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NEW CARIES-FIGHTING SUBSTANCES
I
COSMETIC GUM
..GRAFTING
More and more people are discovering that gum grafting is an option for improving the appearance of their smiles. According to Houston periodontist Michael McGuire, periodontists use a grafting procedure to remove sections of gum in one area of the mouth and insert the tissue into an area where it is needed to make teeth appear the right length. For instance, if patients have gummy smiles that make their teeth appear too short, periodontists can sculpt the gum line to make the patients' teeth look longer and vice versa. Cosmetic periodontal procedures are best performed before restorative dental procedures such as the placement of crowns or veneers. Some new procedures, however, allow cosmetic alterations to the gums next to restored teeth although the restorations may have to be redone. Dr. McGuire cautions that, as with any surgical procedure, there may be some discomfort. But most cosmetic periodontal procedures are performed without general anesthetic or prescription medications for postoperative pain. Instead, periodontists usually perform the procedures in their offices using a local anesthetic, following up with a common pain reliever such as aspirin or ibuprofen. Dr. McGuire recommends that patients considering gum grafting first talk with their general dentist, who may be able to recommend a periodontist experienced in performing these procedures. 1500 JADA, Vol. 128, November 1997
NEW CARIES-FIGHTING SUBSTANCES
Dr. Israel Kleinberg has developed caries-fighting substances that could be twice as effective as fluoride in eliminating cavities. In the 1970s, Dr. Kleinberg isolated sialin, a peptide found in saliva. Sialin and other salivary peptides act as substrates for bacteria and plaque. Higher amounts of these peptides are found in people resistant to tooth decay than in people not resistant to tooth decay. According to Dr. Kleinberg, saliva's arginine-the active component of peptides-creates a base that neutralizes acid and raises the mouth's pH to a protective level. In the 1980s, Dr. Kleinberg discovered salivary precipitin, a component of saliva. Salivary precipitin brings together minerals such as calcium and phosphate that become part of plaque. Acid from sugars and carbohydrates easily dissolve salivary precipitin rather than damage the tooth. Since 1992 Dr. Kleinberg and his colleagues have been designing molecules to take advantage of these two substances. And by the end of 1997, Dr. Kleinberg will begin the clinical trials necessary for sialin and salivary precipitin to go through the federal drug approval process. Dr. Kleinberg wants to see sialin and salivary precipitin added to standard dental hygiene products, as well as candy and chewing gum, to help fight tooth decay. COMPLEX MEDICAL DEVICES
New, high-tech medical devices sometimes are too complicated
for the medical staff who use them, according to two studies conducted at The Ohio State University. Researchers found that poor human-computer interfaces created errors in the setup and use of two devices. They also found that medical professionals had to work around these problems to avoid making mistakes that could jeopardize patients. In the two studies, researchers observed how medical staff worked with two new pieces of equipment: an anesthesiology monitor and an infusion pump. In both studies, the researchers observed that staff had problems remembering complicated sequences of commands and calling up displays showing what mode the machine was in at a given time. In the case of the anesthesiology monitor, the technicians first had to experiment with it until they learned how to call up the most useful displays and configure multiple windows on the screen. However, when they used the monitor in the operating room, the monitor returned to the original screen configuration, obscuring important patient information. As a result, the technicians had to develop new procedures and reminders to undo the computer's reconfiguration. In the case of the infusion pump, nurses had to change existing procedures or create new procedures to help patients avoid changing syringes in the middle of the night. In both studies, the adaptations the medical staff developed worked. However, the fact that they had to adapt the deContinued on page 1504
COSMETIC GUM
..GRAFTING
More and more people are discovering that gum grafting is an option for improving the appearance of their smiles. According to Houston periodontist Michael McGuire, periodontists use a grafting procedure to remove sections of gum in one area of the mouth and insert the tissue into an area where it is needed to make teeth appear the right length. For instance, if patients have gummy smiles that make their teeth appear too short, periodontists can sculpt the gum line to make the patients' teeth look longer and vice versa. Cosmetic periodontal procedures are best performed before restorative dental procedures such as the placement of crowns or veneers. Some new procedures, however, allow cosmetic alterations to the gums next to restored teeth although the restorations may have to be redone. Dr. McGuire cautions that, as with any surgical procedure, there may be some discomfort. But most cosmetic periodontal procedures are performed without general anesthetic or prescription medications for postoperative pain. Instead, periodontists usually perform the procedures in their offices using a local anesthetic, following up with a common pain reliever such as aspirin or ibuprofen. Dr. McGuire recommends that patients considering gum grafting first talk with their general dentist, who may be able to recommend a periodontist experienced in performing these procedures. 1500 JADA, Vol. 128, November 1997
NEW CARIES-FIGHTING SUBSTANCES
Dr. Israel Kleinberg has developed caries-fighting substances that could be twice as effective as fluoride in eliminating cavities. In the 1970s, Dr. Kleinberg isolated sialin, a peptide found in saliva. Sialin and other salivary peptides act as substrates for bacteria and plaque. Higher amounts of these peptides are found in people resistant to tooth decay than in people not resistant to tooth decay. According to Dr. Kleinberg, saliva's arginine-the active component of peptides-creates a base that neutralizes acid and raises the mouth's pH to a protective level. In the 1980s, Dr. Kleinberg discovered salivary precipitin, a component of saliva. Salivary precipitin brings together minerals such as calcium and phosphate that become part of plaque. Acid from sugars and carbohydrates easily dissolve salivary precipitin rather than damage the tooth. Since 1992 Dr. Kleinberg and his colleagues have been designing molecules to take advantage of these two substances. And by the end of 1997, Dr. Kleinberg will begin the clinical trials necessary for sialin and salivary precipitin to go through the federal drug approval process. Dr. Kleinberg wants to see sialin and salivary precipitin added to standard dental hygiene products, as well as candy and chewing gum, to help fight tooth decay. COMPLEX MEDICAL DEVICES
New, high-tech medical devices sometimes are too complicated
for the medical staff who use them, according to two studies conducted at The Ohio State University. Researchers found that poor human-computer interfaces created errors in the setup and use of two devices. They also found that medical professionals had to work around these problems to avoid making mistakes that could jeopardize patients. In the two studies, researchers observed how medical staff worked with two new pieces of equipment: an anesthesiology monitor and an infusion pump. In both studies, the researchers observed that staff had problems remembering complicated sequences of commands and calling up displays showing what mode the machine was in at a given time. In the case of the anesthesiology monitor, the technicians first had to experiment with it until they learned how to call up the most useful displays and configure multiple windows on the screen. However, when they used the monitor in the operating room, the monitor returned to the original screen configuration, obscuring important patient information. As a result, the technicians had to develop new procedures and reminders to undo the computer's reconfiguration. In the case of the infusion pump, nurses had to change existing procedures or create new procedures to help patients avoid changing syringes in the middle of the night. In both studies, the adaptations the medical staff developed worked. However, the fact that they had to adapt the deContinued on page 1504