada. supported research on mottled enamel and fluoride. encouraged dental faculty in the United States to apply for research grants. created an intramural section for epidemiology and biometry. initiated first national surveys of U. genetics. adult oral health and children’s caries. oral and craniofacial diseases and disorders. served as acting deputy director of NIH (November 2008-spring 2009). Scott 1976-1981 Expanded extramurally supported research in periodontal diseases.S. provided for oversight by the National Advisory Dental Research Council. In 1988. fluoridation study that established water fluoridation as a safe.17 The journal Archives of Oral Biology began publication the same year.

A breakdent. with support from IADR. as the small laboratory became visionary dental scientists. ADA Committee on Legislation. a member of the National organization became the American Association of Research Council of the National Academy of SciOral Biologists. largely through the efforts of the ADA tal practice.S. acid-etch man signed legislation that established NIDR. Public Health Service. past presilack of financial support. 21. awarded $85. In 1916.B.21 cial Research (NIDCR)—known as the National InThe NIH originated in 1887 in Staten Island. in 1919. and. ever. The institute was founded in 1948 and has Hygiene in the Marine Hospital Service. Dr. in 1930. craniofacial function and disorders. the major driver of America’s contribution marked the first large dental research grant in the to the science of dental practice and oral health has United States from a foundation outside the dental been the National Institute of Dental and Craniofacommunity. now bonding. oral canNIDCR. fornia College of Dentistry in San Francisco “to undertake. it the American Dental Association. stitute of Dental Research (NIDR) until Oct. and its first annual meeting was ences. Also present (from left): Dr.highlights the directors and history of NIDCR. In July 1930. Dr. Directed by gienic Laboratory. a joint study of pyorrhea THE NATIONAL INSTITUTE OF DENTAL and its possible relation to other human maladies.S.3 In 1918. a committee chaired by Thomas B.S. director. NIDCR has been instruknown as. C. Hartzell from the University of Minnesota was formed to encourage scientific President Harry S. N. Trendley Dean. Brehm (Ohio). the dental practice and our understanding of dental and ADA passed a resolution that requested the U. Carl O. and Dr. government’s funding of oral health research can be traced back many years. H. President Woodrow Wilson created the National Research Council of the National Academy of Sciences to coordinate the nation’s scientific research facilities for defense work. 140 http://jada. Vol. however. New York City.Y. pain control. National through occurred in 1924.22 critical role in many areas of public health and denIn 1948. The table institutes and centers to be established.18 NIDCR-supported established research fellowships to investigate basic research has had a major impact on public health.” 20 AND CRANIOFACIAL RESEARCH AND U. Much of the 14S JADA. a precursor stimulated and funded many of the scientific adto the U. The ADA Scientific Foundation and Research ComFUNDING OF ORAL HEALTH RESEARCH mission helped plan the project. through cooperation of a number of men THE NATIONAL INSTITUTES OF HEALTH.ada. June 24. Washington office of research in dentistry. Bruce D. It has played a surgeon general to conduct dental research. howInstitutes of Health.. when the Carnegie CorporaAmerican Association for Dental Research. a division of medical sciences was created. ADA president. as a small laboratory called the Laboratory of 1998. Truman signs the bill establishing the National Institute of Dental Research. 1948. District of Columbia Dental Society.000 to the University of Caliin 1989. biological and medical problems.org September 2009 . Flagstad. Trudental sealants. It was one of the first federal governmental bodies to promote dental biological research. composite restorations. Willard Camalier. and.20 NIDR was one of the first of the 27 NIH 18 19 cer. Dr. chief dental officer. Washburn. periodontal disease and therapy. Congressman Walter E. Daniel F. the Hyvances in dentistry and dental practice. dental director. In 1891. and the award Overall. the mental in transforming dentistry from a technical Ransdell Act changed the name of the Hygienic Labprofession to one that is based firmly in prevention oratory to the National Institute of Health and and technological innovation. in different fields of science. The U.S. Public Health Service. author of the bill. President Harry S. faced many roadblocks including H. and salivary function. Dr. chairman. This tion. moved to Washington. Forsyth. Lynch. such as caries and water fluoridation.

Md. Accessed July 9. JADA 2001. J Dent Res 1943. Department of Health and Human Services. 1926. 21. Jones RG. Kremenak NW. Kronfeld R. 9.20 RECENT TRENDS IN DENTAL SCIENCE AND PRACTICE In the late 20th century. Ornish N. Crit Rev Oral Biol Med 1997. NIDR had supported more than 1. Annual report of the secretary-treasurer of the Scientific Foundation and Research Commission of the American Dental Association from July 1. muscle. Transactions 1930:160. 1938.135(1):78-83. Karger. Lufkin AW. Evidencebased practice is the process of integrating clinically relevant scientific evidence with the patient’s oral and medical conditions and histories.”24 and it will play an increasingly important role in the way dentistry is practiced in the future. Kronfeld. New York City: The Carnegie Foundation for the Advancement of Teaching. bioinformatics and biomimetics emerged and promise to have a major impact on the future of dental practice. Chicago: University of Chicago Printing Department. 6. Journal of the American Dental Association.25 Taken together. Orland FJ. The educational problem presented by the refugee dentist from Europe. March Twenty-First. and Sicher from Vienna to America. The National Institute of Dental and Craniofacial Research: research for the practicing dentist. 12. Weinmann.org September 2009 15S . Dent Cosmos 1884. 1924. Ornish N. 25. Pioneers in oral biology: the migrations of Gottlieb.136(6): 728-737. Davis WL. Rockville. Ismail AI. 1939: 40-46. Bunting RW. Philadelphia: Lea & Febiger. DDS.: U. research.19:17. 8. Mol Med 1999. First International Conference on Oral Biology: abstracts of papers presented. JADA 2005. U. NIH publication 00-4713. 24. The First Fifty-Year History of the International Association for Dental Research. bioinformatics will facilitate the discovery of more sensitive and specific drugs for the treatment and management of diseases and disorders. and it will enable dental and medical records to be accessed readily anywhere in the world. JADA 1998. education and professional management. Vol. 1973.html”. Bull Chicago Dent Soc 1939. A History of Dentistry. Dental Science in a New Age: A History of the National Institute of Dental Research. 14. 1. dentistry has faced many challenges as it has moved from a purely technical profession to one that is increasingly science-based. BS.S. salivary glands. In: Proceedings of the Sixteenth Annual Meeting of the American Association of Dental Schools Held at Cleveland. Gies Foundation for the Advancement of Dentistry. 23. 2. Slavkin HC. Rudolf Kronfeld. the dentist’s clinical expertise. National Institutes of Health. Gutmann did not report any relevant disclosures. National Institute of Dental and Craniofacial Research. cartilage. Scientific methods in practice. Basel. it promises to take on new importance in terms of tissue engineering and the development of true biological biomaterials to replace body parts such as teeth. Switzerland: S. Dallas: Texas Heritage Press. The Micro-Organisms of the Human Mouth: The Local and General Diseases Which Are Caused by Them. Building sound and regular teeth: the National Institute of Dental Research celebrates its golden anniversary. 3. Philadelphia: Lea & Febiger. Prinz H. Harris RR. 22.29:22-29. Twenty-Second and Twenty-Third.ada. Schleyer T.org/handbook/online/articles/GG/fgoal. 19. Dental Chronology: A Record of the More Important Historic Events in the Evolution of Dentistry. Transactions 1924:182-183. Thompson AH. 4.132(5):605-613.8(2):108-128. ADA Council on Scientific Affairs and Division of Science.600 trainees and fellows. 11. and the patient’s treatment needs and preferences. Pioneer Jewish Texans: Their Impact on Texas and American History for Four Hundred Years. JADA 2004. 1973. Squier CA. Ohio. Research and the future of dentistry. The Handbook of Texas Online. Baylor Dent J 1985. 5. for the improvement of oral and craniofacial health. ■ Disclosure. Gottlieb. Miller WD.19: 266-276. Department of Health and Human Services. The Vienna Medical School of the 19th Century. CONCLUSIONS In the last 150 years.: Montrose Press. 2000. Dental Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Dental informatics: a cornerstone of dental practice. Oral Health in America: A Report of the Surgeon General. Lesky E. A new look at the Gottlieb collection: the continuing evaluation of the Gottleib collection reveals new and significant scientific information. Biomimetics is the study of the structure and function of biological systems as models for the design and engineering of materials and machines.tshaonline. JADA.39:1083-1097. J Dent Res 1960. 2009. 1989. Coolidge ED. Report of the American Dental Association Commission on Dental Legislation to the National Institutes of Health. Orban. 1976. evidence-based practice.20 Fluoridation was the first challenge faced by the leaders of the fledgling institute. Rockville. 1992. Spallek H. 13. International Association for Dental Research.5(10):645-653. 15. 140 http://jada. and continuing now. 10.26(8): 455-464. these relatively new disciplines hold great promise for the future of dental education and clinical practice and. 20.129(6): 694-701. 18. William John Gies: His Contributions to the Advancement of Dentistry. 17. Md. Robinson HGB. bones and joints. Gies WJ. 7. Tabak LA. While biomimetics has had a place in dentistry for many years in developing dental materials. Evidence-based dentistry in clinical practice. MD. 1945. 1989. The future must be driven by a global vision for the provision of science-driven oral health care and the commitment of dental educators and practitioners to embrace science as an integral part of our profession. ultimately. Stein JH. Tabak L. Nineteen-Hundred and Thirty-Nine. “www. 1590-1990. Pihlstrom BL. Goldsmith LA.impetus for this legislation was that during World War II many young American men could not serve in the military because they did not have the minimum number of six opposing teeth required to qualify for combat. 1923. most of whom were involved in teaching and research and more than one-half of whom were involved in providing patient care. Baltimore: Johns Hopkins University Press. and the need to train dental researchers was critical. Williams NB. By 1972. Bader JD.S. Indianapolis: American Association of Dental Schools.23 Dental bioinformatics has been defined as the “application of computer and informational sciences to improve dental practice. Bernhard. Dr. to June 30. New York City: The William J. Aab Institute of Biomedical Sciences. 16. For example.

Scientists are on the threshold of applying knowledge in stem cell biology to regenerative medicine and dentistry.. Overview.140(9 suppl):17S-24S.edu”. Computer power derived from the dramatic breakthroughs of the digital revolution has made extraordinary computational capacity available for diagnostic imaging. today we live in another time of scientific revolution. therapeutic interventions and procedures that improve the quality of life for patients. The University of Southern California. The biological revolution was initiated by the identification of the structure for DNA in 1953. Yet. treatments and biomaterials. Humanity’s most basic and recognizable characteristics—including the face—are now better understood through the elucidation of our genome and proteome. 2250 Alcazar St. behavioral and physical sciences provide the fuel for innovation. Bright minds exposed to questions such as these have created and will continue to create technology that improves patient care. The University of Southern California. Slavkin is a professor. Los Angeles. JADA 2009. 140 http://jada. a discovery that continues to catalyze improvements in patient care through new and better diagnostics. molecular biology. Dr. developmental and stem cell biology. Center for Craniofacial Molecular Biology. scientists identified the structure and function of DNA and applied it to cellular and molecular biology to better understand the microbial and human ecosystems and their interdependence. DDS cience is the fuel for the engine of technology and clinical practice. How do we formulate a diagnosis and prognosis? What are the ways of treating the diseases and disorders that challenge the human condition? Is one outcome better than another? The answers to these questions come from our sustained investment in the science that fuels our educational system. discovery and technology that continuously improves the quality of the human condition. Dr. e-mail “mlsnead@usc. and many other disciplines continue to fuel innovative research findings that form the basis for new diagnostic tests. PhD. chairside application. School of Dentistry. Snead. Discovery.Science is the fuel for the engine of technology and clinical practice Malcolm L. Address reprint requests to Dr. DDS. Slavkin. Los Angeles. characterized by great speed and enormous accomplishment in the chemical. the genes and proteins they encode. We think of the Scientific Revolution of the 16th and 17th centuries as the intellectual and technological movement that shaped the modern world. Advances in the fields of genetics.1-4 The scientific disciplines in the 21st century are being shaped by S ABSTRACT Background. Health care providers are beginning to use personalized medicine that is based on a person’s genetic makeup and predispositions to disease development. Conclusions. School of Dentistry. Calif. JADA.ada. chemical. Center for Craniofacial Molecular Biology. Snead is a professor. Harold C. bioinformatics (the science of information) and numerous aspects of how we practice dentistry in the 21st century. 90033. heralding an era when clinicians can consider using biological engineering to replace tissues and organs lost to disease or trauma. physical and biological realms of inquiry—from discovery to application. The biological. In the 20th century. Key Words. Snead. Vol.org September 2009 17S .

