Dental disease may be rampant in America, but those who seek solutions to the problem often toil inside university walls, far from the limelight. UCSF periodontal disease researcher Yvonne Kapila would not have it any other way: "I love the academic life, the chance to do research and teach. I can't imagine doing anything else."

Kapila is not naive. She realizes that in the private sector, dentists with her knowledge of gum disease, coupled with surgical and orthodontic skills, can command high salaries. But as the youngest of four children raised in the city's Mission District, she was not encouraged to attend college, let alone dream about ever working at one. Having made it to Stanford, followed by the UCSF School of Dentistry, including its PhD program in oral biology and specialty training in periodontology, Kapila has consistently defied expectations and in the process, shaped what she terms a very "satisfying, female-friendly career." That she also met her husband at UCSF (he is a School of Dentistry faculty member as well) only confirms her certitude. "With three kids, I need to be able to balance family and work life. And here I can."

If Kapila's message is comforting, it does not mean that Kapila herself is complacent. She enjoyed the contact with patients during her clinical training, marveling at how such legendary clinicians as Jack Taggart established such ready and reassuring rapport with strangers. "I learned from him that you have to be happy with what you do." Ironically, that lesson led her back to the laboratory, where she had trained as part of the school's summer research program during her first year of study. "Science taught me never to accept anything as it is. The lab kept calling me back," says Kapila.

Investigating inflammation

What intrigued the inquisitive Kapila were the mechanisms and effects of inflammation, a key component of periodontal disease. "I'm particularly interested in the interactions that govern the repair and regeneration of periodontal tissues after disease." Of most concern is the process known as apoptosis, or programmed cell death. All cells proceed through a life-and-death cycle that ensures that new, healthy ones replace those that have been compromised by repeated cell divisions. In following the apoptosis trail, Kapila is exploring the possibility that bacteria behind severe gum and bone disease trigger the formation of destructive fibronectin fragments that both hamper the natural healing process and disrupt cell survival. "Our findings could have implications for other diseases like cancer and arthritis that also involve regulation of cell survival by disease-associated signals."

At the same time, Kapila and her research colleagues are trying to determine what if any correlations may exist between specific fibronectin fragments and the state and stage of periodontal disease. "We really want to know how periodontal disease progresses and if we can create markers that monitor this progression. Our tools for doing this now are pretty crude." Success would mean that periodontal disease could be detected long before it manifested itself in the gum tissue. Early detection, coupled with better understanding of the disease itself -- and the subsequent creation of preventive treatments -- might one day help thousands avoid the expense and pain of gum surgery.

Female-friendly profession

It is precisely this hope -- and the satisfaction it engenders -- that Kapila tries to convey to the dental residents and third-year students she teaches. "I am always singing the praises of the academic life. It's not routine. You can exchange knowledge with colleagues. It's not a 9-to-5 situation. There is flexibility."

The latter is of special interest to women pondering the stresses of career and family, stresses that Kapila acknowledges do not evaporate in academia. "I remember being pregnant with my twins (now one-year old) while my other child was sick. I was told to rest in bed at the same time I was trying to write a grant proposal. It was very difficult." Still the female-friendly message must be reaching its intended audience. "Dentistry used to be dominated by males," says Kapila. "The classes are now more than 50 percent female."