School of Dentistry Deans Briefing You are not healthy if you do not have oral health' Surgeon Gener

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School of DentistryDeans BriefingYou are
not healthy if you do not have oral health.-
Surgeon General Everett KoopThe mouth is
connected to the rest of the body. - Surgeon
General David SatcherApril 16, 2005
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• Introduction to
• The Magnitude of the Problem

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U.S. Surgeon Generals Report Oral Health in
America(May 2000)

• Oral diseases affect health and well being
  throughout lifespan
• Safe and effective preventive measures do exist
• Lifestyle behaviors that affect general health
  such as tobacco alcohol use, and poor dietary
  choices, also affect oral health
• Major oral health disparities
• The mouth reflects general health and well being

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A Case Study California

• The Neglected Epidemic (1993-1994)
• Halting A Neglected Epidemic (2000)
• HRSA Oral Health Survey (2001)
• USC Southern California Center Health (2001)
• California in the New Millennium, Mark Baldassare
  (2000)

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California in 2004

• State population of 35.4 million projected 50
  million by 2028
• Southern Californias 8 Counties (Santa Barbara,
  Ventura, Los Angeles, Orange, Riverside, San
  Bernadino, San Diego Imperial) 24.4 million
• Largest ethnic group is Latinos gt 58 of State
  youth are Latino
• States growth primarily driven by immigration

• Approximately 224 languages/dialects spoken
• The under-18 population grew gt 20 from 1990-2000
• State Asian-Americans grew by 38 versus 35 for
  Latinos (1990-2000)
• Major issues include education, health and
  challenges such as energy, water, and air quality

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Californias Children

• Only 30 of Californians receive the benefits of
  fluoridated drinking water
• More than 25 of preschool children do not have
  dental insurance
• More than 40 of high school students do not have
  dental insurance
• Between 50 and 75 of minority high school
  students need dental care

• Californias children have twice as much
  untreated tooth decay (dental caries) as the
  national average
• Children living in poverty have increased in
  number with attendant increases in disease
  especially minority children.

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From Conception thru Senescence A Developmental
Perspective and Oral Health/Oral Health Care

• Preconception
• Prenatal
• Neonatal
• Infant/Toddler
• School Children
• Adolescents

• Young Adults
• Mature Adults
• Grandparents
• Elderly
• Terminal illness

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Cleft Lip Cleft Palate

• One of the most common birth defects
• Prevalence is one per hour in the United States
  1 per 500 live births in California
• Direct health costs are approximately 150,000
  per child

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Oral Health Disparities - Children

• Dental caries are caused by transmissible
  bacterial infections from caregiver to infant
• Dental sealants are proven to be 100 effective
  in preventing dental caries on chewing surfaces
  of teeth
• Fluoridation of community drinking water is the
  major factor responsible for the decline of
  dental caries in the US
• Cleft lip and palate are the fourth most common
  birth defect
• More than 52 million school hours are lost due to
  dental pain and suffering in children

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Anhydrotic Ectodermal Dysplasia First Described
in India by Charles Darwin in the Late 19th
Century (Today known to be X-linked and caused by
TNF-alpha ligand and/or receptor
haploinsufficiency)
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Oral Infection and Systemic Diseases (Viral,
Bacterial and Yeast Pathogens)
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Oral Health Messages

• Over 43 million Americans (including 10 million
  children) are without medical insurance, and more
  than 110 million including 25 million children
  are without dental coverage
• In California, 11 million people do not have
  access to oral health care
• Over 4.2 million live births each year
• A major complication is low birth weight,
  premature babies
• Most common birth defects being craniofacial,
  oral and dental deformities
• The most common chronic disease in children is
  dental caries (58.6 of children 5-17 yrs of age)
• Unintentional injuries to head and neck in
  children is a major health issue (home,
  automobile sports accidents)
• Child and spousal abuse/violence/trauma have
  major oral-dental implications

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Oral Health Messages (contd)

• In 2004, 30 of high school females smoke
  cigarettes
• An American dies every hour of oral cancer
• Periodontal diseases are found in more than 60
  of adults (linked with tobacco products)
• Oral infection is associated with many systemic
  diseases
• Systemic diseases have oral complications (e.g.
  HIV, diabetes, vitamin deficiencies)
• More than 20 of adults report chronic severe
  facial pain
• By 2020, 1 out of every 5 Americans will be 65
  years of age or older
• Osteoarthritis, osteoporosis, diabetes and cancer
  therapy have significant oral complications
• In adults 65-69 yrs of age, 26 are edentulous in
  USA and 58 in this age cohort are edentulous in
  Canada
• Tooth loss, tooth pain, swallowing and facial
  pain are major complaints of poor elderly

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Genetic Factors in Oral Microbial Infections
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Towards Understanding Oral Squamous Cell Carcinoma

• Inherited and acquired gene mutations
• Multiple and sequential gene mutations ( 110 oral
  cancer genes identified)
• Multiple gene-gene and gene-environment
  interactions
• Significant candidate gene mutations associated
  with transcription controls, mitosis, and
  apoptosis

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• California has 23,000 practicing dentists
• 5 schools of dentistry
• The largest state dental society in the nation
  - California Dental Association (CDA)
• A coalition of deans, CDA and foundations
  (RWJ, Kellogg and California Endowment)
• Beginning 2006, new fluoridation implementation
  by MWD that will effect 17 million people
• Significant oral health disparities

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• School of Dentistry
• An Introduction

