A Summary and View of the Future WILLIAM H. BOWEN National Caries Program, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland 20014 I believe we have had a most stimulating and productive conference and certainly one that I will remember for a considerable time. While we have much to be satisfied with, at the same time, we have no reason to be overconfident. It would be deterimental to the future of dental research, and particularly to the best interests of the caries program, if we were not to recognize the gaps in our
knowledge. This conference has illustrated the necessity of drawing on many talents and diverse skills to understand the pathogenesis of dental caries and to develop techniques and methods for its prevention. It has further shlown the sterility of debating the merits of so-called basic research versus applied research. When this kind of controversy is allowed to flourish-and it is fairly prevalent at the moment-it is usually people, namely the taxpayer, who suffer. Pasteur said there is only one kind of research, "research and its applications." The question now remains of how to apply all that we have learned over the past several days. We cannot go on indefinitely with what some would refer to as Baconian research in which we accumulate knowledge for knowledge's sake. Real progress is made when we use our newly gained information to test hypotheses, formulate new ones, or apply it directly to prevent or treat disease. It would be difficult to summarize this conference in a few minutes; there are, however, a number of points that I believe need to be emphasized. It has become clear, first of all, that the conditions under which microorganisms are grown will influence their composition and their metabolic products. These phenomena have been referred to by a number of workers. Excess attention clearly cannot be placed on these growth conditions if we are to relate occurrences in vitro to the situation in the mouth. There is little doubt
tlhat the application of chemostat teclhniques can enhance our understanding of microbial interactions and may enable us to develop an in vitro model for the investigation of
plaque. I was greatly impressed by the detailed analysis of cell wall antigens, although with one exception, that described by Dr. Hammond in his classic paper, we do not know how, or even whether, these antigens are associated with virulence. The detailed attention lavished on obtaining chemicallv defined antigens is in marked contrast to the standards that we sometimes appear to be prepared to accept in our animals. We seem on occasion to be willing to place these precious antigens into animals that have been derived under poor conditions and housed under less than optimum circumstances. The uneven standards of animal husbandry may perhaps contribute to the diversity of results. I would also stress that immunization schedules be recorded in detail. I believe in many cases the experiments, as described, could not be reproduced in other laboratories. I feel sure that we all admire the specific fluorescent antiserums prepared by the investigators in the Center for Disease Control. It concerned me just a little when it appeared that some may believe that the effort made may not make a significant contribution in the study of dental disease and dental caries in particular. Frequently, the mere existence of a sophisticated tool that enables an investigator to expand his range of activities stimulates research. We need only look at the laser, which some years ago was regarded as an interesting phenomenon; however, the amount of research evoked by the development of this instrument is remarkable. How many of us have not used fluorescent A205
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antibody techniques extensively because we were uncertain of the specificity and quality of the antiserums that were available? Development of these highly specific antiserums will enable us to carry out epidemiological work and to study the transmission of organisms within families and family groups and perhaps even from one population to another. It will also enable us to determine whether particular serotypes localize in specific situations in the mouth. More importantly, they may well stimulate research into determining the factors that determine
J Dent Res Special Issue A
why S mutans localizes, and provoke more research into the development of the oral flora from birth. We are particularly lacking knowledge in that area now. The lack of a simple caries predictive test, which would obviate the necessity of carrying out long-term clinical investigations, is a major deficit in our knowledge. Application of FA techniques may enable us to overcome this problem, in part at least, and thereby expedite the development of safe and effective means of controlling dental caries.
Downloaded from jdr.sagepub.com at DALHOUSIE UNIV on May 18, 2015 For personal use only. No other uses without permission.
knowledge. This conference has illustrated the necessity of drawing on many talents and diverse skills to understand the pathogenesis of dental caries and to develop techniques and methods for its prevention. It has further shlown the sterility of debating the merits of so-called basic research versus applied research. When this kind of controversy is allowed to flourish-and it is fairly prevalent at the moment-it is usually people, namely the taxpayer, who suffer. Pasteur said there is only one kind of research, "research and its applications." The question now remains of how to apply all that we have learned over the past several days. We cannot go on indefinitely with what some would refer to as Baconian research in which we accumulate knowledge for knowledge's sake. Real progress is made when we use our newly gained information to test hypotheses, formulate new ones, or apply it directly to prevent or treat disease. It would be difficult to summarize this conference in a few minutes; there are, however, a number of points that I believe need to be emphasized. It has become clear, first of all, that the conditions under which microorganisms are grown will influence their composition and their metabolic products. These phenomena have been referred to by a number of workers. Excess attention clearly cannot be placed on these growth conditions if we are to relate occurrences in vitro to the situation in the mouth. There is little doubt
tlhat the application of chemostat teclhniques can enhance our understanding of microbial interactions and may enable us to develop an in vitro model for the investigation of
plaque. I was greatly impressed by the detailed analysis of cell wall antigens, although with one exception, that described by Dr. Hammond in his classic paper, we do not know how, or even whether, these antigens are associated with virulence. The detailed attention lavished on obtaining chemicallv defined antigens is in marked contrast to the standards that we sometimes appear to be prepared to accept in our animals. We seem on occasion to be willing to place these precious antigens into animals that have been derived under poor conditions and housed under less than optimum circumstances. The uneven standards of animal husbandry may perhaps contribute to the diversity of results. I would also stress that immunization schedules be recorded in detail. I believe in many cases the experiments, as described, could not be reproduced in other laboratories. I feel sure that we all admire the specific fluorescent antiserums prepared by the investigators in the Center for Disease Control. It concerned me just a little when it appeared that some may believe that the effort made may not make a significant contribution in the study of dental disease and dental caries in particular. Frequently, the mere existence of a sophisticated tool that enables an investigator to expand his range of activities stimulates research. We need only look at the laser, which some years ago was regarded as an interesting phenomenon; however, the amount of research evoked by the development of this instrument is remarkable. How many of us have not used fluorescent A205
Downloaded from jdr.sagepub.com at DALHOUSIE UNIV on May 18, 2015 For personal use only. No other uses without permission.
A206
BOWEN
antibody techniques extensively because we were uncertain of the specificity and quality of the antiserums that were available? Development of these highly specific antiserums will enable us to carry out epidemiological work and to study the transmission of organisms within families and family groups and perhaps even from one population to another. It will also enable us to determine whether particular serotypes localize in specific situations in the mouth. More importantly, they may well stimulate research into determining the factors that determine
J Dent Res Special Issue A
why S mutans localizes, and provoke more research into the development of the oral flora from birth. We are particularly lacking knowledge in that area now. The lack of a simple caries predictive test, which would obviate the necessity of carrying out long-term clinical investigations, is a major deficit in our knowledge. Application of FA techniques may enable us to overcome this problem, in part at least, and thereby expedite the development of safe and effective means of controlling dental caries.
Downloaded from jdr.sagepub.com at DALHOUSIE UNIV on May 18, 2015 For personal use only. No other uses without permission.
