Administration Issues Proclamation Revising Executive Order “Protecting the Nation from Foreign Terrorist Entry into the United States”

Earlier this year, shortly after its term began, the administration issued the executive order (EO) “Protecting the Nation from Foreign Terrorist Entry into the United States,” which among other provisions, suspended entry into the United States for immigrants and nonimmigrants from Iran, Iraq, Syria, Yemen, Sudan, Somalia and Libya for a 90-day period. The International and American Associations for Dental Research (IADR/AADR) strongly opposed that EO, citing its potential chilling effect on the global scientific community and on our mission to advance research and increase knowledge for the improvement of oral health worldwide.

This past Sunday, September 24, President Trump issued a presidential proclamation revising the restrictions and limitations set forth by the previous EO. Per the proclamation, beginning on October 18, entry restrictions and limitations are to be put into effect for the following countries (countries not included in the earlier EO are bolded): Chad, Somalia, Iran, Libya, North Korea, Syria, Venezuela, and Yemen. Venezuela’s restrictions are narrower, with the order’s attention focused predominately on government officials and their families, and Sudan is no longer included in the list.

Beyond the countries included in the proclamation, there are a few notable differences between the orders issued in January and September. First, unlike the previous order, which had a specified 90-day time frame, the new restrictions are intended to be indefinite, though a senior administration official referred to them as “conditions- based, not time-based.” The new proclamation also eases restrictions on individuals who hold visas and states that no immigrant or nonimmigrant visa issued before October 18 will be revoked, though once student or work visas expire, their renewal is not guaranteed. Yet, while there are various exemptions and waivers included within the new text, as was noted in The New York Times, “most [citizens of the countries] will be barred from coming to work, study or vacation in America.”

In the coming months, AADR will we be monitoring this policy’s potential impact on the scientific enterprise (including, but not limited to, faculty and students’ ability to research, teach, or attend international scientific conferences) and take action to safeguard research and champion those who conduct it. Collaboration and the free flow of ideas is core to scientific progress and the advancement of our nation as a whole.

IADR has a global reach, with members and student members from all over the world, including those countries identified above. We remain committed to our diverse membership and will continue to partner with the broader scientific and health care communities in advocating for policies that allow not only our members – but also other students, scientists, and international peers – to partner, study and learn from one another both at home and abroad.

AADR submits comments on inclusion of pediatric research in All of Us Research Program

AADR has submitted comments in response to request for public input on the inclusion of pediatric research in the All of Us Research Program, formerly the Precision Medicine Initiative. Currently, children are excluded from the All of Us Research Program, along with prisoners and adults who are unable to give consent. The Child Enrollment Scientific Vision Working Group of All of Us requested input on the types of research questions that could be answered with the enrollment of children. AADR submitted the following comments in response:

Question 1
What are the most critical short-, medium-, and long-term precision medicine research questions that could be addressed by the inclusion of pediatric populations in the All of Us Research Program?

Short term (0-5 years)

Orofacial clefts affect 1/700 live births and are associated with environmental, dietary and genetic factors. Future studies should integrate genetics with cleft phenotypes, identify and describe the contribution of candidate genes and describe the interaction between genetic and environmental risk factors (Parker SE et al. 2010. Birth Defects Res A Clin Mol Teratol. 88(12):1008-16; Dixon MJ et. 2011. Nat Rev Genet. 12(3): 167-178; Li C et al. 2017. JDR 96(11): 1184 – 1191). Childhood dental caries remain a public health concern marked by pronounced health disparities. There is evidence of heritability of dental caries but few known associated loci (e.g., ACTN2) and polymorphisms (Stanley BO. 2014. JDR 93(7):626-32). The strength of the evidence supporting these associations is limited due to small sample sizes and reliance on candidate-gene study designs. Researchers currently do not understand the magnitude and the mode of influence of these loci and polymorphisms on caries risk in children (Divaris K. 2017. Dent Clin N Am. 619-625), especially in the context of environmental factors like fluoride exposure (Shaffer JR et al. 2015. Hum Genet. 134(2):159-67). Understanding the composition and function of the oral microbiome in health and disease will also help investigators precisely dissect the etiology of caries on an individual level and lead to more effective preventive and therapeutic modalities.

