An introduction to risk prediction and preventive dentistry

  • Per Axelsson
Quintessence Publishing Co, 1999 pp159, Price £38.00 ISBN 0-86715-361-X | ISBN: 0-86715-361-X

This book is the first in a 5-volume series of colour atlases, which focus on risk prediction of dental diseases and their prevention. It aims to provide an overview of current and future trends in risk prediction, control and non-aggressive management of caries and periodontal disease. The author is world-renowned for his work in the 'Karlstad studies' in the 1970s, the main conclusion of this research was that caries incidence could be virtually eliminated by the meticulous professional removal of plaque.

The book starts with an overview of the epidemiology of oral disease over the past 30 years. In the UK addressing inequalities is a key policy, and I found it surprising that there is little mention of how dental caries experience has become concentrated in the poorest groups in the population. The following chapter provides a description of global oral healthcare resources with international comparisons of dental manpower, with a particular emphasis on the availability of hygienists.

The aetiological factors leading to disease are addressed in the next chapter, which deals exclusively with plaque. The author cites work on gnotobiotic animals and the Viperholm study as evidence that sugar is not an aetiological but an external modifying risk factor. However, other aspects of the Viperholm study (the importance of the frequency of sugar consumption), and the Turku, Tristan da Cunha and Hopewood House studies suggest a much more prominent role of sugar in the aetiology of caries.

Perhaps the most contentious statement in the book is that the use of fluorides should be ranked number two behind plaque control in the prevention of caries. The encouragement of self-care and meticulous professional cleaning of teeth are advocated. This approach has been taken in Sweden, where free and comprehensive preventive care is provided to 100% of 0–19-year-olds. While excellent plaque control is clearly a desirable goal, in the UK the most deprived children who experience the greater proportion of caries are least likely to attend a dentist in order to receive professional preventive care. Therefore most commentators would question this approach as a cost-effective public health measure and would support programmes which focus on fluoride. It would have been helpful in this section to see an extended discussion of the relative merits of a whole population approach against a targeting approach to disease prevention.

These criticisms aside, there is an excellent chapter on the fluorides, with some very clear pictorial representations of how fluoride protects and promotes remineralisation of enamel. Not surprisingly, there is a very comprehensive, well-illustrated section on instrumentation and techniques used for professional cleansing. A minimal approach to tooth restoration using glass ionomer and chlorhexidine varnish is very attractively presented, although one wonders to what extent this approach is influenced by the unavailability of amalgam in Sweden. The final chapter of the book describes diagnosis and analytical epidemiology for quality control. All of the outcome measures used are normative in nature and it is surprising given the current interest, that there is no discussion of the role that subjective measures of oral health status can play in the evaluation of clinical interventions.

Overall this is an interesting book. It offers students, GDPs, hygienists and specialists a useful insight into one approach to disease prevention. As this is the first book in a series it perhaps should cross-referenced with others in the series, and alternative texts on prevention written with a different perspective.

[BDJ 825] M.Tickle

Outline of periodontics

  • J D Manson &
  • B M Eley
Heinemann Publishers, Oxford, 2000 pp405, Price £29.99 ISBN 0-7236-1070-3 | ISBN: 0-7236-1070-3

This books strengths lie in those sections which cover the scientific basis of periodontology, which are often excellent, while the chapters which deal with the largely clinical aspects of the subject are more variable. The two best chapters are those on diagnostic testing and the management of bone defects. That on diagnostic testing is perhaps the best review of this subject that I have read. It is telling though, that at the end of the description of each category of potential bio-markers the same drawbacks seem to be quoted, principally the difficulty of knowing which sites to test and when to test them. The chapter on the management of bone defects contains a useful review of regenerative techniques, including an interesting section on growth factors.

Chapters 2 to 7 are concerned, more or less, with the pathogenesis of periodontal disease. There is much detail in places but surprisingly little concerning the formation, development and biochemistry of plaque. This would have been a helpful point at which to introduce the concept of biofilms but this is not mentioned until the chapter on chemotherapy, 200 pages later. This section of the book gives a rather disjointed impression and undergraduates could perhaps be advised to read chapter 8 on the natural history of periodontal disease immediately after chapter 1. This will at least provide context for the following six chapters. There is a very good summary of the effects of tobacco smoking in the chapter on aetiology.

The chapter on 'basic treatment' included a list of contra-indications to ultrasonic scaling. I am afraid I did not entirely agree with any of these and the authors failed to cite any supporting evidence. There is a long chapter on chemotherapy which rightly emphasizes the limited role of this approach in the treatment of chronic periodontitis. The section on bacterial resistance was informative and pertinent. With regard to antibiotic prophylaxis, the recommendation for patients allergic to penicillin is out of date. The drug of choice is clindamycin not erythromycin.

The chapters on mucogingival problems and occlusion were disappointing. The apically displaced flap, as described here, is a technique of, at best, very limited application. I would also question whether group function is always an appropriate objective in occlusal management. There is much to recommend anterior guidance, even in the periodontally compromised. 'Maintenance' is considered, briefly, in the chapter on basic treatment but given the importance of supportive care in the success of periodontal therapy a fuller discussion would have been welcome.

The book is certainly a mine of information, although presented in a way which may not be readily assimilated by the undergraduate. Nonetheless, many others will find it an extremely useful reference text and it deserves a place in any dental library.

[BDJ 826] V.Bissell