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The USC School of Dentistry in 1897 In 1900,
USCSD graduated the first class of 11
students Birthplaces included Vermont,
Michigan, Iowa, Ohio, California, Germany
Canada On May 2005, USCSD will graduate 38
dental hygiene students, 169 DDS students from 38
countries, 56 advanced dental specialty
residents, MS and PhD Craniofacial Biology
graduate students
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Report of the President University of Southern
California
The College of Dentistry is equipped with the
best apparatus obtainable. In addition to the
regular work of such institutions, much research
work of great importance is being done.
Dr. George F. Bovard, 1912
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The USC School of Dentistry was the first in
California and stood as the undisputed leader in
its field for 50 years
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A Tradition of Innovation, Discovery and
Leadership

• In 1897 USC began training students in
  dentistry, establishing what was to become the
  first dental school in Southern California, and
  for 56 years, the only dental
• school in the southwestern United States.
• Through the endeavors of its faculty and alumni,
  the USC School of Dentistry has garnered national
  and international recognition.
• In 1921, George Hollenback pioneered dental
  materials and instrumentation.
• In 1924, Floyde E. Hogeboom (19) published the
  first textbook on the treatment of children. The
  book was subsequently issued in six editions.
• In 1924, Beverly McCollum (07), a pioneer in the
  field of gnathology (the study of jaw movements
  and occlusion of teeth), conducted research that
  proved the existence of a hinge axis within the
  temporomandibular joint and, working with Charles
  Stuart (40), developed the first device to
  record the movement of the mandible.
• Rafael L. Bowen (53) conducted research on the
  development of resin composite and adhesive
  technology that revolutionized the modern
  practice of dentistry.
• Wilma Motley (33), a noted historian and editor,
  served as president of the Southern California
  and American Dental Hygienists Associations as
  well as the International Federation of Dental
  Hygienists.
• Oral surgeon Marsh E. Robinson (42) developed
  the vertical osteotomy for correction of
  mandibular deformities.

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A Tradition of Innovation, Discovery and
Leadership (contd)

• Founded in 1965, the School of Dentistrys Mobile
  Dental Clinic is the most enduring and most
  extensive, self-contained facility of its
  kindand one of the earliest. Our expertise in
  this area has served as a resource for others
  throughout the country who seek to bring dental
  care to underserved areas.
• In the late 1960s, faculty members Lucien Bavetta
  and Marcel Nimni were among the first to
  understand how the major protein of the body,
  collagen, is formed into ligaments, tendons and
  bone.
• Established in 1974, the School of Dentistrys
  Craniofacial Biology graduate program was the
  first of its kind in the country.
• In 1983, researcher Malcolm Snead and his team
  were the first to identify, characterize and
  clone the dental gene amelogenin.
• USC dentistry dean Harold Slavkin (65) is a
  former director of the National Institute of
  Dental and Craniofacial Research, one of the
  National Institutes of Health.
• In 2003, alumnus and associate dean Eugene
  Sekiguchi (74) became the third USCSD graduate
  to serve as president of the American Dental
  Association and the first minority to hold the
  post.
• Researcher Janet Moradian-Oldaks recent findings
  on the function of amelogenin in enamel
  biomineralization holds promise for biomimetic
  approaches to design and fabricate enamel for
  dental restoration and medical devices.

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Building Strategic Capabilities for the
University

• VISION
• Research and scholarship that advances knowledge
  and at the same time addresses issues of critical
  importance to our community, the nation, and the
  world
• Increase global presence that will increase
  international visibility, reach, and the impact
  of our research, scholarship, art, education and
  service
• Focus our educational programs to meet the needs
  of qualified learners worldwide, from
  undergraduate thru continuing professional
  education programs this commitment will require
  a learner-centered approach that will guide our
  pedagogy, instructional technology, curriculum,
  admissions and support services

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To ensure for dentistry a strong and fulfilling
future within the university setting, the leaders
and members of organized dentistry, as well as
the leaders and faculty in academic dentistry,
must make a greater commitment to the mission and
values of the university. The faculty members in
the nations dental schools must become much more
involved with colleagues on the campus, and must
more explicitly adopt the scholarly standards,
including first-class research and academic
service, of the larger parent university. Path
ways Strategies for Dental Education in the
Future ADA Future of Dentistry Report (2001)
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Vision for School of Dentistry

• We are health professionals with an emphasis on
• oral health promotion, risk assessment and
  disease prevention, diagnostics, surgical and
  non-surgical treatments,
• and therapeutics that optimize patient and
  community health
• and well being. We function within a learning
  organization
• that is a diverse community of learning
  students, faculty, staff,
• alumni and friends. Our shared goals involve
  quality, service
• and efficiency, and we strive for excellence and
  innovation
• in what we learn, how we learn, and how we
  communicate
• our innovations and discoveries to others. We
  take enormous
• pride in being part of a major research-intensive
  private
• university in California and we are positioned to
  collaborate
• within our University and with other Colleges as
  well as
• with Pacific Rim and Latin American countries.

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Vision For USC Learners

• Think critically
• Access and absorb new knowledge utilization of
  information technology
• Understand biological, chemical, physical and
  behavioral principles
• Embrace science-based clinical health care
• Embrace cultural diversity
• Possess and renew clinical competencies
• Communication management skills
• Leadership, ethics, professionalism

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Mission for School of Dentistry

• We are committed to improving the health
• of all people through education and training,
  innovation and discovery, patient
• and community health programs,
• and leadership.