Francis Crick and Maurice Wilkins to predict the structure of DNA in 1953.1 In Wilkins’ acceptance speech for the Nobel Prize in Physiology or Medicine in 1962. to celebrate the 150th anniversary of the American Dental Association (ADA). his home base for the second half of the 20th century.Y. His doctoral thesis was titled “Investigation of Submaxillary Mucoid and the Defense Mechanisms of the Mouth. This has resulted in remarkably precise diagnostic tests and rapid improvements in patient treatment. he was considered an expert in diagnosing craniofacial-oral-dental birth defects. engineering and computational sciences to create discoveries at the interfaces of these disciplines. New York City. LINKAGE OF DENTISTRY AND GENETICS The engine of science has contributed to significant advances by mapping and deciphering the nucleotide letters of the human genome and by describing the proteome. phenotypic traits and specific genotypes.”14 Simmons was nominated for the Nobel Prize in Physiology or Medicine in 1972 in recognition of his fundamental studies of changes in light absorption associated with conformational changes within proteins and polypeptides: the so-called “Cotton effects” (named after Aimé Cotton). In this all-too-brief review. books and peer-reviewed publications. These studies led him to explore the structure of viral particles. his fundamental scientific work in nuclear medicine and oral biology at the University of California. When combined with the key ingredient of well-trained clinicians.16 From esoteric to mainstream diseases and disorders. served as the foundation that led to the development of numerous nucleic acid and polypeptide biomarkers for disease diagnostics. Gorlin was widely known for his ability to deftly integrate his encyclopedic knowledge of craniofacial birth defects with clinical observation. dentistry will rely on science to create new diagnostic tests and therapies to improve patient care. genetics. His memory of craniofacial anomalies was almost as extraordinary as was his clinical prowess. this merger has resulted in remarkable strides in our understanding of disease and allows for more rapid advances. St. Los Angeles (UCLA). These images led James Watson. Vol. Minneapolis. Louis. he credited Norman Simmons for “having refined techniques of isolating DNA and thereby helping a great many 18S JADA.5-10 Optimizing care for patients must be our goal. and a Doctor of Philosophy degree in 1950 from the University of Rochester. However.org September 2009 workers. 140 http://jada. . it was a dentist. 3-D: Three-dimensional. the information that comprises all the genes and their encoded proteins that make us human.”13 Norman Simmons received a bachelor’s degree in science in 1935 from the City College of New York. book chapters. Robert Gorlin earned a bachelor’s degree from Columbia University. Rosalind Franklin then created the first x-ray crystallography images from that DNA. One of the most extraordinary scientific discoveries of the 20th century was elucidating the structure and possible functions of DNA (see illustration11). N. Norman Simmons. Readers should appreciate that this review is but a small sampler of the incredible scientific advances that have shaped what we know. we have concentrated on the scientific contributions of scientists who have worked in the United States. We have attempted to do this by focusing on specific themes and ideas to highlight prominent scientific discoveries and attainment of knowledge that have had an impact on patient care. The key to his success was his ability to see. as well as his studies of the isolation of tobacco mosaic virus DNA and RNA.the merging of biology. Significantly. we highlight a few select examples of discoveries. because this supplement commemorates the 150th anniversary of the ADA. BMP: Bone morphogenetic protein. and a dental degree in 1947 from Washington University School of Dentistry. including ourselves. both dentists and physicians consulted him for his diagnostic expertise.15 Thereafter. who first isolated sufficiently pure DNA in 1952 (see photograph12). Science knows no geopolitical boundaries and we recognize the profound contributions of scientists working in other countries. Rochester. how we think and how we practice clinical dentistry in the dawn of the 21st century. to understand and to integrate an array of seemingly disparate information: he saw the system of the ABBREVIATION KEY. drawn from the last 50 to 60 years. UCLA: University of California. Gorlin’s diagnostic skills became known internationally through his lectures. He then made the University of Minnesota School of Dentistry. Even more so than in the past. One of Gorlin’s contributions was the ability to discriminate between syndromic and nonsyndromic birth defects. NIDCR: National Institute of Dental and Craniofacial Research. particularly at the molecular level. Boston. a Doctor of Dental Medicine degree in 1939 from Harvard. New York City. Los Angeles.ada.

ada.24 The molecular cloning and mapping of the gene for ameloblastin. The collaboration of an interdisciplinary team from Baylor College of Medicine.11 Dr.25 Furthermore. Norman Simmons. Reprinted from the U. we appreciate that the mouth is readily accessible and that its tissues may provide a relatively easy route for introducing genes to prevent or treat a variety of oral and other diseases. The future holds great promise that researchers will JADA. extending our understanding of normal and abnormal formation of the dentin and enamel tissues. Bethesda. characterization and clinical application of the major gene for enamel formation: amelogenin. the second most abundant enamelforming protein.17 By the end of the 20th century. Houston. 140 http://jada.12 body when others saw only derangements of its parts. National Institutes of Health. For example. Gorlin became one of the leading geneticists in the world and was the recipient of numerous awards.S. including the Award for Excellence in Human Genetics Education from the American Society for Human Genetics. Researchers at the National Institute of Dental and Craniofacial Research (NIDCR) are moving genes from the laboratory to chairside to treat salivary gland diseases. dentin sialoprotein and dentin glycoprotein.DNA is a double helix formed by base pairs attached to a sugar phosphate backbone. the result of the remarkable sensitivity and specificity derived from molecular biology for applications to clinical dentistry. an autosomal recessive disorder characterized by periodontal disease and palmoplantar keratosis and diagnosed mainly by dentists. is caused by a mutation in the cathepsin C gene.26 Another use of genetic science is somatic cell gene therapy to treat human disease. this was. we have learned that Papillon-Lefèvre syndrome. Los Angeles. and the University of Southern California. researchers had begun to identify the specific role of genes in various oral diseases.19 Another scientific discovery was the isolation.27 It also may be possible to transfer genes to readily accessible salivary glands and use them as “biofactories” or as a source of proteins to treat diseases caused by deficient protein biosynthesis. N.22 Another major advance in dental genetics was the discovery that a gene on chromosome 4 generates three gene products: dentin phosphoprotein. Md. Vol.20 Isolation of this gene to the X and Y chromosomes21 provided a forensic tool to discriminate the corporal remains of males versus females and provided the basis for advancing our understanding of the Mendelian inheritance of enamel birth defects. National Library of Medicine. Rochester. Reproduced with permission of the University of Rochester Medical Center. investigators have linked the human genome and proteome at the level of teeth. As dentists.org September 2009 19S . in no small measure.18. also was accomplished.23.Y. enabled the first dental gene to be cloned.

known as “the neural crest.org September 2009 mercial gel that can induce progenitor cells to regenerate bone and cementum in the treatment of periodontal disease.50 Otto Walkhoff. often with hematopoietic bone marrow. In 1895. smell and hearing and. such as amelogenin. our clinical challenge is to devise a strategy to generate bone to correct birth defects or to replace bone lost as a result of injury or disease. Bone has an essential role in supporting the teeth during mastication.45 Scientists are investigating the use of implantsupported distraction osteogenesis that will prove useful for bone regeneration in craniofacial reconstruction. mainly amelogenin protein. Today. 22 bones evolved to articulate and form the craniofacial-oral-dental complex. is continuing in the hope of discovering how they alter cells and direct their differentiation to form bone and cementum while attenuating the inflammatory response.36-38 The recovery of enamel matrix proteins.47. this research allowed this otherwise scarce protein to be manufactured in the laboratory for use at chairside and bedside.40. and that the images could be used for dental or medical diagnostics. but age. WOUND HEALING. 140 http://jada.32 and researchers used recombinant DNA technology to identify a complementary DNA clone for one of the BMPs. resulting in the first opportunity to see inside the body without creating a surgical wound. a dentist. The neural crest cells participate in forming the bones of the head and face.49 DIAGNOSTIC IMAGING Previous achievements in science have fueled the creative advances in technology in the 20th century. modulate the immune response. which allowed the new technology to produce therapeutic amounts of the protein. Eventually. acellular cementum and alveolar bone. as well as fitted his dental operatory with . a site that was not known previously to contain such cells. trauma and birth defects all serve to remove bone. During this evolution.28. C. PROTEIN DISCOVERY.43 Researchers also have shown that periodontal ligament stem cells. researchers observed that histiocytes were transformed into osteocytes by autoinduction. and Reddi and Huggins31 described the biochemical sequences in the transformation of normal fibroblasts into bone cells.29 Huggins30 showed the capacity of the urinary bladder to induce new bone formation when it came into contact with abdominal muscle cells. while errors in cell signaling can result in developmental birth defects. offering hope for patients with autoimmune diseases such as lupus erythematosus that a new therapeutic tool can be developed. The study of enamel matrix proteins. disease. Overall. a bony armor formed around the head.ada. a process in which explanted bone induced new bone formation. obtained the first radiograph of the jaw just weeks after Roentgen’s discovery.42 In a large collaborative effort that reflects the intense research needed for progress in this field.44 as well as other sources of stem cells. complete with a periodontal ligament.46 They have shown that a unique population of cells with stemlike qualities. as well as contribute to the sutures that permit growth of the skull. researchers used stem cells in pigs to engineer a functioning cellmediated root replacement. the brain. In the 1960s.identify the genetic basis of many diseases so that clinicians can provide specific preventive care and treatment to patients through somatic cell gene transfer therapy. led to the production of a com20S JADA. the isolated protein is a small amelogenin protein that researchers previously thought was involved only in enamel matrix formation. Vol. The extractable protein that induced new bone was termed “bone morphogenetic protein” (BMP).” responds to signals provided by members of the transforming growth factor family of molecules.33 The commercial availability of BMPs helped us understand how they work so that we can harness their healing powers.41 Investigators working at NIDCR recovered stem cells from human primary teeth. leaving cavities for the organs of sight. TISSUE REPAIR AND STEM CELLS: EXAMPLES OF SCIENCE DRIVING CLINICAL PRACTICE We have come a long way since osteoblasts first appeared in primitive bony fish (the ostracoderms).39 Clinicians now use enamel matrix proteins and/or BMPs to recruit and direct resident stem cells to regenerate lost tissues such as periodontal ligament.35 Efforts to examine the ability of dentin to induce bone led researchers to identify a small-molecularweight protein isolated from dentin that induced naive cells to form cartilage and bone. of course. Edmund Kells used radiography. Roentgen accidentally discovered that human bones could be imaged. this research provides insight into the molecular mechanisms that may cause craniofacial anomalies and offers great promise regarding treatment that can improve quality of life for affected patients.34.48 Collectively.51 A remarkable dentist. Rather than a newly discovered BMP.

He served for many years as the chair of the Department of Pathology. National Institutes of Health.63 concluded that atherosclerosis is an inflammatory disease. are still in use today. fibronectin. these accumulated smooth muscle cells contain elaborate secretory vesicles that are filled with several types Dr.57. Using transmission electron microscopy. a novel animal model of parabiotic mice. thereby reducing the lumen of the vessel. This remarkable achievement was the precursor of modern diagnostic imaging used in both dentistry and medicine. compressed air and suction. a dentist and graduate of New York University. These studies have had an impact in many areas of biomedical sciences. cytology. TISSUE-DESTRUCTIVE ENZYMES Tissue destruction was another focus of attention for dental scientists.electric equipment. hardware and algorithms for software introduced a threedimensional (3-D) approach by which x-rays were transmitted through varying tissue densities to capture 2-D and 3-D images of all parts of the human anatomy. he defined the timing. Robert Ledley. Md. although improved. Ross’ team provided the foundation for our modern understanding of wound healing.59 Ross used interdisciplinary scientific inquiry to study the problem of atherosclerosis. Simply stated. wound healing and tissue regeneration owing to. During the early 1970s. His inventions. in no small part. These contributions are examples of how scientific advances in improving the human condition were derived from the passion and creativity of people who began their careers in dentistry. In publications dating to the 1960s. Ross and his team proposed that localized injury to the lining of the arterial wall was responsible for the unusual accumulation of smooth muscle cells within the wall of the artery. the genius of Russell Ross. proteoglycans and fatty acids that assemble into an abundant extracellular matrix associated with atherosclerosis.60. radiology and an exquisite knowledge of the early advances in wound immunology and pathology. Ross62. of collagen. This research had far-reaching consequences for other investigators working to understand the destructive process brought about by inflammation. JADA. physiology. the metalloproteinases. with the work of Fullmer and Gibson64 revealing that collagenase is present in the tissues of the human host. Bethesda. University of Washington School of Medicine. New York City.56 Ledley pioneered computerized tomographic scanning in the early 1950s. revolutionized how we know what we see.55. that formed a yin and yang for homeostasis. a dentist who had a distinguished career in pathology. metalloproteinases. Courtesy of National Institute of Dental and Craniofacial Research. He took the scientific discovery of x-rays to a new level of understanding. along with their endogenous inhibitory counterparts. Vol. Ross synthesized the essence of wound healing. immunology and connective-tissue biochemistry of wound healing. Seattle.52-54 After World War II. Their efforts to understand tissue loss associated with periodontal disease led to significant advances in our understanding of enzymatic degradation of collagen. TISSUE REPAIR AND ATHEROSCLEROSIS Remarkable scientific advances have been made in tissue repair.ada. WOUND HEALING.58 His strategy of using parabiotic mice enabled his team to trace cell origins and cell fate during various stages of wound healing. Robert Ledley.org September 2009 21S . His team discovered a new growth factor called “plateletderived growth factor” that stimulates proliferation of smooth muscle cells.61 Curiously. who worked at the precursor to the National Institute of Dental Research. Investigators identified a new class of metal-containing enzymes. 140 http://jada. these items.

