Can biomedical science be made relevant in dental education? A North American perspective

FOR MANY years I have argued that biomedical science was a powerful force, under-appreciated by the dental education community, which soon would have a major impact on the nature of dental practice (1–4). This opinion has only become stronger over the last few years, as a result of the truly phenomenal progress being made in the biomedical sciences. My sense of the rate of this progress certainly is a reflection of the field of research in which I am engaged and whose literature I routinely read, i.e. gene therapy. Gene therapy offers a level of biological manipulation that elicits considerable interest, and provides major scientific and clinical challenges. Although the field has significant problems, I have been especially impressed by the first report of a successful human gene therapy trial in France, described in 2000 (5). Two small children (8 and 11 months) with a severe combined immunodeficiency, who were confined essentially to a protective isolation (‘bubble’) environment in a hospital, were treated by a gene therapy procedure, and thereafter have been able to live with their families and experience a normal life. While the recent examples of biomedical science progress, directly affecting dentistry may not be as dramatic; they are certainly as meaningful and becoming more numerous. For instance, Kelly et al. (6) reported defining a peptide region of the Streptococcus mutans adhesin protein that is critically involved in tooth colonization and plaque formation. They then synthesized that peptide and, in a clinical trial, showed it specifically could block S. mutans colonization in patients for up to 3 months. Many dental applications have been described for the bone morphogenetic proteins (BMPs; 7). For example, in a pre-clinical model (nude/immunodeficient rats), Alden et al. (8) showed that transfer of the BMP-2 gene into mandibular osseous defects using a recombinant adenoviral vector led to repair of the defect within 3 months. Similarly, in a pre-clinical study, Rutherford (9) used adenoviralmediated delivery of the BMP-7 gene for ex vivo gene transfer to ferret dermal fibroblasts. When these transduced cells were administered to teeth with a reversible pulpitis, they induced reparative dentinogenesis with apparent regeneration of the dentin–pulp complex (9). Perhaps the most advanced applications of biomedical science involve patients with head and neck squamous cell carcinomas. In controlled trials, use of a specially engineered recombinant adenovirus as adjunctive therapy resulted in tumour-specific cytolysis and enhanced tumour susceptibility to conventional chemotherapy (10). As these four examples suggest, the biomedical sciences are unequivocally changing the treatment of conditions that are a part of routine general and special dental practice. While these examples are still at different stages of research, it is doubtless that all (or variants of them) will be commonly used clinically within the next 10 years. Unfortunately, from my perspective, these and other highly relevant examples have not led to any substantive change in the way biomedical sciences are being taught in dental schools. Dental educators in most industrialized countries still do not seem to be preparing their students to administer biological therapies in the fairly near future (4, 11). In North America, the region with which I am most familiar, the average dental student today graduates with little sense of the impending clinical biotechnological revolution and how it could influence his/her plans for practice. They are often unaware of the significant applications to dentistry being made in Eur J Dent Educ 2003; 7: 49–55 Printed in Denmark. All rights reserved