NIH grant advances Dentistry School's work on psychosocial stress

Posted on: Monday, 11/05/2007

$1.88 million award will facilitate comprehensive care for facial trauma victims

Every day, trauma centers throughout the country provide acute care to patients with intentional injuries. The focus is on treating the physical injury of the patients; there is precious little time for attending to the underlying risky behaviors that gave rise to the injury or to what its psychosocial aftereffects may be.

Vivek Shetty, an oral and maxillofacial surgeon at the UCLA School of Dentistry who treats patients with facial trauma, recently proposed that introducing technology to this scenario could lead to a better way to screen for and detect the psychological impact of injuries and thus unite the complementary skills of various health care providers to deliver comprehensive care to patients.

The National Institutes of Health found merit in this unique approach and agreed to fund Shetty's idea.

The UCLA School of Dentistry is among the first research institutions to receive a grant from the NIH's new Genetics, Environment and Health Initiative. Among other goals, the initiative seeks to develop new technologies to measure psychosocial stress and the use of addictive substances, both licit and illicit, in large-scale studies of diverse populations. The four-year, $1,876,920 award to Shetty, the grant's principal investigator, will culminate in the implementation of an innovative new tool that will provide rapid and reliable assessments of the stress response to trauma as evidenced in saliva.

Shetty's previous studies have shown that traumatic facial injury provokes an immediate, intense psychological response from the victim, and a significant number of patients manifest post-traumatic stress disorder-like symptoms even one year after the injury. Nevertheless, a busy trauma center is not the ideal setting for administering the detailed questionnaires that help identify related mental health issues, whether they exist before or develop after injuries.

For these reasons, Shetty felt it important to develop an effective transdisciplinary approach that sets the stage for early integrated case management and interventions across a broad range of allied specialties. If surgeons, nurses and social workers can easily identify at-risk patients who could benefit from psychological treatment and make the appropriate referrals for targeted interventions and follow-up care, they might be able to prevent further trips to the emergency room.

"A handheld salivary biosensor of stress could help health care providers treat not merely the physical injury but the whole person," said Shetty, a professor of oral and maxillofacial surgery at the UCLA School of Dentistry.

In recent years, the concept of using saliva as a reliable, noninvasive and highly informative diagnostic tool has come into its own. As the technology of salivary diagnostics improves, the idea of using a saliva-based expression of the individual stress response as the basis for point-of-use detection becomes a reality.

"Such a tool could have a profound impact on how we screen, triage and treat injured patients," Shetty said. "Enabling surgeons to rapidly assess the risk for future psychological and substance-use problems will set the stage for expanded, high-quality post-trauma care that is specific to the needs of each patient and incorporates appropriate mental health interventions."

For the past decade, the UCLA School of Dentistry has been a leader in the burgeoning field of salivary diagnostics research, which portends dramatic changes in the future of clinical diagnostics. Currently, the school's scientists are engaged in projects that use saliva to assess the risk of dental caries; create smart, targeted antibiotics that preserve beneficial flora; and diagnose various systemic illnesses, from oral and breast cancer to autoimmune diseases and diabetes.

The research currently being conducted by Shetty builds on research on collaborative-care interventions made possible by an ongoing five-year, $3.8 million grant from the National Institute on Drug Abuse.

"UCLA takes great pride in its researchers operating at the cutting-edge of salivary diagnostics. Our objective is to translate the discoveries we make in the laboratory into new tools that will transform the standard of clinical care," said No-Hee Park, dean of the UCLA School of Dentistry. "Dr. Shetty's research brings together the fields of surgery, biostatistics, biomedical engineering and psychology to expand the use of saliva as a diagnostic tool beyond physical illness to include psychological illness."

Shetty's collaborators on the handheld salivary biosensor project include Dr. Dorothy Glover and Dr. Debra Murphy of the UCLA Department of Psychiatry and Biobehavioral Sciences, Dr. David Elashoff of the UCLA School of Public Health and the UCLA School of Nursing, and Dr. Masaki Yamaguchi of the University of Toyama in Japan.

The UCLA School of Dentistry is dedicated to improving the oral health of the people of California, the nation and the world and has established an international reputation for its teaching, research, patient care and public service initiatives. The school provides education and training programs that develop leaders in dental education, research, the profession and the community; conducts research programs that generate new knowledge, promote oral health and investigate the cause, prevention, diagnosis and treatment of oral disease; and implements clinical programs that deliver patient‑centered oral health care.