Research and Future Actions
Several promising actions against factors causing the two major oral diseases, caries and periodontal disease, are ongoing: attempts to control the formation of the biofilm with its microflora are of high priority. One research line is to identify pathogenic bacteria and try to replace them with genetically modified, less pathogenic bacteria or to eradicate them by antibiotics or antiseptics. Preventing dental caries by a vaccine is not a new idea, and efforts continue. Among other ideas is the use of plantibodies (plant-derived therapeutic antibodies) or genetically modified bacteria, releasing components targeting pathogens. Functional foods, which include various elements in food, may be another future option to control oral diseases. Although pilot or small-scale studies seem promising, it will be several years before such methods can possibly be of use in populations because large clinical trials have not even started.
Saliva is believed to be usable as a diagnostic tool, providing noninvasive assessment of a number of oral and systemic diseases. Devices are being designed to identify in saliva various bacteria and their virulence factors, drugs, metabolic products, hormones, biomarkers for oral cancer, inflammatory mediators, and more. Future developments may result in other affordable and effective devices.
Continuous attempts are being made to assess the sociobehavioral factors in oral health and the information on risk factors. Caries risk assessment models are tested also for the individual cases. Through present knowledge, individuals in need of targeted actions can be identified. Another strong trend is to use evidence-based reviews. This type of research is, of course, not restricted to oral health. Several reviews have already been done, and a frequent conclusion is that the number of randomized clinical trials is limited, in particular for common clinical procedures. This trend will change as the quality of future oral health research improves, but not all research problems can be solved by such studies. Community-based participatory research is another approach that may be used to improve oral health studies (O'Fallon and Dearry 2002).
Within the management of dental diseases—in particular, caries—is the "minimally invasive dentistry" approach, which promotes the concept that large restorations (crowns, bridges) are not as necessary as believed. Risk assessment, preventive measures, and improved dental materials with good adhesion capacity are some of the several components in this approach.
Research in transfer of knowledge using the Internet or other electronic media is another strongly expanding area, from which developing countries should be able to benefit.
