Advances in Big Data analytics and precision medicine may have significant impact on the future of dental public health. Using Big Data analytics, public health professionals can combine the power of precision medicine with population-based approaches resulting in effective targeted interventions. Data-driven public health interventions were shown to successfully facilitate prime concerns for public health including reduction of health disparities, disease prevention, and health promotion. Learning health systems may be powerful allies in implementing major steps that are necessary for precision public health such as monitoring morbidity and mortality, tracking health conditions, aggregating heterogeneous clinical data streams, and training new generations of health professionals.
Using Big Data to Promote Precision Public Health in the Context of Learning Health Systems
Joseph Finkelstein, MD, PhD, Associate Professor, Columbia University Medical Center
Implications and Potential Precision Health Impact for the New FDI Definition of Oral Health
Michael Glick, DMD, Professor and Chair, School of Dental Medicine, University at Buffalo, State University of New York
General awareness of the importance of oral health among policymakers, health planners and the health community at large remains low. Therefore, a more comprehensive, yet operationalized definition of oral health is needed. The new FDI definition of oral health raises awareness of the different dimensions of oral health and emphasizes that it does not occur in isolation, but is embedded in the wider framework of overall health. This presentation will provide the new FDI oral health definition, its theoretical framework, and address the subsequent international work that is presently underway to develop an accompanying measurement tool. Implications for future applications both in the United States and internationally in the area of precision health will be discussed.
Keynote Address: From High Definition Precision Healthcare to Precision Public Health: Challenges and Opportunities
Harold C. Slavkin, DDS, Professor and Dean Emeritus, Ostrow School of Dentistry, University of Southern California
The success of high definition precision healthcare requires a public health perspective to enhance generalizability, assess methods of implementation, and to focus on prevention, while providing a balance between generation of long-term knowledge and short-term health gains. Sensitivity and resolution, cost, and time advances in whole genome sequencing and big data analyses, coupled to other advances in biotechnology and the behavioral and environmental sciences, offers remarkable opportunities to improve the health and wellness of the American people [ genotype + phenotype + environment + behavior = high definition prevision healthcare]. The opportunity is to significantly improve the well-being and life expectancy of the least-advantaged people in our society.
At the Crossroads of Oral Health Inequities and Precision Public Health
Stuart A. Gansky, DrPH, Professor, University of California San Francisco School of Dentistry
Most precision health research has emphasized high tech micro-level approaches (e.g. genome, proteome, and microbiome) and collected data through methods (e.g. wearable personal health monitoring devices) that are expensive for many population groups. Thus, precision health may differentially benefit specific populations, unintentionally exacerbating health inequities. Carefully incorporating family and community social, environmental, and behavioral contextual information (e.g. social determinants of health measurements in electronic health records and geographical information systems data) with -omics data, as planned in the NIH’s Precision Medicine Initiative (All of Us), may promote health, prevent disease, and improve healthcare without increasing health disparities.
Understanding Early Childhood Oral Health via a Pediatric Precision Health Cohort: ZOE 2.0
Kimon Divaris, DDS, PhD, Associate Professor, University of North Carolina School of Dentistry
Early childhood oral health is determined by the interaction of social, environmental, behavioral and innate factors. The advent of precision health care is expected to inform risk assessment and improve prevention and treatment of early childhood caries (ECC), which remains a significant clinical and public health problem. The presentation will describe the establishment and progress to-date of a pediatric precision oral health cohort, carried out as the ZOE 2.0 study (NIH/NIDCR U01DE025046). The research program entails the collection of clinical, behavioral, social, environmental and ‘omics’ information along a large, community-based sample of preschool-age children in North Carolina.
Intersecting Big Data with Deep Phenotyping to Power Risk Factor Discovery in the Era of Precision Medicine
Jennifer Below, PhD, Assistant Professor of Medicine, Vanderbilt University Medical Center
Interpretation of genetic association results is difficult devoid of a biological context. To better understand the genetic etiology of complex traits, we have employed tools to estimate the genetically determined component of gene expression from common variants using tissue-specific genetic predictors of transcription levels established in the GTEx Consortium. This approach allows us to then determine genes with tissue-specific predicted expression levels associated with trait. Using these association measures, calculated phenome-wide in large EMR DNA databanks, we can examine clinical impact of dental health-associated loci by linking previously identified genetic variants to the full medical history captured in health systems. These analyses focus on clinical characterization and health outcomes to develop a more complete picture of genomic risk of disease in diverse populations.
Use of Biologic Diagnostics for Precision Oral Health: What Role in the Public Health Sector?
Jeffery Ebersole, PhD, Associate Dean of Research, University of Nevada Las Vegas School of Dental Medicine
Periodontitis affects up to 80% of adults with deleterious economic/societal effects on the population. The disease is modulated by aging, sex, environmental factors, and is a co-morbidity for various systemic health problems. Biomarker profiling is strategic for moving dentistry into the era of predictive, preventive, personalized and participatory evidence-based diagnosis and clinical decision strategies. This strategy needs to be conveyed to the future dental workforce, as well as being a portion of the public health sector for improving oral health disparities and health inequities. The presentation will describe our studies on various populations with regards to biologic diagnostics in periodontitis.
Implementation of Public Health Genomics and Possible Future Dental Applications
Debra Duquette, MS, CGC, Associate Professor of Medicine, Northwestern University
Integrating genomics at the population health level has the potential to increase our understanding of disease, improve public health, reduce health disparities, and promote genomic literacy. While many of the goals of precision medicine focus on long-term discovery efforts, current evidence for certain genomic applications suggests that many lives could be saved now if these were implemented in the recommended populations. This presentation will focus on the existing evidence and clinical utility of precision public health applications for specific populations. Examples of public health genomics implementation efforts by the Centers for Disease Control and Prevention, National Academy of Medicine, state public health departments, and health systems will be explored. The importance of addressing health disparities in the precision medicine era will also be highlighted. Genetic syndromes with relevance to dental public health practitioners will be included when possible. Possible ways for individuals with expertise in dental public health to become involved in existing precision public health efforts will also be discussed.
Precision Public Health: Current and Future Landscape
Sarah Meyer, MLIS, Dentistry Liaison at George A. Smathers Libraries, University of Florida
Advances in technology, biomedical research and data analytic tools combined with reduced data storage costs are increasing accuracy and altering focus of the health care system. New research approaches are working to move the model from disease management to disease prevention. Precision Public Health (PPH) is an innovative research approach that exploits disparate data sets, comprehensive risk identification, environmental and social determinants of health, combined with interdisciplinary expertise to identify subpopulations to tailor and target for public health interventions. Currently, PPH research is unchartered territory; early adopters are convening interdisciplinary workgroups to create models, best practices, tools, techniques, and identify challenges and opportunities for conducting research at the state and county-level. The broad scope of dental public health is perfectly poised to shape the future of precision oral health research and practice. Dental public health professionals will be instrumental in leading precision oral health research, policy development, education, improving collaborative care models and surveillance of risk and diagnosis identification and promoting closer integration of oral and general health.