BACKGROUND

Although the field of dentistry has produced one of the most successful public health efforts in disease prevention in the recent history of the United States, the campaign to prevent caries has not been a panacea as far as elimination of oral and craniofacial disease in the U.S. population. The recent release of the first Surgeon General’s report on oral and craniofacial health documented that “…’a silent epidemic’ of oral diseases is affecting our most vulnerable citizens—poor children, the elderly, and many members of racial and ethnic minority groups”. The standard community-based prevention programs such as water fluoridation and school rinse programs have had a significant impact on preventing caries in the broader middle to upper class populations. However, those segments of the population not reached bear a heavy burden of oral and craniofacial disease, usually have limited access to oral care, and often do not utilize oral care when there is access. Extending successful prevention to them will require research into new paradigms of thought to understand the barriers to oral health, and demand the development of innovative interventions to change behavior and/or alter the oral microbial environment based on that understanding. At the same time, important issues in oral and craniofacial diseases now extend far beyond and are much more complex than prevention of caries. Coexisting systemic diseases such as diabetes and HIV can affect the immune system and make patients more susceptible to oral diseases such as periodontitis. On the other hand, there is some evidence and much speculation that the presence of oral infections such as in periodontitis might have an impact on other systemic diseases such as coronary heart and cerebrovascular disease, as well as on adverse pregnancy outcomes. Sorting out the complex issues in understanding how to change behavior in different social and ethnic groups, how to untangle the complex interrelationships between oral diseases and other systemic diseases, especially when they share multiple risk factors such as smoking and diet, and how to evaluate the efficacy of new clinical treatments such as implants or bone regeneration techniques which often involve multiple (correlated) treatment sites within each patient, requires understanding of sophisticated public health and behavioral research methods, as well as of the underlying biological and clinical issues. This training program is designed to address this need by producing personnel who can function as members of interdisciplinary teams of biostatisticians, epidemiologists, health services researchers, behavioral scientists, and clinicians conducting research on oral health issues. The increasingly complex nature of studies of oral diseases of emerging importance suggests that further progress will be enhanced if more interaction occurs between dentistry and the public health disciplines of biostatistics, epidemiology, and behavioral/health services research. The training program described here proposes to accomplish that by taking advantage of a unique situation at the University of Washington that includes large Departments of Biostatistics (37 faculty, 79 graduate students), Epidemiology (52 faculty, 140 graduate students), Health Services (36 faculty, 230 graduate students), and Psychology (63 faculty, 130 graduate students), all of which have large and very strong graduate programs. It also includes a Department of Dental Public Health Sciences (13 faculty and 7 postdoctoral trainees) which has a mission and history of integrating dental and public health research and whose faculty have joint or adjunct appointments in the collaborating departments. As is demonstrated in Figure 1, the purpose of the training program is to create interaction among dentistry, epidemiology, biostatistics, health services, and behavioral science by offering training opportunities to four kinds of trainees:

i)         For dentists, by providing long term or short term postdoctoral support to obtain postgraduate training (preferably a Ph.D. or Master’s degree) in epidemiology, biostatistics, health services, or psychology.

ii)        For non-dentist Ph.D. students in epidemiology, biostatistics, health services, and psychology by providing predoctoral stipends during their graduate training, especially for dissertation research done on a thesis topic related to oral disease.

iii)      For Ph.D.’s in epidemiology, biostatistics, psychology, or health services by providing postdoctoral fellowship opportunities to engage in research on oral diseases or to extend methodology that will facilitate such research.

iv)      For predoctoral dental students, by providing short term support to participate in a summer research experience in which they get fundamental exposure to research methods and work on a research project with a public health/behavioral focus.

Training opportunities offered are both short term and long term in nature.  For dentists (who are often current or prospective faculty members from dental schools), the short term training is primarily in the form of participation in the Summer Institute in Clinical Dental Research Methods, an intensive six-week didactic program in epidemiology, biostatistics, behavioral research and related topics, followed by a short concentrated effort to develop and write a research proposal.  For those who wish to have a similar short term research training experience but cannot schedule the Summer Institute, a customized but similar 3-month program involving regularly-offered graduate courses can be developed for Autumn Quarter (September–December).  For dentists interested in longer-term research training, a two or three year program can be pursued in which a Master’s degree (or an equivalently structured non-degree) program is followed.  A dentist interested in more extensive training to pursue a Ph.D. degree will typically take 5 years or more to complete the program, and waivers to extend postdoctoral support beyond the usual 3 year maximum have to be pursued. For non-dentist Ph.D. students, the training program is long term, with support up to the maximum of 5 years usually needed.  For Ph.D.’s spending a true postdoctoral fellowship working on oral health issues, the training period is one to three years, depending on individual circumstances.  And for dental students participating in the summer research fellowship, the training period is 3 months.

This training program complements existing training programs in the Departments of Epidemiology, Biostatistics, Health Services, and Psychology and aims to focus research training on applications of these disciplines in dentistry.