May 2008, Volume 4, Issue 5
Published by AEGIS Communications
Columbia University College of Dental Medicine
Question No. 1
Inside Dentistry (ID): What is the most significant area of research at your school?
Columbia University (CU): Research at the College of Dental Medicine (CDM) has developed along "thematic" lines. This concept fosters collaboration of dental faculty with faculty from other health sciences schools at Columbia, as well as schools across the University. A number of these themes have developed, including dental and craniofacial bioengineering, oral infection/oral inflammation and systemic health, social and behavioral determinants of oral health, and skin and mucosal biology.
Dental and craniofacial bioengineering works closely with faculty in the Department of Biomedical Engineering at the Columbia University School of Engineering and Applied Science. This work has focused on the replacement of tissue lost as a result of disease or injury, and includes the engineering of a multi-tissue construct of the human condyle. Another project is exploring the use of adipose stem cells to form soft tissue grafts. These grafts could be used to replace lost soft tissue. A third project is exploring how endothelial stem cells can be used to vascularize engineered connective tissue grafts. This work has attracted a great deal of interest from industry, and intellectual property has developed from this research.
We also have an outstanding research effort examining the relationship of oral infection/inflammation to systemic diseases. Animal models have been developed to study both diabetes mellitus as a risk factor for periodontal disease, and the effect of periodontal infection on cardiovascular disease. Clinical trials have examined the effect of periodontal therapy on pregnancy outcomes, the relationship of periodontal infection to the risk for ischemic stroke, and the occurrence of periodontal disease in children and adolescents with diabetes mellitus. In related work, our faculty is studying gene expression profiles in periodontal tissue.
Question No. 2
ID: What endeavors have been most successful for you in terms of securing funding for this type of research or other types of translational research?
CU: Obtaining support for research and other related activities is essential for continuing the process of discovery. Our faculty has been successful in obtaining support from the National Institutes of Health (including the National Institute for Dental and Craniofacial Research, the National Institute for Bioengineering and Biomedical Imaging, and the National Institute for Allergy and Infectious Diseases). We have also been successful in obtaining support from industry and foundations. It is important to emphasize that other sources of funding which do not directly support research, such as the Health Resources and Services Administration and the New York State legislature, provide funding for some of our patient care programs that serve as the foundation for clinical research.
Question No. 3
ID: The demographics of dental schools overall—in terms of faculty composition and the student population—are changing. What changes have you seen at your school in particular?
CU: In 2003, the CDM was one of two dental schools that participated in a pilot program to add a dental component to the successful Summer Medical Education Program (SMEP). Funded by the Robert Wood Johnson Foundation, this was a 6-week program for college-age, underrepresented minorities who sought a career in medicine. The pilot program added students who were interested in a career in dentistry, and our College developed a linked but parallel track focusing on dentistry. The 2-year pilot proved very successful, and when the SMEP program was renewed by the Foundation, a formal dental component was added. The pilot, and now the fully funded program, have helped change the nature of our student body. While traditionally having a diverse student body, the College still lacked a critical number of African-American, Hispanic, and Native American students. The SMEP program, along with the creation of an Office of Diversity and Multicultural Affairs and the selection of an associate dean to lead that office, have allowed us to recruit a greater number of UID (underrepresented in dentistry) students. In the past few years, 10% to 15% of our entering class have been UID students.
Question No. 4
ID: How has your school responded to these changes, and what have the reactions been from students, faculty, and administrators?
CU: These changes have been transformational for the College. The students we have been able to recruit have become student leaders, and have helped to change our environment. As examples, the Student National Dental Association, which traditionally is the organization of African-American dental students, has evolved into a student organization focused on issues related to care for the underserved and recruitment of UID college students to a career in dentistry. The effects upon the College have been positive in many ways. As an example of our success, this year both the President of the Student National Dental Association and the American Student Dental Association are Columbia predoctoral students, and both are African-American.
Question No. 5
ID: There are many challenges and opportunities in oral healthcare. What do you see as the most urgent need, and how does your school differentiate itself in efforts to respond to those challenges and opportunities?
CU: This is a critical question for the dental profession. The challenges include no less than defining the future of the profession, the critical issue of access to care for all Americans, and the role of dental schools within their universities.
We believe that dental practitioners must be members of the health sciences fraternity, and be prepared to care for patients with complex medical and pharmacological histories, as well as dental needs. To accomplish this, our dental students have essentially the same basic science/pre-clerkship courses as the first- and second-year medical students at Columbia. Further, we stress the importance of at least 1 year of postdoctoral training.
As a school, we are focused on care to the underserved. Approximately 50% of the patients treated in the predoctoral, postdoctoral, and residency clinics have Medicaid insurance, and last year we provided more than $6 million of uncompensated care. The College also offers specific offsite care programs for children and older adults. These offsite programs have been developed by placing clinics in local schools, and our outreach to older adults begins by visits to senior centers, and individuals needing care are referred to a limited number of community-based treatment sites.
Dental schools at major universities must be aware of how their mission is in line with the mission of their parent university. In the case of the CDM, there is a recognition of the importance of being a valuable community partner, as well as a global citizen. We have developed an international program focused on both academic exchange and provision of care. We have signed agreements with 10 dental schools across Europe, Asia, and the Middle East. Our international care programs extend to a collaboration with the Millennium Villages Project, which is a joint effort of the Earth Institute at Columbia and the United Nations. In this program, faculty, residents, and students visit the villages, perform a needs-assessment, and will be working to develop a sustainable oral healthcare program. These efforts offer many wonderful professional opportunities for our faculty, residents, and students.
Ira B. Lamster, DDS, MMSc
Martin J. Davis, DDS
Joseph M. McManus, Jr,DMD, MS, MHA