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Prognoses of oral cavity carcinomas. Results of a multicentric multicentric retrospective observational study
J. Dent.
136
1987;
15: 136-l
38 Printed in Great Britain
Book Reviews
Section
Editor:
P. N. Hirschmann
Dental Plaque Control Measures and Oral Hygiene Practices. Proceedings from a State-of-the-Science Workshop. Edited by l-l Lee and D. V. Kleinmann. Pp. 352. 1986. Oxford, IRL Press. Softback, f 28.00. This 332-page paperback with no index contains the proceedings of yet another workshop on dental plaque, held at the NIDR in February 1985. The contents range from the biology of supragingival plaque to the mechanical, chemical and behavioural aspects of oral hygiene, organized as 12 “state-of-the-science” chapters each by a single reviewer, followed by a “response” by a second reviewer and then by general discussion. As with previous books of this kind, the quality of the reviews is variable. If there is one overall consensus, then it is the need for more research into all aspects of dental plaque but it should not be necessary to purchase these proceedings to realize that. There are many out-dated attitudes, including a persistent desire to eliminate all plaque, and a poor understanding of oral microbial ecology. Despite the strange intention to restrict the discussion to supragingival plaque, subgingival plaque and calculus, and the effects of various agents on them, do, not surprisingly, surface liberally. It is regrettable that the chapter on plaque merely rehashes the established data and omits entirely natural plaque formation, particularly approximally and in fissures, that is, the principal sites at which plaque-related diseases commence. Although the value of root planing is questioned in the section on mechanical plaque control, one reason given for this procedure is “to render the root surface smooth and hard, to facilitate plaque removal, and to retard regrowth of plaque”. It is encouraging, however, that the same reviewer concludes that a less than perfect level of oral hygiene is compatible in many patients with a functional natural dentition, in accord with the results of current clinical studies based on simplified mechanical oral hygiene regimens. Some aspects of chemical aids to plaque control are already out-of-date: for example, chlorhexidine is now available in the USA as an oral rinse. Certain contributors to the discussion on more esoteric ways of controlling plaque have a somewhat cavalier attitude to its elimination without regard to the possible consequences, and there is no mention of the current views of hydrophobicity in relation to plaque formation nor of pellicle as a protective layer. The possible means of altering plaque ecology, whether by the use of bacteriocins and plasmids, to implant non-disease-related strains, or by genetic interaction or by DNA recombinant technology are
considered, and this section does contain an appeal for “fine tuning” of the balance between plaque and host, indicating that, 1 1 years after the first ever conference on plaque ecology, there is at last a growing awareness of this logic in the USA. The long consideration of the behavioural aspects is perhaps best summarized by the senior participant who stated that, despite many attempts to change his behaviour, the therapists have now finally given up. The rather trite conclusions and broad future research outlined in the concluding section include some surprising remarks. Surely we were already aware that dental plaque is essential for the development of gingivitis. And why, even now, should some of our American colleagues still fail to recognize the enormous volume of research on chlorhexidine? Why, too, will they not admit that no organism is exclusive to caries or to chronic inflammatory periodontal disease? But to end on a hopeful note, many will concur with Harald Lee that “there will be no single, magic bullet.. . no single procedure that will eradicate caries or (inflammatory) periodontal disease”. Although many chapters do contain useful references, and there are interesting sections, particularly those on modifying plaque ecology and biochemistry, the book as a whole is disappointingly inconclusive, too complicated for routine use, yet lacking the detail needed by an informed scientist. H. N. Newman
Prognoses of Oral Cavity Carcinomas. Results of a Multicentric Retrospective Observational Study. Helmut Platz, Rudolf Fries and Marcus Hudec. Pp. 187. 1986. Munchen Wien, Carl Hanser Verlag (Distr.: Chichester, John Wiley). Softback, f 25.15. This is a report on a multicentre study from DOSAK (the German-Austrian-Swiss Association for Head and Neck Tumours) on the prognosis of oral carcinomas. The 187 pages cover the prognostic values of various factors used in classification of tumours, their clinical parameters and treatment modalities. The text really consists of a collection of papers with numerous tables and much data, presented with the meticulous attention to detail that one might expect from this part of the world. Although somewhat difficult to read, because of a strong emphasis on various statistical manoeuvres and the number of classifications, as well as rather bizarre English, this study should be of great interest to those managing patients with oral cancer. The authors rightly regard it as one of the first comprehensive attempts to supply a sound basis for objective and reliable prognosis determination.
