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Improving dental practice through preventive measures
Book
Reviews
The first edition assumed that the qualified dentist was familiar with all the features of caries and periodontal disease and these topics were omitted. For completeness they have been added in the new edition. In addition, both the illustrations and the text have been revised. The basic concept is attractive, but the reader is soon aware of some practical difficulties in following the idea through to a logical end point. For quite a number of entities the author has had to decide arbitrarily into which group the condition should be placed. Moreover, because the text is brief and dogmatic the expert would not agree with all that is said, or indeed with all the interpretations. However, one must accept that the book is not intended for the expert, or intended to do more than give a basic minimum of information about each subject. Judged in this way it covers a great deal of ground and illustrates most of the appearances which the busy practitioner may encounter. It certainly seems to work as a quick source of reference and should help to make everyday general practice more interesting. It should be noted that it is not intended as a definitive textbook for either the undergraduate or the postgraduate and would not be a suitable purchase for use in this way. G. R. SEWARD
Law and Ethics in Dentistry (Dental Practitioner Handbook No. 19). By J. SEEAR. 220x 142 mm. Pp. 2OO+xi, with 15 illustrations. 1975. Bristol: Wright. E5.50. Until recently the field of dental jurisprudence and forensic dentistry had been covered by only one or two comprehensive textbooks and a number of booklets issued by various bodies relating to their particular areas of interest. This situation has been considerably altered during the past year or two by the appearance of a number of volumes in this country and America relating to these subjects, and if this rate of publication continues potential readers will soon be spoilt for choice when making their selection. The more recent the publication, of course, the more up to date will be the subject matter, and this is a matter of importance in view of the spate of new legislation which has become a feature of modern government. A reviewer must, therefore, attempt at this stage to appraise the relative values of new publications and to suggest which would be most appropriate to a particular class of reader if this appears to be the case.
149
The book which is the subject of the present review is the latest addition to the Dental Practitioner Handbooks series, and at E5.50 cannot be said to be unduly expensive by modern standards. It is well produced and excellently written. The author has the outstanding advantage of first hand personal experience, in his capacity as Dental Secretary of the Medical Protection Society, of much on which he writes. He is, therefore, in a position to know the more common problems of dental practice and to provide the answers in his book. This he does very satisfactorily, aided by extensive case quotations from past reports of the Medical Protection Society. The treatment of professional ethics is somewhat disappointing, in that the chapter on this subject consists of one page of the author’s own views and the remainder a reproduction of the already published booklet of the British Dental Association and pronouncements by the World Medical Association and the International Dental Federation. However, with this one exception the whole field is very adequately covered, and in the chapter entitled ‘The Practitioner and his Staff ‘, sixteen Acts of Parliament, mostly recent enactments, are brought to the notice of the reader, who should find it a valuable guide. As a bonus the author has included a short chapter on insurances, both personal and professional, and two appendixes dealing with ionizing radiations and emergencies in dental practice. To sum up, this book can be recommended to any member of the dental profession and to dental students and others interested in the practice of dentistry as interesting reading, a mine of valuable information and an authoritative source of reference. D. V. TAYLOR
Improving Dental Practice through Preventive Measures. Ed. by JOSEPHL. BERNIERand JOSEPHC. MUHLER. Third Edition. 245 x 170 mm. Pp. 425 + xii, with 294 illustrations. 1975. St Louis: Mosby (London: Kimpton). E14.60. The concept of preventive dentistry adopted in this book is that any procedure which forestalls something worse from developing is prevention. Thus, carrying out treatment properly, or using apparatus, such as an X-ray machine, correctly is prevention because the damaging sequelae of bad treatment or incorrect usage are avoided. By these criteria there is hardly an activity in the entire field of health care which is not preventive in
150
nature. Whilst it is certainly a tenet of preventive dentistry that treatment, when required, should be of the highest attainable standard, the field of preventive dentistry is usually regarded as embracing only those procedures which prevent the manifestation of disease and preserve the tissues in their original healthy state. Many of the chapters in this book then, such as those dealing with operative dentistry, full dentures, oral surgery and orthodontics, are concerned with interceptive, early or simply, good treatment, which the reviewer regards as correct therapy, not prevention. However, these chapters are clearly written and contain much interesting information and guidance, and the dental practitioner, for whom the book is intended, will welcome them and benefit from them. Among the chapters dealing with the more strictly preventive topics there is a curious chapter on motivation, a tine review of fluorides, a good account of prevention in dental practice, an authoritative discussion of dentifrices and ‘backup’ chapters on nutrition and microbiology. The matter of plaque control is well covered and is repeated again and again in various chapters and thereby receives the emphasis it deserves. Although there is a good account of nutrition in general, the discussion of diet therapy for the control of dental caries and the use of caries-activity tests is woolly and defeatist ; the practitioner requires clearer, more spirited, guidance than this if he is to scuceed in this difficult field. The book is adequately illustrated and is well produced, using materials of good quality. Of its kind, it is probably the best text available and, apart from its fearful price, this welcome third edition is a safe recommendation. W. SIMS
