Empowering Women Researchers in the New Century: IADR's Strategic Direction.

Gender inequality in science, medicine, and dentistry remains a central concern for the biomedical research workforce today. Although progress in areas of inclusivity and gender diversity was reported, growth has been slow. Women still face multiple challenges in reaching higher ranks and leadership positions while maintaining holistic success in these fields. Within dental research and academia, we might observe trends toward a more balanced pipeline. However, women continue to face barriers in seeking leadership roles and achieving economic equity and scholarship recognition. In an effort to evaluate the status of women in dental research and academia, the authors examined the role of the International Association for Dental Research (IADR), a global research organization, which has improved awareness on gender inequality. The goal of this article is to review five crucial issues of gender inequality in oral health research and academics-workforce pipeline, economic inequality, workplace harassment, gender bias in scholarly productivity, and work-life balance-and to discuss proactive steps that the IADR has taken to promote gender equality. Providing networking and training opportunities through effective mentoring and coaching for women researchers, the IADR has developed a robust pipeline of women leaders while promoting gender equality for women in dental academia through a culture shift. As knowledge gaps remained on the levels of conscious and unconscious bias and sexist culture affecting women advancement in academics, as well as the intersectionality of gender with race, gender identity, ability status, sexual orientation, and cultural backgrounds, the IADR has recognized that further research is warranted.

Gender Inequalities in the Dental Workforce: Global Perspectives.

The aim of this review is to investigate the growth of diversity and inclusion in global academic dental research with a focus on gender equality. A diverse range of research methodologies were used to conduct this review, including an extensive review of the literature, engagement of key informants in dental academic leadership positions around the world, and review of current data from a variety of national and international organizations. Results provide evidence of gender inequalities that currently persist in dental academics and research. Although the gender gap among graduating dental students in North America and the two most populous countries in Europe (the United Kingdom and France) has been narrowed, women make up 30% to 40% of registered dentists in countries throughout Europe, Oceania, Asia, and Africa. In academic dentistry around the globe, greater gender inequality was found to correlate with higher ranking academic and leadership positions in the United States, United Kingdom, several countries in European Union, Japan, and Saudi Arabia. Further disparities are noted in the dental research sector, where women make up 33% of dental researchers in the European Union, 35% in North America, 55% in Brazil, and 25% in Japan. Family and societal pressures, limited access to research funding, and lack of mentoring and leadership training opportunities are reported as also contributing to gender inequalities. To continue advancing gender equality in dental academia and research, efforts should be geared toward the collection and public dissemination of data on gender-specific distributions. Such evidence-driven information will guide the selection of future strategies and best practices for promoting gender equity in the dental workforce, which provides a major pipeline of researchers and scholars for the dental profession.

A Mentoring Network for Diversity in Dental, Oral, and Craniofacial Research.

The American Association for Dental, Oral, and Craniofacial Research (AADOCR) has developed a national and sustainable mentoring and mentor training network titled AADOCR Mentoring an Inclusive Network for a Diverse Workforce of the Future (AADOCR MIND the Future). This program is instrumental in fostering a diverse group of early-career investigators in dental, oral, and craniofacial (DOC) research. The network's principal purpose has been to establish a robust and enduring national mentoring program centrally managed by AADOCR. The overarching goal is to develop a sustainable, nationally recognized mentoring network that enhances the career development of early-career DOC researchers from diverse backgrounds. The program aligns with the National Institute of Dental and Craniofacial Research Strategic Plan and aims to cultivate a robust pipeline of future DOC researchers who can address critical scientific challenges. AADOCR MIND the Future guides mentors and mentees in individual career development as well as improving the quality of mentoring at the home institution through dissemination of lessons learned by mentors and mentees in the program. As science practices have evolved, investigators have moved from isolated individual projects to interactive multidisciplinary teams. Within this research framework, AADOCR MIND the Future offers the global infrastructure and the variety of scientists/AADOCR members. While most institutional mentoring efforts have been developed using conventional single mentor-mentee pairs, the AADOCR MIND the Future program supplements this model with additional group mentoring (mentors-mentees) and peer mentoring (interactions between just the mentees). Mentees commit to 12 mo of programming devoted to enhancing research career development through intensive hands-on work, distance-learning components, and engagement in a mentored grant-writing experience. Mentees are strongly encouraged to remain engaged with the program beyond the initial 12-mo period. Years 1 to 3 alumni (cohorts 1 to 3) mentees continue to participate in a meaningful way, and after the completion of the program, it is envisioned these alumni will become mentors for another generation.

