ANXIOUS YOUNG PATIENTS

HEALTH MEDIA WATCH

the candidates. Write down your questions ahead of time to get the information you need. Have candidates meet other staff members. See how they interact with staff members and ask staff members for their opinions of the candidates. You may want to have candidates spend a day—with pay—at your practice, so that you can observe how they interact with patients and fit into the office routine. Taping the interview—with the candidate’s permission—will give you a chance to listen to his or her responses again. You may hear something you missed when speaking to the candidate face to face. Finally, be alert to red flags such as a candidate who asks about money and time issues early in the process or repeatedly hesitates before answering questions about his or her philosophy. (ADG Impact 1998;26[1]:14-5) TOOTH CRACK CLASSIFICATION SYSTEMS INTRODUCED

In the February issue of Compendium of Continuing Education in Dentistry, Dr. Richard Carlos Tatum proposes two new systems for classifying propagating tooth cracks. The first—The Surface and Position Classification System— is a simplified, ready framework that includes the following 12 types of cracks: denamel cracks are beginning cracks; ddentin cracks are advanced in length and depth; dincline plane cracks result from repeated loading and overloading of compressive, tensile and shearing stresses;

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dcuspal cracks are single-point cracks frequently associated with occlusal imbalances; dcoronal cracks are clinically visible cracks found above and below the marginal gingiva; dmarginal ridge cracks occupy a small area on the occlusal surface and are often hidden by stained fossae, pre-existing restorations or adjacent tooth contact; dgrooves and fissure cracks are segmented or intermittent, and loading changes their length and depth; dsymptomatic pulpally involved cracks create pain responses ranging from profoundly acute to low grade; dasymptomatic pulpally involved cracks are often diagnosed from progressive changes on radiographs and an early history of minor discomfort; droot cracks are found from the cervix to the apex; dcervical area cracks are found on mesial, distal, buccal and lingual surfaces; dmidtooth buckling cracks are not limited to the cervical area and may extend toward the cusps or incisal edges or toward the apex. The second system—The Classification Directional Crack Propagation System—is more comprehensive than the first and includes 10 types of cracks: doblique incomplete cracks are vertical and become deflected secondary cracks as their length increases; doblique complete cracks run along or are parallel to the enamel rods or dentinal tubes and were subjected to heavy or repeated overloading; dvertical incomplete cracks are early-stage, small

vertical cracks; dvertical complete cracks are long-standing cracks that have grown in length and depth as a result of repeated loading and overloading; dvertical-horizontal or rightangle cracks begin vertically and then intersect with horizontal cracks, interfaces or restorations and run perpendicular to them; dvertical-cervical buckling and bending cracks are cervical-area cracks in which moisture content may be the cause; dvertical-occlusal flaking and chopping cracks result from the flaking of occlusal surface enamel; dzigzag cracks are complete fractures resulting from trauma that displaces the incisal half of highly vulnerable and restful teeth; dhorizontal cracks appear midway in the buccal surface of teeth that support a disproportionate load; dcombination directional cracks appear in teeth with multiple compromises such as cross-bites and multiple restorations. (Compendium 1998;19[2]:211-8) ANXIOUS YOUNG PATIENTS

Dentists who work with young children need to recognize and differentiate between developmental separation anxiety, or DSA, and separation anxiety disorder, or SAD, according to an article in the November/ December issue of Pediatric Dentistry. DSA occurs in children between 10 and 12 months of age who become distressed and apprehensive when removed from

HEALTH MEDIA WATCH their parents, homes or familiar surroundings. This developmental stage usually resolves around 24 to 36 months—depending on the age of onset— without any specific intervention or treatment. However, if DSA becomes excessive, continues past three years of age and begins to interfere with a child’s functioning, it becomes known as SAD. Several studies cited by the article’s author, Dr. Andrew

BOOK REVIEWS ORTHODONTIC MANAGEMENT OF THE DENTITION WITH THE PREADJUSTED APPLIANCE

By Drs. John C. Bennett and Richard P. McLaughlin, Bradford, England, Isis Medical Media Ltd., 380 pages, $255, 1997, ISBN 1899066918

This book is a great reference source for the specialty and practice of clinical orthodontics. This book presents essential details required to successfully use the preadjusted appliance in the treatment of malocclusions. The transition from the standard edgewise appliance to the preadjusted appliance have introduced significant advantages in treating orthodontic problems. However, the use of preadjust-

Guthrie, show a trend among dentists toward allowing parents to remain in the dental operatory with children three years old or younger, taking into consideration the presence of DSA and the child’s emotional needs. Dr. Guthrie also found that many dentists have adjusted their practice policies and techniques to accommodate standard DSA reactions. He says, however, that dentists who have patients three years of age or older who demand that their parents be pre-

sent in the operatory need to differentiate between emotionally delayed children with continued DSA and children with SAD. Dr. Guthrie recommends that dentists who suspect patients of having severe cases of SAD refer them to child psychiatrists or psychologists for evaluation and intervention or treatment. (Pediatr Dent 1997;19:486-90)

ed appliances requires significant changes in treatment and anchorage sequencing from treatment methods that used the standard edgewise appliances. The authors have identified these changes and have very appropriately outlined procedures to circumvent problems that may arise from the use of preadjusted appliances. Hence, clinicians can maximize the use of these appliances with minimal adverse effects. In addition to the changes in treatment and anchorage sequencing they necessitate, preadjusted appliances present clinicians with numerous dayto-day problems in the practice of clinical orthodontics. Also, since the introduction of the preadjusted appliances, numerous bracket designs have appeared in the market with claims of performance superiority over existing versions. The authors have presented an extremely rational approach to the selection of appropriate

bracket designs and prescriptions for appliances. This will help solve some of the problems iatrogenically created by other versions. The authors have used sound research methods and clinical experiences to substantiate their methods. This book attempts to point out common clinical situations and to provide tools to solve them. In summary, this 380-page hardcover book with numerous high-quality illustrations is the most comprehensive and clear presentation of common clinical situations and their solutions for the orthodontic practitioner. It is a must-read for students, researchers and clinicians involved in the orthodontic treatment of malocclusions. Reviewed by Pramod K. Sinha, B.D.S., D.D.S., M.S., Assistant Professor, Department of Orthodontics, The University of Oklahoma Health Sciences Center, College of Dentistry, Oklahoma City

Compiled by Amy E. Lund, editorial coordinator.

JADA, Vol. 129, April 1998

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