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Pharmacology and therapeutics for dentistry
Book
87
Reviews
photographs could be improved. For future editions, further editing so as to shorten it slightly and to make the style more even would be beneficial. I thought Chapter 6 was particularly good. It deals with general anaesthesia and intravenous sedation In the dental surgery. Who would disagree that there is no dental procedure which justifies the practitioner taking any risk with the patient’s life? The oft-repeated strictures against practitioners adopting the dual role of operator and anaesthetist have surely been reinforced since the publication of this edition by the first conviction of manslaughter of a dentist who did act in both capacities. For the general practitioner a careful look at Chapter 13 on the Terms of Service could be profitable. In daily casework one frequently encounters practitioners who have not the slightest idea of some of their contractual obligations under the National Health Service regulations. There are valuable appendices on’radiological protection, emergencies in dental practice and guidelines for handling mercury. There is also an excellent index. The publisher does not show the price on the cover or in the book but it is as stated above and in these litigious days I unreservedly recommend that every practitioner invests in a copy. A. L. Gwynne FIXED BRIDGE PROSTHESIS. 2nd ed. By D. H. Roberts. 234 X 156 mm. Pp. 300 + 336 illustrations. 1980. Bristol, Wright PSG. $14.50. In this edition Mr Roberts has revised and expanded the text first published in 1973. Following an informative history of fled bridges the book is divided into three main sectionsGeneral Considerations, Bridge Types and Clinical Procedures. In General Considerations the author discusses indications for bridgework; the properties of relevant dental materials; and the concept and design of pontics, abutments and retainers. The first two sections offer a balanced and realistic general view of the theories of bridgework. Throughout, the reader will be aware that the information given is based on a wide practical experience, particularly so in the third section of the book, where the operative techniques used by the author, or his colleagues at the Eastman Dental Hospital, are described. Most sections, such as those on compound, cantilever and spring cantilever bridges, are detailed and comprehensive. Elsewhere, where the subject is complex, for example in the chapter on precision attachments, the author widely summarizes, but includes a comprehensive bibliography. Mr Roberts’ taut and lucid style has been maintained in the informative chapters by Mr Ming Tay on adhesive bridges, and by Mr Brian Parkin on occlusal records. I must, however, say how much I dislike the use of the phrase ‘offer the bridge to the mouth’, in place of ‘try in’. The chapter on periodontal preparation of the mouth is not entirely successful. Basic oral hygiene and simple periodontal theory is covered in a rather more florid style, but in very little greater depth, than elsewhere in the book, and potted surgical procedures would be better learned from periodontal texts. More value might have been gained from a deeper consideration of the problems of plaque control, patient motivation, and the practical difficulties that may be met when undertaking bridgework on periodontally involved mouths. The book is well set out, though the use of the same bold typeface for different orders of subheadings is confusing. Most of the diagrams are clearly drawn and informative, though one showing the placement of pins in a weakened tooth is misleading, and a number are bizarrely titled. The photographic reproduction is execrable (though the information can usually be gleaned by careful observation). Thii misfortune is probably an inevitable consequence of a printing process that allows the book to be published at its relatively modest price. Fixed Bridge Prosthesis is not an initial text but has been written for those having at least a basic working knowledge of some crown and bridge procedures. It is Inevitable that in a book of such practicality any interested reader will find smalldifferences of emphasis. However, these will be miniial, and the book must be read with great profit by students who have completed their practical course m crown and bridgework. Practitioners with limited crown and bridge experience will find it to be a useful text and manual; those with greater experience will be stimulated and informed. I greatly enjoyed reading the book and recommend it highly. I. E. Barnes PHARMACOLOGY AND THERAPEUTICS 1980. St Louis, Mosby. E21.75.
FOR DENTISTRY.
By E. A. Mosby et al. 227 illustrations.
It is difficult to comment fairly on this book as American ideas about the teaching of pharmacology and therapeutics are so different from our own. In the United States pharmacology is usually regarded essentially as a ‘basic science’ subject to be taught by academic pharmacologists who have little or nothing
88
Journal
of Dentistry
Vol.