Book Reviews
The results of the study, which was in progress from 1969 to 1982 and included 1021 patients with intraoral carcinoma from 13 centres, have re-emphasized the deficiencies in the TNM classification and confirmed statistically some clinical impressions such as the prognostic value of clinically positive fixed regional lymph nodes, old age, large tumour size, tumour infiltration and distant metastases. Most importantly, it confirms that radical surgery, either alone or combined with radiotherapy, improved the prognosis over no treatment, whereas “non-radical surgery”, that is where the margin of healthy tissue at the tumour periphery was less than 1 cm, did not: nor did chemotherapy with bleomycin and cyclophosphamide. Although few of these results are in any way surprising, it is none the less heartening to see an attempt at providing objective evidence for the results of various types of treatment. This should be a reference book for all dental libraries and a source for those with a special interest in oral cancer. c. Scully.
Human Oral Embryology and Histology. Edited by lvar Mjor and Ole Fejerskov. Pp. 336. 1986. Copenhagen, Munksgaard. Hardback, Dkr 400-00. This very readable book is an expanded version of an earlier text. The new contributors are all authorities in their fields and, as a result, it now covers much more adequately the syllabus in the UK. The major additions are to the development of the face and oral cavity, oral mucosa, salivary glands, temporomandibular joint and the maxillary sinus. The inclusion of Embryology in the title might lead the reader to expect an increased emphasis on development but, apart from the first chapter and those on enamel and dentine, only a short paragraph, placed surprisingly, in many instances at the close of the chapters, covers this aspect. Indeed, in the largest single revision, that on the oral mucous membrane, there is no recognition at all of the fact that this tissue also undergoes a developmental stage. The emphasis is on material from human sources and for this the authors are to be congratulated. The illustrations are, on the whole, excellent and some of the earlier criticisms of poor labelling have been corrected. To my mind, the chapter on Dental Enamel remains the outstanding part of the book, putting into perspective many of the conflicting viewpoints but without being too dogmatic, to provide a very reasonable and readable explanation of what surely must be one of the most difficult structures to describe by means of the written word and two-dimensional representation alone. Not all the readers’ questions are answered, however. For instance the maturation of enamel is described as beginning when the full width has been laid down and continuing until eruption. This begs the question of the role of ameloblasts in maturation and implies that a similar process continues even after formation of the reduced enamel epithelium. There is conflict here with the more generally accepted explanation given when the detailed function of these cells is discussed. Although the distribution of trace elements in dentine gets a mention, similar studies in enamel have been ignored. As in the earlier text the development of the root is dealt with rather superficially and has now been moved from the chapter on cementum to that on the periodontium. Perhaps in a future edition it could find itself in the section on dentine and pulp where, some
137
would argue, it rightly belongs. It is strange to learn that root formation in man is initiated after the onset of eruption but, apart from these few criticisms, these are, on the whole, well-written and interesting chapters. The success of the book will depend largely on the new material and, apart from the absence of some important work on mandibular development, the section on development of the face is adequately described and well written. However, in line with the excellent illustrations elsewhere it would have benefited from histological demonstrations of maxillary and mandibular ossification. The structure of the chapter on the Oral Mucosa (it is by authors whose contributions in this field have been seminal) is interesting in that much of the introduction is based on quite detailed electron microscopy whereas most students’ first contact is likely to be clinical, followed by the light microscope level. Some clinical illustrations of the regional differences