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Strategic Plan Goals 2003-2006 (Revised 12/03)
PATIENT CARE COMMUNITY ORAL HEALTH
EDUCATION LEARNING
INNOVATION DISCOVERY
LEADERSHIP FOR THE HEALTH PROFESSIONS
IIA. Provide major scientific innovations and
discoveries to advance theories, principles and
applications that improve health.
IIIA. Promote oral health as a fundamental
component of optimal overall health. IIIB.
Increase access to care for underserved
populations through focused community
outreach. IIIC. Ensure that quality patient care
and satisfaction are integral parts of all
educational programs and centers for oral health.
IA. Phase implementation of Problem Based
Learning (PBL) completed by 2005. IB. Expose
students to real-world problems and academic
health professional experiences enabling students
to pursue a broad range of professional career
pathways. IC. Achieve eminence for all advanced
dental specialty programs.
IVA. Foster participation in leadership
opportunities for students, faculty and staff to
serve our University, communities and professions
on local, national and international
levels. IVB. Provide leadership in the
development of PBL training models for training
of faculty from other Universities.
CRITICAL OPERATIONAL FACTORS HUMAN RESOURCES and
MANAGEMENT PRACTICES, COMMUNICATIONS, INFORMATION
TECHNOLOGY
HR. Align USCSD individuals and teams
(students, faculty, staff and alumni) and
management systems with the USCSD mission,
vision, values and priorities.
C. Ensure effective organizational and
interpersonal communication within USCSD, the
University and beyond.
IT. Enable Information Technology to support
present needs and future strategic directions of
USCSD.
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Strategic Directions at USCSD

• Four Major Strategic Directions
• Education and Learning
• Innovation and Discovery
• Patient Care and Community Oral Health
• Leadership in Health Professions

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Education and Learning 2001 -

• Four-year conversion to problem-based learning
  graduate first full PBL class in May 2005
• New AEGD Program first class of residents in
  June 2002
• Initiated GME thru University Hospital
  (2001-2006)
• Initiated Deans Lecture Series, Faculty Staff
  Development Training Programs
• Improved admissions, retention, graduation on
  time, National Board scores, State/Regional
  Board scores graduates pursuing advanced
  education
• Initiated White Coat Ceremony and Professional
  Oath

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Innovation Discovery 2001 -

• Initiated Student Research Group with D.D.S.
  students win national competition awards from
  ADA, ADEA and IADR/AADR
• Initiated entering dental student Summer
  Research Program
• NIH research support increases
• USCSD received its first NIH Small Business
  Grant and creates Oral Solutions
• USCSD faculty continue to publish in tier 1
  journals in their respective fields (e.g.,
  Science, Development, Journal of Biological
  Chemistry, Structural Biology and Journal of
  Dental Research, and appropriate dental specialty
  journals)

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Patient Care Community Oral Health 2001-

• Created new USC Oral Health Center opened in
  January 2003
• Created new USC Center for Dental Technology to
  open July 2005
• Group Practices in predoctoral program increased
  from 6 to 9 to increase faculty supervision (goal
  is 12)
• Acquired new Mobile Clinic to add to USC
  resources 14 different sites
• New affiliation with Childrens Hospital, San
  Diego and Orange County for Pediatric Dentistry
• New USC Rescue Mission to care for homeless
  opened
• New California Endowment Grant to address access
  to oral health care and underserved minority
  students to enter oral health professions

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Leadership for the Profession 2001-

• Election of Gene Sekiguchi as President of ADA
  for 2003-04
• Deans Leadership Seminar Series for DDS/DH
  students to engage with leading figures in the
  oral health professions
• USC hosts first-time-ever Oral Health Summit
• USC hosts California Dental Board of Examiners,
  CDA and five California Dental School Deans
• USC engages with coalition to achieve increased
  fluoridation for 17 million people via MWD (March
  2003 effective 2006)
• Increase USC student participation with ASDA,
  ADEA, CDA and Federal and California Legislature
• Increase percent of residents becoming
  Board-Eligible in various dental specialties
  (goal is 100)

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Administrative Leadership Team
Patients
Students
Part-time faculty
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Reorganization Reconfiguration at USCSD
Health Promotion, Disease Prevention,
Epidemiology Jane Forrest
Diagnostic Sciences Mahvash Navazesh
Surgical, Therapeutic Bioengineering Sciences
Ilan Rotstein
Craniofacial Sciences Therapeutics Yang Chai
Primary Oral Health Care Terry Donovan Casey
Chen
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The Five Academic Divisions are Supportedby
Seven Functional Areas
Division 1 Health Promotion Disease Prevention
Epidemiology
Division 3 Surgical Therapeutic And
Bioengineering Sciences
Division 4 Patient and OralHealth Care
Division 5 Cranio Facial Sciences And
Therapeutics
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Performance Highlights 2001-

• Applicant Pool Increase (25 of all dental school
  applications in nation)
• Freshman GPA and DAT Scores Increase (3.4 and
  19/20)
• PBL DDS National Board Scores Part 1 in 5th
  quintile for 8 years
• Graduation On Time Increase (60 to 92)
• Graduates Pursuing Advanced Specialty Program
  Education Increased (7 to gt20)
• Western Regional Dental Board and California
  State Board Examination Success Increases
• Faculty NIH Research Grants Increases (20)
• Student/Resident Clinic performance Increases
  (March,2005 highest month in USCSD history at
  776,000 goal is 1 million per month) Faculty
  Practice goal is 500,000/month
• Reorganize academic and administrative functions
• Advance research infrastructure through
  recruitments (appointments and joint-appointments)
  , renovations, core facilities
• School-wide information technology achieves
  connectivity within a virtual school of
  dentistry using Axium software
• Numerous faculty recognitions through NIH Merit
  Awards, leadership, collaborative research
  activities and so much more