1 O/No.
1
to do with the management of patients. This is clearly reflected in the authors’ approach to the subject. Thus, there are no fewer than 46 chapters and the first section is devoted to chapters on Pharmacodynamics, Pharmacokinetics, Pharmacotherapeutics and General Mechanisms of Drug Interactions. This alone amounts to approximately 100 pages. Thirtyeight chapters are then devoted to the Pharmacology of Specific Drug Groups. The four final chapters by clinicians are in the section entitled ‘Special Subjects in Pharmacology and Therapeutics’ and comprise Management of Pain and Anxiety, Treatment of Oral Complications of Radiotherapy, Drug Abuse and Prescription Writing. From the viewpoint of factual information the text is generally sound but perhaps as a consequence of the large number of contributors there is a certain amount of repetition. There is, for example, a whole chapter on Ganglion-blocking Agents (a largely obsolete group of drugs) and another on Antihypertensive Agents. The authors, incidentally, claim in their Preface that they ‘feel it fair to characterize Pharmacology and Therapeutics for Dentistry as a standard, basic, thorough textbook of pharmacology and therapeutics, written specifically with the dentist in mind. With this new book the dentist should be able to understand basic pharmacology, to know how and when to use specific drugs and what dosage of these drugs to use and to know how a patient’s pharmacologic status will determine the treatment and medicine prescribed for that patient’. Leaving aside the problem of what is meant by a patient’s ‘pharmacologic status’, the claim seems ambitious. Nevertheless, one is forced to wonder whether many readers would find that this book provides a particularly practical guide to the use of drugs in dentistry. The art of therapeutics is not merely to choose the most appropriate drugs, but also to know when drugs are not the most useful form of treatment. However, it is even claimed in the Preface that the reader is told which antibiotics would be appropriate for acute suppurative pulpitis! The authors seem therefore to be blissfully unaware that, in spite of the fact that most dental disease (caries and periodontal disease) is infective, treatment is primarily surgical in nature. Most chapters describe large numbers of drugs, often in considerable detail but, though there is a section entitled Implications for Dentistry tacked on to most chapters, there is little in the way of practical guidance as to what to use or to do in any particular situation. The text is certainly not uninteresting to read but some surprising statements appear from time to time. What, for example, is one to make of the suggestion (in a section headed ‘Implications for Dentistry’) that ‘patients who are sensitive to the more common anti-anxiety agents may be more effectively relaxed and calmed by ethanol or an antihistamine’. One may question what is meant by ‘sensitive’ in this context but no one would dispute the calming and relaxing effects of alcohol. But do American dentists really use alcohol to sedate their patients? To give just one more example, is it wise to suggest that a patient with xerostomia should ‘suck on lemon drops’? Is it not just faintly possible that a patient with xerostomia might have some remaining teeth? Not for very long with such assistance. It is perhaps unfair to seem to put too much emphasis on items such as these. Much is praiseworthy in this text and certainly it is beautifully and meticulously carefully produced. Nevertheless, one serious criticism must be made, especially in view of yet another claim in the Preface that ‘every major class of drug is covered thoroughly and with utmost contemporaneity’. In spite of the enormous rapidity of the advance of pharmacology (with its flood of publications on clinical as well as experimental research), the most recent reference in many chapters is 1977 and many are considerably older. There are as a consequence some serious omissions even in relation to drugs important in dentistry. Thus, for example, the imidazole antifungal drugs are not even mentioned. More remarkable perhaps is the fact that no explanation is apparently given for the haemopoietic and neurological effects of prolonged exposure to nitrous oxide. This phenomenon was observed a quarter of a century ago and its mechanism was discovered not long afterwards. No doubt, however, this book will more than adequately fulfil the requirements of many pharmacology teachers in the United States and will go on to further editions. It is greatly to be hoped, therefore, that the editing will be improved and the text brought up to date. R. A. Cawson BRITISH NATIONAL ceutical Press. c3.80.