would have been useful and, in a book which includes a special section of techniques for studying mineralized tissues, the use of histochemistry and fluorescent and monoclonal antibodies should have a place. The chapter on the temporomandibular joint merits more detail in future editions. It is difficult to fully understand the design of this joint in relation to function when the role of the musculature and innervation is almost totally ignored. The publishers are to be congratulated on the clarity of presentation but it is regretted that the same cannot be said for the quality of proof-reading. There are too many small irritations such as variable spellings of technical terms, repeated or missing lines of print and confused use of English. Altogether, though, this is a very good book both for undergraduate and postgraduate use and at a price which should be acceptable to the former. D. K. Whittaker
The Clinical Handling of Dental Materials. Dental Practitioner Handbook 12. 6. G. N. Smith, P.S. Wright and D. Brown. Pp. 278. 1986. Bristol, Wright. Softback, f 12.50. This book presents a novel approach to the subject of dental materials and, although directed primarily at the practising clinician, also contains much that will be of interest to the clinically orientated materials scientist. Unlike many textbooks on the subject, which concentrate excessively on its scientific aspects, the authors have focussed on the information required by a clinician so as to be able to select from the large range of available materials those most appropriate for a specific task. The presentation is in four parts, all of which can be read independently, although there is a clear link between Part II and Part Ill. Part I considers the properties of materials in relation to practical dentistry and, although quite brief, it covers their physics, chemistry, handling characteristics and service performance together with the required physical, mechanical and biological properties. This section is illustrated with examples chosen so as to improve the reader’s understanding. Part II is essentially the meat of the text and is presented not in the conventional manner by class of material, but in the more logical form of treatment sequence, commencing with examination and diagnosis and continuing with each speciality in turn-prevention, conservation, prosthetics, orthodontics, periodontology and oral surgery. The coverage is extensive, ranging from mirrors, burs, and cotton wool, through hand
136
1987;
15: 136-l
38 Printed in Great Britain
Book Reviews
Section
Editor:
P. N. Hirschmann
Dental Plaque Control Measures and Oral Hygiene Practices. Proceedings from a State-of-the-Science Workshop. Edited by l-l Lee and D. V. Kleinmann. Pp. 352. 1986. Oxford, IRL Press. Softback, f 28.00. This 332-page paperback with no index contains the proceedings of yet another workshop on dental plaque, held at the NIDR in February 1985. The contents range from the biology of supragingival plaque to the mechanical, chemical and behavioural aspects of oral hygiene, organized as 12 “state-of-the-science” chapters each by a single reviewer, followed by a “response” by a second reviewer and then by general discussion. As with previous books of this kind, the quality of the reviews is variable. If there is one overall consensus, then it is the need for more research into all aspects of dental plaque but it should not be necessary to purchase these proceedings to realize that. There are many out-dated attitudes, including a persistent desire to eliminate all plaque, and a poor understanding of oral microbial ecology. Despite the strange intention to restrict the discussion to supragingival plaque, subgingival plaque and calculus, and the effects of various agents on them, do, not surprisingly, surface liberally. It is regrettable that the chapter on plaque merely rehashes the established data and omits entirely natural plaque formation, particularly approximally and in fissures, that is, the principal sites at which plaque-related diseases commence. Although the value of root planing is questioned in the section on mechanical plaque control, one reason given for this procedure is “to render the root surface smooth and hard, to facilitate plaque removal, and to retard regrowth of plaque”. It is encouraging, however, that the same reviewer concludes that a less than perfect level of oral hygiene is compatible in many