Diagnosis of the orthodontic patient

  • F McDonald &
  • A J Ireland
Oxford University Press, 1998 pp264, price £19.95 0-19-262889-5 | ISBN: 0-19-262889-5

This book has been written to provide information on the most important part of orthodontic treatment, diagnosis. It was inspired by the book 'Orthodontic Diagnosis' written more than 20 years ago by the late Professor W J B Houston. The present book is directed at the undergraduate student and those with an interest in orthodontics. It has ten chapters that cover a range of subjects from basic diagnosis, the evaluation of risk/benefit balance, dynamic occlusion and evidence- based practice. At the end of each chapter is a summary of the chapter and a list of learning objectives for the reader.

The first few chapters outline the development of the normal dentition, the aetiology of malocclusion, the patient and parent interview and the orthodontic examination. These chapters provide standard information in a structured way and give a modern insight into basic diagnosis. The next two chapters include important information on dynamic occlusion and health considerations of orthodontic treatment. These are new additions to most orthodontic texts and provide a sensible and balanced view to two controversial areas.

A major strength of the book is the inclusion of a chapter on evidence-based practice and again this is a sensible overview of the evidence for certain orthodontic treatment procedures and decisions. This is followed by a section on basic treatment planning. Again, this is presented in a realistic manner. I was particularly impressed with information provided on balancing and compensating extractions, in which the authors provided a simple explanation of a subject that can be made very complicated. I still remember in my undergraduate days learning pages of text on this subject, in which the decision to balance appeared to be governed by a myriad of factors concerned with skeletal pattern, age of the patient, the amount of crowding and whether we saw a magpie on the way into dental school!

The book concludes with two useful appendices. The first is a proforma for an orthodontic examination, which will act as a prompt to anyone carrying out an orthodontic assessment. The second appendix is an orthodontic sieve that allows the reader to follow a pathway to a correct diagnosis.

In general, I found this book covered all areas of orthodontic diagnosis in a fairly simple manner. However, in some sections the style was rather 'wordy', for example, some paragraphs are lengthy and somewhat overfacing. The book would have been made more readable if the authors had been able to use more photographs and illustrations. Unfortunately, all the clinical photographs are in monochrome and this detracts from the visual appeal of the book. However, this approach must keep down the cost and enable the average dental student to purchase this book.

In recent years many of the undergraduate orthodontic programmes have changed the emphasis of their teaching away from providing treatment with removable appliances to the recognition and diagnosis of malocclusion. As a result, this book is a timely addition to the undergraduate literature and can be recommended to undergraduates and those practitioners who wish to improve their diagnostic skills.

[BDJ 779] K O'Brien

Oral cancer: a synopsis of pathology and management

  • G Dimitroulis &
  • B S Avery
Butterworth-Heinemann, 1998 pp168, price £19.99 0-7236-1022-3 | ISBN: 0-7236-1022-3

This pocket book written by two maxillofacial surgeons is intended for medical and dental practitioners, dental students and registrars as an introduction to the subject. It is divided into ten chapters, is well illustrated with line drawings and has an easy to read text. Much of the text is in boxes that unfortunately have not been well typeset and are often incomplete and continue onto the next page. Each chapter ends with a 'further reading' list.

The introduction is simple and provides very basic epidemiological data. A chapter follows on the biology of oral cancer, parts of which are weak. Predisposing factors are quoted that have not been validated by case control studies and the references quoted are mainly from the 1980s. Although rare epithelial tumours are briefly mentioned there are no details given of bony tumours presenting in the mouth.

The next chapter called 'Evaluating the Patient with Squamous Cell Carcinoma of the Mouth' provides the clinician with the basic facts that need to be gathered and how staging systems and prognostic indicators help in evaluation of patients. The last paragraph of the chapter mentions the impact cancer can have on the patient but fails to address issues such as how the news should be broken and what support a patient needs.

After a good basic chapter on the principles of surgery there follow three chapters on ablative surgery, neck dissection and reconstruction, which take up more than 70 pages. They are very detailed but well illustrated and easy to follow. To the non-specialist some of the surgery described is horrendous and yet no reference is made to how the patient may be helped to cope both with the physical and psychological aspects of such surgery. Patients often turn to their medical and dental practitioners for advice after such surgery, and it would have been useful to include some practical tips, for example, oral hygiene and speech therapy.

In contrast the chapter on radiotherapy deals with just the basic principles. The effect of radiotherapy on the quality of life for patients and the management of the complications are dealt with in two pages. The final chapter deals with other treatment modalities, many of which are still experimental.

Although quality of life and psychological support is alluded to a few times, no mention is made of the importance of providing patients with information both written and verbal. The role of psychologists, McMillan nurses, dentists, hygienists, social workers and speech therapists is dealt with in one sentence and yet without the support of all these other professionals these patients would not survive with any quality of life. Yet is exactly these people that this book is especially useful to.

The authors write that the 'treatment of the cancer is only one aspect of the overall management of patients with malignant disease' and yet this book only addresses treatment from the surgical viewpoint.

[BDJ 772] J M Zakrzewska