FORMULATORY
1981 No. 1. Edited by G. R. Brown. Pp. 387. 1981. Pharma-
Most readers will probably have seen the new British National Formukary even if they have not dipped into it. The smart new cover is not belied by the contents which comprise a marvelIously concise compendium of current drug treatment. To give some idea of the scope of the new BNF an outline of the contents is unavoidable. In addition to a Preface and Guide to the Arrangement of Information, there is detailed Guidance on Prescribing which includes not merely notes on prescription writing, conversion tables and related information,
87
Reviews
photographs could be improved. For future editions, further editing so as to shorten it slightly and to make the style more even would be beneficial. I thought Chapter 6 was particularly good. It deals with general anaesthesia and intravenous sedation In the dental surgery. Who would disagree that there is no dental procedure which justifies the practitioner taking any risk with the patient’s life? The oft-repeated strictures against practitioners adopting the dual role of operator and anaesthetist have surely been reinforced since the publication of this edition by the first conviction of manslaughter of a dentist who did act in both capacities. For the general practitioner a careful look at Chapter 13 on the Terms of Service could be profitable. In daily casework one frequently encounters practitioners who have not the slightest idea of some of their contractual obligations under the National Health Service regulations. There are valuable appendices on’radiological protection, emergencies in dental practice and guidelines for handling mercury. There is also an excellent index. The publisher does not show the price on the cover or in the book but it is as stated above and in these litigious days I unreservedly recommend that every practitioner invests in a copy. A. L. Gwynne FIXED BRIDGE PROSTHESIS. 2nd ed. By D. H. Roberts. 234 X 156 mm. Pp. 300 + 336 illustrations. 1980. Bristol, Wright PSG. $14.50. In this edition Mr Roberts has revised and expanded the text first published in 1973. Following an informative history of fled bridges the book is divided into three main sectionsGeneral Considerations, Bridge Types and Clinical Procedures. In General Considerations the author discusses indications for bridgework; the properties of relevant dental materials; and the concept and design of pontics, abutments and retainers. The first two sections offer a balanced and realistic general view of the theories of bridgework. Throughout, the reader will be aware that the information given is based on a wide practical experience, particularly so in the third section of the book, where the operative techniques used by the author, or his colleagues at the Eastman Dental Hospital, are described. Most sections, such as those on compound, cantilever and spring cantilever bridges, are detailed and comprehensive. Elsewhere, where the subject is complex, for example in the chapter on precision attachments, the author widely summarizes, but includes a comprehensive bibliography. Mr Roberts’ taut and lucid style has been maintained in the informative chapters by Mr Ming Tay on adhesive bridges, and by Mr Brian Parkin on occlusal records. I must, however, say how much I dislike the use of the phrase ‘offer the bridge to the mouth’, in place of ‘try in’. The chapter on periodontal preparation of the mouth is not entirely successful. Basic oral hygiene and simple periodontal theory is covered in a rather more florid style, but in very little greater depth, than elsewhere in the book, and potted surgical procedures would be better learned from periodontal texts. More value might have been gained from a deeper consideration of the problems of plaque control, patient motivation, and the practical difficulties that may be met when undertaking bridgework on periodontally involved mouths. The book is well set out, though the use of the same bold typeface for different orders of subheadings is confusing. Most of the diagrams are clearly drawn and informative, though one showing the placement of pins in a weakened tooth is misleading, and a number are bizarrely titled. The photographic reproduction is execrable (though the information can usually be gleaned by careful observation). Thii misfortune is probably an inevitable consequence of a printing process that allows the book to be published at its relatively modest price. Fixed Bridge Prosthesis is not an initial text but has been written for those having at least a basic working knowledge of some crown and bridge procedures. It is Inevitable that in a book of such practicality any interested reader will find smalldifferences of emphasis. However, these will be miniial, and the book must be read with great profit by students who have completed their practical course m crown and bridgework. Practitioners with limited crown and bridge experience will find it to be a useful text and manual; those with greater experience will be stimulated and informed. I greatly enjoyed reading the book and recommend it highly. I. E. Barnes PHARMACOLOGY AND THERAPEUTICS 1980. St Louis, Mosby. E21.75.
FOR DENTISTRY.
By E. A. Mosby et al. 227 illustrations.
It is difficult to comment fairly on this book as American ideas about the teaching of pharmacology and therapeutics are so different from our own. In the United States pharmacology is usually regarded essentially as a ‘basic science’ subject to be taught by academic pharmacologists who have little or nothing
88
Journal
of Dentistry
Vol.
