G. C. Craig, K. R. Powell. Dental Outlook Publications price £40.50; pp 37 ISBN

9780992311001

This handbook is intended to expand practitioners' caries management armamentarium for anxious patients. Its primary goal is clear – reduction in the number of children requiring hospital admission for dental extractions under general anaesthetic (GA).

The techniques included have been drawn from the Bourke study, which both authors were involved in. The study ran from 1978-1984 in a remote part of New South Wales, Australia, where caries-risk in children was high and access to GA services was severely limited. In view of this, along with the growing levels of dental anxiety in local children, a three-stage system of acclimatisation was developed.

The authors highlight the need to eliminate all equipment that could be perceived as threatening by children. This would include local anaesthetic apparatus, high-volume suction, matrix bands and probes. It may seem like an impossible task to effectively manage caries without such tools. However, the authors go on to thoroughly describe the values of alternative methods such as silver fluoride, stannous fluoride paste, and ultra low-speed excavation.

The section of this handbook dedicated to the recognition of high-risk sites for caries progression in the primary dentition could be useful as a guide for treatment prioritisation in children. The chapter detailing the use of rotary instruments provides superb suggestions for retentive cavity preparation in primary teeth and is supplemented by a range of photographs, radiographs and diagrams.

UK readers will notice considerable variation from current management principles for grossly carious teeth, retained roots and teeth with acute or chronic infection. Whilst use of a minimally invasive technique is encouraged and forms an essential part of an acclimatisation programme, it must be recognised that there are occasions when it seems unreasonable to go to such lengths to avoid an extraction. Some of the techniques described have perhaps been eclipsed by more modern, evidence-based techniques such as the Hall technique for preformed metal crowns and regular application of topical fluoride vanish.

This is an intriguing read based on a fundamental piece of research that remains useful in controlling caries risk in more isolated communities with severely limited access to dental care. However, in patient populations with reasonable access to modern materials, techniques and facilities, including treatment under general anaesthetic, some of the methods described may not be so relevant.