ada. all of the proteins produced by the salivary gland). Food and Drug Administration approval and clinical use of collagenase-inhibiting low-dose doxycycline in the treatment of periodontal disease.”71. such as oral microbiology and immunology.76 Other investigators77. aligned with the foundation’s previous support of Flexner and Pritchett’s5 analyses for medicine. as well as the degradation of enamel matrix proteins during enamel biomineralization. Irwin Mandel of the School of Dental and Oral Surgery at Columbia University recognized the potential of saliva as an “informative body fluid. Dating back to at least 1960. Trendley Dean (first director of the then National Institute of Dental Research). The first major scientific achievement of the fledgling dental institute was the use of fluoridation to prevent caries. like blood and urine.68 In addition. 140 http://jada. Vol.org September 2009 organs that can be used as surrogate markers for a variety of disease states. in doing so. provided informative clues about health and disease. an organism associated with dental caries. leaders of the ADA helped establish a dental institute within the National Institutes of Health in Bethesda. which can induce secretion of salivary immunoglobulin A.87 Thereafter. While working at the University at Buffalo. Mandel asserted that saliva.helping us understand such phenomena as cancer cell metastasis and angiogenesis. The Gies report was published in 1926. Md.75. the institute focused on fundamental research in many areas. Mandel’s contributions to science opened up opportunities in many areas of biomedical scientific research and clinical practice with regard to the diagnosis of disease or monitoring the progression of disease or treatment by using salivary biomarkers. human .73 Later. For example.69 SALIVA AS A DIAGNOSTIC FLUID Saliva is emerging as an exciting diagnostic tool for dentists and physicians. a biochemist at Columbia University who convinced the Carnegie Foundation to support an analysis of dental science and education in the United States.6 In 1948. Michael Levine spawned several important discoveries regarding salivary proteins. as found in major academic health science universities. but also proteins from other 22S JADA. including caries and periodontal disease. which allowed cells to be maintained in a 3-D architecture that resembled native tissue. forming a molecular fastener similar to Velcro.79 Levine and his colleagues identified the importance of salivary proteins as part of the framework for bacterial adherence to the teeth via bacterial proteins that interact with specific domains within salivary proteins. and it heralded a new age in American dentistry that would have a foundation in the biological.82 Bacterial biofilms are inherently resistant to antimicrobial agents and are associated with many infections. studies of the metabolism of the extracellular matrix led to the formulation of an artificial basement membrane.65-67 Knowledge about the destructive effects of inflammation also led to U. because it contains not only salivary proteins. dental scientists at UCLA are investigating saliva as an aid in the diagnosis of oral cancer. His basic work in saliva sampling and analysis provided the framework for many contemporary salivary studies.78 have been instrumental in characterizing the salivary proteome (that is. Gies.80 Other dental scientists who began their careers at the University at Buffalo contributed to our understanding of streptococci in the aggregation of human platelets and virulence factors associated with bacterial endocarditis.84 These findings led other investigators to explore the possibility of producing a human vaccine to streptococci. dental scientists found that viral particles can be secreted through the salivary glands. others provided the foundation for the use of enamel remineralization to control caries by identifying salivary proteins that modulate the maintenance of salivary calcium and phosphorous.70 Many dentists have provided the foundation for using saliva as a diagnostic fluid. The interdisciplinary work of so-called “dental research” blossomed and became the beacon of dental science for the world. Oppenheim and colleagues74 identified the molecular basis of the beneficial effects of saliva on the oral cavity by identifying antimicrobial properties of various salivary proteins.86 HISTORICAL PERSPECTIVE Dental science in the 20th century evolved from the crucible of William J.83 However. The State University of New York. the most common infection of mankind.81.72 His passion to understand saliva was infectious and attracted many dental scientists to this field of inquiry. investigators have shown that protective immunity to caries may be achieved by ingestion of Streptococcus mutans. thus connecting general health with the oral cavity. they laid a foundation for the use of saliva as a diagnostic fluid.85. made possible by H. chemical and physical sciences. In the mid-1960s.S.

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Biochem Biophys Res Commun 1982. J Oral Pathol Med 1990. pioneer in the field of dental x-rays. J Cell Physiol 2009. Computerized medical imaging and graphics evolves from computerized tomography. Stem Cells 2009.106(2):390-396. 53.58(2):515-522. Recent advances in craniofacial morphogenesis. Simmer JP. Ross R. Gronthos S. 48. Ayers WR. Edmund Kells. Hammarstrom L. 43. Isolation of a low molecular weight glycoprotein inhibitor of calcium phosphate precipitation from the extra-parotid saliva of macaque monkeys. Enamelysin (matrix metalloproteinase 20)-deficient mice display an amelogenesis imperfecta phenotype. Bennick A. Science 1999. SHED: stem cells from human exfoliated deciduous teeth. 42. primary structure. 68. Fortman K. Enamel matrix. Wada N. 71. Yen HY. 61. J Craniofac Surg 2009. Vol. a novel family of histidine-rich proteins in human parotid secretion: isolation. 254(11):4800-4808. 78. Menicanin D. Sabeh F. Calandra JC.165(5):1033-1040. Martin GR. Implant-supported distraction osteogenesis: a technique to advance the deficient maxilla. Gong K.108: 197-212. Han J. Steffensen B. J Biol Chem 1977. Akiyama K. NIH publication 00-4713. Md. Surg Infect (Larchmt) 2008. Chai Y. Appl Microbiol 1966.192(4245):1238-1240. Nat Rev Immunol 2006. Collagenolytic activity in gingivae of man. cementum development and regeneration. Ota I.

Indianapolis. DDS.1 The disease is unequally distributed in the U. Department of Preventive and Community Dentistry. population. and director. and the director. Carlos González-Cabezas. a professor and the chair.org September 2009 25S . Dr. E. MSD. Future management of dental caries requires early detection and risk assessment if the profession is to achieve timely and cost-effective prevention and treatment for those who need it most. Address reprint requests to Dr. Zero is the associate dean for research. the dental biofilm. 140 http://jada. We now know that caries results from complex interactions among the tooth structure. e-mail “dzero@iupui. but there is a need for new diagnostic tools and treatment methods. population. diagnosis and treatment of dental caries. PhD. The distribution of caries has changed in the last century. DDS.1 This article briefly outlines major scientific advances in cariology—with. homeless. children with disabilities and of lower socioeconomic status suffer from the highest prevalence and severity of dental caries. the Fluoride Research Program. Microbial Caries Facility. homeless.The biology. prevention. Ando is an assistant professor. Laboratory Research Facility. Stephen Bayne. Early Caries Detection Program. Oral Health Research Institute. predoctoral education. Oral Health Research Institute. JADA 2009. Zero. School of Dentistry. Indianapolis. DDS. Secondary Caries Program. Dr. Indianapolis. sitespecific disease caused by shifts from protective factors favoring tooth remineralization to destructive factors leading to demineralization. Indianapolis. 415 Lansing St. Masatoshi Ando. Key Words. an emphasis on contributions made by those living and working in the United States. 46202-2876. Department of Preventive and Community Dentistry. migrants. Indianapolis. MS. Ann Arbor. Results. Dr. Graduate Education. Department of Preventive and Community Dentistry. remineralization. Fontana is an associate professor and the director. Zero. in honor of the 150th anniversary of the American Dental Association (ADA). González-Cabezas is an associate professor and the director. DDS.edu”. Vol. Dr.S. Caries. PhD. Dr. Andréa Ferreira-Zandoná. Restorative Sciences and Endodontics. MS. Indiana University School of Dentistry. Scientific advances have led to improvements in the prevention. Margherita Fontana. Dr. Bayne is a professor and the chair. Ind. Relatively recent data indicate that about 90 percent of carious lesions occur in the pits and fissures of permanent posterior teeth and that molar teeth are most susceptible to caries. dietomicrobial. Scientific advances in cariology in the past 150 years have led to the understanding that dental caries is a chronic. Epidemiologic data indicate that caries has changed in the last century. Dental professionals look forward to the day when people of all ages and backgrounds view dental caries as a disease of the past. D ABSTRACT Background. and the director. Ferreira-Zandoná is an associate professor and the director. Dr. PhD ental scientists living and working in the United States during the last 50 to 60 years have contributed to our understanding that dental caries is a chronic. and dietary. Indiana University School of Dentistry. Angeles Martínez-Mier. saliva. Cariology. Department of Preventive and Community Dentistry. director. Department of Preventive and Community Dentistry. diagnosis and treatment of dental caries Scientific advances in the United States Domenick T.. migrants. PhD. salivary and genetic influences. PhD. Conclusions and Clinical Implications. site-specific disease caused by a shift from protective factors favoring tooth remineralization to destructive factors leading to demineralization. MSD. people who are minorities. PhD. Indianapolis. Indiana University School of Dentistry. dietomicrobial. Martínez-Mier is an associate professor and the director. MSD. Oral Health Research Institute. Department of Preventive and Community Dentistry.ada.140(9 suppl):25S-34S. University of Michigan. Indiana University School of Dentistry. School of Dentistry. JADA. DDS. Indiana University School of Dentistry.S. People who are minorities. Indiana University School of Dentistry. DDS. children with disabilities and of lower socioeconomic status have the highest prevalence and severity of caries. it now is distributed unequally in the U.

such as S. the mutans streptococci (MS) group captured the greatest interest.Cr:YSGG: Erbiumchromium–doped yttrium scandium aluminum garnet.29 Available studies with humans have not supported the cariogenicity of starches. caries is a microbial disease in which etiologic bacteria are normal constituents of the oral microbiota that cause disease only when their proportions and pathogenicity change in response to environmental conditions.27 The role of specific sugars was a subject of great research interest in the latter half of the 20th century. However.25 demonstrated the relationship between caries and sugar exposure. mutans. QLF: Quantitative lightinduced fluorescence.11. Weiss and Trithart26 reported a direct relationship between caries experience and the frequency of between-meals consumption of sweet snacks. Highly processed starch-containing foods. proposed that oral bacteria in the presence of fermentable carbohydrates produced acids that dissolved tooth structure.10 Therefore. Stephan24. when researchers conducted animal studies. Willoughby Miller. such as “extension for prevention. . Er.”5 were not successful in controlling the disease.18.32 The recognition of sucrose as a major factor in dental caries. The relative cariogenicity of starches as compared with that of sugars has been the subject of considerable controversy. leading to the acidification of dental plaque.2 a dentist and early dental researcher.4 this concept evolved as the foundation for our current knowledge of caries etiology.9 Children acquire some oral microorganisms. MS: Mutans streptococci. however. therefore. 140 http://jada. FOTI: Fiber-optic transillumination.16 Although S. bis-GMA: Bisphenol-A glycidyl methacrylate. that the bacterial etiology of dental caries was established firmly. Researchers initially isolated Streptococcus mutans from human carious lesions. from their mothers or primary caregivers early in life. especially when combined with sugars.20 These findings provide support for the ecological plaque hypothesis. early caries investigators did not understand the specific nature of the bacterial infection contributing to caries and that restorative strategies alone. as well as work by Bibby33 regarding ABBREVIATION KEY. with a view toward developing novel antimicrobial interventions. Moreover.11 The key caries-associated microbial virulence traits include acidogenesis and acid tolerance. CO2: Carbon dioxide. which findings supported those of the earlier Vipeholm study in Sweden.8. mutans is only one of many endogenous microorganisms involved in the pathogenesis of caries. ACP: Amorphous calcium phosphate.15. Dietary factors. and in the 1940s. because they are able to prolong food retention on tooth surfaces. Thus.17 In studies using molecular identification of bacteria. of all possible etiological organisms associated with dental caries. are associated with dental caries and that S. Vol. LED: Lightemitting diode. which is an important microbial virulence factor (discussed above).ada.2 researchers have recognized fermentable carbohydrates as the “fuel” for the caries process. Dental caries cannot occur in the absence of dietary fermentable carbohydrates and.28 Sucrose (table sugar) has a unique role as the sole substrate for glucosyltransferases (bacterial enzymes) involved in the synthesis of extracellular glucan. have the potential to be cariogenic.12 intracellular polysaccharide storage13 and extracellular glucan formation. dentists dealt mainly with the continuing sequelae of this widespread disease during the first half of the 20th century. it has been characterized as a “dietobacterial” disease.6 Throughout the 20th century. including some novel species.org September 2009 characterize this complex biofilm and subsequently identify microbial risk factors leading to caries activity.23 Since the original observations of Miller.ETIOLOGY OF DENTAL CARIES Microbial etiology.29 For example. Nd:YAG: Neodymium-doped yttrium aluminum garnet. ICDAS: International Caries Detection and Assessment Criteria. Together with research on plaque by William3 and Black. investigators have reported that diverse bacterial communities. OCT: Optical coherence tomography. Er:YAG: Erbium-doped yttrium aluminum garnet.31. it is only one of more than 500 species found in dental plaque.19 Recent evidence also has supported the role of yeast (Candida albicans) as a member of the mixed oral microbiota involved in caries causation. which promotes MS attachment14 and increases plaque’s pH-lowering ability. CAD-CAM: Computer-aided design/computer-aided manufacturing.22 A challenge for researchers is to 26S JADA. Newbrun and colleagues30 reported that people with hereditary fructose intolerance who are unable to eat fructose and sucrose but consume large quantities of starch have a much lower caries experience than do those without fructose intolerance. mutans is one of the most researched cariogenic microorganisms.7 but it was not until much later. which proposes that S. mutans is not detectable in 10 to 20 percent of people who have severe caries.21.