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• Academic Programs
• and
• Curricula

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• Evaluation of publications on the analysis of
  learning conducted by the National Academy of
  Science
• Thorough analysis of the links between pedagogy
  and learning and the effectiveness of different
  strategies for creating learning environments.
• Learner-centered education using case-based or
  problem-based learning coupled with
  service-learning as in health professional
  education

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Concepts, Facts Skills
Students abilities to acquire organized sets of
facts and skills are actually enhanced when they
are connected to meaningful problem-solving
activities How People Learn National Academy
Press 1999
Problems are learning opportunities in
disguisePam Kuhns
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Problem Based
Small Group
Student Centered
USCSD Problem-Based Learning
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The PBL Process
IDEAS What we think
LEARNING NEEDS What we need to know
FACTS What we know
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Learner-Centered Education (USCSD PBL goals)

• To develop dental student learners dedicated to
  life-long, self-motivated learning
• To use learner-centered, inquiry-based methods of
  pedagogy
• To encourage learners to question theory and
  practices and to engage and interact with faculty
• To vertically integrate the entire DDS curriculum
• To provide a solid fundamental background in the
  biomedical and behavioral sciences
• To ensure that faculty members act to facilitate
  student learning
• To introduce clinical experiential learning
  opportunities very early in the educational
  sequence of dental professional education
• To use case-directed learning to introduce
  preclinical skills
• To measure clinical competency by traditional
  standards
• To deliver comprehensive patient-centered health
  care

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Academic Programs - DH/DDS/ASPID
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Academic Programs Advanced Specialties
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Academic Programs Advanced Specialties (contd)
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Academic Programs - Advanced Specialties (contd)

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Academic Programs Graduate/Postdoctoral
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• Continuing Oral Health Professional Education

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Goals

• Provide excellent life-long learning
  opportunities to all oral health care providers
  including
• Dentists
• Dental Hygienists
• Dental Assistants
• Dental Technicians
• Oral and Health Care Managers
• Increase the visibility and leadership role of
  USC nationally and internationally, with focus on
  the Pacific Rim and Latin America
• Provide revenue to further advance the USCSD
  education programs and strategic directions

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Number of Courses Per Year
Number of Hands-On Courses Per Year
Number of Multidisciplinary CoursesPer Year
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Continuing Education
Course Revenue and Expenses
Revenue from Corporate Sponsorships Per Year
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Future Goals

• Strengthen our leadership role in life-long
  learning for all oral health professions
• Increase the number of CE courses and programs
• Introduce new courses and topics
• Introduce more multidisciplinary programs
• Increase number of hands-on and
  behind-the-shoulder clinical courses
• Partner with other USC colleges to create joint
  programs (e.g., MBA Certificate in Oral Health
  with Marshall School of Business)
• Partner with other universities, mainly in the
  Pacific Rim and Latin America, for joint symposia
  and programs (e.g., Mexico, Taiwan, Korea, China,
  Japan)
• Increase enrollment
• Increase revenue
• Introduce distant learning opportunities
• Broaden CE professional network
• Increase partnership activities with Corporate
  America

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• Community
• Health Programs

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USCSD Affiliated Clinics
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Hospitals and Higher Educational Institutions
Affiliated with USCSD
Programs include clinical treatment,
interdisciplinary teams, and didactic coursework.
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USCSD Community Preventive Dentistry/Sealant
Program
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Community Clinical Education
USCSD Mobile Clinics (Since 1964)
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USC Dental Clinic
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Preventive Care/Sealant Program
Educating Local Children on Oral Health
Sealant Process as shown to school kids
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Seniors Hollenbeck Center
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Birth
Childrens Hospital of LA
Queens Care Mobile Clinic
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School Sealant Project
USC Mobile Clinic
Childrens Dental Center
USC Neighborhood Mobile Clinic
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USC Union Rescue Mission
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LAC/USC Medical Center
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VA Health Systems, Long Beach
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Solis Dental Arts Center
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Lifeline of Dental Educational Experiences April
2005
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Hollenbeck Home
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Death
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Money Awarded from Grants to Fund Community
Health Programs
FY 00
FY 05
FY 06
Baseline
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Education and Care Community Partnerships
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COMMUNITY PROGRAM EDUCATION, SERVICE LEARNING
AND RESEARCH
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• International, Professional
• Legislative Affairs

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Advanced Standing Program for International
Dentists (ASPID)

• First in the U.S. 1967 with 3 dentists 32
  dentists admitted in 2005
• Total graduates through 2004 748
• Class of 2004 Statistics
• Most applicants have residency status in the U.S.
  prior to application
• 30 specialize compared to 20 for U.S. graduates
  
• Trend is to remain in the U.S. helping serve the
  underserved due willingness to practice in these
  areas
• Number of first opportunity California Board
  takers increased by 100, first opportunity pass
  rate improved 13 (2003 to 2004)
• National Board Part II pass rate is 100

