Common oral conditions in the elderly.

As the proportion of elderly persons in the population increases, physicians will more frequently see patients with the oral lesions that commonly occur in this group. Periodontal disease represents the most common cause of tooth loss in the elderly. Dentures can create several problems, including traumatic ulceration, denture stomatitis, inflammatory papillary hyperplasia and epulis fissurata. Erythroplakia, rather than leukoplakia, is the most common precursor of oral carcinoma in elderly persons.

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.

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-Petroff's 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 alpha-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 greater than MG2 approximately nonglycosylated alpha-amylases approximately glycosylated alpha-amylases.

A randomized double-blind pilot study to compare conscious sedation produced by diazepam against sufentanil.

Intravenous sufentanil, an analog of fentanyl, was compared to diazepam for conscious sedation in ambulatory dental outpatients. Ten patients undergoing the surgical removal of impacted third molars served as subjects in a double-blind, within-subject, single crossover study. Sedation was achieved with a combination of 30% nitrous oxide/70% oxygen by nasal mask and either diazepam (0.05-0.15 mg/kg) or sufentanic (0.05-0.15 µg/kg) titrated to a clinical endpoint of altered speech and relaxation. Intraoperative physiologic monitoring, patients' and the oral surgeon's subjective estimates of efficacy and psychomotor recovery were used to compare the two treatments. Both patients (eight of 10) and surgeons (six of 10) preferred sufentanil sedation. No significant differences were noted between treatments for psychomotor recovery. These preliminary data in a small sample suggest that sufentanil produces adequate conscious sedation in dental outpatients and should be evaluated further with larger patient samples.

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.

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.

Masticatory lubrication. The role of carbohydrate in the lubricating property of a salivary glycoprotein-albumin complex.

We report for the first time a masticatory-lubrication assay system to assess the lubricating properties of salivary constituents. The lubricating ability of the proline-rich glycoprotein (PRG) of parotid saliva was enhanced by human serum albumin. The interactive effect of albumin was abolished by chemically deglycosylating the glycoprotein. Fluorescence spectroscopy with a hydrophobic probe verified the existence of a PRG-albumin complex and demonstrated that deglycosylation of the PRG altered the nature of its interaction with albumin.