Manual of Minor Oral Surgery. A Step by Step Atlas. By H. BIRN and J. E. WINTHER. 210x 295 mm. Pp. 131, with 212 illustrations. 1975. Copenhagen : Munksgaard. Dkr 90. In this book two well-known Danish teachers of oral surgery set out to explain the everyday practical procedures of minor oral surgery. It is a stepby-step guide to elementary operative techniques, each stage in each procedure being illustrated by simple diagrams. No attempt has been made to cover matters of diagnosis, the reasons why one operative procedure should be employed for a case rather than another or the natural history of the conditions for which the operative treatment is
Journal of Dentistry, Vol. ~/NO. 3
described. This atlas therefore will be helpful to the undergraduate to prepare him to carry out these procedures for the first time, or to the senior student to improve his technique. It should also be ideal for the new graduate who, perhaps, is intending to carry out some of these small operations in the unfamiliar environment of general practice and no longer has his teacher to hand to give him encouragement. The first part of the book deals with the techniques of forceps extraction, flap reflection, suturing and root removal. There follow sections on the treatment of cysts, apicectomy, the exposure and removal of buried teeth and minor pre-prosthetic will surgery. Not every detail of technique meet with the approval of all teachers but this is inevitable. As is to be expected by those who know the authors, the reasons for their points of view are always logical, and undergraduates would certainly benefit from debating any differences in technique with their teachers. Certain techniques, however, particularly struck the reviewer as unfortunate. The fenestration procedure is described as an alternative to enucleation as a treatment for cysts. There are times when a limited opening and a cyst plug are particularly indicated, but a much larger opening to marsupialize or saucerize a cyst is preferable whenever possible (but only if enucleation is contraindicated). Further, a small tube or cyst plug such as is described may be displaced easily and aspirated or swallowed. The authors frequently illustrate the contra-angled handpiece as an instrument for use in removing impacted teeth. There is a risk that the inexperienced might be tempted to interpret these as air-turbine handpieces, overlooking the difficulties of sterilizing the turbine handpiece and incurring a risk of surgical emphysema from the air which they discharge. It is also advocated that lower third molar sockets should be tightly sutured. This is fine if haemotasis is absolute, but if there is any postoperative ooze a buccal space haematoma will result. Perhaps an even greater risk is that some practitioners might think that acquaintance with the technical matters covered by this book is all they need to know about oral surgery, and that major errors of judgement may be committed. The reader is warned about this in the Preface. These criticisms apart, and properly used, this is likely to be a useful and popular book. True, its usefulness will be of short duration, but at times which are important in the development of the student or practitioner. G.R. SEWARD
Reviews
The first edition assumed that the qualified dentist was familiar with all the features of caries and periodontal disease and these topics were omitted. For completeness they have been added in the new edition. In addition, both the illustrations and the text have been revised. The basic concept is attractive, but the reader is soon aware of some practical difficulties in following the idea through to a logical end point. For quite a number of entities the author has had to decide arbitrarily into which group the condition should be placed. Moreover, because the text is brief and dogmatic the expert would not agree with all that is said, or indeed with all the interpretations. However, one must accept that the book is not intended for the expert, or intended to do more than give a basic minimum of information about each subject. Judged in this way it covers a great deal of ground and illustrates most of the appearances which the busy practitioner may encounter. It certainly seems to work as a quick source of reference and should help to make everyday general practice more interesting. It should be noted that it is not intended as a definitive textbook for either the undergraduate or the postgraduate and would not be a suitable purchase for use in this way. G. R. SEWARD
Law and Ethics in Dentistry (Dental Practitioner Handbook No. 19). By J. SEEAR. 220x 142 mm. Pp. 2OO+xi, with 15 illustrations. 1975. Bristol: Wright. E5.50. Until recently the field of dental jurisprudence and forensic dentistry had been covered by only one or two comprehensive textbooks and a number of booklets issued by various bodies relating to their particular areas of interest. This situation has been considerably altered during the past year or two by the appearance of a number of volumes in this country and America relating to these subjects, and if this rate of publication continues potential readers will soon be spoilt for choice when making their selection. The more recent the publication, of course, the more up to date will be the subject matter, and this is a matter of importance in view of the spate of new legislation which has become a feature of modern government. A reviewer must, therefore, attempt at this stage to appraise the relative values of new publications and to suggest which would be most appropriate to a particular class of reader if this appears to be the case.