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International Affairs

• Leadership in Global Oral Health
• USC-UNAM
• Bi-national Fluoresis/Fluoride Research Project,
  Oral Cancer Project, Faculty Exchange Program,
  Student Exchange Programs
• USC-LaSalle
• Bi-national Lecture series
• USC-Taiwan Symposium
• USC-Korea Symposium
• USC-France Symposium
• Thirty year history of international postdoctoral
  fellow research programs at CCMB
• Faculty Service in International Leadership
• ISO Dental Informatics Standards Committee
• Delegate to Federation Dentaire International
• Global Dental Education
• Leadership in the International Association of
  Dental Research (IADR)

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International Affairs (contd)

• Global Dental Education
• Faculty invited to lecture in 30 countries
• Distance Learning with 2 countries additional
  countries to follow
• Faculty provided training for PBL in Japan,
  Korea, Thailand and Mexico
• Global Health Policy
• El Salvador
• Multidisciplinary-international USC
  collaboration to build an national inclusive
  healthcare system
• Service Learning and Outreach
• Belize, Mexico City, Tijuana, Guatemala, San
  Salvador
• Pacific Rim Center For Dental Excellence
• Develop relationships with countries to form a
  Center for Dental Excellence (13 countries)
• Exchange of expertise, education, faculty,
  students, knowledge, expertise and technology
• Latin American and Asiatic ties will enhance our
  student and faculty cultural and linguistic
  competencies

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Current USCSD Policy Activities

• Cultural and linguistic competency requirement
  for licensure
• License by credential allowing movement from 39
  states
• Reducing licensure by credential requirement for
  service to underserved populations
• Special permits for dental school faculty
• Participation in the National and California
  Pipeline project
• National clinical examination and licensure
  reform
• Restore Medicaid cuts
• Single standard of care education
• Regional Clinical Licensure Examination
• Access solution w/foreign trained dentist

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• Innovation Discovery
• (Research)

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Federally Financed Research Expendituresat
Universities and Colleges for Fiscal Year 2003

• USC ranks 10 among all private universities
• USC ranks 20 among public and private
  universities
• Funding increased from 149.9 million (1993) to
  210.8 million (2000) to 300 million in 2003
• USCSD ranks 1 of all private, 9 of all dental
  institutions, and 7 of all dental schools

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Comparison of USC Research Grant Awards by
School 2003-2004

• Dentistry 8.094m
• Gerontology 11.114m
• Pharmacy 9.784m
• Medicine 165.688m
• Engineering 95.342m
• Social Work 6.895m
• LAS Natural Sciences 40.680m
• Indirect Cost Recovery an additional 65
• 2.5m for USCSD (April, 2003 April, 2004)

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NIDCR Support for Dental Institutions FY 2003

• 1 Forsyth 12.1M
• 2 UCSF 11.6
• 3 Minnesota 10.0
• 4 Washington 9.6
• 5 Michigan 8.5
• 6 North Carolina 7.4
• 7 Rochester 6.9
• 8 Florida 5.7
• 9 USC 5.6
• 11 UCLA 5.0
• 30 Harvard 1.36

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Health Research Agenda
BASIC RESEARCH
Infectious Agents Cell and Organ Systems
CLINICAL RESEARCH
Translational Research
Pathways and Drug Discovery
Clinical Trials
Epidemiology
POPULATION SCIENCE
Behavioral Research
Groups at Risk
Outcomes and Health Services Research
Environmental Hazards
- Adapted from David Nathan presented at
the Clinical Research Roundtable meeting,
06/12/02
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Patients 27 Million People in Southern
California 1/3 Underserved (Bakersfield to
Mexican Border)
Multidisciplinary Dentistry, Medicine, Nursing,
Pharmacy, Education, Gerontology, Public Policy,
Engineering, Social Work,Communications
Research at USCSD
Extramural Funding NIH, DOD, Foundation
Industry
Data Data Gathering, Data Management, Data
Processing, IT Infrastructure
Present Facilities NIH-Supported CCMB Norris
Research Themes Craniofacial Molecular Biology,
Craniofacial Human Genetics, Infection Mucosal
Immunity, Biofilms, Head Neck Cancers Patient,
Family Community Health Promotion, Disease
Prevention, Diagnostics, Treatments
Therapeutics, Dental Materials
Biomaterials, Health Services/Outcomes Saliva
Diagnostics
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Bacteria in all natural and pathogenicsystems
live predominantly in biofilms
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Biofilm formation is controlled by simple
chemical signals.The process can therefore be
blocked by signal inhibitors
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New Center for Biofilms

• USC Affiliations
• School of Dentistry
• Chuck Shuler (CCMB) Casey Chen (Primary Oral
  Health Care) Steve Goodman (Diagnostic
  Sciences) Dennis Cvitkovitch (Visiting
  Professor)
• Viterbi School of Engineering and Medicine
• Florian Mansfeld (Materials Science) Paul
  Ronney (Aerospace and Mechanical) Teh Fu Yen
  (Civil/Environmental)
• College of Letters, Arts Sciences
• Ken Nealson (Earth Sciences) Tony Michaels
  (Wrigley Environmental Research) Steve Finkel
  (Computational and Molecular Biology)
• Keck School of Medicine
• Fred Sattler (Infectious Diseases) Michael
  Patzakis (Orthopaedics) Bert Shapiro (Pulmonary
  and
• Adult Cystic Fibrosis Clinic)
• Keck/Viterbi
• Howard Phillips (Doheny Eye Institute and
  Biomimetics ERC)
• CHLA/Keck
• Roberta Williams (Pediatrics)
• House Ear institute
• Paul Webster

