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Improving dental practice through preventive measures
Among the: topics discussctd 1)~. Kwc~i is tllr rolt! of 111~Il101llii ill ])s)-(*ll<1sexual derelopment. Treatment for l/1(3 clliminatioll <)I’ (Il’ill hahits is illclucltlcl. Occlusal mannerisms that result wticbn c~hildrcn or acl~lls l)ra~tic*c~(~~~ri:iitl (‘(‘centric mandibular positions anti tootIt p tessures that disturb the c~c~lusiott 01’ the teeth and can affeet the health of the pcriodontium have IIO~.rc~c~c~iv(~(1 duct attention. Orthodontists will find thcb text provocative informalivct. TIl(> chapters dealing with the handlin g of children, whc$Iirr from the psyc+ioIogicr or t,he psychodynamic approach to oral pathologic aspec*ts, kll bc founti of special value. iltl
Improving
Dental
Practice
Through
Preventive
By J. I,. Bernier uad J. C. Xt~hkr. pany. 378 pages. Price, $17.50.
St. huis,
Measures l%ti,
7’hf
C’. 1’. Moshy
Corn-
Combined opinions of many authorities on various aspects of caries prevention, including nutrition, fluoride therapy, dentifrices, pedodontics, periodontics, ort,hodontics, prosthodontics, surgery, and general physical fitness, aro presented. The claim t.hat “we are literally what. WC eat” is stressed as being as important in the prevention of dental problems as in general health. Under “Cause and Control of Dental Caries,” it is stated that caries is primarily “initiated and sustained by acid demineralization of the inorganic content of susceptible tooth st.rucfure” and that the control of caries is best achieved by eliminating the cause and establishing normal control mechanisms. These include caries removal, topical fluoride applications, patient. counseling, diet, oral hygiene, and salivary, systemic, and familial factors. Success depends mainly upon what t,he patient, does for himself and to a large extent also on proper dent,ist-patient counseling. topical fluoridation, is thoroughly covered. Fluoride therapy, including While sodium fluoride is a caries-preventive agent in children3 stannous fluoride may be of benefit to all ages in the population and other fluorides, while they may show promise as anticariogcnic agents, require additional clinical evaluation before their role in the caries-prevention program pan be det,ermined and their use recommended. Eventually dental caries may be completely controlled by mcans of a prophylactic paste of stannous fluoride for topical application togethcr with a calcium pyrophosphate dentifrice and optimal water fluoridation. Since the American Dental Association formaI1.v recognized a commercially advertised dentifrice as having “therapc>utic value” in the prevention of decalcification many manufacturers are competing for other chemical agents which may be superior to stannous fluoride for the control of dental decay. Chapter VII, on preventive pedodontics, deals with the loss of teeth from dental caries, tooth shifting, the necessiby of space maintenance, and the advisability of early and diligent dental prophylaxis. Gingivitis and periodontal disease lead to early tooth loss, and thus preventive periodontics also becomes an
Volume Number
Reviews and
53 11
abstracts
865
important part of dental care. However, most of these conditions are local factors, which are accessible, correctible, and controllable. Preventive orthodontics is an important part of this book. Malocclusions lead into greater dental decay, periodontal problems, and facial deformities. These present some of the greatest of all problems to the dentist. The authors deal with genetic and environmental factors and also with deleterious habits, many of which can be controlled. They mention that early orthodontic treatment may be most beneficial in some cases, while in others it may be detrimental. The same may be true in the cases of serial extractions, where timing and judgment are of the greatest importance. Preventive adult space maintainers (partial dentures) fall into the category of “secondary prevention” in which an attempt is made to arrest further progress or recurrence of disease. Emphasis is placed on the regrettable creation of food traps by improper partial denture construction, and the final harmful results on the adjacent soft tissues. In the treatment of oral pathologic conditions the dentist must take careful histories and use other laboratory aids to make an accurate diagnosis at a time when it may still be possible to prevent irreparable damage, and he must also be able to teach patients how to prevent oral diseases. Lowrie J. Po,rter
Clinical
Implications
of a Follow-up
By G. ,4. James. D. Practitioner
Study
After
7: 299, April,
Frenectomy 1967.
Results do not support the possibility that frenectomy is indicated as a routine procedure wherever the frenum is enlarged and a midline space is present. Nor do they solve the problem of whether frenectomy, independent of orthodontic treatment, is ever justified during the mixed-dentition phase. It is the author’s opinion that it is likely to be very difficult to establish criteria for this procedure. There is a variable elcmcnt of closure of t,he midline space following surgical removal of the superior labial frenum, despite the firm attachment of the teeth to the supporting alveolar process. The wider the space is, the less efftctivc will be the contractile reaction in achieving tooth movement. There is also a possibility that the actual frenectomy technique has an influence in deciding what type of tooth movement will result. Frenectomy, associated with orthodont.ic treatment, could be advantageous. The question of timing must be considered. If it is scar tissue reaction which accounts for the observed tooth movements after frenectomy, it follows that the surgical intervention should be arranged to utilize this reaction. If the central incisors are to be approximated or rotated as part of orthodontic treatment, it will take some months to accomplish this toot,h movement. If the frenum is removed before this orthodontic treatment, then the period of maximum scar tissue contraction will have passed before the teeth are aligned. Furthermore,
Improving
Dental
Practice
Through
Preventive
By J. I,. Bernier uad J. C. Xt~hkr. pany. 378 pages. Price, $17.50.