Priorities for future innovation, research, and advocacy in dental restorative materials.

Innovations in materials science, both within and outside of dentistry, open opportunities for the development of exciting direct restorative materials. From rich dialog among experts from dental and non-dental academic institutions and industry, as well as those from policy, research funding, and professional organizations, we learned that capitalizing on these opportunities is multifactorial and far from straightforward. Beginning from the point when a restoration is needed, what materials, delivery systems, and skills are needed to best serve the most people throughout the world's widely varied economic and infrastructure systems? New research is a critical element in progress. Effective advocacy can influence funding and drives change in practice and policy. Here we articulate both research and advocacy priorities, with the intention of focusing the energy and expertise of our best scientists on making a difference, bringing new innovations to improve oral health.

Ensuring the global availability of high-quality dental restorative materials.

The Minamata Convention, a global legally binding instrument (treaty) on mercury, has been the catalyst for the emerging agenda on global dental materials research. If the current and future challenges of oral health maintenance and healing on a global scale are to be met, a logical and effective research agenda for the discovery and introduction of new, environmentally sustainable, dental materials must be developed through a coordinated effort involving materials scientists, dental clinicians, representatives of industry, members of regional and national regulatory bodies, and advocacy from research organizations. For universal impact, this agenda should be created with awareness of several important ongoing initiatives, such as the WHO non-communicable diseases action plan, the UN sustainable development agenda, and the IADR Global Oral Health In Inequalities Research Agenda (GOHIRA). A significant contributor to this cause is the FDI and its membership, who, through their Vision 2020 initiative, acknowledge their role and responsibility in globally preventing and managing dental disease and providing leadership to the profession in terms of information dissemination and affecting change. Dental researchers also have an obligation to advocate for appropriate funding to match the identified research needs, thus enhancing the possibility that key decision-makers will provide the needed support to achieve the research agenda agreed upon by this diverse group of stakeholders.

Use of professionally administered topical fluorides in Asia.

Professionally applied topical fluoride varnish, gel, and solution have been shown to be effective in preventing and in arresting dental caries. Their use in different countries in Asia varies greatly and may not correlate with the dental caries situation of the populations in the countries. In the higher-income countries, use of fluoride varnish and gel is common among dental professionals. In contrast, the use of professionally administered topical fluorides is not common in the lower-income countries. Fluoride varnish, being easy to apply and safe, has been the preferred agent for the prevention of early childhood caries, which is prevalent in many developing countries in Asia. The relatively high cost of professionally administered fluoride agents and the shortage of a dental workforce, especially in lower income countries, have hampered the widespread adoption of these effective caries prevention methods in the private and public dental services. Government health policies should be pursued to lower the cost of treatment, either through incentives for local production and/or elimination of taxes and tariffs on imported fluoride products.

Evolutionary pattern of human immunodeficiency virus (HIV) replication and distribution in lymph nodes following primary infection: implications for antiviral therapy.

Evolutionary patterns of virus replication and distribution in lymphoid tissue during the early phases of HIV infection have not been delineated. Lymph node (LN) biopsies were excised from patients at different times after the estimated time of primary infection. Within 3 months of the acute viral syndrome, HIV was mostly present in individual virus-expressing cells in LNs; trapping of virions in the follicular dendritic cell (FDC) network was minimal or absent, but was the predominant form of HIV detected in LNs of subjects with chronic infection, either recent (4-20 months after primary infection) or long-term (>2-3 years after primary infection). Plasma viremia was significantly higher in patients during the first 3 months than in those recently infected; however, there were no significant differences in the number of virus-expressing cells per square millimeter of LN tissue in these two groups. Numbers of virus-expressing cells in lymphoid tissue were significantly lower in the subjects with long-term infection than in the other two groups. Therefore, during the transition from primary to chronic HIV infection, the level of HIV replication in lymphoid tissue remains elevated despite the fact that viremia is significantly downregulated. These findings have implications for therapeutic strategies in primary HIV infection and in recent seroconvertors.

Salivary diagnostics and its impact in dentistry, research, education, and the professional community.