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New Center for Biofilms (contd)

• Grant Activity (Funded or Pending)
• Maurice Amado Foundation (funded)
• NASA grant with Paul Ronney (pending)
• NSF grant with Paul Majors of the Pacific
  National Lab (pending)
• RO 1 with John Olerud (University of Washington)
  (pending)
• RO 1 with Casey Chen (consultant)
• K 21 with Parish Sedghizadeh (pending)
• R 13 NIH Conference grant for Biofilm symposium
  (pending)
• Conference grant from Philips Oral Healthcare
  (funded)
• Research grant from Philips Oral Healthcare
  (pending)
• Research grant from Bard Urological (pending)
• Pioneer grant from NIH (pending)
• SBIR with Intelligent Optical Systems (funded)
• SBIR with Sequoia Sciences (funded)
• SBIR with Atmospheric Plasma (funded)

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Genes That Regulate Tooth Morphogenesis
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• Examples of the Regulatory Genes that Control
  Tooth Position, Number, Size and Shape
• Anhydrotic Ectodermal Dysplasia TNF- alpha
  ligand and receptor genes
• A Novel Oligodontia PAX9 transcription factor
  gene
• Cleidocranial Dysplasia (supernumerary teeth)
  CBFA-1 transcription factor gene
• Rieger Syndrome (tooth number, size and shape)
  PitX2 transcription factor genes

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A novel form of oligodontia involving posterior
teeth and PAX9 mutations

• Panoramic dental x-ray demonstrating the
  phenotype (Stockton, Das, Goldenberg, DSouza and
  Patel. NATURE GENETICS, January 2000)

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Sensory Neurosciences
David McKemy, Ph.D.

• Chronic pain is a thief. It breaks into your
  body and robs you blind. With lightning fingers,
  it can take away your livelihood, your marriage,
  your friends, your favorite pastimes and big
  chunks of your personality. Left unapprehended,
  it will steal your days and your nights until the
  world has collapsed into a cramped cell of
  suffering.
• - Time Magazine

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Research in the lab is focused on the molecular
mediators of pain

• We and others have recently identified the
  molecular detectors responsible for the
  sensations of thermally-evoked pain.
• These are ion channels located on peripheral
  nerves in the skin and mouth, and transform
  thermal stimuli into neuronal signals.
• These ion channels are essential for not only
  temperature perception, but also neuronal
  hypersensitivity following injury.

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Anh Le, DDS, PhD
THE PROBLEM OF KELOIDS

• Funding
• NIAMS/NIH S11AR-47359
• Hypoxia Regulation of VEGF/VEGF Receptors in
  KeloidsPI Anh Le
• NIAMS/NIH R43 AR 051620
• Scarless Wound RepairPI Chia Soo (Plastic
  Surgery/Scarless Technologies Inc.)
• Co-PI Anh Le

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Craniofacial Developmental Biology/Developmental
Genetics Supported by National institute of
Dental and Craniofacial Research and National Eye
Institute, NIH March of Dimes Birth Defects
Foundation. Collaborators Keck School of
Medicine Harvard University Fred Hutchinson
Cancer Center NIDDK, NIH Vanderbilt University
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TGF-b Signaling Craniofacial Morphogenesis
Loeys et al., 2005, Nature Genetics 37, 275-281
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flox
TGF-b IIR
Wnt1 promoter
Cre
Exon 2
Exon 1
loxp
loxp
Wnt1 xpression
Cre-mediated recombination
Exon 1
WT
flox/D2
Wnt1-CreTGF-ß IIR
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Functional Significance of TGF-b Signaling in
Regulating Calvaria Development
Tgfbr2 flox/flox Wnt1-Cre
WT
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Bioimaging (Three Dimensional Craniofacial
Imaging) Supported by National Institute of
Dental and Craniofacial Research, NIH Private
Research Foundation Collaborators Viterbi
School of Engineering Harvard University Korean
National University
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Examples of NewTom Images
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Patient Care 21st Century?
VIRTUAL CRANIOFACIAL PATIENT
CURRENT PATIENT RECORD
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Head and Neck Cancer Center Goal To improve the
quality of life through the collaboration of
basic and clinical scientists. Supported by
Program Project Grant from NCI, NIDCR, NIH
Collaborators School of Dentistry Keck School
of Medicine Norris Cancer Center UCLA UCI Medical
Center Tata Memorial Hospital, Mumbai,
India National University of Mexico, Cancer
Hospital of Beijing, China Peking University, and
more
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Regenerative Medicine Goal To establish a
center for tooth regeneration. Supported by
NIDCR RFA on tooth regeneration, California Stem
Cell Initiative. Collaborators School of
Dentistry Keck School of Medicine University of
Washington Finland Academy of Sciences Tulane
University, and more
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• Advances in Biomimetics Using Adult Stem Cells
• Cartilage Tissue Regeneration
• Muscle Tissue Regeneration
• Bone Tissue Regeneration
• Ligament Tissue Regeneration
• Dentin Tissue Regeneration

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New Oral SolutionsSaliva, Diagnostics
Prognostics at USC Paul Denny, PhD Mahvash
Navazesh, DMD