St. huis,
Measures l%ti,
7’hf
C’. 1’. Moshy
Corn-
Combined opinions of many authorities on various aspects of caries prevention, including nutrition, fluoride therapy, dentifrices, pedodontics, periodontics, ort,hodontics, prosthodontics, surgery, and general physical fitness, aro presented. The claim t.hat “we are literally what. WC eat” is stressed as being as important in the prevention of dental problems as in general health. Under “Cause and Control of Dental Caries,” it is stated that caries is primarily “initiated and sustained by acid demineralization of the inorganic content of susceptible tooth st.rucfure” and that the control of caries is best achieved by eliminating the cause and establishing normal control mechanisms. These include caries removal, topical fluoride applications, patient. counseling, diet, oral hygiene, and salivary, systemic, and familial factors. Success depends mainly upon what t,he patient, does for himself and to a large extent also on proper dent,ist-patient counseling. topical fluoridation, is thoroughly covered. Fluoride therapy, including While sodium fluoride is a caries-preventive agent in children3 stannous fluoride may be of benefit to all ages in the population and other fluorides, while they may show promise as anticariogcnic agents, require additional clinical evaluation before their role in the caries-prevention program pan be det,ermined and their use recommended. Eventually dental caries may be completely controlled by mcans of a prophylactic paste of stannous fluoride for topical application togethcr with a calcium pyrophosphate dentifrice and optimal water fluoridation. Since the American Dental Association formaI1.v recognized a commercially advertised dentifrice as having “therapc>utic value” in the prevention of decalcification many manufacturers are competing for other chemical agents which may be superior to stannous fluoride for the control of dental decay. Chapter VII, on preventive pedodontics, deals with the loss of teeth from dental caries, tooth shifting, the necessiby of space maintenance, and the advisability of early and diligent dental prophylaxis. Gingivitis and periodontal disease lead to early tooth loss, and thus preventive periodontics also becomes an
Volume Number
Reviews and
53 11
abstracts
865
important part of dental care. However, most of these conditions are local factors, which are accessible, correctible, and controllable. Preventive orthodontics is an important part of this book. Malocclusions lead into greater dental decay, periodontal problems, and facial deformities. These present some of the greatest of all problems to the dentist. The authors deal with genetic and environmental factors and also with deleterious habits, many of which can be controlled. They mention that early orthodontic treatment may be most beneficial in some cases, while in others it may be detrimental. The same may be true in the cases of serial extractions, where timing and judgment are of the greatest importance. Preventive adult space maintainers (partial dentures) fall into the category of “secondary prevention” in which an attempt is made to arrest further progress or recurrence of disease. Emphasis is placed on the regrettable creation of food traps by improper partial denture construction, and the final harmful results on the adjacent soft tissues. In the treatment of oral pathologic conditions the dentist must take careful histories and use other laboratory aids to make an accurate diagnosis at a time when it may still be possible to prevent irreparable damage, and he must also be able to teach patients how to prevent oral diseases. Lowrie J. Po,rter
Clinical
Implications
of a Follow-up
By G. ,4. James. D. Practitioner
Study
After
7: 299, April,
Frenectomy 1967.
Results do not support the possibility that frenectomy is indicated as a routine procedure wherever the frenum is enlarged and a midline space is present. Nor do they solve the problem of whether frenectomy, independent of orthodontic treatment, is ever justified during the mixed-dentition phase. It is the author’s opinion that it is likely to be very difficult to establish criteria for this procedure. There is a variable elcmcnt of closure of t,he midline space following surgical removal of the superior labial frenum, despite the firm attachment of the teeth to the supporting alveolar process. The wider the space is, the less efftctivc will be the contractile reaction in achieving tooth movement. There is also a possibility that the actual frenectomy technique has an influence in deciding what type of tooth movement will result. Frenectomy, associated with orthodont.ic treatment, could be advantageous. The question of timing must be considered. If it is scar tissue reaction which accounts for the observed tooth movements after frenectomy, it follows that the surgical intervention should be arranged to utilize this reaction. If the central incisors are to be approximated or rotated as part of orthodontic treatment, it will take some months to accomplish this toot,h movement. If the frenum is removed before this orthodontic treatment, then the period of maximum scar tissue contraction will have passed before the teeth are aligned. Furthermore,