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New directions in dentistry--the role of the National Institute of Dental and Craniofacial Research.

The National Institute of Dental and Craniofacial Research (NIDCR) is one of 27 Institutes and Centers that comprise the National Institutes of Health (NIH) in the United States (for additional information, visit http://www.nih.gov/icd/). The NIH mission is to uncover new knowledge that will lead to better health for all people. This mission is accomplished through conducting research in its own laboratories; supporting the research of non-Federal scientists in universities, medical schools, dental schools, hospitals, and research institutions throughout the U.S. and abroad; helping in the training of research investigators; and fostering communication of medical information. With the simultaneous announcement of the draft sequence of the human genome in February 2001 from the public and private sectors,1,2 we have entered the postgenomic era of biomedical science. Regulatory networks that underlay the spatial and temporal expression of genes during development will be dissected;3 their recapitulation will afford new opportunities for tissue repair and replacement, particularly when merged with emerging principles of bioengineering.4 Whole genome analysis will become increasingly important to define host response to infectious disease.5 During this new era, analysis of the human proteome will offer new targets for pharmaceuticals.6 Therapeutics will become more individualized as genotypic variation7 is defined and fuels the emerging field of pharmacogenomics.8 Genetic diagnosis will be used increasingly to identify individuals most in need of interventions; for example, there is at least one genetic screening being used as a means to target surgical prevention of malignancy.9 Diagnostic procedures will increasingly be diverted from the hospital and laboratory to the community and the home. Pervasive computing will permit realtime monitoring of any number of physiological parameters and analytes. Where facile, “non-invasive” sampling is desired, saliva is the medium of choice.10 Many analytes can be measured in saliva and oral fluids including hormones, drugs of abuse, and antibodies (as a means to detect exposure to infectious agents such as human immunodeficiency virus). Whole-mouth fluids are also a facile source of host-derived DNA samples and have been used for both biomarker profiling and forensic identification. For example, mitochondrial DNA mutations found to be associated with primary tumors of the human bladder, head and neck, or lung can be detected in saliva.11 A recent report suggests that head and neck squamous cell carcinoma may be detected using microsatellite analysis of DNA derived from exfoliated oral mucosal cells sampled from saliva.12 This will catalyze the shift in a health care system concerned largely with disease diagnosis to health surveillance. With the advance of technology to monitor health in real time, perform genetic testing for susceptibility to disease, and determine efficacy of potential therapeutics comes the increased obligation to ensure that patients’ rights are maintained.13