NIH Looks at the Future of Dentistry

Like almost anything in the future, digital technologies are predicted to continue helping dentistry evolve and play an integral role in connecting oral health and overall health. The National Institutes of Health (NIH) reached this and other important findings in its December 2021 report "Oral Health in America: Advances and Challenges."

The NIH report is the organization's first comprehensive evaluation of the status of oral health in the United States in more than 20 years. The exhaustive analysis covers virtually every aspect of oral health in its nearly 800 pages and 5,000 references. It's unjust to summarize it here, so I'll share a few observations instead.

It uses as its baseline the landmark study "Oral Health in America: A Report of the Surgeon General," published in 2000 under the auspices of former Surgeon General David Satcher, MD, PhD. If our collective goal is optimal health for all, the new NIH report's take home message is both encouraging and a little disappointing. Many of the most compelling statements and emerging challenges from the earlier report were echoed in the update, highlighting the slow pace of progress.

The NIH report underscores the integral role of oral health in overall health. It points to great strides in our understanding of the science related to oral disease. From a scientific perspective, discoveries in precision health related to the oral microbiome have exponentially expanded our understanding of oral health and its relationship to overall health. The report predicts that digital technologies will further expand research while also enhancing treatment. Advances in genetics, digital dentistry, and data science are already pointing to more personalized approaches to treatment.

However, even with major advancements in data science, the report points out that interoperable electronic health records that combine medical, dental, and behavioral data are not the norm. At UCSF Dentistry, this has been on our radar for years and is why we're adopting the same electronic health records system as UCSF Health this fall.

Understanding oral health today also requires acknowledging new demographic trends, including a population that is significantly older and far more diverse than was the case just 20 years ago, according to the report. These trends, moreover, are only expected to accelerate in the coming years. While social determinants of oral health are being investigated with increasing frequency, we are just beginning to understand the upstream variables that contribute to oral health, or the intersectionality of social determinants with environmental and cultural factors.

The inequality of oral health for patients and how it contributes to overall health, was a strong emphasis in the report. Academic health centers with dental schools, like UCSF, should ask how they may be contributing to disparities, in addition to how they are supporting access to care. We should also take the lead in supporting research to better understand and address disparities in our workforce composition and background of our organizations.

Another major call to action was for dental schools to serve as a model of care delivery. To support this, schools should expand their clinical services, educate the next generation to work more effectively as a member of a team, and prepare for changing demographics and managing an aging population. UCSF Dentistry's partnership with UCSF Health, which will integrate oral health services into the health system, is right on target with these recommendations.

The report was clear that the future of dentistry as a science-backed health profession is only as strong as the research enterprise underlying it. As such, universities like UCSF must continue to embrace their research missions, supporting and advancing discoveries that will move the profession forward. Today, not all dental schools have robust research programs. Without more faculty who pursue research and serve as role models for recruiting the next generation of dental scientists, the profession will stop evolving.

I am proud that UCSF has already been influential in the areas outlined in the report. We should use this report not just to reaffirm what we have done, but to challenge us to do the work before us and push even further.

Michael S. Reddy, DMD, DMSc Dean, UCSF School of Dentistry Associate Vice Chancellor, Oral Health Affairs