• Diagnosis using oral buccal cells for DNA
  genotyping
• Therapy using salivary proteins as antimicrobial
  agents (e.g. histatins, proline-rich proteins,
  defensins)
• Diagnosis and monitor substance abuse
• Diagnosis and monitor systemic diseases such as
  immunodeficiency
• Assess risk factors for dental caries (and
  beyond) using point-of-care devices for saliva to
  detect electrolytes, DNA, RNA and proteins (i.e.
  microfluidics, arrays, sensors, and
  nanomaterials)
• Monitor clinical trials for drug studies
• Example of NIH-sponsored Phase I and II Small
  Business Grant, creation of university
  incubator, followed by Venture Capitol support

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Failing Dentition due to Periodontal Disease
Esthetic Dentistry A Case Study
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Same Day 24 Extractions5 Implants in Mandible
Esthetic Dentistry A Case Study (contd)
Immediate Maxillary DentureImmediate Loading of
Mandible
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Before
Esthetic Dentistry A Case Study (contd)
After
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New Concepts Opportunities

• Health and Healthy Community USC-wide
  collaborative research (e.g. health promotion,
  health literacy, risk assessment, disease
  prevention, demonstration projects)
• Norris Dental Science Building, Web Tower, Café
  84, Lyons Center and Student Health Center A
  Health Community (see Case Statement draft)
• New six-story building with two floors for
  Student/Faculty/Staff Health and four floors for
  biomedical research (e.g. translational research,
  pre-phase 1 clinical research, etc.)
• Research supported by federally sponsored
  research grants (direct and indirect cost
  recovery) foundations
• Health Services supported by student, faculty and
  staff health insurance and USC
• Integration and alignment of Dentistry,
  Occupational Physical Therapy, Pharmacy,
  Medicine (Adolescent Pediatrics/CHLA, Radiology,
  Internal Medicine, Primary care), Behavioral
  Sciences with Health Services for students,
  faculty and staff, and research collaborations
  that are inter-professional and interdisciplinary
  in nature

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• Infrastructure
• Facilities

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Strategies to Increase Research Infrastructure

• Study Advisory Panel Consultants determine
  feasibility for 100 million capitol project
  (March-June 2005)
• Plan Campaign and develop print media and visual
  media
• Identify major prospects and define base support
• Partners include Michael Jackson, Vice President
  for Student Life Larry Nienstein, Director of
  Student Health Services Students and Parents
  Consultants and Trojan Dental Community
• Timeline Raise required funding, design/build
  and occupy by 2010
• Alternative cost effective strategy is to
  renovate the entire 4th floor of Norris Dental
  Science Building for research, renovate part of
  the second floor for research, and build a
  single-story wing for faculty offices this would
  increase research space and faculty, increase
  research support from NIH (and beyond), decrease
  density of Norris, decrease clinic facilities,
  decrease students in DDS Program, increase
  external clinic rotations, and increase endowment
  thru chairs for magnet research faculty

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• Norris Dental Science Building
• Originally Built as One-Story Building in 1952
• Three Floors added in 1966-68

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New Research Building Prospects

• Center For Biofilms Center For Oral Infection
  Immunity
• Center For Craniofacial Human Genetics
• Center For Biomimetic Approaches to
  Craniofacial-Oral-Dental Therapeutics
  Biomaterials
• Center For Diagnostics Biomarkers Bioimaging
• Center For International Consortium for Head and
  Neck Cancer
• Center For Community Health
• Center For Education Research

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USC Oral Health Center at University Village
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Faculty Group Practice
USC Oral Health Center (contd)
Informatics Digital Images
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USC Oral Health Center - Utilization

• OHC averages between 90-100 patients per day up
  from 40-50 patient per day at opening
• New patients average 5 per day or 80-100 per
  month up from 1-2 per day or 40 per month at
  opening
• OHC has a total of 24 chairs AEGD - 9 chairs
  Dental Hygiene 4-5 chairs, Faculty Practice -
  10-11 chairs
• 23 USCSD faculty, 7 hygienists and 12 AEGD
  residents utilize the OHC
• Faculty practitioners work an average of one day
  per week each, averaging 8-15 patients per day
  depending on type and length of procedures
• Dental hygienists treat an average of 7 patients
  per day
• AEGD residents average 2-3 patients per day

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USC Oral Health Center Project Revenues (FY
2004-2005 and Beyond)

• OHC revenue for FY 04-05 is projected to be
  4,243,912 on target to meet that projection by
  June 30, 2005 (net surplus 110,000)
• Steady growth anticipated over the next few years
• Goal of 5 million production and collection rate
  of 95 to be achieved in fiscal year 2005-2006
• Increased in earnings due to marketing program,
  increased USC faculty providers, increased
  comprehensive services, increased access to
  services (evenings and Saturdays), increased
  referral base, and increased support staff
  efficiency and productivity

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Center for Dental Technology at OHC

• Center for Dental Technology, a 2,200 square feet
  state-of-the-art facility will be constructed in
  the Oral Health Center and should be operational
  by Fall 2005.
• The Center for Dental Technology will be a
  revenue producing after initial start-up and will
  provide education (i.e. DDS, residents,
  postgraduate, and CE courses), research (industry
  related) and patient care.