46 a practicing dentist. scientific interest in the cariogenicity of foods waned with recognition that the prevalence and severity of caries were declining.35 In the latter part of the 20th century. They reached a consensus that foods had “no cariogenic potential” if their human plaque pH profiles were statistically equivalent to that of sorbitol.ada. shortly after their first teeth erupt. in identifying patients who require caries-control measures.the cariogenicity of snack foods.36 Chronically low salivary flow rate is one of the strongest indicators of increased caries risk.39 The objective measurement of salivary flow is an important cornerstone of caries risk assessment and management.S. position and occlusion.48 the chief chemist at the Aluminum Company of America.44 It is useful in determining whether additional diagnostic procedures are required. associated “mottled enamel”47 with reduced susceptibility to caries.41 However. characterization of foods as having “low cariogenic potential” has not proven to be practical because of individual variability in eating frequency. tooth eruption time and sequence. It is well established that saliva plays an important role in the health of soft and hard tissues in the oral cavity.34 The conference participants considered several approaches for testing foods to determine their potential cariogenicity. PREVENTION OF CARIES Risk assessment.37 A subjective complaint of xerostomia often does not correlate with objective findings of reduced salivary flow rate. Caries risk assessment is the cornerstone of patient-centered caries management. They recommended an integrated approach that involved using combinations of methods to determine the cariogenicity of foods. Hostrelated factors are important contributors to a person’s dental caries susceptibility. researchers must determine efficient ways to identify children at high risk of developing caries earlier. researchers must develop molecular and genetic methods to improve the identification and characterization of cariogenic microbes and identify ways to reduce or eliminate harmful effects of their colonization. American contributions to fluoride’s role in caries prevention are seminal.V. timing of eating (such as eating before bedtime) and after-eating behaviors (oral hygiene. the information arises too late to be useful in preventing caries because many irreversible events already have taken place. H.38 This finding has led to clinical recommendations and guidelines for the clinical assessment of hyposalivation. government placed less emphasis on the need for labeling food regarding its cariogenicity.42. results of recent studies in populations of twins have shown that genetic factors may explain more than 50 percent of the variance in caries experience among people. Vol. Researchers initially believed that genetic factors—such as tooth morphology. he later traced this condition to fluoride. fluoride use. because this may prove to be the best strategy to identify patients in need of intensive caries prevention efforts. It also will be important to develop improved technology to detect and quantify early lesions and to assess carious lesion activity directly. and as a guide in treatment planning and scheduling recall appointments. and sweetness preference—were less important in determining caries risk than were environmental influences.45 While previous caries experience may be the most useful criterion for risk assessment. and the U. resistance or both. Churchill. such as microbial and dietary factors. in assessing the effectiveness of attempts to control caries.44 Investigators have shown that previous caries experience is the best predictor of future caries experience in primary teeth. It is the determination of the probability of a person’s developing new carious lesions during a specific period41 and of the probability of a change in the size or activity of existing lesions across time. Unfortunately. human plaque acidity and demineralization and remineralization. Trendley Dean. They began at the turn of the 20th century when Frederick McKay.40. sequence of eating foods. salivary composition. but the future holds interesting possibilities for improvements in caries diagnosis and prognosis.org September 2009 27S . followed by parental education and socioeconomic status.28 It also has been challenging to apply information about food cariogenicity in dietary counseling. gum chewing). including models involving animal caries. in collaboration with H.45 Fluoride. young children’s age at the time of MS colonization also was found to be an important risk factor. precipitated a series of ADA conferences in the late 1970s and early 1980s that culminated in a consensus conference in 1985. To enable effective prevention. To accomplish this goal.43 Much remains unknown about geneticenvironmental relationships in caries etiology and risk assessment. the first director of what then was called the National Institute of Dental Research (now the JADA. Host salivary and genetic factors. 140 http://jada.

Y. R. conducted research regarding the inclusion of fluoride in dentifrices.L. including the “hidden sugars” in many processed foods.75 A wide range of sugar substitutes have low or no cariogenic potential.80 Some food additives may have protective properties that reduce cariogenicity.81 and tea extracts inhibit salivary amylase activity.85 Sealants prevent food from collecting in molar pits and fissures and. Dental scientists in the United States have been key players in developing ways to manage and control caries. Bowen.76 For example. Michael Buonocore.94 Remineralization.National Institute of Dental and Craniofacial Research).73 Dairy products have properties that protect teeth against caries. However. obtained a patent for restorations with a tooth-colored plastic.54. This research led to the establishment of the first community water fluoridation program targeted at caries prevention. Parents and caregivers of young children can reduce children’s caries risk by limiting their consumption of sugar-containing soft drinks70. The Forsyth Institute.66-68 Diet. a physician and dentist who practiced dentistry at the Jefferson Hospital in Philadelphia. conducted several studies in the 1930s and 1940s with colleagues that provided the conclusive epidemiologic evidence linking what they referred to as “dental fluorosis” or “enamel fluorosis” to excessive fluoride in drinking water. cranberries can reduce bacterial adherence and glucosyltransferase activity of S. In 1955.. prevent dental caries.74 and eating cheese after exposure to sugar rapidly neutralizes plaque acidity. building on the work of scientists throughout the world. Seven years later. Indianapolis.55 Interestingly. Boston.62 American cariologists contributed to knowledge of the physicochemical aspects of fluoride-enamel interactions.53 During the 1940s and 1950s. is important for people at high risk of experiencing caries. the influence of fluoride on the demineralization and remineralization process. These two developments initiated a rich era of adhesive dentistry involving sealants and restorative materials that improved caries prevention and tooth conservation. reducing the amount and frequency of sugar consumption.86-89 The placement of sealants over carious lesions arrests the disease process88-92 and is cost-effective compared with routine restorative care.77 and xylitol has been reported to have anticariogenic properties.84 a scientist at the ADA Research Unit at the National Bureau of Standards (now the ADA Foundation’s Paffenbarger Research Center). observed that demineralized enamel could be “rehardened” to the point at which “the enamel could no longer be scratched by a lancet. refined sugars and sugar substitutes.83 a researcher at the Eastman Dental Center in Rochester. for instance.ada.63-65 and the pharmacokinetics of fluoride in the oral environment.82 Sealants. The results of animal experiments and clinical trials supported topical fluoride application and the safe and effective use of fluoride. The results of clinical trials of dietary fluoride supplements resulted in recommendations by the ADA for fluoride supplementation for people who did not have access to fluoridated water.72.”95 Decades later. investigated the synthesis of fluoride compounds and their potential use in toothpaste for preventing caries.58-61 American scientists contributed to the paradigm shift in which fluoride’s predominant effect became viewed as mostly posteruptive and topical. N.69 The effectiveness of dietary measures to control caries is limited 28S JADA. and the University of Rochester. one of the earliest studies by Bibby56 involving a dentifrice formulated with sodium fluoride did not prove successful..93. researchers .org September 2009 because modern diets are complex and contain many natural sugars. and their findings served as the basis for determining the optimal level of water fluoridation for preventing caries and minimizing dental fluorosis. bisphenol-A glycidyl methacrylate (bis-GMA).Y. a program that began in January 1945 in Grand Rapids. Vol.78 Chewing sugar-containing gum increases caries risk. Use of fluoride has reduced the need for strict dietary control of sugar. N.79 but chewing sugarfree gum after meals can reduce caries risk. Joseph Head. 140 http://jada. described etching enamel to improve retention of restorative materials. Epidemiologic evidence demonstrated that water fluoridation decreased caries prevalence in both children and adults. particularly in children. mutans. Scientists from Indiana University. American researchers. sucralose is a high-intensity noncariogenic sweetener. Rochester. Mich. because the presence of calcium in the abrasive interfered with the action of the fluoride ion.49-51 In these studies. therefore. Dean and colleagues52 also found that dental fluorosis was associated with lower caries experience.57 The results of subsequent clinical trials with improved formulations provided conclusive evidence of fluoride’s caries-preventive benefits when applied topically.71 and increasing their consumption of milk and other dairy products.

which was developed for dental use by Ming Tung. Studies have yet to show conclusive evidence of effectiveness in clinical trials108. Numerous other researchers throughout the world also have contributed to our current understanding of remineralization.101 Nevertheless.121 a New York physician. a member of the faculty at the Indiana University School of Dentistry. and most remineralization occurs at the surface. Raper.C. Black.124 More recent developments include higher-speed film and digital radiography.105 The reversal of incipient carious lesions led to a paradigm change for caries management. Howard R. and Indiana University.116 ICDAS was designed to facilitate the standardized diagnosis of caries on all tooth surfaces at all stages of severity. Indianapolis.71. remineralization is not possible. but not noncavitated lesions. he perfected the intraoral bitewing radiograph. This leaves a sealed surface102 that is more resistant to subsequent demineralization than is sound enamel. as well as satisfactory sensitivity and specificity.123 and in 1925.104.”109 One of the most important early contributions to diagnosis of dental caries came from G. none has been shown to be more effective than fluoride. attempts to remineralize subsurface areas of the lesion have continued.116. who was a practicing dentist before becoming dean of the Northwestern University School of Dentistry in Chicago.org September 2009 29S . Partially demineralized enamel and dentin apatite crystals can be remineralized to almost their original size under optimal laboratory conditions.96-98 These observations were corroborated by Koulourides and colleagues at the University of Alabama. Vol. Because it favored reliability and comparability. a researcher at the ADA Foundation’s Paffenbarger Research Center.99-101 who demonstrated in situ that saliva rehardens incipient enamel lesions and small amounts of fluoride accelerate the process greatly. that still are in use 100 years later. methods of visual and tactile detection of dental caries as part of an oral examination. including the cleaning and drying of teeth and the use of explorers.114 Since the days of Black.V. They relied heavily on an explorer “catch” for detection of caries on occlusal surfaces and recorded cavitated lesions.118-120 Radiographic methods. but not necessarily exceed. in a book entitled “Skinner: A Treatise of Human Teeth. once the mineral phase is lost completely.107 Commercial products that contain ACP and preparations of casein derivatives (casein phosphopeptide-ACP complex) are commercially available. 140 http://jada. our diagnostic understandings have been far more advanced than simply diagnosing caries at the level of cavitation. which to this day remains the conventional method for detecting proximal caries. the development of which involved a joint effort of international cariologists with significant contributions from the United States. Ann Arbor. An updated version of ICDAS (ICDAS II)117 has been well accepted in the United States and has been used in clinical studies with good intraexaminer and interexaminer agreement.110 Black110 was among the first to describe. Much of this research is focused on calcium-containing preparations such as amorphous calcium phosphate (ACP). was one of the first to report (during a meeting of the New York Odontological Society) that x-rays could have dental applications. that of images obtained by JADA.110 Black’s diagnostic methods laid the groundwork for future criteria for the detection of dental caries. in explicit detail. reported on the role of radiographs in dentistry. Roentgen’s discovery of the x-ray. However.102. Soon afterward. resulting in a highly caries-resistant enamel surface. generating great interest in developing new and better remineralizing therapies. Visual detection of caries was described as early as 1801.122 a dentist practicing in New Orleans.111-113 Radike111 described detailed criteria for the visual and tactile detection of dental caries that until recently were used widely in epidemiologic and clinical research.106 and data suggest that some of these preperations have remineralizing properties. particularly from the University of Michigan. William J. it was the predominant diagnostic system used in the United States.115 The latest contribution to visual diagnostic criteria for caries are the International Caries Detection and Assessment Criteria (ICDAS). Morton. Less than six months after W. Current digital imaging technologies generate images whose diagnostic yield may equal. DIAGNOSIS OF CARIES Clinical methods.103 The process is diffusion-controlled. Edmund Kells. Black described the use of separators to directly visualize areas of concern and the use of ligatures (dental floss) passed through the contact point to detect surface roughness and breakdown.ada.conducting clinical studies in Europe demonstrated that incipient caries could be repaired by saliva when fluoride application was combined with regular removal of overlying plaque. C. further advanced dental radiography by writing the first book on the topic. For detection of proximal caries.

