Oral diagnosis – the clinician's guide
- W. Birnbaum &
- S. M. Dunne
This book is written by two experienced clinicians and teachers from the GKT stable. It is a pleasure to read in the preface that dentistry 'though scientifically based, is also an art' and the authors attempt, in the first chapter, to outline the principles of the art of being a competent clinician. The remaining chapters focus primarily on the science. It is intended chiefly for undergraduate dental students and follows the trend in recent years to make undergraduate textbooks affordable and comprehensive. The outcome is a book which traverses many specialities in dentistry, especially oral medicine and oral surgery, and covers more than 'diagnosis'.
The best chapters in this book are those dealing with pain of dental and non-dental origin. The authors have worked hard to make the information here – which is so obviously at the heart of effective orofacial diagnosis and yet often dealt with in a superficial way by modern textbooks – relevant, concise and readable.
I am not sure that the few black and white photographs scattered throughout the text add anything to the book except, perhaps, to the price. Similarly, the line drawings are often overly simple and sometimes bizarre! For example, the examiner's hands in Figure 3.4 are transposed from left to right, and the patient shown in the sequence on mucosal examination is clearly not enjoying the procedure! There are one or two misleading concepts evident in the text. We are told that 'consent of a parent or legal guardian is required for children under 16 years old' – this is certainly not the spirit of the Children's Act (Scotland); the reader is advised to biopsy 'any persistent or suspect white patch' – our profession should be advising the referral of all patients with white patches for specialist opinion since it is not only the 'suspect' white patch which may harbour potential or overt malignancy. The sections on various non-dental pains often end with the advice to refer the patient but no indication is given as to the most appropriate speciality; similarly, drugs are often listed with no indication of dosage regimes. It is surprising to note that dental amalgam is hidden away in the section on 'drug' causes of mucosal lichenoid reactions; the literature would suggest mercury/amalgam as a significant cause of oral lichenoid reactions.
However, this book, as an undergraduate text, is useful. It emphasises basic concepts such as the diagnostic ('surgical') sieve, appropriate tests, investigations and specimens. The use of 'keywords' in highlighted boxes in the chapters on pain diagnosis is most helpful. This textbook will now compete with many similar publications on the market and , given its listed objectives, may do well.
[BDJ 833]
J Gibson
Periodontics in practice: science with humanity
- T L P Watts
Our duty as dentists is to advise and to provide what help we can to patients who, in some cases may desperately need friendship and kindness.
This statement by the author, which appears in Chapter 28, reflects the essence of his treatment philosophy, one with which few would disagree. It also explains a lot about the book which is an intensely personal view of periodontal practice, not always mainstream, and reflecting many years experience of teaching and caring for patients.
There are 30, mostly short, chapters and, in a book entitled Periodontics in Practice it is surprising that the reader waits until chapter 17 before he reaches the practical part. The preceding 16 chapters contain some excellent theoretical summaries of epidemiology, pathology, and the interpretation of clinical trials. The author also bares his social conscience on page 104 when, writing about the influence of cigarette smoking, he rails against 'this unfortunate addiction which has been shown in the USA to be exacerbated by corporate greed and deceit on an unprecedented scale.'
The book is unusual in that it dispenses with the traditionally obligatory full literature review in favour of a selection or the author's favourite papers, for many of which he has already provided abstracts for the BDJ. While this is both interesting and useful it does give a view of the periodontal practice which reflects the author's own experience, and is not always in line with current practice 'out in the field'. The sections on mucogingival surgery, for example do not mention the work of PD Miller, Pat Allen, or Randall Harris, on which much of today's gingival grafting technique is based. This section does not reflect the state of the art in mucogingival surgery and consequently, the frenal pull shown in Fig 13,2 is described as 'no problem' whereas most practising periodontists, especially in the USA would consider it a strong indication for a predictable and necessary gingival or connective tissue graft.
Similarly, his plaque monitoring is based on O'Leary's 1972 presence or absence index, which can easily be overscored, particularly after lunch! Far better to rely on bleeding on probing as the most useful parameter, reflecting as it does the effect of plaque which has been present for some time. The section on guided tissue regeneration and bone substitutes mentions only a few of the many alternatives on today's market, some of which appear to have strong scientific evidence to commend them.
The crucial chapters on non-surgical therapy explain the principles well, and an explanation of the importance and technique of instrument sharpening might perhaps have completed the detailed description of the use of Gracey curettes.
This book, although not suitable for basic undergraduate teaching, can be recommended to postgraduates and practising dentists as one senior academic clinician's view of how we apply periodontal science to our patients and therein lies its fascination.
[BDJ 842]
P Greene
Developing research in primary care
Edited by: 
- M Saks,
- M Williams &
- B Hancock
This volume from Radcliffe Medical Press is part of their Primary Care Research series. Written by authors with considerable experience in this field of investigation, each of the six chapters has clearly stated aims and objectives and the layout is clear and well ordered. The first chapter gives a practical guide to starting practice-based research. It takes readers through the task of formulating the research question and developing a framework for their research.
Particularly useful are the exercises that readers must undertake to conceptualise their own research ideas. In fact this exercise pattern is a theme that runs through the entire book and it is used to very good effect. This first section also gives excellent advice on applying for funding –and having put together a grant application readers are asked to put themselves in the position of a referee reviewing that application.
In-depth guidance on carrying out a literature review is the theme of the next chapter. Readers are advised of what a review is, and why and how it should be undertaken. They are guided to appropriate sources of literature and the various bibliographic tools available to the researcher. The skills necessary to critically appraise the existing literature are also considered. Chapter 3 then follows with an examination of research ethics. General principles are discussed and readers are then taken through an application to gain ethical approval for their research project.
A health needs analysis is the specific focus of the fourth chapter. Health needs assessment aims to achieve health gain for groups by identifying need and targeting resources effectively. The authors stress the need for the practitioner to have a clear idea as to why a needs assessment should be conducted and they present four frameworks which can be used to design a health needs assessment project.
Presenting and disseminating research is then considered. Clear advice is given on writing up the project. The focus is on the construction of reports and dissertations and a section is included on the channels for the dissemination of research. The final chapter discusses the implementation of the research findings. Sound advice is given on how to appraise research data. As the authors point out, evidence-based medicine argues that each clinician should have the skills to appraise reports of research and implement the findings if appropriate.
Quite reasonably this book is aimed at the medical team. This being the case, is it relevant to the dental practitioner who is interested in undertaking practice-based research, and will it be of benefit in developing a research project? The answer to both questions is definitely yes. The principles involved are directly transferable to our field of endeavour. There are some areas that need to be considered in greater depth, but where this is the case the reader is given relevant recommended further reading. Anyone interested in practice-based enquiry should read this book.
[BDJ 837]
L B Cabot
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Reviews. Br Dent J 189, 518–520 (2000). https://doi.org/10.1038/sj.bdj.4800816
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DOI: https://doi.org/10.1038/sj.bdj.4800816