Oral fluid-based (salivary) tests have the potential to create practical, point-of-care clinical instruments that are convenient, practical, and comfortable to use in dentistry and medicine. Currently, there are no simple, accurate, and inexpensive sampling, screening, or detection methods to support definitive diagnostic platforms across dental and medical disciplines. Though the benefits from advancing screening and detection technologies seem eminent, analytical, chemical, molecular, genetic, and protein markers are still under development. Clinical applications in patient care must be validated independently to ensure that they are clinically accurate, reliable, precise, and uniformly consistent for screening and detecting specific diseases or conditions. As technology designed to improve patient care through risk assessment, prevention, and disease management is transferred into clinical practice, dentistry may need to reassess its role in general health care.

cDNA cloning of the B cell membrane protein CD22: a mediator of B-B cell interactions.

We have cloned a full-length cDNA for the B cell membrane protein CD22, which is referred to as B lymphocyte cell adhesion molecule (BL-CAM). Using subtractive hybridization techniques, several B lymphocyte-specific cDNAs were isolated. Northern blot analysis with one of the clones, clone 66, revealed expression in normal activated B cells and a variety of B cell lines, but not in normal activated T cells, T cell lines, Hela cells, or several tissues, including brain and placenta. One major transcript of approximately 3.3 kb was found in B cells although several smaller transcripts were also present in low amounts (approximately 2.6, 2.3, and 1.6 kb). Sequence analysis of a full-length cDNA clone revealed an open reading frame of 2,541 bases coding for a predicted protein of 847 amino acids with a molecular mass of 95 kD. The BL-CAM cDNA is nearly identical to a recently isolated cDNA clone for CD22, with the exception of an additional 531 bases in the coding region of BL-CAM. BL-CAM has a predicted transmembrane spanning region and a 140-amino acid intracytoplasmic domain. Search of the National Biological Research Foundation protein database revealed that this protein is a member of the immunoglobulin super family and that it had significant homology with three homotypic cell adhesion proteins: carcinoembryonic antigen (29% identity over 460 amino acids), myelin-associated glycoprotein (27% identity over 425 amino acids), and neural cell adhesion molecule (21.5% over 274 amino acids). Northern blot analysis revealed low-level BL-CAM mRNA expression in unactivated tonsillar B cells, which was rapidly increased after B cell activation with Staphylococcus aureus Cowan strain 1 and phorbol myristate acetate, but not by various cytokines, including interleukin 4 (IL-4), IL-6, and gamma interferon. In situ hybridization with an antisense BL-CAM RNA probe revealed expression in B cell-rich areas in tonsil and lymph node, although the most striking hybridization was in the germinal centers. COS cells transfected with a BL-CAM expression vector were immunofluorescently stained positively with two different CD22 antibodies, each of which recognizes a different epitope. Additionally, both normal tonsil B cells and a B cell line were found to adhere to COS transfected with BL-CAM in the sense but not the antisense direction.(ABSTRACT TRUNCATED AT 400 WORDS)

Quantitative analysis of mononuclear cells expressing human immunodeficiency virus type 1 RNA in esophageal mucosa.

The mucosa of the gastrointestinal tract is presumably an important reservoir for human immunodeficiency virus type 1 (HIV-1), but the level of virus-expressing cells within the mucosa of infected patients is not known. To study this issue, we identified HIV-1 mRNA-expressing (positive) mononuclear cells by in situ hybridization in specimens of esophageal mucosa from eight patients with acquired immune deficiency syndrome (AIDS) and esophageal infections. Such cells were not found in four patients with AIDS and no esophageal disease. Immunocytochemical staining revealed that the mononuclear cells expressing HIV-1 mRNA were lamina propria macrophages. The prevalence of positive cells was measured by triplicate determinations in each of three experiments using an inverse sampling technique. No significant differences in prevalence were found among patients or among experiments. The overall prevalence of HIV-1 mRNA-expressing cells in the esophageal lamina propria was 0.059 +/- 0.01%. This prevalence of cells expressing HIV-1 mRNA in the mucosa of patients with mucosal infections may reflect the local abundance of stimuli such as bacterial endotoxin and certain cytokines capable of inducing viral transcription.

Endothelins, peptides with potent vasoactive properties, are produced by human macrophages.