York. Irvington. Technology-based dental caries detection methods first arose in the United States more than 40 years ago. N.137 Polarization-sensitive OCT is a variation of conventional OCT that uses polarized incident light to create images and quantify caries. high-copper dental amalgam. In 1968. Vol. now Dentsply Austenal.139. patenting of radiopacifiers for composites 1984-2005 Development and commercialization of flowable.org September 2009 evaluated in clinical studies.) screw implant 1955-1962 Development of titanium casting for single-unit and multiple-unit restorations. commercialization of bis-GMA–based sealants. Pa. silicate cement 1895-1935 First experiments with copper-containing amalgam and formulation of low-copper amalgam alloys 1962-1995 Development of high-copper and zinc-free.129 and fiber-optic transillumination (FOTI)130 in caries detection had their roots in the United States.125 Other technology-based detection methods.ada.~1985 Development of plastic extracoronal laminate veneers and subsequent intracoronal porcelain veneers Adhesive Systems Glass Ionomers Varnishes.Y. Electro-Optical Sciences. Amsterdam) method in Europe.131 was tested in the laboratory132. zinc phosphate restorative material and cement. cohesive gold foil. enamel and dentin bonding systems 1972-1985 Introduction of glass ionomer restorative materials and glass ionomer admixture with amalgam alloy 1985 Introduction of glass ionomer materials for use with atraumatic restorative technique 1992 Introduction of resin-modified glass ionomers 1860-1870 Introduction of use of zinc oxide eugenol as a cement 1920-1929 Development of first strict formulation of zinc phosphate cement. and in 1970. fluoride-releasing dental amalgam. commercial cavity varnish and calcium hydroxide pulpcapping material ~1969 Development of first hard-set calcium hydroxide composition 1903-1907 Introduction of porcelain jacket crown. A digital version of the latter system (digital imaging [DIFOTI]. Liners and Bases Indirect Restorative Materials for Single Units using conventional film. but uses light waves rather than sound waves—has been used in dentistry for nearly a decade. they and Lobene127 published early research regarding its use for caries detection. Lees and Barber126 first suggested the application of ultrasound in dentistry.136.* DATE EVENT. ACCORDING TO MATERIAL/TECHNOLOGY Early Restorative Materials 1842-1908 Introduction of various restorative materials: gutta-percha. lost-wax casting process 1937 Placement of the first Vitallium (Austenal Laboratories. which has been studied extensively by investigators at .TABLE Key events in the United States involving restorative materials and technologies for managing single-tooth problems caused by caries.). Inspektor Research Systems BV. 140 http://jada. patenting of commercial porcelainbonded-to-metal system 1968 Introduction of the first blade-vent implants ~1974.138 Fluorescence has received considerable attention because teeth fluoresce under the excitation of ultraviolet rays.135 Optical coherence tomography (OCT)—which is similar in operation to ultrasound imaging. mercury-free silver filling material Dental Amalgam Resin-Based Sealing and Restorative Materials 1947-1960 Introduction of polymethyl-methacrylate–based direct restorative materials 1962 Patenting of bisphenol-A glycidyl methacrylate (bis-GMA)–based dental composites 1968-1977 Introduction of commercial dental composites.133 and later 30S JADA.140 This idea later led to the development of the quantitative light-induced fluorescence (QLF. The early applications of electrical conductance128.134. packable nano and trimodal composites for dental use 1955-1983 Development and commercialization of acid-etching.

org September 2009 31S . Vol. corporate.000 rpm).000 rpm) high-speed handpieces 1973-1977 Commercial development of ultraviolet-light– and visible-light–curing units 1980-1995 Development of carbon dioxide (CO2). hybrid composites and glass ionomers.147 and as an oral health screening tool in public schools.S. association-based and governmental dental research entities and scientists.149 Bayne and Thompson. Germany) for caries detection. CONCLUSIONS Dental caries is a dynamic dietomicrobial disease involving cycles of demineralization and remineralization. We acknowledge the progress they have enabled dentistry to achieve in fighting oral disease. dental burs.149-157 Whereas this table focuses on accomplishments in this country. The table summarizes key historical events in the United States involving restorative dental materials.000 rpm) 1955-1957 Development of water-turbine (50.157 Indiana University. European researchers introduced an infrared laser fluorescence device (DIAGNOdent.Cr:YSGG) hydrokinetic lasers for dentistry 1993-1995 Introduction of air-abrasion cutting equipment for dental use ~1995-2000 Development and introduction of high-torque electric dental handpiece 1989 Introduction of second generation of computer-aided design/computer-aided manufacturing (CAD/CAM) equipment ~1998 Introduction of commercial light-emitting diode (LED) light-curing units * Sources: Buonocore. neodymium-doped yttrium aluminum garnet (Nd:YAG). 140 http://jada. diamond cutting instruments and special finishing instruments. silicate cements. All of these technical developments in materials and treatment to restore carious lesions have involved a strong partnership of academic. equipment and techniques related to the treatment of dental caries in single teeth.150 Bower and Marjenhoff. erbium-doped yttrium aluminum garnet (Er:YAG) and erbium-chromium–doped yttrium scandium aluminum garnet (Er. foot-treadle dental engine (700 revolutions per minute [rpm]). electric dental engine (1.153 Rueggeberg. This approach manages JADA.141-144 QLF is a promising and nondestructive method of detecting and quantifying carious lesions. Researchers have evaluated this device in research settings146. The effects of prevention on caries prevalence and the advantages of improved dental materials have shifted the focus in caries management from surgical methods and restoring tooth structure to development and use of dental materials to prevent disease. minimally invasive treatments for difficult-to-access regions and materials with which early lesions can be impregnated to prevent further progression. Biberach. U. high-speed dental engine (>10.000 rpm).83 American Dental Association.148 TREATMENT OF CARIES Restorative materials. The early stages of this process are reversible by modifying or eliminating etiologic factors (such as plaque biofilm and diet) and increasing protective factors (such as fluoride exposure and salivary flow). Throughout the long history of restorative dentistry. for example) and Europe (who developed dental amalgam. steel dental burs 1937 Introduction of automated amalgamation equipment 1942 Introduction of diamond cutting instruments. Continuing dental caries disease usually results in tooth loss.ada. Contributions related to restoration for tooth replacement are not included here.152 Mahler. It is based primarily on fluorescence absorption by bacterial by-products in porous carious lesions.TABLE (CONTINUED) Cavity Preparation and Restoration Equipment 1864-1891 Development of rubber dam. It allows for longitudinal clinical monitoring of carious lesions and potentially can determine carious lesion activity. dental companies have developed many specialized hand instruments.000 rpm) and tungsten carbide burs 1953 Development of ball-bearing high-speed handpiece (25.145 In the late 1990s. microfill composites.151 Gelbier. KaVo Dental.83. remineralization procedures.154 Schulein. among others) also have made many significant contributions.155 Thompson and colleagues156 and Wilwerding. belt-driven (150.000 rpm) and air-turbine (300. we should note that scientists in Japan (who developed dentin bonding systems and glass ionomers.

Shepard Printers. 27. 31.” J Dent Res 1987. The salivary secretions in health and disease. 1. and enamel fluorosis—United States. Vol. Oral Sci Rev 1976(8):25-47. nutrition.5:141-147.149(Pt 2):279-294. San Antonio. Gustafsson BE. Hay DI. Bibby BG. Arch Oral Biol 1993. Quensel CE. Our understanding of caries has changed markedly in the last century. edentulism. Br J Exp Pathol 1924. JADA 1960. Caries-risk assessment.101(4):619-626. 1988-1994 and 1999-2002. Zero DT. Systematized Prevention of Oral Disease: Theory and Practice. Leys EJ. Acta Odontol Scand 1954. J Dent Res 1986. Chicago: Henry O. Fitzgerald RJ. Miller W. Stephan R.6(4):319-342. 7. In: Granath L. The presence of bacterial plaques on the surface of teeth and their significance. Cohen L. Messer LB. Int Dent J 1999. A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to Streptococcus mutans and the specific-plaque hypothesis. 68(3):451-459. 33. Crit Rev Oral Biol Med 1995. 15. “The best of times and the worst of times. 21. Bacterial diversity in human subgingival plaque. Oppenheim FG. Tehrani A. Black’s conclusions reviewed again. Hoover C. Fox PC. JADA 1980. ■ Disclosure. 16. 19. J Dent Res 1989. et al. Socransky SS.33(2): 147-174. Loesche WJ. Dardis SR. Mandel ID. Molecular analysis of bacterial species associated with childhood caries.dental caries by means of prevention and cure. Caries Res 1988. On the bacterial factor in the aetiology of dental caries. Birkhed D. noncavitated) stages. 2. 20. Burt BA. et al. Goulet D. Dental caries: dietary and microbiology factors. JADA 1987. 36. Physical and chemical aspects of saliva as indicators of risk for dental caries in humans. 22. William LJ. Black GV. Lussi A. Increased pH-lowering ability of Streptococcus mutans cell masses associated with extracellular glucanrich matrix material and the mechanisms involved. Van Houte J. et al. Food starches and dental caries. Dent Clin North Am 1999. Texas. Bacteria of dental caries in primary and permanent teeth in children and young adults. Surveillance for dental caries. J Clin Microbiol 2002. Van Houte J. 10. Black GV. reserving surgical approaches for those whose disease severity and tissue loss leave no other option. Harris EL. Dr. Crit Rev Oral Biol Med 2000. 37. Brudevold F. Future caries management must include risk assessment to enable clinicians to provide timely and cost-effective care to those most in need. Dent Cosmos 1898. 35. J Dent Res 1986. Executive summary. Conry JP. Subjective reports of xerostomia and objective measures of salivary gland performance. Gibbons RJ. Russo J. Almekinder KJ.49(1):15-26. Stephan R. Infect Immun 1986.ada. Orland F.13(2):108-125. prevention.43(4): 635-664. Use of the germfree animal technic in the study of experimental dental caries.66(7):1210-1212. Becker MR. Gibbons RJ. eds. Paster BJ. 1899:71. Zero DT.183(12):3770-3783. diagnosis and treatment of dental caries since the founding of the ADA 150 years ago. MMWR Surveill Summ 2005. Boraas JC. de Soet JJ. Zero DT. dentists tend to err on the side of more aggressive operative treatment than often might be warranted. Baum BJ. Barker LK.46(4):1407-1417. 42. How can oral health care providers determine if patients have dry mouth? JADA 2003. . Between-meal eating habits and dental caries experience in preschool children. JADA 1940. Trithart AH. We have made much progress in our knowledge of the biology. 13. Kuhlisch E. Navazesh M. J Dent Res 1986. Lingstrom P. American Dental Association Council on Scientific Affairs and Division of Science. 39. dental sealants. prevention and management of caries in its early (that is. 38. dental practitioners and researchers alike have an incomplete understanding of the natural history of caries. Bacterial specificity in the etiology of dental caries. Boca Raton. 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Biofilms that cause gingivitis and periodontitis are complex polymicrobial communities that are resistant to antimicrobial agents and host defense mechanisms. As a result. DDS. September 2009 . University of Washington. Seattle. 94143-0650. Results of laboratory studies of factors that enhance prevention and treatment of periodontal disease have made the transition to clinical practice. Address reprint requests to Dr. diagnosis and treatment of periodontal diseases Scientific advances in the United States Gary C. School of Dentistry. This overview focuses on the discovery of relationships between dental plaque and the host periodontal tissues.ada. these efforts have fundamentally changed our understanding of periodontal infections and constitute a revolution in how clinicians treat patients with periodontal disease. Earl Robinson Distinguished Professor. endocrine disturbances.org ABSTRACT Background. Data from randomized controlled clinical trials have shown that most conventional forms of periodontal therapy are effective as long as patients comply with posttreatment maintenance programs. They highlight some of the pioneers in the United States who shaped new approaches to prevention and treatment of periodontal disease. JADA 2009. MS. Armitage. Results. occlusal trauma. circulatory problems. These advances include the demonstration that gingivitis and periodontitis are biofilm-induced infections caused by components of the indigenous oral microbiota.ucsf. Md. many theories existed regarding the underlying causes of gingivitis and periodontitis. Scientific advances. Armitage is the R. Paul B. Conclusions. nutritional deficiencies. San Francisco. and strong support from the National Institutes of Health. substantial public and private-sector research activity. Key Words. 140 http://jada. and that host inflammatory-immunologic responses to these microbial challenges are responsible for most of the observed tissue damage. Types of Studies Reviewed. and it highlights only a fraction of the pioneers who shaped new approaches to periodontal disease prevention and treatment. diagnosis and treatment of periodontal diseases during the past 150 years have been characterized by scientific partnerships among a dedicated practicing profession. Robertson is a professor and dean emeritus.140(9 suppl):36S-43S. Division of Periodontology. Vol. Box 0650. San Francisco. gout. Among the proposed causes were physiological degeneration of periodontal tissues secondary to aging. MS he contributions of researchers in the United States to scientific advances in the biological understanding. human genetics and stem cell biology have set the stage for significant discoveries that will pave the way for the development of procedures needed for the predictable regeneration of periodontal tissues. Dr. Major scientific advances in periodontology in the past 150 years have fundamentally changed how clinicians detect and treat periodontal diseases. Armitage. new generations of people in the United States can expect to retain a healthy and functional dentition for a lifetime. University of California. prevention. DDS. Bethesda. An increased understanding of natural inflammation-resolving mechanisms suggests that control of inflammation is at least as important as is antimicrobial therapy in the treatment of periodontal infections. School of Dentistry. Department of Orofacial Sciences. Many mechanisms involved in the repair and regeneration of periodontal tissues have been identified. Robertson. periodontology. extensive international collaboration. T ETIOLOGY AND PATHOGENESIS OF PERIODONTAL INFECTIONS Throughout the 19th century and first half of the 20th century. Advances in the fields of molecular biology. e-mail “Armitageg@dentistry. dystrophic anomalies in tooth development. the authors focus on the discovery of the relationships between dental plaque and the host periodontal tissues. dental history. In this brief overview.edu”. prevention. Dr.The biology. and mechanical irritation arising from local factors 36S JADA. Calif. C-628. Taken collectively.. 521 Parnassus Ave.