patients with a functional natural dentition, in accord with the results of current clinical studies based on simplified mechanical oral hygiene regimens. Some aspects of chemical aids to plaque control are already out-of-date: for example, chlorhexidine is now available in the USA as an oral rinse. Certain contributors to the discussion on more esoteric ways of controlling plaque have a somewhat cavalier attitude to its elimination without regard to the possible consequences, and there is no mention of the current views of hydrophobicity in relation to plaque formation nor of pellicle as a protective layer. The possible means of altering plaque ecology, whether by the use of bacteriocins and plasmids, to implant non-disease-related strains, or by genetic interaction or by DNA recombinant technology are
considered, and this section does contain an appeal for “fine tuning” of the balance between plaque and host, indicating that, 1 1 years after the first ever conference on plaque ecology, there is at last a growing awareness of this logic in the USA. The long consideration of the behavioural aspects is perhaps best summarized by the senior participant who stated that, despite many attempts to change his behaviour, the therapists have now finally given up. The rather trite conclusions and broad future research outlined in the concluding section include some surprising remarks. Surely we were already aware that dental plaque is essential for the development of gingivitis. And why, even now, should some of our American colleagues still fail to recognize the enormous volume of research on chlorhexidine? Why, too, will they not admit that no organism is exclusive to caries or to chronic inflammatory periodontal disease? But to end on a hopeful note, many will concur with Harald Lee that “there will be no single, magic bullet.. . no single procedure that will eradicate caries or (inflammatory) periodontal disease”. Although many chapters do contain useful references, and there are interesting sections, particularly those on modifying plaque ecology and biochemistry, the book as a whole is disappointingly inconclusive, too complicated for routine use, yet lacking the detail needed by an informed scientist. H. N. Newman
Prognoses of Oral Cavity Carcinomas. Results of a Multicentric Retrospective Observational Study. Helmut Platz, Rudolf Fries and Marcus Hudec. Pp. 187. 1986. Munchen Wien, Carl Hanser Verlag (Distr.: Chichester, John Wiley). Softback, f 25.15. This is a report on a multicentre study from DOSAK (the German-Austrian-Swiss Association for Head and Neck Tumours) on the prognosis of oral carcinomas. The 187 pages cover the prognostic values of various factors used in classification of tumours, their clinical parameters and treatment modalities. The text really consists of a collection of papers with numerous tables and much data, presented with the meticulous attention to detail that one might expect from this part of the world. Although somewhat difficult to read, because of a strong emphasis on various statistical manoeuvres and the number of classifications, as well as rather bizarre English, this study should be of great interest to those managing patients with oral cancer. The authors rightly regard it as one of the first comprehensive attempts to supply a sound basis for objective and reliable prognosis determination.
Book Reviews
The results of the study, which was in progress from 1969 to 1982 and included 1021 patients with intraoral carcinoma from 13 centres, have re-emphasized the deficiencies in the TNM classification and confirmed statistically some clinical impressions such as the prognostic value of clinically positive fixed regional lymph nodes, old age, large tumour size, tumour infiltration and distant metastases. Most importantly, it confirms that radical surgery, either alone or combined with radiotherapy, improved the prognosis over no treatment, whereas “non-radical surgery”, that is where the margin of healthy tissue at the tumour periphery was less than 1 cm, did not: nor did chemotherapy with bleomycin and cyclophosphamide. Although few of these results are in any way surprising, it is none the less heartening to see an attempt at providing objective evidence for the results of various types of treatment. This should be a reference book for all dental libraries and a source for those with a special interest in oral cancer. c. Scully.
