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Dentistry: forecasting the future.

What do synthetic sapphire, hydraulic valves, and computer imagery have to do with your mouth?

If someone asked you that question today, you'd probably answer, "Nothing"-but five or ten years from now, your response might be quite different. Technological advances in such areas as these are pushing back the frontiers of dental knowledge, bringing with them new tools and treatments to help you maintain your dental health.

The 21st century may well witness dental offices equipped with computerized "drills" that read X-rays and use lasers to carve damaged teeth for new crowns and fillings. New biomaterials will match natural tooth color more closely, and dental restorations will last much longer, perhaps a lifetime. Computers with artificial intelligence will help dentists diagnose complex oral cancer and other diseases more quickly and more accurately. Timed-release fluoride capsules will be attached to the teeth of persons with severe physical handicaps to provide the same preventive effect others achieve from fluoridated dentifrices. Bone regeneration and dental implants will reduce tooth loss and the need for false teeth. When false teeth are needed, they will fit better, look more natural, and cost less. Vaccines may greatly reduce the prevalence of such dental diseases as caries (decay) and periodontitis. Dental surgery will be easier and less painful, and recovery will be much quicker.

Although a decade or more may pass before we see some of these developments, others are rapidly taking their place in dentistry's future. And surprising as it may seem, hydraulic valves, synthetic sapphire, and computers are right up there at the head of the line.

Synthetic sapphire, for example, is an industrial product made from aluminum-oxide crystals. The resulting sapphire has many of the same qualities of the natural gemstone, including its strength, hardness, and transparency. Natural sapphire is bluish, due to impurities in the earth from which it is formed, but these laboratory-grown crystals are as clear as water. Dentists and other scientists at Johnson & Johnson have devised a technique that allows them to shape this synthetic sapphire into orthodontic braces.

The use of synthetic materials in orthodontic appliances is not new, but this sapphire system avoids many of the problems encountered with other "clear" brace systems, such problems as discoloration and distortion. Many people believe that because this new product is aesthetically more pleasing than traditional wire braces, more consumers will be inclined to seek out much-needed orthodontic work.

But synthetic sapphire is just one example of the many technological innovations changing the way dentistry will be practiced in the future.

Consider the matter of hydraulic valves. For all that dentists know about the mouth, their knowledge of chewing and its effects on tooth structure and on restorative materials ("silver" or amalgam fillings, for example) has been limited because of the long periods required for normal chewing to have any effect on either the natural or artificial materials. In years past, when dental scientists wanted to test a new restorative material, such as might be used to construct a new ceramic crown, a sample of the material was subjected to stress testing and put into use, and as the years went by, field reports were compiled to monitor how well the material was actually holding up in patients' mouths.

Thanks to computers, hydraulic valves, and a dose of creative genius, researchers at the University of Minnesota can now test materials in an artificial mouth that simulates not only the complex actions required by chewing, but the salivary flow and thermal conditions of the mouth as well. Acting as an almost perfect simulator, the mouth chews at a rate of four "bites" per second and applies the same force as a person would apply. In a mere 24 hours, the artificial mouth accomplishes as much normal chewing as an ordinary person would perform in a year.

The simulated mouth holds from 1 to 32 teeth at once, and eachtooth is carefully mapped, using a combination of computer image analysis and topography, before the testing starts. Various measurements are taken as the testing continues, and upon completion, the laboratory's computers can create highly detailed before-and-after statistics and graphic images of the tooth (and its artificial filling). The computer can even compute the differences to show how much material has been lost from the tooth's surface and where the lost material has come from.

Dr. William Douglas, who headed the team that developed the simulated mouth, says: "The implication of this technology on the development and testing of teeth and dental biomaterials is difficult to explain. A good analogy would be the wind tunnels used in aeronautical research. Before the wind tunnel and night simulators, engineers did their best to design an aerodynamic plane, built it, and hoped it would fly. We've been doing the same thing in dentistry. The artificial mouth will allow us to develop materials which are much stronger and longer lasting than those we've had in the past." Ultimately, the reduced research and development costs may lead to restorative materials less expensive for patients.

What's next in Dr. Douglas' lab? He's trying to figure out a way to build an artificial throat so the simulated mouth can be used to study the effects of food products and dietary patterns on tooth structure. "We've just got to teach the thing to swallow," Dr.

Douglas quips.

Speaking of dietary patterns, nutritional researchers at several dental research centers have made major strides toward understanding the biochemical and microbial actions that occur during and after the chewing of foods. One key activity is the breakdown of carbohydrates into the acids that cause tooth decay. Researchers are studying this process and the ways individual food products are broken down in the mouth. Many food products start breaking down into acids almost immediately after entering the mouth and often leave a residue of acid in the mouth that remains for several hours, even after brushing. Such foods are said to be cariogenic, or decay causing. Other foods, such as Cheddar cheese, for example, appear to counteract or inhibit the formation of decay-causing acids.

Because the tendency of various foods to form these decay-causing acids in the mouth can be measured, we may well see the day when food products carry a "caries index" on the package, a numerical figure telling consumers of the relative risk that the product will promote tooth decay.

Any discussion of the future of dentistry would be remiss if it failed to touch on the prospects for a decay-prevention vaccine. A major bacterial cause of tooth decay is Streptococcus mutans, the agent that causes carbohydrates to ferment and change into acids in your mouth. An effective vaccine would stimulate the body's immune system to ward off this bacteria.

Preliminary tests on animals injected with prototype vaccines, and on human volunteers who ingested the vaccines, suggest to researchers at the National Institute of Dental Research in Bethesda, Maryland, that a significant antibody response can be created in humans. Such an antibody might greatly reduce our susceptibility to dental decay. Substantial research, coupled with long-range clinical trials in humans, will be required before widespread use of a caries vaccine is possible, however. Don't count on a vaccine to solve your decay problems, but by the year 2010, it may be in common use. When such a vaccine does arrive, dental caries may be eliminated, just as the Salk vaccine has nearly eradicated polio.

Prevention has long been a watchword in dentistry. More than any other health profession, dentistry has devoted itself to prevention. Fluoridated water supplies, dentifrices, and mouth rinses-probably the most outstanding public-health successes of the 20th century-have had such an impact on dental decay that the dental profession itself is undergoing a transformation. Dentists are shifting their attention from tooth decay to previously neglected areas of dental health, including such topics as head and neck pain and diet and nutrition, among others.

Elsewhere on the dental scene, fluoridation has so reduced the problems of dental caries in children and young people that attention is shifting to the dental problems of older adults. Says Dr. Lawrence Meskin, dean of the University of Colorado School of Dentistry and a man regarded as a "visionary" by many dental educators: "Every available indicator tells us that the future of dentistry lies with the older adult. Demographers point out that during the next 30 years the 'over 50' age group will be increasing constantly. Because of fluoride, better diets, and healthier life styles, people are keeping their teeth longer, And while our lives are longer and happier, the fact remains that as we age, our bodies ultimately begin to deteriorate. Health care, including dental care, becomes much more complicated because breakdowns in one body system often have effects in other systems. Medications used to treat certain diseases of the aged often affect salivary flow, which, in turn, affects the body's ability to fight tooth decay, for example. Tomorrow's dentists will need to understand the physiology of aging and will need a much stronger background in medicine if they are to effectively manage oral health in their patients. The dentist of the future is going to face problems quite unlike those most of us in practice today were trained to solve. , ,

Thanks to today's dental researchers, tomorrow's dentists will have the technological tools necessary to deal with those problems, thereby ensuring the finest dental care for you and your children well into the future.
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Author:Born, David O.
Publication:Saturday Evening Post
Date:Sep 1, 1987
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