Blacksburg. such as MacDonald.C. favored the nonspecific plaque hypothesis in which increased numbers of indigenous bacteria (that is. several are historically significant. the concept that bacteria were the principal cause of gingivitis and periodontitis in susceptible people did not become mainstream thought until 75 years later. Michael G. qualitative changes occurred in the composition of the dental plaque microbiota. OPG: Osteoprotegerin. According to Fine. MacDonald of the pathogenic potential and virulence of the aerobic and anaerobic components of the indigenous oral microbiota supported the concept that gingivitis and periodontitis are infections. Va.10 A historical review11 of evidence supporting the bacterial etiology of periodontal diseases includes many scientists who contributed to these major advances in periodontal microbiology. During the development of gingivitis and subsequent return to health. Sigmund S. RANK: Receptor activator of nuclear factor kappa B. localized aggressive periodontitis) harbored a disease-specific subgingival microbiota. Moore12 at the Virginia Polytechnic Institute. In addition. the composition of the microbial community is of considerable etiologic importance. Moreover.10 In the 1990s. rather.4. Newman and colleagues9 reported that patients with “periodontosis” (that is. Socransky.ada. and Lillian V.6 In Sweden. After experimental proof of the germ theory of disease was provided in 1876. In 1964. favored the specific plaque hypothesis in which a small number of specific bacteria are responsible for triggering the tissue damage observed in inflammatory periodontal diseases.5 These studies showed that gingivitis developed in all volunteers who refrained from oral hygiene procedures for a three-week period and that reinstitution of daily dental plaque removal resulted in a return to gingival health. Haffajee and Anne C. control animals that underwent daily plaque removal via investigatorapplied oral hygiene procedures during the same period did not develop gingivitis or periodontitis. Keyes and Harold V. Boston. these studies concluded that periodontal infections are not caused simply by an increased quantity of dental plaque on the teeth. in 1967 Stanley R. some investigators.org September 2009 37S . The classical experimental gingivitis studies conducted by Harald Löe and colleagues in the mid-1960s resulted in a major shift in how scientists and clinicians viewed the etiology of periodontal diseases. Tanner at the Forsyth Institute.2 Most of these theories were supported by little or no scientific evidence. believed that bacteria played an important etiologic role in periodontal diseases. Lexington. Socransky and colleagues14 used cultivation methods and DNA probe technology to show statistically significant associations between clusters of indigenous bacteria in the subgingival microbiota and the presence and progression of ABBREVIATION KEY. These investigators demonstrated that tooth cleaning every other day for 18 months was associated with clinically healthy periodontal tissues. JADA. including Rosebury. Miller. quadrants of teeth in the same dogs that were not cleaned developed gingival inflammation and attachment loss. Jordan8 of the National Institute of Dental Research showed that periodontitis could be transmitted from periodontitis-affected Syrian hamsters to healthy animals by inoculating the healthy animals with Actinomyces viscosus from the diseased animals. this finding challenged the prevailing assumption that periodontosis was a degenerative disease and suggested strongly that the disease was an infection.7 Among many critically important studies of the microbiology of periodontal diseases. One decade later. Advances in microbiology of periodontal diseases. Jan Lindhe and colleagues7 confirmed these findings by showing that experimental gingivitis in most beagle dogs progressed to periodontitis across a four-year period if dental plaque was not removed on a daily basis. Ellison and John B.1. GTR: Guided tissue regeneration. an increased plaque biomass) overwhelm host defenses and result in periodontal disease. Loesche13 summarized this concept in a discussion of nonspecific versus specific hypotheses regarding the microbial etiology of periodontal infections. Saxe and colleagues6 at the University of Kentucky. RANKL: RANK ligand. reported a strong association between dental plaque accumulation and the development of periodontal disease in beagle dogs.10 the results of studies conducted by Theodor Rosebury and his students Solon A. Some authorities.such as calcified deposits. The advent of improved laboratory methods for culturing anaerobic bacteria revealed that some bacteria in plaque are more important than others as causative agents of periodontal infections. Anne D. 140 http://jada. including Willoughby D. Gibbons. Vol.3 However. Paul H.R. Other investigators. Walter J. (Holdeman) Moore and William E. notably Ronald J. RCTs: Randomized clinical trials. however.

that untreated gingivitis progresses to periodonTreponema denticola. Thomas Temple. Roy Page. Aggregatibacter (formerly that most of the destruction of periodontal tissues Actinobacillus) actinomycetemcomitans and Preduring the course of the disease was due to inflamvotella intermedia are important members of the matory or degenerative/atrophic processes. the clinical and histologic levels.highly likely that the other. Vol.16 that dental plaques destructive inflammatory responses by the host. Ronald Gibbons. Roy C. When the results of microbiological studies Of equal scientific importance was the demonshowed clearly that gingivitis and periodontitis are stration by several groups. circa 1975). From a addition. 140 http://jada. It is likely that this work will lead to a better understanding of how oral biofilms form. genic than others. Streptococcus intermedius. the late 1960s..25 the oral microbiota can be grown in the laboratory In 1976. Warrenton. John Goggins. yet-to-becultivated 50 percent contains microorganisms that are of etiologic importance or play important roles in biofilm ecology. investigators began to unravel the comJohn W. Anthony Rizzo. Campylobacter rectus. Kneeling (left to right): Ernest Newbrun. Tannerella forsythia. these biofilms are complex ducted by Max A. It is documented a dynamic series of inflammatory 38S JADA. It became clear that bacteria such as dominated by the premise that all people are equally susceptible to developing periodontitis and Porphyromonas gingivalis. plex mechanisms of how bacteria could trigger Kolenbrander and colleagues. researchers believed Eubacterium nodatum. James English. dthe amount of dental plaque is of etiologic the results of morphological studies alone were importance.23 Until consortium of microorganisms that cause periodontitis. The early history of periodontal pathogenesis was periodontitis. mature and interact with the host to cause disease. Listgarten24 clarified the relapolymicrobial communities that are resistant to tionship of junctional epithelium to the tooth. He externally applied antimicrobial agents and also made major contributions to understanding antibacterial host mechanisms. medical pathology models. mechanisms of biofilm-host Walter Loesche. A consistent observation was that the dthe causative agents are part of the indigenous affected tissues were chronically inflamed at both (normal) microbiota. Page and Hubert E. Bernard Advances in pathogenesis of Guggenheim. In are highly organized bacterial biofilms. William Bowen. Va. innovative ultrastructural studies contherapeutic perspective.19-22 What has emerged from this work is the extraordinary diversity of oral microbiota in health and disease. periodontal diseases. titis linearly over time. Novel treatment approaches and intervention strategies will result Researchers at a National Institute of Dental Research conference on dental plaque from discoveries dealing with the (Airlie Center.ada. Costerton and colleagues15 and Paul E. Photograph courtesy of Richard Ellen. interactions. sues. unable to explain the mechanisms responsible for dsome bacteria in dental plaque are more pathothe tissue destruction at inflamed sites. Robert Fitzgerald. Unfortunately. On the basis of general Micromonas micros. Sigmund Socransky. Many investigators are applying gene-detection methods to determine the presence of uncultivable components of dental biofilms. Harald Löe. researchers based their studies priThe major microbiological conclusions estabmarily on observations and individual interpretalished during this period include the following: tions of the histologic changes in the diseased tisdperiodontal infections are polymicrobial.17 interactions between microbiota and periodontal It is now known that only about 50 percent of tissues in health and disease. including those led by infections. Thomas Valega. Standing (left to right): Paul Keyes. William McHugh. Robert Genco. unknown. Schroeder26 18 by using modern cultivation techniques. Max Listgarten.org September 2009 . Reproduced with permission of Marcia Gibbons. Jan Carlsson.

40 The presence of such associations may reflect risk factors common to periodontitis and other chronic inflammatory diseases.32.35. demonstrating that only a subset of the population developed severe periodontitis.33 Also. with tooth extraction being the ultimate management strategy. ingestion of patent remedies. many clinicians observed that the frequent removal of acquired deposits from teeth resulted in a noticeable improvement in overall periodontal health.1. location and composition of the biofilm. local application of caustic chemicals. results of practice-based studies challenged the prevailing concept that all patients are equally susceptible to periodontal infections. and the regularity of oral care.34 The results of epidemiologic studies indicate that smoking is an especially important risk factor. it could assume a number of clinical presentations depending on the nature and radius of effect of the infecting bacteria. However.38 Future models of the pathogenesis of inflammatory periodontal disease will incorporate genomic. Moreover. periodontal anatomy. such as persistent exposure to microbial challenges. evidence indicates that periodontal infections may interfere with the metabolic control of diabetes mellitus. occlusal adjustment. This observation led influential clinicians such as John W. Long before investigators recognized that gingivitis and periodontitis are infections caused by indigenous oral microbiota.V. the frequency and duration of epithelial ulceration.28 The results of longitudinal epidemiologic studies confirmed these observations. investigators have reexamined the possibility that untreated periodontal infections can have an adverse effect on general health and that other diseases can contribute to periodontal pathogenesis. are known to produce strong epigenetic changes in affected tissues.39 Potential effect of periodontitis on general health. genetic predisposition and expression of the host inflammatory response. it became clear that the progression of periodontitis was neither linear nor an automatic consequence of gingivitis. PREVENTION AND TREATMENT OF PERIODONTAL DISEASES Dental calculus. appears to be triggered by a cascade of host-response events involving the receptor activator of nuclear factor kappa B [RANK]). removal of local irritants and surgical resection of affected tissues. Chronic periodontal inflammation may induce increases in the RANKL-OPG ratio. Black44 to conclude in the 1880s that dental calculus was a major local irritant that caused periodontal inflammation.37 An increased understanding of the inflammatory response and the natural mechanisms of its resolution suggests that control of inflammation is at least as important as is antimicrobial therapy in the treatment of periodontal infections. At the beginning of the 20th century. 140 http://jada. because some did not respond well to conventional treatment.27. there were JADA. Critical variables also included the size.30 In the late 1990s. Vol. the results of observational and interventional studies vary and the relationship between periodontal disease and general health remains unclear. chronic inflammation. After decades of work by many researchers. treatment included a range of therapies including dietary changes. the RANK ligand (RANKL) and osteoprotegerin (OPG). emerging evidence suggested that the intensity of inflammation and susceptibility to periodontal damage after a microbial challenge were mediated by the host response.29.events in the development of periodontal lesions. which stimulates osteoclast maturation from precursor cells.36 Furthermore. In addition. In some situations.34 A number of risk factors associated with periodontitis.ada. gingival massage. smoking and diabetes. no universal consensus existed with regard to this issue. most of the tissue damage found in patients with periodontitis appeared to result from host responses to bacterial challenges rather than from direct lytic effects of the pathogenic microbiota. Riggs43 and G. nonhemorrhagic strokes and adverse birth outcomes. proteomic and metabolomic data into dynamic biological networks that include mechanisms of disease initiation and resolution. During the past two decades. dentists and patients considered periodontal disease to be untreatable.31 Observational studies of twins have shown that a significant portion of the population variance in periodontal disease prevalence can be attributed to genetic factors.org September 2009 39S .2 As a result of the confusion regarding the etiology of periodontitis. Indeed. osteoclast-mediated bone loss. Although this is a highly important area of ongoing investigation. a hallmark of periodontitis. including genetic polymorphisms. The results of these studies40-42 suggest that untreated periodontitis may be a risk factor for myocardial infarction. the everyday habits of the host. rather. it appears likely that genetic changes caused by environmental insults affect the clinical phenotype observed in patients with periodontal infections.

profession.49 Goldman claimed tion. hypothesis that healing patterns of the periodontal One approach.48 tivity. treatment of last resort and Proponents of the second should be used only in the most approach held that the disease advanced cases in which subginwas caused by local irritation gival access for scaling and root from dental calculus. Ramfjord. Many clinicians master’s degree in periodontics still advocated surgical pocket and a Doctor of Philosophy reduction to create a gingival architecture that degree in pathology and then joined the faculty.60 would facilitate oral hygiene and periodontal mainTaken collectively.47 Irving in resolving periodontal infection and inflammaGlickman48 and Saul Schluger. esthetics). Sigurd P.62 It now method for eliminating periodontal pockets that seems clear that the choice of nonsurgical or surconsisted of the initial resection of the diseased gical treatment depends on anticipated patientperiodontal pocket wall and subsequent removal of centered outcomes (such as discomfort.61. Glickman stated that scaling and root planing was Investigators throughout the world have replinot required before surgery and described a cated these results in many studies. Rampatients with periodontitis was fjord.45 nonsurgical approach to treatment of periodontitis These practitioners thought that the bone was included Russell W. They believed that as well as by mechanical irritasurgical intervention was a tion from dental calculus. the concept that perioMichigan in 1946 to study under dontal diseases are plaqueBunting. and they resulted in sustained repair of periothat gingivoplasty would create “physiologic” gindontal tissues when combined with an appropriate gival contours that were “self-cleansing. who was then dean of induced infections was bethe School of Dentistry. RamDr. cacy of periodontal treatment By the middle of the 20th are now known as The Michigan century. they therapy did not exist until publiopposed the gingival resection cation of a series of studies by a approach in favor of the nonsurteam of investigators from the School of Dentistry.org September 2009 .49 the use of surgical resection of periodontal pockets Nonsurgical intervention. Practitioners in this Scientific data supporting group included Riggs43 and either approach to periodontal William J.45 caused chronic osteitis. without surgical intervention. Bell.two major approaches to treatment of periodontitis. Vol.51 necrotic or affected by a carious process that Arthur H. a Norwegian dentist who neither necrotic nor carious. 140 http://jada. vided the first data showing that nonsurgical and Surgical intervention. involved with which they are in contact. Goldman.23 In came to the University of addition.”47 posttreatment maintenance program.53 These 44.54-58 The multidisciplinary studies confirmed that the alveolar bone of team was led by Sigurd P. the results of many Longitudinal Studies. advocated by many influential pracsoft tissues are determined by the hard tissues titioners in the United States and Europe. Advocates of the followed by curettage of the underlying bone.ada. Reprinted with permission coming widely accepted by the fjord (see photograph59) earned a from the American Academy of Periodontology 59 23 from Ramfjord. These deposits followed by a rigorous critical investigations of the effiprogram of oral hygiene.50 Isador Hirschfeld. these clinical investigations protenance procedures. Bunting. Younger46. and the planing was impossible without underlying bone was not surgical entry. Advocates of this clinicians promoted the concept that most patients approach considered the soft tissues of the pocket with periodontitis could be treated satisfactorily wall to be irreversibly damaged by pus at the site.44. affected.62 The Michigan 40S JADA. Advocates of surgical surgical forms of periodontal therapy were effective intervention included Henry M. such as a reduction in probing depths during periodontal surgery on the basis of the and gains in clinical attachment. Merritt52 and Dickson G. Ann Arbor. University gical removal of acquired of Michigan. root sensicalculus and smoothing of the tooth surface. as well as on traditional clinical Schluger promoted the use of osseous resection outcomes.