Medium (5-10 years)

In 5-10 years, All of Us could help scientists understand the genetic, lifestyle and environmental factors that contribute to oral health disparities in children and that are not completely explained by differences in socioeconomic status. A better understanding of the biological underpinning of oral and craniofacial conditions in children can help explain how social deprivation and other upstream factors can have such profound impact on multiple, clinical oral health endpoints. For example, All of Us could help elucidate the impact of genetics and epigenetics (a mechanism that may illuminate previously uncharacterized links between social factors, environmental exposures and biological or clinical outcomes) on intermediate oral and craniofacial phenotypes such as tooth anatomy, salivary factors, the oral microbiome as well as directly on oral disease susceptibility (Divaris K. 2016. JDR 95(3):248-254).

Long (more than 10 years)

Understanding how oral health and disease develop over time requires longer follow-up periods than what is typically feasible with a research project grant. The inclusion of pediatric research in All of Us will enable longitudinal studies of oral and craniofacial health among large, population-based samples. Gaps in knowledge that need to be addressed include the impact of craniofacial developmental diseases, such as cleft lip/palate and enamel hypomineralization and hypoplasia, on susceptibility to or exacerbation of other diseases; common risk factors between oral and other diseases leading to common prevention and treatment strategies; the quantification of risk for certain oral diseases like dental caries (Divaris K. 2016. JDR 95(3):248-254); caries progression from ages 0-18; and oral health across the lifespan. The health of children with complex medical conditions or with cancer can be further compromised when they have untreated caries lesions. The development of effective means for the prevention or management dental caries among this and other pediatric populations with special health care needs is critical.

All of Us should collect and bank saliva and other biological specimens (e.g., plaque) to enable genetic and microbiome analyses, as well as studies on how salivary factors change from infancy over the life course. Saliva collection methods for valid downstream omics (e.g., genomics, microbiomics and proteomics) analyses in very young children need to be studied.

Question 2

What are the key gaps in current pediatric study designs that might be appropriate for All of Us to address through the enrollment of children (for example, preconception studies, sibling studies)? 

All of Us should enroll families and follow these family cohorts over time. Children are subject to the behaviors, environment and resources of their caregivers, e.g., caregiver oral health literacy is associated with the oral health status of the child (Vann WF et al. JDR. 89(12):1395-400).  Maternal periodontitis treatment may improve low birth weight, but the evidence is low quality (Iheozor-Ejiofor Z et al. 2017. Cochrane. (6)) due to study sizes and possibly treatment intervention at the end of the first trimester versus preconception.

All of US should include community-based participants, i.e., individuals enrolled regardless of health or disease status. Oral and craniofacial research has relied on case-control study designs or clinic-based samples, but these designs are subject to numerous biases.

All of Us should enroll racially/ethnically diverse children from younger age groups. Precision oral health studies (e.g., genome-wide association studies) have been mostly conducted in children of European decent and have included few children under the age of 6, the cutoff age for early childhood caries. Many studies of oral diseases have also been conducted in small cohorts or clinical (care-seeking) samples. A larger, diverse pool of community-based (not necessarily care-seeking or clinic-attending) participants can alleviate previous challenges with low statistical power, validity, reproducibility and generalizability (Divaris. 2017. Dent Clin N Am. 619-625).

Question 3
What are the research resources that the inclusion of children into the All of Us Research Program could potentially generate (for example: registries, databases, or innovative methods)?

The data generated from All of Us will enable the refinement, validation and ultimately improvement of current caries risk assessment tools (Divaris K. 2016. JDR 95(3):248-254) and the generation of more precise algorithms for the prediction of disease occurrence, time to disease development, and disease severity as well as methodologies in genetics and social and behavioral research. The dental research community will greatly benefit from using samples stored in biobanks for future research. The inclusion of pediatric research in All of Us will enable hypothesis generation and testing for future research. It is expected that the availability of such rich biorepositories (offering opportunities for ‘deep phenotyping’) and other big data sources (allowing ‘wide’ research explorations) will accelerate scientific discovery and the potential for translation of research findings to meaningful, individual and population health-improving solutions in the oral and craniofacial domain.

 

AADR Comment on Prenatal Fluoride Exposure Study in Mexico

AADR Comment on “Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico” by Bashash, M. et al. in Environmental Health Perspectives published online September 19, 2017

The findings reported by Bashash et al. add to the scientific literature on associations between fluoride exposure and cognitive outcomes. Their epidemiologic study using 299 mother-child pairs in Mexico examined maternal urinary fluoride levels, as a proxy measure of pre-natal fluoride exposure, and two measures of cognitive outcomes in their children at age 4 and 6 -12 years. Their findings must be taken into context with previous studies, including the New Zealand Dunedin longitudinal study that did not find an association between fluoridated water and IQ.