Human Oral Embryology and Histology. Edited by lvar Mjor and Ole Fejerskov. Pp. 336. 1986. Copenhagen, Munksgaard. Hardback, Dkr 400-00. This very readable book is an expanded version of an earlier text. The new contributors are all authorities in their fields and, as a result, it now covers much more adequately the syllabus in the UK. The major additions are to the development of the face and oral cavity, oral mucosa, salivary glands, temporomandibular joint and the maxillary sinus. The inclusion of Embryology in the title might lead the reader to expect an increased emphasis on development but, apart from the first chapter and those on enamel and dentine, only a short paragraph, placed surprisingly, in many instances at the close of the chapters, covers this aspect. Indeed, in the largest single revision, that on the oral mucous membrane, there is no recognition at all of the fact that this tissue also undergoes a developmental stage. The emphasis is on material from human sources and for this the authors are to be congratulated. The illustrations are, on the whole, excellent and some of the earlier criticisms of poor labelling have been corrected. To my mind, the chapter on Dental Enamel remains the outstanding part of the book, putting into perspective many of the conflicting viewpoints but without being too dogmatic, to provide a very reasonable and readable explanation of what surely must be one of the most difficult structures to describe by means of the written word and two-dimensional representation alone. Not all the readers’ questions are answered, however. For instance the maturation of enamel is described as beginning when the full width has been laid down and continuing until eruption. This begs the question of the role of ameloblasts in maturation and implies that a similar process continues even after formation of the reduced enamel epithelium. There is conflict here with the more generally accepted explanation given when the detailed function of these cells is discussed. Although the distribution of trace elements in dentine gets a mention, similar studies in enamel have been ignored. As in the earlier text the development of the root is dealt with rather superficially and has now been moved from the chapter on cementum to that on the periodontium. Perhaps in a future edition it could find itself in the section on dentine and pulp where, some
137
would argue, it rightly belongs. It is strange to learn that root formation in man is initiated after the onset of eruption but, apart from these few criticisms, these are, on the whole, well-written and interesting chapters. The success of the book will depend largely on the new material and, apart from the absence of some important work on mandibular development, the section on development of the face is adequately described and well written. However, in line with the excellent illustrations elsewhere it would have benefited from histological demonstrations of maxillary and mandibular ossification. The structure of the chapter on the Oral Mucosa (it is by authors whose contributions in this field have been seminal) is interesting in that much of the introduction is based on quite detailed electron microscopy whereas most students’ first contact is likely to be clinical, followed by the light microscope level. Some clinical illustrations of the regional differences would have been useful and, in a book which includes a special section of techniques for studying mineralized tissues, the use of histochemistry and fluorescent and monoclonal antibodies should have a place. The chapter on the temporomandibular joint merits more detail in future editions. It is difficult to fully understand the design of this joint in relation to function when the role of the musculature and innervation is almost totally ignored. The publishers are to be congratulated on the clarity of presentation but it is regretted that the same cannot be said for the quality of proof-reading. There are too many small irritations such as variable spellings of technical terms, repeated or missing lines of print and confused use of English. Altogether, though, this is a very good book both for undergraduate and postgraduate use and at a price which should be acceptable to the former. D. K. Whittaker
The Clinical Handling of Dental Materials. Dental Practitioner Handbook 12. 6. G. N. Smith, P.S. Wright and D. Brown. Pp. 278. 1986. Bristol, Wright. Softback, f 12.50. This book presents a novel approach to the subject of dental materials and, although directed primarily at the practising clinician, also contains much that will be of interest to the clinically orientated materials scientist. Unlike many textbooks on the subject, which concentrate excessively on its scientific aspects, the authors have focussed on the information required by a clinician so as to be able to select from the large range of available materials those most appropriate for a specific task. The presentation is in four parts, all of which can be read independently, although there is a clear link between Part II and Part Ill. Part I considers the properties of materials in relation to practical dentistry and, although quite brief, it covers their physics, chemistry, handling characteristics and service performance together with the required physical, mechanical and biological properties. This section is illustrated with examples chosen so as to improve the reader’s understanding. Part II is essentially the meat of the text and is presented not in the conventional manner by class of material, but in the more logical form of treatment sequence, commencing with examination and diagnosis and continuing with each speciality in turn-prevention, conservation, prosthetics, orthodontics, periodontology and oral surgery. The coverage is extensive, ranging from mirrors, burs, and cotton wool, through hand