64 Pitcher and colleagues65 reported that vigorous swishing with mouthrinses did not impel the antiseptics into subgingival infected sites. The results of histologic studies showed partial regeneration of lost periodontal tissues. has been less effective. Prichard69 in which treatment resulted in dramatic osseous repair. Under such conditions. bone and a functional periodontal ligament.71 Subsequent investigations reviewed in a meta-analysis72 of the clinical effectiveness of GTR procedures suggest that these procedures can promote gains in clinical attachment levels and reductions in probing depths. the limited adjunctive effects of antimicrobial agents in treating these infections are enhanced somewhat by placing slow-releasing vehicle preparations directly into the periodontal pocket. had beneficial adjunctive effects. allergic reactions. believed that once periodontal tissues were detached from the teeth as a result of periodontitis. including Black.ada.66 Systemically administered antibiotics gain access to infected periodontal sites via the circulatory system. in which infecting bacteria are sequestered in biofilms within deep periodontal pockets. Miller3 was among the first to suggest that antiseptics applied topically or via mouthrinsing might be useful in the treatment of periodontal diseases. especially of narrow three-walled defects.63 However. This procedure temporarily excluded the gingival epithelium and connective tissue from the osseous defect and allowed pluripotent cells from the periodontal ligament to colonize the wound. The clinician’s decision to administer antibiotics is complicated by the possible development of microbial resistance to the drug. as well as difficulties in delivering the drugs to subgingival sites. Vol.74 Growth factors are naturally occurring mediators produced by a variety of cells that affect the complex cascade of events during wound JADA.73.org September 2009 41S . As the field of periodontics matured from 1970 to 2000. Adjunctive use of antimicrobials. In a systematic review and metaanalysis of these studies. The results of many clinical trials indicated that irrigating or rinsing with antimicrobial agents as stand-alone treatments for periodontitis was insufficient to eliminate or control periodontal infections because of the inherent antimicrobial resistance of biofilms. Sture Nyman and colleagues71 placed a barrier membrane between the periodontal flap and a tooth scheduled for extraction in a patient with severe periodontitis. investigators in many controlled studies evaluated the effects of periodontal flap procedures alone compared with flap procedures combined with the insertion of various bone-replacement graft materials.”68 Although this view was not held universally. it was the prevailing opinion until clinicians began publishing practice-based series of cases in which therapy resulted in the clinical closure of periodontal pockets with radiographic evidence of osseous repair. 140 http://jada. Future basic research regarding the mechanisms of the initiation and maturation of dental plaque likely will lead to novel therapeutic ways to interfere with and disrupt these disease-producing biofilms. The results of well-conducted clinical trials demonstrated that topically applied antiseptics. Two of Ramfjord’s legacies were the introduction of RCTs to periodontology and the promotion of an evidence-based approach to clinical practice. Also during the past two decades. researchers have shown an increasing interest in studying the role of growth factors in tissue repair and regeneration. W. many authorities. Among these publications was a report by John F. They concluded that the role of topically applied antiseptics is strictly adjunctive to mechanical disruption and removal of biofilms. In a meta-analysis of data from a large number of clinical trials.D. particularly chlorhexidine. The next major advance in periodontal regeneration was the proofof-principle introduction of guided tissue regeneration (GTR) procedures in 1982. “there is no chance whatever for a reattachment. Throughout the first half of the 20th century. combined with mechanical removal of plaque via scaling and root planing. including gains in clinical attachment levels and reductions in probing depths. Reynolds and colleagues70 concluded that bone-replacement grafts resulted in statistically significantly increased bone and clinical attachment levels and reduced probing depths compared with flap procedures alone. use of topical antimicrobials in the treatment of periodontitis. gastrointestinal disturbances and other side effects. including the formation of new cementum. were highly effective in the treatment and prevention of gingivitis. Repair and regeneration.Longitudinal Studies were randomized clinical trials (RCTs) that were the first of their kind in periodontology. An important advance in the past 100 years has been clarification of the benefits and limitations of antimicrobial agents as an adjunct to mechanical periodontal therapy. Haffajee and colleagues67 found that systemic antibiotic therapy. Guided tissue regeneration.

Subsequent editors were Maynard K. first published in 1930. Oral Sci Rev 1976. part II: longitudinal clinical and bacteriological investigation. Theodor Rosebury: grandfather of modern oral microbiology. Bethesda. Gillette Hayden and Grace Rogers Spalding. Microbial complexes in subgingival plaque.36(3):177-187. new approaches to the prevention. Hurt. with major advances occurring in establishing a ligamentous attachment to alveolar bone. Robert J. Periodontol 2000 1994. Socransky SS. June 2009). Drs. 5.28:689-692. all of whom made major contributions to dental research and established the journal’s reputation for scientific excellence (Alice DeForest. Periodontol 2000 1994. Although the mechanical removal of biofilms and its products. and periodontal disease in the beagle dog. J Periodontol 1976. 25(2):134-144. Haffajee AD. Keyes PH. periodontal therapy in the United States will build on the remarkable scientific advances made during the past 150 years. Kornman. 4.73 Advances in developmental and molecular biology. Pyorrhea alveolaris. Theilade E. Va. 10. and promoting international scientific collaboration.85(11):990-995. Theilade E. American and International Associations for Dental Research. 11. diagnosis and treatment of periodontitis are well within sight. cell differentiation and synthesis of the extracellular matrix. The American Association for Dental Research and the International Association for Dental Research. Fine DH. 1890. private sector industry and insurance carriers. J Periodont Res 1975. 6. The results of fundamental microbiological research will lead to innovative methods of identifying and altering pathogenic biofilms. Plaque induced periodontal disease in beagle dogs: a 4-year clinical. Goldman. 7. White Dental Manufacturing Co. Dr. Löe H. . Md. 12.. written communication. Scientific progress in this area has led to the isolation of natural growth factors and the development of recombinant forms that have been evaluated preliminarily for their effect on periodontal regeneration in humans. has been essential in its support of research that has advanced the understanding of periodontal disease biology and treatment. Haffajee AD. Newman MG. Smith C. Hamp SE. Vol. Socransky SS. 15. 13. Evidence of bacterial etiology: a historical perspective. Jordan HV. Timothy J. combined with professional periodontal maintenance. have been critically important in the discussion and dissemination of research findings applicable to treating periodontal diseases (Christopher H. Studies of the microbiology of periodontosis. new generations in the United States can expect to retain a healthy and functional dentition for a lifetime.. Lindhe J. 1899.5:7-25. Armitage and Robertson did not report any disclosures.S. 1. Experimental gingivitis in man. 14. roentgenographical and histometrical study.S. J Dent Res 2006. June 2009)..ada. Wright WH. Saxe SR. Philadelphia: S. Kent RL Jr.org September 2009 CONCLUSIONS In the future. The bacteria of periodontal diseases. J Periodontol 1965. The academy was founded in 1914 by Drs. 2.healing. Cugini MA. Miller WD. J Periodont Res 1966. Moore LV. Bohannan HM.1(1):1-13. Vermillion JR. executive director.9:65-107. Crawford A. written communication. Korber D. Chemotherapy of dental plaque infections.10(5):243-255. encouraging research in periodontal disease biology and treatment. 5(5):217-225. clinician-scientist research centers. Spalding served as the editor of the Journal of Periodontology. 140 http://jada. Fox. Experimental gingivitis in man. William C. O’Leary. Socransky SS. Propas DA. Greene JC. The National Institute of Dental and Craniofacial Research. ■ Disclosure. 3. Original Investigations Concerning Pyorrhea Alveolaris: The Micro-Organisms of the Human Mouth. Dental Cosmos 1886. Löe H.5:66-77. The American Academy of Periodontology. Loesche WJ. White Dental Manufacturing Co. Jensen SB. will remain a cornerstone of care.74 MAJOR INFLUENCES AND FUTURE ADVANCEMENTS Major influences on periodontology in the United States in the past 150 years include strong interrelationships among the American Dental Association. calculus. nanotechnology and stem cell biology have set the stage for discoveries that likely will soon allow clinicians to manipulate sophisticated tissue-engineering procedures required for the predictable regeneration of periodontal structures. executive director. part III: findings related to an infectious and transmissible component. schools of dentistry. Talbot ES. Oral debris. Savitt ED. Periodontics 1967. also has played a major role in supporting patient care. Lewandowski Z. Periodontal lesions in the Syrian hamster. Chicago.. Arch Oral Biol 1964. Alexandria. Genco and Kenneth S. Costerton JW. Talbot ES. 8. As a result of these scientific advances. Henry M. American Academy of Periodontology. Jensen SB. Growth factors act in a coordinated fashion that regulates the timing of cell division and recruitment of progenitor cells. The rapid evolution of implant therapy as an integral part of periodontal treatment will continue. Moore WE. Interstitial Gingivitis or So-Called Pyorrhea Alveolaris. DeBeer D. and the practicing dental profession.47(7): 373-379. Caldwell D. Löe H.9(4):377-400. J Clin Periodontol 1998. proteomics. Philadelphia: S. On the horizon are major breakthroughs in understanding essential mechanisms that mediate and resolve tissue destruction in periodontal inflammation. Hine. Such discoveries will provide new tools for regeneration of periodontal structures and clarify associations between periodontitis and other chronic inflammatory diseases. 9. human genetics. 42S JADA.

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A long-term survey of tooth loss in 600 treated periodontal patients. Shick RA. 17. Sigurd Ramfjord and Major Ash.: Dental Items of Interest Publishing. 51. Ouverney CC. Paquette DW. inflammation.38(6):33/605. Listgarten MA.Y. In: Litch WF. A hidden periodontitis epidemic during the 20th century? Community Dent Oral Epidemiol 2003. Gunsolley JC.14(8): 445-452. Aeppli D. 49. 64.35(8 suppl):380-397. J Clin Periodontol 1987. Lindhe J. Smoking-attributable periodontitis in the United States: findings from NHANES III. Pitcher GR. The Toothbrush: Its Use and Abuse—A Treatise on Preventive Dentistry and Periodontia as Related to Dental Hygiene. 47. 73. Paster BJ. Bunting RW. J Bacteriol 2001. Palm K. 18. J Bacteriol 1994. Bell DG. Van Dyke TE. Aichelmann-Reidy ME. Longitudinal study of periodontal therapy. Periodontol 2000 2006.30:9-23. J Periodontol 2000. 21. Needleman I. Dental biofilms: difficult therapeutic targets.44(2):66-77. physiology and repair of gingival epithelium. 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DDS. dental and craniofacial diseases and disorders. the learners inherit the future. More precise and faster diagnostic tests. Lawrence A. Our investments in research have improved the lives of millions of people and demonstrated that oral health is integral to overall health. New tools are enabling researchers to understand the mysteries of oral biology and disease and to change profoundly the treatment of oral. scientifically. the world of research has undergone such drastic changes that. September 2009 . Bethesda.A view of the future Dentistry and oral health in America Isabel Garcia. National Institute of Dental and Craniofacial Research.gov”. National Institute of Dental and Craniofacial Research. Revolutionary tools unimaginable even a decade ago now are enabling researchers to unravel the mysteries of oral biology. Md. Md. 31 Center Drive. 140 http://jada. Emerging technologies such as salivary diagnostics.”1 More than 60 years ago. The authors explore advances in modern science and technology and how they will change oral health care in the future. Results. and anti-inflammatory drugs and pain medications will be tailored to maximize efficacy and safety. Key Words.140(9 suppl):44S-48S. 20892. the 1940s seem as distant as medieval times. the National Institute of Dental and Craniofacial Research (NIDCR) was created to ensure the dental health of people in the United States. Large teams of clinicians and scientists will tackle increasingly complex problems. National Institutes of Health. A 44S JADA. Tabak. “In times of drastic change. PhD merican social writer and philosopher Eric Hoffer wrote. and advances in computational sciences will make it possible to create virtual teams across the world. A new generation of cell-based therapies will be available for regenerating tissues.nih. emerging technology. Genomic and proteomic advances combined with the power of super-fast computers are profoundly changing our understanding of oral. Dr. e-mail “GarciaI@mail. Address reprint requests to Dr. highresolution imaging and nanotechnologies. MPH. Information technology systems will enable clinicians to examine and integrate information obtained from all databases in cyberspace.ada. Building 31. Garcia is the deputy director. Vol. Garcia. dental and craniofacial diseases and disorders. Tabak is the director. Since then. Conquering the array of complex diseases that affect the oral and craniofacial complex will require multifaceted strategies and multidisciplinary cooperation. As scientists discover newer and better methods to preempt and prevent disease. DDS.org ABSTRACT Background. they must translate these methods into tools for people at greatest risk of developing disease. The learned usually find themselves beautifully equipped to live in a world that no longer exists. Clinical Implications. JADA 2009. National Institutes of Health. Room 2C39. Dental research. oral health and disease. as well as other new tools will lead to efficient and highly effective personalized dental treatments. Dr. Bethesda.