Endothelins are peptides, originally isolated from endothelial cells, with potent vasoactive and mitogenic properties. In this study, we demonstrate that human macrophages synthesize and secrete endothelins. Cultured human macrophages were found by immunocytochemistry to stain positively for endothelin 1 and endothelin 3. Their capability to produce and release these peptides was confirmed by a combination of reverse-phase high-performance liquid chromatography and radioimmunoassays, specific for endothelin 1 and 3, respectively. Immunoreactive peptides were identified both in cellular extracts and in macrophage-conditioned medium. The secretion of endothelin 1, but not of endothelin 3, from macrophages could be stimulated 6-10-fold by lipopolysaccharide or phorbol myristate acetate (PMA). Northern blot analysis of total macrophage RNA using an endothelin 1 cDNA probe revealed induction of endothelin mRNA in PMA-treated macrophages. Furthermore, immunoreactive endothelin 1 and 3 were found in U937 cells, a human promonocytic line, and in freshly isolated human monocytes. In contrast, no immunoreactive endothelin was detected in cell extracts from human neutrophils and lymphocytes. The expression of endothelins in tissue macrophages was demonstrated in paraffin sections of human lung using immunohistochemistry. In conclusion, the finding that human macrophages produce endothelins suggests an important role for these peptides in the microenvironment of tissue macrophages. Macrophage-derived endothelins may have an essential function in blood vessel physiology, and aberrant production may contribute to vessel pathology.

Assessing the Translation of Research and Innovation into Dental Practice.

INTRODUCTION: Over the past 100 y, there have been an unprecedented number of innovations that have improved oral health and functioning. Variations in lag times between discovery and clinical adoption are related to dentist education, the clinical availability of technology, and the perceived value of an innovation. OBJECTIVES: The purposes of this cross-sectional study were 1) catalogue research discoveries and innovations over the past 30 y and 2) from that list identify those which practicing dentists believe have maximally affected patient care. METHODS: Thirty International Association for Dental Research leaders identified innovations over the past 30 y that have significantly affected dental care. The 30 most cited innovations were included in a questionnaire that was sent to a random sample of US dentists who graduated dental school during or before 1995 (before the recency of identified discoveries) and devoted ≥50% of their time to patient care. Eighty-two percent of respondents identified as general dentists and 18% as specialists. Respondents were asked to identify 5 to 7 items whose loss would have the most adverse effects on patient care. RESULTS: The most cited advances were adhesive dental materials (74.5%), dental implants (71.9%), direct bonding systems (71.2%), dental loupes (54.7%), universal precautions for infection control (48.6%), and digital imaging (46.0%). There were differences in the ranking of responses between generalists and specialists. For the oral surgeons and periodontists (OMSPER, n = 51), top choices were dental implants (82%), cone beam computed tomography (CBCT) imaging (74%), regenerative dentistry and tissue engineering (68%), universal precautions (58%), digital imaging (56%), and dental loupes (48%). CONCLUSIONS: There was agreement among generalists and specialists about the importance of dental implants, digital imaging, use of dental loupes, and universal precautions in improving patient care. However, generalists also cited the importance of adhesive dental materials and bonding, and OMSPER cited CBCT and biological-based tissue restoration as major advances. KNOWLEDGE TRANSFER STATEMENT: Many advances in dental patient care capitalize on innovations and technologies that have emerged after dentists graduate from dental school. Adoption of new technologies is influenced by information acquired from professional journals, continuing education, industry marketing activities, and interactions with colleagues. The results of this study suggest that innovations that are directly related to clinical procedures were rated most impactful. Future research should consider cost-effectiveness and patient perceptions on the impact of innovations and technologies.

Survey of Dental Researchers' Perceptions of Sexual Harassment at AADR Conferences: 2015 to 2018.

The American Association for Dental Research (AADR) is committed to providing a collegial, safe, and welcoming environment for all. As part of this effort, we assessed perceptions and experiences related to sexual, gender-based, and non-gender-based harassment among registrants at AADR annual meetings from 2015 to 2018 (n = 10,495); examined demographic factors associated with reported experiences; and identified facilitators and potential solutions concerning these types of harassment. Registrants were emailed an invitation to an anonymous online survey. Demographics were assessed categorically, and response distributions to close-ended survey items were evaluated by these variables. Bivariate analyses of participant demographics were conducted with 8 types of perceived harassment. To determine the demographic distribution of reporters, along with bivariate associations among them, restricted analyses were performed among individuals reporting any type of harassment. Qualitative data analysts conducted content analysis of the open-ended responses to questions asking participants to reflect on the topic. Peer debriefing was used to refine the coding schema. A total of 824 responses were received, of which 172 individuals reported experiencing ≥1 of the 8 types of harassment surveyed. Among those, reports of condescending remarks occurred most frequently (70%). Reported harassment of a more sexual nature was less common by comparison. Reporters of harassment were more likely to be women, members of the AADR/CADR (Canadian Association for Dental Research) divisions, and/or frequent meeting attendees. A total of 229 respondents answered at least 1 of the open-ended questions. While the majority of survey respondents reported no personal experience with harassment at AADR meetings, the fact that 1 in 5 did should be cause for concern. In 2018, AADR introduced a "Professional Conduct at Meetings Policy" delineating unacceptable behaviors, including intimidating or harassing speech and actions. Results of this survey form an important baseline from which its impact may be monitored to ensure that future AADR meetings are respectful, supportive, and safe environments for all.