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New Center For Dental Technology Education,
Research Patient Care
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Patterson Dental Technology Center
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Patterson Dental Technology Center

• Gift from the Patterson Dental Supply Company
  remodel of Row A in the 2nd floor clinic at
  Norris Dental Science Building
• Enhanced clinical setting similar to the OHC
  design
• Utilization of Cerec 3 (CAD/CAM by Sirona)
  technology to meet patients need by producing
  single unit all ceramic restorations at chair side

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Example of Information Technology Innovation in
Infrastructure

• AXIUM - investment in infrastructure to promote
  scholarly activity and improve student experience
• Program provides capacity to eliminate paper
  records
• Enhances data base capability for research
  opportunities
• Enables mining data to answer significant
  health services questions
• Reporting metrics enable more immediate feedback
  for students, residents and faculty to
  facilitate quality of learning
• Connectivity throughout the virtual School of
  Dentistry (multiple locations such as OHC,
  Norris, USC-Rescue Mission, Mobile Clinics,
  etc.)
• Enhances quality controls and accountability
• Increases the business management of clinic
  activities

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Axium
ROLODEX general patient selection module for
axiUm
The PATIENT CARD contains the patient
demographic information
SCHEDULER Allows patients to be scheduled by
students or staff
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AXIUM Accomplishments
350 new PCs were installed in all operatories at
USCSD clinics
38 new PCs were installed at the Library Learning
Center in order to facilitate training activities
New patient triaging process for the Center for
Diagnostic Sciences
Emergency Clinic relocated to old Faculty
Practice area
Staff reorganization to support new processes and
functions
Activation of verticalized Undergrad DDS student
teams by Group Practice
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AXIUM Accomplishments (contd)
Training, training, and more training
Phase 3 implementation Extramural clinics
Implementation of Digital Radiography/Digital
Imaging (pilot) at the 1st floor clinics
Integration of Student Evaluations (clinic)
Integration of Quality Assurance functionalities
(e.g. patient surveys)
Reporting/Data Warehouse implementation
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Administration
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Fundraising and Development

• Endowment (increased from 35 million in 2000 to
  54 million in 2004)
• Twelve new endowed scholarships
• Three new endowed professorships
• One new endowed lectureship
• 2.5 million in renovations conference rooms
  (Blair Rooms) and clinic venues (dental hygiene,
  endodontics, periodontics, oral-maxillofacial
  surgery, pediatric dentistry)
• 16 new Presidential Associates (total number at
  is 45)
• Fundraising 3.1 million per year average over
  last 4 years in 2004 reached 4.6 million
  (highest in 4 years)
• Fundraising for new faculty start-up packages
  500,000
• Initiated feasibility study for major Capitol
  Campaign to build new research building (in
  progress)
• Projected Capitol Campaign to build new building,
  renovate Norris Dental Science Building, and
  increase endowment thru endowed chairs and
  professorships for magnet research faculty
• Key goal is to build a sustainable research
  infrastructure

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Revenue Changes FY 2000 - FY 2005 (estimated)
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Expense Changes FY 2000 - FY 2005 (estimated)
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Major ReorganizationFY 2002
Streamlined Organization
Prior Administration
Current Administration
34 separate departments to
5 divisions/ 7 functions
16 Assistant/ Associate Deans
to 8
Assistant/ Associate Deans
13 Department Chairs
to 5
Division Chairs
54 separate budgets to
12 budgets
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Administrative Leadership Team
Patients
Students
Part-time faculty
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Accomplishments An Overview

• Education and Learning
• Phase-in School-wide PBL (2001-2005)
• Increase DDS applicant pool by 30 improve
  applicant qualifications
• Revise the curriculum, external service learning
  model, and community clinical venues (Hospitals,
  Clinics and Mobile Clinics)
• New AEGD Residency (2002)
• New Orofacial Pain Residency (2004)
• Innovations and Discovery
• Increase faculty scholarship
• Informatics/Axium/Computer Technology
• Strategic planning for research infrastructure
• Recruit new research faculty, joint appointments
  (LAS, Medicine, Education)
• Patient and Community Health
• Major renovations of clinics in Norris Dental
  Science Building
• New External Clinic Learning Venues from
  Bakersfield to Mexican Border
• New USC Oral Health, USC Imaging, Patterson
  Technology, Dental Technology Esthetic
  Dentistry Centers
• Leadership in Health Professions
• MWD Fluoridation Policy
• ADA Presidency
• Increased faculty, staff, and student leadership
  in the domestic and international health
  community

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Whats Coming? 2005-2010

• Improve patient care (quality improvements)
• Enhance information technology connectivity
• Improve student and resident academic performance
• Renovations for research, faculty staff
  offices, and clinics in Norris Building and
  University Village
• New Center for Dental Technology in University
  Village Oral Health Center
• Recruit new research profile faculty and increase
  USCSD
• federally-sponsored research
• Increase staff and faculty training development
• Increase communication, coordination, cooperation
  between all stakeholders
• Build new Research Building and renovations of
  4th floor of Norris Building
• Increase the endowment

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Where can the Provost Assist in 2005 and Beyond?

• Plans to align and integrate Occupational Therapy
  Physical Therapy Programs into the School of
  Dentistry
• Enable research advancement through brokering
  joint appointments, subvention when appropriate,
  support for critical core facilities when
  appropriate, and assistance with major research
  faculty recruitments
• Advocacy and assistance in building a new
  research building vis-à-vis debt financing, or
• Advocacy and assistance in building
  multifunctional building that integrates Student
  Health and dental research
• Advocacy and assistance in renovations to
  decompress the Norris Building vis-avis
  University loans
• Efforts to expand internal education and research
  activities

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Together, We Will Achieve a Remarkable Future!
Rated 1 SOD in California
Expand Norris Building
USCSD 1st National Boards
USCSD STRATEGIC PLAN
Faculty Scholarly Activity
U.V. Oral Health Center
Increase Clinic Income