It is also important to note that Bashash et al. used data from a longitudinal birth cohort study in Mexico (ELEMENT) originally designed to examine how environmental exposures to metals and other chemicals affect pregnant women and children, and not to examine the specific relationship between fluoride exposure and cognitive development. The current study is examining samples of urine from two cohorts, the first to investigate prenatal lead exposure (1997-2001) and the second, the effect of calcium supplementation (2001-2006). As an examination of fluoride was not part of the original study design, there are no data on total fluoride intake by the pregnant mothers or their children, other than the fact that Mexico does not have community water fluoridation. Exposure to fluoride would be from naturally occurring in water supplies, fluoridated salt, and other dietary and environmental sources.

Some places in Mexico with high concentrations of naturally-occurring fluoride in water also have high concentrations of arsenic, a known neurotoxin. As the authors noted, information regarding the study population’s exposure to arsenic or other environmental toxins was not available, and therefore, could not be ruled out as a confounding variable. Given such lack of exposure data, among other limitations clearly cited by the authors, the results should not alter current policy recommendations on the use of fluorides for caries prevention.

The AADR concurs with Bashash et al. that the ability to extrapolate their findings to how exposures may impact general populations is limited given the lack of data on fluoride exposure and fluoride pharmacokinetics during pregnancy. The authors conclude that their findings must be confirmed in other populations. The AADR agrees with the authors that these findings reinforce the need for additional research.

AADR notes that fluoride has been an important tool in reducing the prevalence of dental caries in the United States. Specifically, the Centers for Disease Control and Prevention named community water fluoridation one of the top 10 public health achievements of the 20th century. Other fluoride interventions include the application of topical fluorides including fluoride varnish, the use of fluoride supplements and fluorides in toothpaste. As a result, caries prevalence in children has been reduced dramatically as has the number of older adults with total tooth loss in the United States.

Senate appropriations committee approves $2 bil NIH increase for FY 2018

Today, the Senate Appropriations Committee approved a $2 billion increase in the budget of the National Institutes of Health (NIH) to $36.1 billion for FY 2018. If enacted, this would constitute a 6% increase over FY 2017. The Senate spending bill includes $400 million for the BRAIN initiative, a $140 million increase; $290 million for the All of Us Research Program, a $60 million increase; and increases to to every NIH institute and center, according to the Senate Appropriations press release. Importantly, the bill also prohibits capping indirect costs at 10%.

Earlier this summer, the House Appropriations Committee approved a spending bill that only provided an additional $1 billion – a 3% increase. The National Institute for Dental and Craniofacial Research (NIDCR) received a $6 million increase in this bill, only a 1.6% increase over FY 2017 levels.


Update: The Senate Appropriations Committee has released the bill text. The spending bill provides for an additional $14 million over FY 2017 for NIDCR, which is a 3% increase over FY 2017.

AADR submits comments on NIDCR FY 2019 proposed research initiatives

AADR has provided input on the National Institute of Dental and Craniofacial Research’s (NIDCR’s) Proposed Research Initiatives for FY 2019. Each year, NIDCR solicits input from its stakeholders as the institute decides on which areas to focus research efforts for future fiscal years. The research themes outlined in the request for comment will be used to guide research initiatives for FY 2019 but do not fully capture the entire research portfolio of NIDCR. Instead these initiatives serve as research goals for the institute and can be further developed into funding opportunities. The proposed initiatives are:

  • Advancing Our Understanding of Enamel Development
  • Basic and Translational Research on HIV and AIDS-Related Pathogens in the Oral Cavity
  • Bioinformatics/Data Science Jumpstart for Dental, Oral, and Craniofacial Diseases
  • Biological Factors Underlying Dental, Oral, and Craniofacial Health Disparities
  • Biology of Aging in Dental, Oral, and Craniofacial Tissues
  • Dental Practice-Based Research Networks
  • FaceBase 3 – Bioinformatics and Data Management Hub
  • Precision Imaging of Oral Lesions
  • Understanding Gene-Environment Interactions in Dental, Oral, and Craniofacial Diseases

In its letter to NIDCR Director, Dr. Martha J. Somerman, AADR strongly supported the proposed initiatives. AADR also urged NIDCR to incentivize collaboration between researchers and provided additional feedback on the proposed initiatives on enamel development, HIV/AIDS and precision imaging of oral lesions. To view the full comments, please click here.