Quantitative reflection contrast microscopy of living cells.

Mammalian cells in culture (BHK-21, PtK2, Friend, human flia, and glioma cells) have been observed by reflection contrast microscopy. Images of cells photographed at two different wavelengths (546 and 436 nm) or at two different angles of incidence allowed discrimination between reflected light and light that was both reflected and modulated by interference. Interference is involved when a change in reflected intensity (relative to glass/medium background reflected intensity) occurs on changing either the illumination wavelength or the reflection incidence angle. In cases where interference occurs, refractive indices can be determined at points where the optical path difference is known, by solving the given interference equation. Where cells are at least 50 nm distant from the glass substrate, intensities are also influenced by that distance as well as by the light's angle of incidence and wavelength. The reflected intensity at the glass/medium interface is used as a standard in calculating the refractive index of the cortical cytoplasm. Refractive indices were found to be higher (1.38--1.40) at points of focal contact, where stress fibers terminate, than in areas of close contact (1.354--1.368). In areas of the cortical cytoplasm, between focal contacts, not adherent to the glass substrate, refractive indices between 1.353 and 1.368 were found. This was thought to result from a microfilamentous network within the cortical cytoplasm. Intimate attachment of cells to their substrate is assumed to be characterized by a lack of an intermediate layer of culture medium.

The reservoir for HIV-1 in human peripheral blood is a T cell that maintains expression of CD4.

Human immunodeficiency virus type 1 (HIV-1) selectively infects cells expressing the CD4 molecule, resulting in substantial quantitative and qualitative defects in CD4+ T lymphocyte function in patients with acquired immunodeficiency syndrome (AIDS). However, only a very small number of cells in the peripheral blood of HIV-1-infected individuals are expressing virus at any given time. Previous studies have demonstrated that in vitro infection of CD4+ T cells with HIV-1 results in downregulation of CD4 expression such that CD4 protein is no longer detectable on the surface of the infected cells. In the present study, highly purified subpopulations of peripheral blood mononuclear cells (PBMCs) from AIDS patients were obtained and purified by fluorescence-automated cell sorting. They were examined with the methodologies of virus isolation by limiting dilution analysis, in situ hybridization, immunofluorescence, and gene amplification. Within PBMCs, HIV-1 was expressed in vivo predominantly in the T cell subpopulation which, in contrast to the in vitro observations, continued to express CD4. The precursor frequency of these HIV-1-expressing cells was about 1/1000 CD4+ T cells. The CD4+ T cell population contained HIV-1 DNA in all HIV-1-infected individuals studied and the frequency in AIDS patients was at least 1/100 cells. This high level of infection may be the primary cause for the progressive decline in number and function of CD4+ T cells in patients with AIDS.

Benthic walking, bounding, and maneuvering in flatfishes (Pleuronectiformes: Pleuronectidae): New vertebrate gaits.

Video-based observations of voluntary movements reveal that six species of pleuronectid flatfishes use sequential portions of long-based dorsal and anal fins as "feet" (hereafter, fin-feet) to move on the substrate. All six species used a gait that we term "walking," which produced constant forward movement, and several of these species also used a second gait that we call "bounding" for intermittent movements over the substrate. We selected Pacific Sand Sole, Psettichthys melanostictus, and English Sole, Parophrys vetulus, for kinematic analyses of these two gaits. Psettichthys melanostictus consistently used walking for benthic locomotion; Parophrys vetulus primarily used a bounding gait. During forward walking, a fin ray swings up off the substrate, protracts and converges with neighboring fin rays to contribute to a fin-foot. The fin-foot pushes down on the substrate and rotates posteriorly by sequential recruitment of fin rays, a pattern known as a metachronal wave. As one fin-foot passes off the posterior end of the fin, a new fin-foot forms anteriorly. During bounding, undulations of the body and tail assist one or two waves of fin-feet, producing rapid but intermittent forward acceleration of the body. Flatfishes also use fin-feet to maneuver on the substrate. The Starry Flounder, Platichthys stellatus, performs near zero displacement rotation by running waves of fin-feet in opposing directions along the dorsal and anal fins. Although other teleosts use specialized pectoral fin rays for bottom walking (e.g., Sea Robins: Triglidae), the duplication of structures and patterns of movement in the median fins of flatfishes more closely resembles metachronal motions of millipede feet or the parapodia of polychaete worms. Sequential use of median fin rays in flatfishes resembles that of other teleosts that swim with elongate median fins, including Amiiformes, Gymnotiformes, and some Tetraodontiformes, but flatfishes offer a novel form of substrate locomotion based on dorsal and anal fins.

