Dental school seizes opportunities to raise its research profile
by C.W. Wolff

It was just four words in a short story in a New Jersey newspaper, but it was exceptionally gratifying to some at the dental school. The story quoted Dr. Michael Rosenblatt about his appointment as Tufts medical school dean. Rosenblatt noted he would be in the “good company” of bone disease researchers “at several of Tufts’ schools, including the dental school.”

Researchers Driss Zoukhri and Jake Chen are helping the dental school build a basic science research program © Kathleen Dooher

Rosenblatt’s own research focuses on bone metabolism, so the comment wasn’t surprising. But mention of the dental school was.

Dr. Lonnie H. Norris, dean of the School of Dental Medicine, was pleased, according to Dr. Gerard Kugel, the school’s associate dean for research: “He said to me, ‘When in the world would we ever expect the new dean of the medical school to mention our school in terms of basic research?’ ”

Not until recently, most agree, because it was in 1999 that the dental school launched a strategic planning effort for a full-scale basic science research program. Since then, the dental school has built new research space and hired a research program administrator and four scientists, including two who arrived with National Institutes of Health (NIH) research grants.

In addition, Tufts was one of 15 dental schools in the country to secure a $95,500 planning grant from the National Institute of Dental and Craniofacial Research (NIDCR) to plot what infrastructure is needed to develop a sustainable, credible research program. A university-wide Institutional Planning Committee is developing that research strategy. There is the opportunity, under the second phase of the NIDCR grant, to receive a second award of up to $1 million to implement the research program.

Faculty and administrators at the dental school are exploring collaborative research with Tufts’ other schools, especially the School of Engineering’s biomedical engineering program. “We don’t intend to be a major player in research in the near future,” said Patricia Campbell, the dental school’s executive associate dean. “But we want to be a significant player.”

The timing is right. “Our resources are better than in the past; our applicant pool is larger and more varied. It’s a time when we can add faculty without sacrificing anything,” including the school’s focus on patient care, Norris said. “We have a reputation nationally and internationally for our clinical program and for developing dentists of the highest caliber. Our primary goal is to maintain that reputation.”

Looking back
There was a time in the 1950s and 1960s when Tufts was a “hotbed for periodontal research,” Kugel said. “We had at least half a dozen faculty involved in basic research, some good basic science.”

Students also got involved, primarily through the school’s annual Bates-Andrews Research Day competition. Some have gone on to careers in dental research, including Dr. Bruce Baum, D71, who heads the NIDCR’s gene therapy and therapeutics branch.

But in 1971, the school downsized to a three-year curriculum, leaving little time for research by faculty or students. “When we converted back to the four-year curriculum, we began integrating research back into the program,” Norris said. “But we focused mainly on clinical research—such as testing dental materials and therapies.”

Tufts isn’t alone. A 1995 book-length study of dental education by the Institute of Medicine noted that dental schools generally focus on clinical education and are isolated from their universities, especially their universities’ research communities, which tend to eschew clinical research.

Only a half-dozen of the nation’s 54 dental schools have substantial, basic science research programs. Forty-four dental schools, including Tufts, responded “not applicable” when asked about federally funded biomedical research in a 2001 American Dental Association (ADA) survey of trends at U.S. dental schools. Among the dental schools receiving federal biomedical research support, three accounted for almost $22 million of the $23.5 million in such funding reported.

When Petros Damoulis and Eleni Gagari joined the dental faculty in 1999, the school expanded its research laboratories on the Boston campus. © Kathleen Dooher

Funded research at the dental school has increased steadily over the past four years, according to Carol Marshall, the school’s director of administration and finance, Funding rose from $3.6 million in fiscal year 2000, to $4.6 million this year, and is expected to be $4.7 million next year. That compares with $2.8 million in 1995.

Tufts has a “realistic chance of placing among the nation’s top 10 dental schools in terms of research,” said Naomi Rosenberg, dean of the Sackler School of Graduate Biomedical Sciences, who is principal investigator of the dental school’s NIDCR planning grant. Success, Rosenberg said, will require “a cohesive development plan.”