149
The book which is the subject of the present review is the latest addition to the Dental Practitioner Handbooks series, and at E5.50 cannot be said to be unduly expensive by modern standards. It is well produced and excellently written. The author has the outstanding advantage of first hand personal experience, in his capacity as Dental Secretary of the Medical Protection Society, of much on which he writes. He is, therefore, in a position to know the more common problems of dental practice and to provide the answers in his book. This he does very satisfactorily, aided by extensive case quotations from past reports of the Medical Protection Society. The treatment of professional ethics is somewhat disappointing, in that the chapter on this subject consists of one page of the author’s own views and the remainder a reproduction of the already published booklet of the British Dental Association and pronouncements by the World Medical Association and the International Dental Federation. However, with this one exception the whole field is very adequately covered, and in the chapter entitled ‘The Practitioner and his Staff ‘, sixteen Acts of Parliament, mostly recent enactments, are brought to the notice of the reader, who should find it a valuable guide. As a bonus the author has included a short chapter on insurances, both personal and professional, and two appendixes dealing with ionizing radiations and emergencies in dental practice. To sum up, this book can be recommended to any member of the dental profession and to dental students and others interested in the practice of dentistry as interesting reading, a mine of valuable information and an authoritative source of reference. D. V. TAYLOR
Improving Dental Practice through Preventive Measures. Ed. by JOSEPHL. BERNIERand JOSEPHC. MUHLER. Third Edition. 245 x 170 mm. Pp. 425 + xii, with 294 illustrations. 1975. St Louis: Mosby (London: Kimpton). E14.60. The concept of preventive dentistry adopted in this book is that any procedure which forestalls something worse from developing is prevention. Thus, carrying out treatment properly, or using apparatus, such as an X-ray machine, correctly is prevention because the damaging sequelae of bad treatment or incorrect usage are avoided. By these criteria there is hardly an activity in the entire field of health care which is not preventive in
150
nature. Whilst it is certainly a tenet of preventive dentistry that treatment, when required, should be of the highest attainable standard, the field of preventive dentistry is usually regarded as embracing only those procedures which prevent the manifestation of disease and preserve the tissues in their original healthy state. Many of the chapters in this book then, such as those dealing with operative dentistry, full dentures, oral surgery and orthodontics, are concerned with interceptive, early or simply, good treatment, which the reviewer regards as correct therapy, not prevention. However, these chapters are clearly written and contain much interesting information and guidance, and the dental practitioner, for whom the book is intended, will welcome them and benefit from them. Among the chapters dealing with the more strictly preventive topics there is a curious chapter on motivation, a tine review of fluorides, a good account of prevention in dental practice, an authoritative discussion of dentifrices and ‘backup’ chapters on nutrition and microbiology. The matter of plaque control is well covered and is repeated again and again in various chapters and thereby receives the emphasis it deserves. Although there is a good account of nutrition in general, the discussion of diet therapy for the control of dental caries and the use of caries-activity tests is woolly and defeatist ; the practitioner requires clearer, more spirited, guidance than this if he is to scuceed in this difficult field. The book is adequately illustrated and is well produced, using materials of good quality. Of its kind, it is probably the best text available and, apart from its fearful price, this welcome third edition is a safe recommendation. W. SIMS
Manual of Minor Oral Surgery. A Step by Step Atlas. By H. BIRN and J. E. WINTHER. 210x 295 mm. Pp. 131, with 212 illustrations. 1975. Copenhagen : Munksgaard. Dkr 90. In this book two well-known Danish teachers of oral surgery set out to explain the everyday practical procedures of minor oral surgery. It is a stepby-step guide to elementary operative techniques, each stage in each procedure being illustrated by simple diagrams. No attempt has been made to cover matters of diagnosis, the reasons why one operative procedure should be employed for a case rather than another or the natural history of the conditions for which the operative treatment is
Journal of Dentistry, Vol. ~/NO. 3
described. This atlas therefore will be helpful to the undergraduate to prepare him to carry out these procedures for the first time, or to the senior student to improve his technique. It should also be ideal for the new graduate who, perhaps, is intending to carry out some of these small operations in the unfamiliar environment of general practice and no longer has his teacher to hand to give him encouragement. The first part of the book deals with the techniques of forceps extraction, flap reflection, suturing and root removal. There follow sections on the treatment of cysts, apicectomy, the exposure and removal of buried teeth and minor pre-prosthetic will surgery. Not every detail of technique meet with the approval of all teachers but this is inevitable. As is to be expected by those who know the authors, the reasons for their points of view are always logical, and undergraduates would certainly benefit from debating any differences in technique with their teachers. Certain techniques, however, particularly struck the reviewer as unfortunate. The fenestration procedure is described as an alternative to enucleation as a treatment for cysts. There are times when a limited opening and a cyst plug are particularly indicated, but a much larger opening to marsupialize or saucerize a cyst is preferable whenever possible (but only if enucleation is contraindicated). Further, a small tube or cyst plug such as is described may be displaced easily and aspirated or swallowed. The authors frequently illustrate the contra-angled handpiece as an instrument for use in removing impacted teeth. There is a risk that the inexperienced might be tempted to interpret these as air-turbine handpieces, overlooking the difficulties of sterilizing the turbine handpiece and incurring a risk of surgical emphysema from the air which they discharge. It is also advocated that lower third molar sockets should be tightly sutured. This is fine if haemotasis is absolute, but if there is any postoperative ooze a buccal space haematoma will result. Perhaps an even greater risk is that some practitioners might think that acquaintance with the technical matters covered by this book is all they need to know about oral surgery, and that major errors of judgement may be committed. The reader is warned about this in the Preface. These criticisms apart, and properly used, this is likely to be a useful and popular book. True, its usefulness will be of short duration, but at times which are important in the development of the student or practitioner. G.R. SEWARD