1986 to 1992. Also, compared with all full-time dental school faculty, OHR scientists were somewhat older (48.6 to 49.1 years, 1992-1993). OHR scientists generally held higher academic rank than full-time dental school faculty. In 1992-1993, 73 percent of OHR scientists held senior rank (full or associate professor) compared with 65 percent of all full-time dental faculty. From 1986-1987 to 1992-1993, the percentage of OHR scientists who identified their primary appointments as clinical sciences decreased from 44 percent to 36 percent (comparative figure for all full-time faculty is 58 percent). As a proportion of all OHR scientists, those holding the Ph.D. only (without a clinical degree) decreased somewhat (51 percent to 45 percent). No change was found for the dual-degree (D.D.S./Ph.D.) OHR scientists, whose proportion remained stable, but the category “other” (predominantly clinical degree with or without Masters degree) increased from 4 to 10 percent of OHR scientists (Figure 6-1).

Over the time of analysis, OHR scientists turned over (entered and left) by more than one-third (361 entered, 357 left). Most entries were in their 30s and early 40s; departures were evenly spread over the age range of the faculty. Departing faculty OHR scientists were more likely to hold a nonclinical doctorate than were entering OHR scientists.

These analyses indicate that OHR scientists are an aging group, approaching retirement. Although total numbers of OHR scientists are staying constant despite declines in total faculty, reflecting increased emphasis on research in the schools, those with Ph.D.s who leave seem to be replaced to a greater extent by those without Ph.D.s. This reflects the lack of growth in training programs for OHR since 1985. It also suggests a concern for a decrease in competitive stature for grants for OHR scientists among all research workers.

Other factors also contribute to the acute shortage of OHR scientists. Because of the undersupply of research workers for dental institutions, OHR scientists tend to 1) not take postdoctoral training to the same extent as their

FIGURE 6-1 Percent academic degrees by academic year. SOURCE: Solomon, 1993.

competitors for research grants; 2) get drafted into, or otherwise move too soon into, administrative positions; and 3) have insufficient available mentoring capability existing in the institutions where they are employed. In addition, institutional support is generally minimal, so that it is difficult to find start-up funds or bridge support.

Additional factors that contribute to the shortage of OHR scientists are similar to other areas of biomedical research. These include low funding rates for grants, lower income possibilities in academic endeavors than in practice careers, and the debt of graduating dental students. Dental students' debt is the greatest of all health care professionals: it exceeds $55,000 on average and often exceeds $100,000.

OUTLOOK FOR ORAL HEALTH RESEARCH SCIENTISTS

Although much progress has been made, oral diseases remain among the most prevalent diseases in the United States. More than 84 percent of children, 96 percent of adults, and 99.5 percent of those over 65 years of age in this country have experienced dental caries. Many millions of Americans have one or more periodontal diseases or other oral disease. Over 17 million have lost all of their teeth. In 1989, 164 million hours were lost from work and 52 million hours were missed from school because of dental conditions. In 1992, $38.7 billion was spent for dental services. By the year 2000 the annual cost for dental health is expected to reach $62 billion.

Cancer of the oropharyngeal region is more common than leukemia, melanoma, Hodgkin's disease or cancers of the brain, liver, bone, thyroid, stomach, ovary, or cervix. It affects primarily older Americans and causes approximately 8,000 deaths per year. The 5-year survival rate for oral cancer is 51 percent but only 31 percent for blacks.

Millions are at high risk for oral health problems because of other handicapping or medical conditions. These



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