FIGURE 6-1 Dental caries among 5- to 17-year-olds.

FIGURE 6-1 Dental caries among 5- to 17-year-olds.

SOURCE: National Center for Health Statistics, 1996. tissue replacements and molecular imaging tools that utilize

the oral cavity as an exceptionally accessible window into complex biological systems beyond the mouth is no longer a starry ideal, but an increasingly practical reality.

The findings of the 2009 NIDCR strategic plan mirror the thinking of the present committee in terms of its assessment of the national needs for biomedical, behavioral, and clinical research personnel. The direction set by the new NIDCR strategic plan is consistent with the committee’s view of the problems related to the need for researchers in the oral health sciences and reflects both previous (2005) and current committee recommendations in this area.3

Although a tighter integration of research, clinical practice, and health educational communities is essential, it will be equally important to establish and maintain a critical mass of investigators possessing a unique and intimate knowledge of orofacial structures and disorders. Only in that way can schools of dentistry become more competent collaborators in the biomedical research enterprise in the quest to create vibrant research pathways for students and faculty and, ultimately, to improve the health of the public. Recent evidence, however, suggests the reverse trend; that is, a gradual de-emphasis of research in the nation’s dental schools. Figure 6-2 shows the proportion of NIDCR extramural grant support by type of academic institution. Although NIDCR extramural grant support increased by more than 2.6-fold between 1993 and 2008, the percentage of funding going to dental schools decreased from 68.7 percent to 46.7 percent. This suggests that the nation’s dental schools are not competing as effectively for available research dollars in the oral health sciences as are other kinds of academic institutions that have gravitated to dentally related research.

Over the past 50 years the number of dental schools fluctuated between a low of 47 in 1961 and a high of 60 in 1980.4 Between 1982 and 2000, seven dental schools closed—none having a significant research portfolio—and four have opened since 2000, with another eight under consideration for establishment. Of the 12 new and potential dental schools since 2000, 7 are associated with osteopathic medical schools.5 Although these data are viewed in aggregate, it appears that a redirection of dental education away from its historic mission of research, teaching, and service toward a more limited and exclusive focus on teaching may be taking place. This interpretation is corroborated by the decline in the total number of dental faculty members in the biomedical sciences from 933 in 1998 to 663 in 2008 (Figure 6-3).6 This decline of nearly 30 percent in biomedical sciences faculty in dental schools contrasts with the nearly constant number of faculty in the dental and clinical sciences. The implications of this drop are discussed in detail below in the section on faculty shortages.

One factor that may be propelling this trend is a substantial increase in the compensation of practicing dentists, leading to a greater demand for dental education from an expanded pool of academically outstanding dental applicants for whom high compensation is a key driver in the selection of an occupation. Between 2003 and 2008 the overall college grade point average (GPA) of applicants to dental schools increased from 3.43 to 3.55 (see Figure 6-4), and the science GPA increased from 3.34 to 3.47. Existing dental schools have adapted to this market demand by admitting these highly competitive applicants. Moreover, as a further response, a new style of non-research-intensive dental school has emerged.7 Such schools have been founded with a simple, tuition-based, financial plan, often in non-research-intensive universities. Some of these schools do not support a large resident faculty, tenure, or basic scientists. They may have little or no preclinical educational infrastructure and tend not to run large (often money-losing) student clinics or operate research laboratories. As dental schools apparently disengage, research in the oral health sciences has been undertaken by medical schools, engineering schools, hospitals, and other academic institutions.

Obviously research scientists cannot be trained in an environment in which research is not being conducted, and, as a response, the proportion of NIDCR extramural training and career development support going to dental schools decreased from 89.4 percent in 1993 to 73.1 percent in 2008 (Figure 6-5)—again, despite a near doubling of NIDCR support for this purpose.

If this trend is a manifestation of a change in the mission of existing dental schools or a reflection of new dental schools

3

NRC. 2005. Advancing the Nation’s Health Needs: NIH Research Training Programs. Washington, DC: The National Academies Press.

4

IOM. 1985. Personnel Needs and Training for Biomedical and Behavioral Research. Washington, DC: National Academy Press.

5

IOM. 2009. The U.S. Oral Health Workforce in the Coming Decade: A Workshop. Washington, DC: The National Academies Press. See in particular Chapter 4, ”Current Demographics and Future Trends of the Dentist Workforce.”

6

American Dental Education Association, Center for Educational Policy and Resources, 2009.

7

American Dental Association. 2009. Survey of Dental Education, Volume 3: Faculty and Support Staff. Available at https://www.ada.org/sections/professionalResources/pdfs/survey_ed_vol3.pdf.



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