Predicting the duration of antiviral treatment needed to suppress plasma HIV-1 RNA.

Effective therapeutic interventions and clinical care of adults infected with HIV-1 require an understanding of factors that influence time of response to antiretroviral therapy. We have studied a cohort of 118 HIV-1-infected subjects naive to antiretroviral therapy and have correlated the time of response to treatment with a series of virological and immunological measures, including levels of viral load in blood and lymph node, percent of CD4 T cells in lymph nodes, and CD4 T-cell count in blood at study entry. Suppression of viremia below the limit of detection, 50 HIV-1 RNA copies/mL of plasma, served as a benchmark for a successful virological response. We employed these correlations to predict the length of treatment required to attain a virological response in each patient. Baseline plasma viremia emerged as the factor most tightly correlated with the duration of treatment required, allowing us to estimate the required time as a function of this one measure.

Heterozygosity for a defective gene for CC chemokine receptor 5 is not the sole determinant for the immunologic and virologic phenotype of HIV-infected long-term nonprogressors.

HIV-1-infected long-term nonprogressors are a heterogeneous group of individuals with regard to immunologic and virologic markers of HIV-1 disease. CC chemokine receptor 5 (CCR5) has recently been identified as an important coreceptor for HIV-1 entry into CD4+ T cells. A mutant allele of CCR5 confers a high degree of resistance to HIV-1 infection in homozygous individuals and partial protection against HIV disease progression in heterozygotes. The frequency of CCR5 heterozygotes is increased among HIV-1- infected long-term nonprogressors compared with progressors; however, the host defense mechanisms responsible for nonprogression in CCR5 heterozygotes are unknown. We hypothesized that nonprogressors who were heterozygous for the mutant CCR5 gene might define a subgroup of nonprogressors with higher CD4+ T cell counts and lower viral load compared with CCR5 wild-type nonprogressors. However, in a cohort of 33 HIV-1-infected long-term nonprogressors, those who were heterozygous for the mutant CCR5 gene were indistinguishable from CCR5 wild-type nonprogressors with regard to all measured immunologic and virologic parameters. Although epidemiologic data support a role for the mutant CCR5 allele in the determination of the state of long-term nonprogression in some HIV-1- infected individuals, it is not the only determinant. Furthermore, long-term nonprogressors with the wild-type CCR5 genotype are indistinguishable from heterozygotes from an immunologic and virologic standpoint.

The NIH's Funding to US Dental Institutions from 2005 to 2014.

This study examines funding from the National Institutes of Health (NIH) to US dental institutions between 2005 and 2014 based on publicly available data from the NIH Research Portfolio Online Reporting Tools. Over the 10-y span, 56 US dental institutions received approximately $2.2 billion from 20 Institutes, Centers, and Offices at the NIH. The National Institute of Dental and Craniofacial Research (NIDCR) is the largest NIH supporter of dental institutions, having invested 70% of the NIH total, about $1.5 billion. The NIDCR is also the primary supporter of research training and career development, as it has invested $177 million, which represents 92% of the total NIH investment of $192 million. Over the past 10 y, about half of the NIDCR's extramural award dollars have gone to dental schools, while the NIH has invested about 1%. There has been an approximately 10% net decrease in extramural dollars awarded to dental institutions over the past decade; however, given the year-to-year variability in support to dental institutions, it is unclear if this net decline reflects a long-term trend. In addition, there was an overall reduction in the extramural dollars awarded by the NIDCR and by the NIH. For example, from 2005 to 2014, the total NIDCR budget for extramural research decreased by roughly 4%, which represents a decrease of $20 million to dental institutions. After adjusting for inflation, the decline in funding to dental institutions from the NIDCR and NIH was approximately 30%. Although the NIDCR and NIH continue to invest in dental institutions, if the current decline were to continue, it could negatively affect the research conducted at dental institutions. Therefore, we discuss opportunities for dental institutions to increase NIDCR and NIH support and improve their capacity for research, research training, and career development.