1 O/No.
1
to do with the management of patients. This is clearly reflected in the authors’ approach to the subject. Thus, there are no fewer than 46 chapters and the first section is devoted to chapters on Pharmacodynamics, Pharmacokinetics, Pharmacotherapeutics and General Mechanisms of Drug Interactions. This alone amounts to approximately 100 pages. Thirtyeight chapters are then devoted to the Pharmacology of Specific Drug Groups. The four final chapters by clinicians are in the section entitled ‘Special Subjects in Pharmacology and Therapeutics’ and comprise Management of Pain and Anxiety, Treatment of Oral Complications of Radiotherapy, Drug Abuse and Prescription Writing. From the viewpoint of factual information the text is generally sound but perhaps as a consequence of the large number of contributors there is a certain amount of repetition. There is, for example, a whole chapter on Ganglion-blocking Agents (a largely obsolete group of drugs) and another on Antihypertensive Agents. The authors, incidentally, claim in their Preface that they ‘feel it fair to characterize Pharmacology and Therapeutics for Dentistry as a standard, basic, thorough textbook of pharmacology and therapeutics, written specifically with the dentist in mind. With this new book the dentist should be able to understand basic pharmacology, to know how and when to use specific drugs and what dosage of these drugs to use and to know how a patient’s pharmacologic status will determine the treatment and medicine prescribed for that patient’. Leaving aside the problem of what is meant by a patient’s ‘pharmacologic status’, the claim seems ambitious. Nevertheless, one is forced to wonder whether many readers would find that this book provides a particularly practical guide to the use of drugs in dentistry. The art of therapeutics is not merely to choose the most appropriate drugs, but also to know when drugs are not the most useful form of treatment. However, it is even claimed in the Preface that the reader is told which antibiotics would be appropriate for acute suppurative pulpitis! The authors seem therefore to be blissfully unaware that, in spite of the fact that most dental disease (caries and periodontal disease) is infective, treatment is primarily surgical in nature. Most chapters describe large numbers of drugs, often in considerable detail but, though there is a section entitled Implications for Dentistry tacked on to most chapters, there is little in the way of practical guidance as to what to use or to do in any particular situation. The text is certainly not uninteresting to read but some surprising statements appear from time to time. What, for example, is one to make of the suggestion (in a section headed ‘Implications for Dentistry’) that ‘patients who are sensitive to the more common anti-anxiety agents may be more effectively relaxed and calmed by ethanol or an antihistamine’. One may question what is meant by ‘sensitive’ in this context but no one would dispute the calming and relaxing effects of alcohol. But do American dentists really use alcohol to sedate their patients? To give just one more example, is it wise to suggest that a patient with xerostomia should ‘suck on lemon drops’? Is it not just faintly possible that a patient with xerostomia might have some remaining teeth? Not for very long with such assistance. It is perhaps unfair to seem to put too much emphasis on items such as these. Much is praiseworthy in this text and certainly it is beautifully and meticulously carefully produced. Nevertheless, one serious criticism must be made, especially in view of yet another claim in the Preface that ‘every major class of drug is covered thoroughly and with utmost contemporaneity’. In spite of the enormous rapidity of the advance of pharmacology (with its flood of publications on clinical as well as experimental research), the most recent reference in many chapters is 1977 and many are considerably older. There are as a consequence some serious omissions even in relation to drugs important in dentistry. Thus, for example, the imidazole antifungal drugs are not even mentioned. More remarkable perhaps is the fact that no explanation is apparently given for the haemopoietic and neurological effects of prolonged exposure to nitrous oxide. This phenomenon was observed a quarter of a century ago and its mechanism was discovered not long afterwards. No doubt, however, this book will more than adequately fulfil the requirements of many pharmacology teachers in the United States and will go on to further editions. It is greatly to be hoped, therefore, that the editing will be improved and the text brought up to date. R. A. Cawson BRITISH NATIONAL ceutical Press. c3.80.
FORMULATORY
1981 No. 1. Edited by G. R. Brown. Pp. 387. 1981. Pharma-
Most readers will probably have seen the new British National Formukary even if they have not dipped into it. The smart new cover is not belied by the contents which comprise a marvelIously concise compendium of current drug treatment. To give some idea of the scope of the new BNF an outline of the contents is unavoidable. In addition to a Preface and Guide to the Arrangement of Information, there is detailed Guidance on Prescribing which includes not merely notes on prescription writing, conversion tables and related information,