Ingredients for success
Besides a cohesive plan, “all you need is energy, money and people,” jokes David Kaplan, professor and chair of biomedical engineering, who also serves on the dental research planning committee. Kaplan helped develop and now directs Tufts’ biomedical engineering program at the School of Engineering, which actively seeks research collaborations with other Tufts schools, including the dental school.

Time is another necessary factor. “Right now our faculty spend 80 percent of their time teaching,” Norris said. “We would like to see some faculty spending 80 percent of their time in the lab.” And he’d like to see students have more time for research.

One long-range goal is to increase from 5 percent to 10 percent the number of dental students extensively involved in research. However, a packed clinical curriculum, especially for third- and fourth-year students, places constraints on students’ availability to conduct research. Further on the horizon is the possibility of either a dual-degree (D.M.D./Ph.D.) or a Ph.D. program.

Time also is needed to change perceptions—within and outside the school. “Our profession is way beyond drill, fill and bill,” said Dr. Petros Damoulis, director of graduate research at the dental school. “But that’s the public perception.”

Changing this perception, especially within the profession is important, Damoulis said. He believes that better integrating research into the dental curriculum would provide the intellectual training the evolving profession demands.

Then there’s focus. With such a small program and just starting out, seeking a research niche is essential, according to Rosenberg. Bone development and function is likely to be that focus for the dental school because some research in that area is already under way. That area of inquiry is also “translational”—relevant to Tufts dental students, faculty and, in the foreseeable future, patients. And it dovetails with ongoing investigations in other Tufts schools, allowing natural corridors for collaboration.

Cross-disciplinary collaboration is central to the dental school’s research plan—both practically and philosophically. It is also part of Tufts President Lawrence S. Bacow’s vision for the university. A great university, Bacow says, has the capacity to work across traditional disciplinary boundaries and integrates teaching and research.

Oral health, increasingly recognized as an important component of overall health, requires broad scientific investigation. In addition, the dental school’s administration is well aware that at this point, the school needs the mentoring, the resource sharing and the critical mass of established, road-proven researchers.

The non-dental, research-savvy Tufts faculty recruited to serve on the dental research planning committee is impressed with the school’s determination.

“I wouldn’t be investing my time in all these meetings if I didn’t have pretty good confidence that a research program can be built at the dental school,” said Kaplan, the biomedical engineer. “There are two things you need—people who want to take research as a primary focus and a leader who sees the need to do this. Those things are in place, and what’s really good is the school is open to figuring out what the needs are and how to address them.”

An external advisory committee on the research endeavor includes the dental school deans at the University of Michigan and the University of California at San Francisco, the Forsyth Institute’s VP for research and a scientist from Proctor & Gamble Co.

Getting started
In 1999, the school hired two scientist/clinicians, Damoulis and Dr. Eleni Gagari, assistant professor of oral pathology. Damoulis has done work on the role of nitric oxide in bone biology, and Gagari on stem cell factor and its involvement with dental pulp stem cells.

Half of the sixth floor of the dental school on the Boston campus was converted into laboratory space for Gagari and Damoulis. Additional research space since has been added.

The appointment of Dr. Jinkun (Jake) Chen as a professor of general dentistry followed in 2002. Chen brought with him from the University of Texas Health Sciences Center in San Antonio an expertise in building transgenic mice and a laboratory staff of five, including a doctoral student now enrolled at the Sackler School. Chen has a joint appointment in the medical school’s Department of Anatomy and Cellular Biology. He arrived with a $1 million NIH grant to continue his investigation of the genetic regulation of BSP, a bone protein. He secured another $1.4 million NIH grant earlier this year.

This year, Dr. Driss Zoukhri joined the faculty as an assistant professor of general dentistry, coming from the Harvard-affiliated Schepens Eye Research Institute. He has a $1.5 million grant to continue his research on the molecular mechanisms of Sjögren’s syndrome, an autoimmune disease. He holds joint appointments in the medical school’s departments of Neuroscience and Ophthalmology.

Space may prove to be the biggest issue facing the growth of oral health research at the dental school. “There definitely will have to be some university decisions on permanent research space in the next year or two,” Norris said.

If a critical mass of investigators is to be achieved—and allowed the synergy that working in neighboring labs can provide—more space is needed.

Kaplan suggested the university one day may want to develop satellite research programs, putting investigators from several schools in one location.