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hen patients arrive at the Salivary Gland Center in Columbia University’s School of Dental and Oral Surgery complaining of a dry mouth, center director Dr. Louis Mandel gives them a cracker. It’s not high tech, but the aptly named “cracker test” identifies people who make too little saliva. “Without saliva, you can’t swallow your food,” Dr. Mandel says. “If the patient can eat a dry cracker, they don’t have a problem. If they can’t, they do.”

Dr. Mandel, who graduated from SDOS in 1946, has performed research and taught oral surgery at SDOS for the past 50 years. Ten years ago, his commitment became full-time when he opened the center after leaving his part-time oral surgery practice in the Bronx when his partner became ill. He also became assistant dean for extramural hospital programs. Though he takes pride in his oral surgery career and the 100 or so papers he’s published in his discipline and on salivary glands, Dr. Mandel says he came back to a full-time job in his retirement years because of a love of teaching.

“He’s a tremendous asset,” says Dr. Ira Lamster, SDOS dean. “We’re celebrating his 50th anniversary at Columbia, and that shows his incredible dedication and loyalty to this institution. Besides that, he publishes a great deal and generally includes a dental student or hospital resident in patient evaluation and, subsequently, as a co-author when cases are reported in the literature. This is a remarkable thing to do and it energizes the student during his or her Columbia experience.”

Dr. Mandel clearly remembers when he decided to become a dentist. “I was 10 or 11, and I went out on a house call one night with my big brother, who was a physician,” Dr. Mandel says. “In the car, he asked me what I wanted to do with my life and I didn’t know. He thought dentistry was a good idea, because I could combine my mechanical skills—I used to build things—with my interest in biology.

“Dentistry has been good to me,” Dr. Mandel says. “It’s an interesting profession because it combines biological with mechanical science.” Over the years, Dr. Mandel has seen many changes in oral surgery practice and education. Fifty years ago, dental implants didn’t exist and surgeons used nitrous oxide as an anesthetic, which had a higher mortality rate than the intravenous sedatives used today. With more techniques to learn, the oral surgeon’s education lengthened. Dr. Mandel learned oral surgery at SDOS in a two-year postdoctoral program. The current program now takes six years and culminates with an M.D. degree.

Dr. Mandel started the Salivary Gland Center with SDOS professor emeritus and special lecturer Dr. Irwin Mandel, who was interested in the biochemistry of saliva and its anti-bacterial, buffering, and digestive activities. Dr. Louis Mandel did research in saliva when he was a graduate student in oral surgery. Now, as an expert in dry mouth, salivary gland stones, and even cat scratch fever (which may resemble a salivary gland tumor if a nearby lymph node swells from the infection), Dr. Mandel sees about 10 patients a week in the center.

To help publicize the center, Dr. Mandel several years ago began writing a newsletter on salivary gland problems, which he sends to every physician and dentist at Columbia-Presbyterian Medical Center and to New York City specialists in oral surgery and periodontal disease. The newsletter helped him increase the number of center patients, many of whom suffer from Sjorgen’s disease, an autoimmune disorder that destroys the salivary glands and affects 3 million Americans.

Dr. Mandel hopes the newsletter generates referrals, but his greatest pride is “having a stupid joke in each issue.” For example, he illustrated an issue on salivary gland stones with a picture of the Rock of Gibraltar. The caption read: “Now that’s a stone!”

“I think the jokes are pretty good,” Dr. Mandel says.

His latest research in salivary gland disorders may lead to a better way to prevent the salivary gland destruction that occurs during treatment for thyroid cancer. Many patients are treated with radioactive iodine that hones in on the thyroid and kills the cancer cells. But the radioactive iodine attacks the salivary glands, which if destroyed lead to infected glands, dry mouth, and ruined teeth because of the absence of bacteria-fighting saliva.

Radiologists give thyroid patients lemon drops to increase saliva production to flush out the radioactive iodine, but some damage still occurs. Dr. Mandel thinks saliva-producing drugs, such as Salagen and Evoxac, increase transit time of the radioactive iodine through the gland and lessen gland damage. He is working with Dr. Rashid Fawwaz, professor of clinical radiology, to test the idea.

As he has done with all his research papers, when the data are ready, Dr. Mandel finds a dental student to help him write the results. Recent papers, which are often published in the Journal of the American Dental Association, have addressed ultrasound and CT scanning to diagnose salivary gland problems and HIV’s effect on the parotid salivary gland.

“To me, teaching is the highest calling,” Dr. Mandel says. “It allows me to return to students what I got from the school as a student.” In 1998, a committee of students and faculty honored him with the annual SDOS Teaching Award at commencement. “I cried when it was announced,” Dr. Mandel remembers. “And why was I crying? I was crying because that’s what I do: I live to teach students and their demonstrated appreciation was most touching.”



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