Michael N. Hatton

Artificial Salivas: Present and Future:

Modern technology has allowed us to understand better the functions of saliva and now provides a rationale for developing: (1) diagnostic reagents for monitoring oral and systemic health status and (2) replacement therapies for individuals with salivary dysfunctions. Several areas of dental research are directed at augmenting or enhancing both the quality and quantity of saliva for individuals with dry mouth. An “intrinsic” approach is being explored which utilizes medications such as pilocarpine and bromhexine to stimulate the salivary glands to produce more saliva. An “extrinsic” approach proposes to use topically applied artificial saliva. Studies in our laboratory have been directed toward developing artificial salivas which incorporate many of the protective features of “native” saliva. An ideal artificial saliva should be “long-lasting”, provide lubrication, inhibit colonization of microflora responsible for dental caries and gingivitis, and coat the oral soft tissues for protection against environmental insult and desiccation. Studies are currently under way to determine the structural requirements of salivary molecules responsible for these protective functions. Composite salivary molecules consisting of multiple biologically active or “functional domains” could then be designed and synthesized based upon primary sequence and conformational analyses, computer-assisted structural predictions, and in vitro testing. These supersalivary substances could then be used as saliva substitutes for targeting to selected oral surfaces to promote mineralization, hydration, and/or regulate microbial-mediated disease.

Lubrication and viscosity features of human saliva and commercially available saliva substitutes

The lubricating features and viscosity of human saliva and five commercially available saliva substitutes were compared. The results indicate that little correlation exists between these parameters. Saliva substitutes based on carboxymethylcellulose do not appear to lubricate biocompatible hard interfaces well and, therefore, might not protect against the rapid attrition observed in xerostomic individuals. In contrast, a mucin-based substitute proved to be a better lubricant with values comparable to whole human saliva.

In vitro characterization of human salivary lubrication

The friction coefficients for parotid and submandibular-sublingual salivas of 7 subjects were measured. At the load and speeds used, the lubricatory properties of the secretions followed the McKee-Petroffs curve. The friction coefficients for both secretions approximated those reported for boundary and thin film lubrication.

Lubrication of selected salivary molecules and artificial salivas

The lubrication regime displayed by human salivas (parotid and submandibular-sublingual), purified salivary molecules (the mucins MG1 and MG2 and α-amylases), and selected artificial salivas (Oracare D, Saliva Substitute, and Orthana) was assessed in vitro using a friction-testing device. Thin-film (boundary) lubrication was observed for all of the salivary samples and two of the artificial salivas examined. Oracare D, a glycerol-based artificial saliva, was the exception since it lubricated by a thick-film (hydrodynamic) regime. On a molar basis, the best lubricants of the purified salivary molecules were MG1 > MG2 ≈ nonglycosylated α-amylases ≈ glycosylated α-amylases.

Intubation by use of the light wand: experience in 253 patients.

Use of the light wand for 253 intubations in a variety of clinical settings is described. Twenty patients were successfully intubated by the light wand method who had failed to be intubated by direct laryngoscopy. Three failures were noted on patients who weighed more than 350 pounds each. Both nasal and oral endotracheal intubations were accomplished with minimal morbidity.

Acquired Tufted Angioma of Upper Lip: Case Report and Review of the Literature

Acquired tufted angioma is a rare, cutaneous and slow growing benign vascular neoplasm that usually affects pediatric populations. Only six cases of oral mucosal acquired tufted angioma have been reported in the English language literature. We present in this report the seventh case and discuss its clinical and pathological features.

Treatment of severe sinus infection after sinus lift procedure: a case report.

Maxillary sinus floor augmentation may have a variety of postoperative complications including infection, sequestration of bone, and maxillary sinusitis. Complications can also occur due to a preexisting sinus condition called ostium stenosis. This case report presents a complication after sinus lift and grafting procedure due to an unrecognized ostium stenosis. Case Report:A 50-year-old male patient had sinus augmentation on his right side. However, postoperatively, his symptoms were protracted. A CT scan showed thickening of the Schneiderian membrane and scattered graft material. Management included endoscopic nasal examination and ostium enlargement, antibiotic coverage, and full enucleation of the graft and diseased tissue. Conclusion:Patency of the sinus ostium should be carefully evaluated before sinus lift/grafting procedure using CT technology. Radiology and otolaryngology consultations may be necessary to rule out ostium stenosis before surgery.

Immunochemistry of Monkey Salivary Mucin

The immunochemistry of monkey salivary mucin was examined using a monospecific antiserum. Quantitative precipitation assays using various mucin derivatives indicated that the antiserum contained antibody populations with specificity toward carbohydrate moieties as well as toward non-glycosylated peptide regions. Using quantitative inhibition assays, the carbohydrate specificity was found to reside in a complex oligosaccharide containing fucose.

Thermodynamic Effects of 3 Different Diode Lasers on an Implant-Bone Interface: An Ex-Vivo Study With Review of the Literature

&NA; The aim of this study is to assess the increase of temperature following laser irradiation with 810 nm, 980 nm, and 1064 nm diode laser wavelengths, of an implant under conditions that more closely replicate those of the human body. A 4×14 mm machined surface implant was placed in a porcine rib to replicate the conductivity of heat given by the bone. A peri‐implant vertical defect was made that was 2 mm wide and 2 mm deep to simulate bone resorption. Two thermocouples were positioned crestally and apically on the implant surface. The tip of the laser was kept 3 mm away from the surface and continuously moved in an up‐and‐down and side‐to‐side fashion, inside the defect for 60 seconds. Initial temperatures and the time needed to reach an increase of 10°C were recorded. The experiment was repeated at room temperature and in a 37°C water bath with the following settings: 0.6 W, 0.8 W, 1 W continuous and repeated in pulsed. A critical increase of temperature of more than 10°C is reached with all lasers at 0.8 W and 1 W in continuous mode at room temperature. Only the 1064 nm diode laser reached the critical increase at 0.8 W in pulsed mode. No critical increase of temperature was registered with other settings and when the bone block was placed in a 37°C water bath. The results of this study suggest that use of these diode lasers does not cause a harmful increase in temperature when used under conditions similar to those of the human body.

Excessive postextraction bleeding associated with Cordyceps sinensis: a case report and review of select traditional medicines used by Vietnamese people living in the United States

Many older people who have emigrated from Vietnam to the United States continue to use the traditional medicines that they used in their country of origin. Clinicians trained in the West may not be familiar with these products. We reviewed 6 Asian traditional medicines that are popular among older Vietnamese people living in the United States. Each medicine has significant side effects that can lead to complications in patients undergoing surgery. Here, we present the case of a patient who used Cordyceps sinensis daily as a tonic and experienced prolonged bleeding after dental surgery.