science will give us the tools to short-circuit diseases at the molecular level. THE PERILS OF PREDICTIONS Predicting the future is risky business. to alter the course of disorders by manipulating defective genes. our success will depend not only on the remarkable advances of modern science and technology. it is reasonable to predict that within the next two decades. This all-in-one chip first will isolate the patient’s DNA and rapidly decode ABBREVIATION KEY. the president and founder of Digital Equipment Corporation (headquartered from 1957 to 1992 in Maynard. what changes can we predict? Can we achieve a future in which prevention and delivery of care empower all Americans to maintain good oral health for a lifetime? Can we develop smart. stating “there is no reason for any individual to have a computer in [his] home. JADA. practice-based research and culturally sensitive interventions are providing novel avenues to improve oral health. who.ada. “We are making the historic transition from the age of scientific discovery to the age of scientific mastery in which we will be able to manipulate and mould nature almost to our wishes. In 1839. in 1872. One area of science that holds exceptional potential to alter the practice of dentistry is salivary diagnostics.org September 2009 45S . A staff member will load the contents onto a disposable diagnostic chip about the size of a dime.”4 Fortunately. is said to have argued against personal computers. Hoffer’s words give us an irresistible mandate to embrace lifelong learning. ‘Knife’ and ‘pain’ are two words in surgery that must forever be associated in the consciousness of the patient. Dentists of the future will rely on a range of diagnostic and treatment tools that rapidly and efficiently process a patient’s biological information. This emerging technology will allow dentists to make a quantum leap forward in their ability to predict. Ken Olsen. Alfred Velpeau offered a downbeat view of the future.3 French surgeon Dr. It is absurd to go on seeking it today. Consider the following scenario: On entering a dental office. and to treat conditions by using drugs or other therapies customized with stealth precision for individual patients. “The abolishment of pain in surgery is a chimera.”2 Although the statement was not in reference to the modern personal computer.6 According to American theoretical physicist Michio Kaku. molecularly based diagnostics and integrated electronic risk management systems. NIDCR: National Institute of Dental and Craniofacial Research. In 1977. Mass. genome scans to evaluate patients’ responses to pharmaceuticals. The visual and tactile methods of dental diagnostics will be augmented by powerful technologies such as smart imaging systems. Vol. said that “Louis Pasteur’s theory of germs is ridiculous fiction. this pronouncement was wrong. a new patient will expectorate into a small vial. not professional isolationism.).new drugs and biologics. DENTISTRY IN THE FUTURE Looking beyond the horizon.”7 Regardless of whether we achieve the kind of scientific and technological utopia described by Kaku. he declared. but also on our ability to achieve closer integration between dental research. As more remarkable discoveries and greater achievements in science and technology emerge. early interventions to avert suffering from chronic orofacial pain or craniofacial disorders? Will we have the tools to allow clinicians to recognize oral malignancies at their earliest stage and short-circuit their progress? Will we successfully bioengineer replacement teeth or discover small molecules to alter the composition of oral biofilms? Can the salivary glands be a gateway to the body for the delivery of precise molecular therapies with few side effects? Dental research is well-positioned to attain all of these goals. the forecasting of a severe shortage of dentists in the United States in the mid-1960s was never realized as a result of unforeseen sharp declines in population growth and the increased federal support for dental schools. detect and prevent disease. from their genes to their proteins to their metabolites. Another example of the perils of forecasting the future came from surgeon Pierre Pachet. However. dental practice and education.”5 Finally. Predictive tools. Conquering the array of complex diseases that affect the oral and craniofacial complex will require multifaceted strategies and multidisciplinary cooperation. the perceived error in judgment reportedly played a large role in the company’s demise. in the oral health arena. 140 http://jada. for both patients and surgeons. maker of large business mainframe computers.

In the dental operatory. Novel biologics and drugs. These tests will measure levels of disease-linked antibodies or defense cells as they begin to amass.ada. the clinician then will compare unusual changes in various proteins. type 2 diabetes. patients likely will never see or hear a handpiece. preserving both healthy tissue and function. within minutes. Using specialized software and a computer. In the rare instances in which the disease persists and destroys tooth-supporting bone. People who have disfiguring wounds to the head and face or those who are born with birth defects will benefit from a new generation of cell-based therapies to regenerate tissues and heal wounds without common . To treat people with oral autoimmune diseases. They will complement gene-scanning tests that alert a dentist or physician that his or her patient has an inherited susceptibility to diseases such as Sjögren syndrome or diabetes. This “lab on a chip” then will scan the saliva to determine the levels of numerous molecules present in the fluid.Envisioned signatures for oral cancer. but before overt symptoms occur. He or she will use these results as the baseline measures against which findings from future visits will be compared. and a staff member will add automated alerts to the patient’s electronic record to ensure that the proper medication dosage will be provided if needed in the future.org September 2009 shows early signs of demineralization. 140 http://jada. Pervasive computing. dentists will possess additional predictive tools to characterize the bacteria underlying the infection and the specific nature of the immune response. health care professionals will possess much more sensitive and precise blood. They will have an array of tools available to perform rapid molecular pathological analysis to help identify premalignant lesions and take the preemptive steps of characterizing the internal molecular patterns of these cells (much like whorls in a fingerprint) and matching them with a drug that kills the tumor cells selectively. Dentists also will possess high-resolution imaging devices to visualize any unusual lesions in the oral cavity. breast cancer. In cases of chronic periodontal disease. periodontal disease and caries. the process will be reversed with advanced nanomaterials that deliver biologically based therapies to promote remineralization naturally. These tests will enable the early detection of various oral diseases. Targeted approaches. Vol. in the form of nanochips that can be implanted in the mouth or introduced into the circulation or soft tissues. and they will be able to personalize treatments that most effectively target and eliminate both the bacteria and the infection. dentists will know how to regenerate bone and prevent tooth loss. surgeons will have sophisticated imaging tools and stains at their disposal that indicate whether other tumor cells have spread inconspicuously nearby. In places where the enamel 46S JADA. Following this fluorescent trail. as well as reveal signs of developing medical conditions. a detailed report will be produced. To reduce the likelihood of a recurrence. antibodies or other analytes. This information will be analyzed for drug response genes.8 the genetic blueprint of life. Adapted with permission of Wong from The Wong Lab. either localized or part of a complex syndrome. ranging from cancer to diabetes to various infectious diseases (see illustration8). will act as stealth sentinels yielding real-time information about the patient’s health status.or saliva-based diagnostic tests. Personalized treatment. Dentists will perform routine examinations that include use of a high-resolution imaging device to better visualize the subsurface tomography of each tooth. they will surgically remove all of the potentially affected tissues.

communities. “Thus. tioner. but many of our most integrate information Extraordinary advances in computaeffective preventive measures and obtained from all tional sciences.ada. preemptive oral health care that will improve the health of and quality of life for millions of people. Stubborn inequalities in oral health continue to exist among many groups. With respect to health disparities in the RESEARCH United States. Tarand compare them with anonymized electronic geted programs and interventions addressing unique populations are necessary but not records throughout the globe. planet. community and societal Consider the situation in which one’s patient has levels is necessary but not sufficient. purposeful and findings from clinical trials around the world. clinician with the seminal information needed to deduce a diagnosis and establish a course of action. strategies. Vol. As we discover create virtual teams that span the and adopt newer and better methods cyberspace. we scalable information technology sysmust improve our ability to translate tems will enable clinicians of the future to investiand disseminate these methods effectively into gate and then integrate information obtained from tools for communities and people at greatest risk of all databases in cyberspace. the large number of people with chronic orofacial pain conditions will be treated with a new generation of nonaddictive pain medications that will be tailored for them through the use of pharmacogenomic principles to maximize efficacy and safety while avoiding dangerous side effects. contracture or dysfunction. We are embracing new tools and technologies and applying new biologically based approaches to solving old problems. link the findings with those of extensive genetic Systematic action is needed to address oral studies of every type. such as cloud commessages have never reached those databases in puting. Teasing out an unknown disease in the mouth. Today. as well as with the latest health inequalities in a rational. we are on the verge of many opportunities to develop tailored. The clinician the underlying biological.”10 The 21st century already has seen the self-assembly of large teams of Dentistry can proudly claim a will enable clinicians clinicians and scientists to tackle strong record of championing health of the future to increasingly complex problems.complications such as scarring. who may be physically alone but who will be How do we turn the corner on health inequalilinked electronically with thousands of people comties? Improving our understanding of what causes prising the scientific community worldwide. and many massively scalable uncommon diseases. By the 1950s. Crick and common diseases. People with inflammatory diseases will benefit from a new generation of anti-inflammatory drugs that will enhance resolution of the immune response via natural signals to heal and cease the inflammation. these new developing disease. 140 http://jada. He or she then will sufficient. predictive algorithms will provide the JADA. Science and interpret the blizzard of data at his or her disposal. it is not Early science largely was a cottage given in our genome that there must industry. behavioral and/or culwill analyze the clinical and laboratory findings tural factors is necessary but not sufficient. technology can be a vehicle for eliminating dispariIn the end. such promotion and disease prevention investigate and then as decoding the human genome. Ironically. Watson. it has been said. cities and NEW WAYS OF CONDUCTING SCIENTIFIC towns. inequalities at individual. investigators be inequalities in health. The science-driven way that recognizes both societal clinician will use software to integrate and help and personal responsibility for health. rather than via an attempt to interrupt the immune response. It is a social began forming small teams (for fact that most risk factors for The availability of example. technology systems wealthy.org September 2009 47S . or we will risk replicating the approaches will make it easier for the solo practishortcomings of the past. are more prevaFranklin) to tackle complex problems information lent among the poor than among the requiring different sets of expertise. In addition. have made it possible to who need them most. SHARING THE HEALTH Science changes our lives.9 The availability of massively to preempt and prevent disease. But we must be mindful that science has not reached everyone adequately.

com/quotes/kenolsen.ties if used to root out causes of disease. Gartner Research. Reflections on the Human Condition.J. Accessed July 1. Schein EH. . N. Accessed July 1. 2009. and the Community.shtml”. 5. The Wong Lab at the UCLA School of Dentistry. Cearley DW. Snopes. Doing so will ensure that our profession is poised to inherit the future. 140 http://jada. “http://news. In: Schein EH. Oxman AD. Socioeconomic inequalities in health: what they look like and what can be done about them (edited transcript). Alison Davis to the manuscript of this article. Neither Dr. Bob Kuska and Ms.ucla.snopes. As we look toward the future of oral health care and research.jsp”. Plummer DC. However. What’s the next big thing? Softpedia. 1992:301. 4. Highfield R. Burt BA.gartner. our best prospects for making the next leap toward solving complex oral diseases—from caries to clefting or from rare craniofacial disorders to oral cancer—are by supporting the best science. Now is the time for policymakers to consider undertaking a vigorous debate about how scientific advances could improve the public’s health.uk/scienceandtechnology/science/ sciencenews/3311478/Future-of-science-We-will-have-the-power-of-thegods. Philadelphia: Saunders. Dental educators and clinicians will need to rise to the challenge of adapting to novel ways of providing care and applying new approaches to solving old problems. intrigued and dazzled our imagination. 3. Editorials. Dental Practice. Long Live DEC: The Lasting Legacy of Digital Equipment Corporation. 10. given the complexities of our health care delivery system and the economic and cultural differences that constitute our nation. 2003:38. embracing new avenues of inquiry and welcoming the expertise of people in other disciplines. 6. “http://wilsoncenter.’ Telegraph.com/it/products/research/cloud_computing/cloud_ computing. Accessed July 9. Striffler DF. Sonduck M. 2009. Dental Research Institute.ada. investing in healthy communities and developing social and economic policies that increase opportunities. ID G00159034. Vol. “www. we have learned that oral diseases have no anatomical or disciplinary borders.uk. Hoffer E. 9. our nation’s oral health was so poor that one could not have anticipated today’s remarkable gains.telegraph. Delisi P. Smith DM. Dentistry. 1. Scientific research will continue to yield 48S JADA. They have improved the oral health of and quality of life for countless people and communities. Accessed July 9. 2009. ■ Disclosure. Lewis DW. “www. Tabak reported any disclosures.asp”. Eklund SA. 8. Future of science: ‘we will have the power of the gods.org/events/docs/kaplan1.pdf”. Cloud computing confusion leads to opportunity.: Hopewell Publications. 2009. to reprogram the biology of disease and to target the most vulnerable people for early intervention. “www. 4th ed. San Francisco: Berrett-Koehler. Ken Olsen. DEC Is Dead. 2009.com. Titusville. education and access to quality health care will go a long way toward breaking the cycle of health inequalities. Kampas PJ. CONCLUSIONS The tools of modern science have surprised. Ken Olsen.html”. 2. softpedia.co.edu/wonglab/”. Accessed July 1. Kaplan G. Washington. When Congress established NIDCR more than 60 years ago. “www. 2009. Garcia nor Dr. 2007. J Clin Epidemiol 2005. 2006. 7. April 4. Accessed July 9.co. Presented at: Health Status Disparities in the United States.org September 2009 exciting technologies and effective treatments.58(2):113-116. Flottorp S. Yet.com/news/What-s-the-Next-Big-Thing-17057. The OFF theory of research utilization. the scientist-engineer. The authors acknowledge the contributions of Mr. Fretheim A.hspp.