NIH – Biologic Factors Underlying Dental, Oral, and Craniofacial Health Disparities (R01, R21 – Clinical Trial Not Allowed)

August 1, 2018 by School of Medicine Webmaster

The following description was taken from the R01 version of this FOA.

The purpose of this funding opportunity announcement (FOA) is to encourage research on biologic factors that mediate the differences in prevalence and severity of Dental, Oral, and Craniofacial (DOC)-related diseases and conditions in oral health disparities populations.  It is long recognized that certain racial and ethnic populations suffer an increased burden of DOC diseases and conditions, such as oral/oropharyngeal cancers, early childhood caries (ECC), dental caries, and periodontitis. For each of these diseases, substantial racial and ethnic differences exist in prevalence, severity, persistence and/or disease progression. Biologic factors are believed to play a role in oral health disparities in addition to behavioral, social, and environmental factors. Because critical scientific gaps remain in our understanding of underlying biologic mechanisms that could contribute to these differences, it is difficult to develop targeted therapeutic regimens for those in greatest need.


Recent studies of some non-DOC diseases demonstrating racial/ethnic disparities have identified biologic factors as possible reasons for differences in disease outcomes. African American women are as likely to get breast cancer as white American women, yet they have a higher breast cancer death rate. Tumor analyses indicate that the disparity in death rates may be due in part to an increased risk of triple-negative breast cancer in African American women as compared to women from other racial/ethnic groups in the US. Biologic factors may contribute to other cancer health disparities, such as differences in colorectal cancer and prostate cancer incidence and mortality in African-Americans.

African-Americans who develop oral cavity and oropharyngeal cancers (OPC) have consistently had poorer survival than whites. An analysis of SEER data from 1973 to 2008 found that the 5-year relative survival of whites with squamous cell carcinoma of the tongue, base of tongue and tonsils was close to 57%, while blacks had a survival rate of close to 33%. While recent data indicate there has been a slight improvement in 5-year relative survival for oral cancers, African-Americans continue to experience much poorer survival. Whites are more likely to have human papillomavirus (HPV)-positive OPC, which is associated with better survival and may account for some of the long-term differences in outcomes; however, other biologic factors have not been explored in detail.

Caries is much more prevalent in African-American, Hispanic and American Indian / Alaska Native children. Investigations of biologic factors have focused on whether these children harbor more virulent strains of Streptococcus mutans (S. mutans), whether humoral responses differ by racial/ethnic group, timing of tooth eruption, and whether varying concentrations of selected salivary innate immunity proteins are associated with different caries outcomes. To date, highly virulent S. mutans strains that could account for the higher caries burden in children with oral health disparities have not been identified, though children with more S. mutans genotypes had higher levels of caries. However, few studies have examined the microbial flora other than S. mutans and Lactobacillus, and few have used comprehensive methods of comparing salivary proteins in different populations.

There are multiple reports that African-Americans and other minority populations exhibit increases in the prevalence and severity of destructive periodontal disease as compared to US whites. Differences in disease prevalence by race were found in studies of children and young adults, and in analysis of NHANES III data after adjustment for age and gender. Preliminary studies suggest differences in subgingival bacterial profiles are associated with this increased prevalence and severity of disease in African-Americans, while ethnic/racial differences in host response to bacterial colonization, including serum antibody levels also were identified in small cohort studies.

New in vitro technologies to examine the oral microbiome, inflammatory mediators of periodontal disease, genetic risk/protective factors, social epigenomics and salivary proteins could be employed to advance research to explore biologic factors underlying oral health disparities. Cross-sectional studies could be proposed that involve collection of biospecimens from racially and ethnically diverse populations for disease. Existing biorepositories with matched oral health clinical data can also be used to accelerate this area of research.

Since the goal of this initiative is to better understand the underlying mechanisms of documented disparities in DOC diseases, studies whose sole purpose is to assess incidence and prevalence of DOC diseases in specific populations or subpopulations are not appropriate for this FOA.

The scope of this FOA includes but is not limited to, research on:

  • Microbial and inflammatory mediators of oral diseases in different racial/ethnic groups, and their contribution to racial/ethnic differences in disease prevalence, severity and/or outcomes.
  • The biologic responses to social, environmental, behavioral, cultural, and socioeconomic factors that contribute to oral health disparities.
  • Research defining mechanisms by which social factors lead to biologic changes that affect health disparities
  • Biologic responses to conventional therapy for dental, oral, and craniofacial diseases that may explain the persistence of these diseases in different health disparities populations.
  • Genetic/genomic risk or protective factors that might contribute to racial/ethnic differences in dental caries and periodontal diseases, and the interplay with other factors.
  • Genetic/genomic risk factors that could contribute to poorer health outcomes among various health disparity populations with oral and oropharyngeal cancers.

NIMHD Research Interests

NIMHD is interested in etiologic studies focused on biological mechanisms and pathways that influence DOC-related health disparities, including mechanisms by which individual behavioral risk and protective factors and structural and cultural extrinsic factors such as neighborhood social environment (e.g., social cohesion, social capital, collective efficacy, community resilience), structural barriers and facilitators (e.g., access to healthy foods, access to dental preventive care), and environmental exposures affect physiological functioning at various stages in life and thereby influence health trajectories or modify disease risk. Projects must focus primarily on one or more health disparity populations (African Americans/Blacks, Hispanics/Latinos, American Indians/Alaska Natives, Asians, Native Hawaiians and Other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minority populations). Comparison groups or populations may be included as appropriate for the research questions posed. Settings of interest include but are not limited to low-resourced urban neighborhoods and communities, rural communities, and health care settings. NIMHD will not accept applications under this FOA that propose using only animal and/or in vitro model systems.

Studies examining biologic responses to conventional therapy for dental, oral, and craniofacial diseases that may explain the persistence of these diseases in different racial/ethnic minority populations will be considered clinical trials if conventional therapy is delivered as part of the research procedures.  These applications are encouraged, but investigators must apply to a different FOA that allows clinical trials, such as the NIDCR Clinical Trial Planning and Implementation Cooperative Agreement (UG3/UH3).

Deadlines:  standard dates and standard AIDS dates apply


Filed Under: Funding Opportunities