Book Reviews

Management of Temporomandibular Disorders and Occlusion

gion and dentistry needs to appreciate the intricate relationships of all of these masticatory components, which the textbook provides in a foundation building manner with its rst six chapters. In chapters seven through ten, the author provides a lucid description of the etiology and identication of functional disturbances of the masticatory system when less than ideal anatomical and physiological conditions exist. A thorough presentation of the epidemiology of these disturbances emphasizes the prevalence of these conditions in our general population of which the practitioner needs to be keenly aware. Of great practical importance is the detailed how-to information offered regarding the clinical examination, data gathering, and differential diagnosis of TMD. The third section of the textbook that discusses the treatment aspects of TMD in chapters eleven through sixteen, is very practical as the author presents a clear description of different types of treatment that are appropriate for an effective management approach of muscle disorders, temporomandibular joint disorders, and growth disorders involving the masticatory system. This treatment portion opens with a chapter on general considerations to set the stage for the specics needed for each of the aforementioned TMD areas, and it ends with an extremely resourceful chapter on treatment sequencing in which the authors approach provides a summary via the use of graphical algorithms that succinctly routes the patient through treatment based upon individual responses to therapy. Chapters seventeen through twenty comprise the nal section of the textbook, which pertains to permanent occlusal therapy. The author very carefully differentiates reversible and irreversible therapy, and he provides a very thorough content on the use of articulators, selective grinding, and restorative considerations relative to permanent occlusal therapy.

Jeffrey P. Okeson, 5th edition. Mosby Publishing Co., St. Louis, MO, 2003: ISBN 0-323-01477-1. (671 pages, no color illustrations; price $79.95) The authors clearly stated purpose of this book is to present a logical and practical approach to the study of occlusion and masticatory function. Intended readers of this book would include practitioners in the elds of dentistry and any allied health sciences interested in the areas of occlusion and temporomandibular disorders (TMD), and members of dental academia as the schools integrate the study of TMD and occlusion into the curriculum. The 20-chapter textbook is comprised of four sections: Functional Anatomy, Etiology and Identication of Functional Disturbances in the Masticatory System, Treatment of Functional Disturbances of the Masticatory System, and Occlusal Therapy. The functional anatomy portion of the text provides the reader with an excellent foundation of the anatomical, physiological, and biomechanical aspects of the various components of the masticatory system so that one would be able to better comprehend the later portions of the text that pertain to the disorders of this complex system. The material is essential to understanding the health of the orofacial re230

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The illustrations are very helpful in elucidating the authors detailed text in this portion. From an overall perspective, the textbook is clearly laid out in its content and is welldesigned in presenting the information to the reader. With this textbook being in its 5th edition, it is very well-honed and up-to-date with its rich number of scientic references for each chapter (more than 1850 references in total). The author is internationally renowned for his knowledge and expertise in the elds of occlusion and TMD, and this is portrayed throughout the maturity and depth of the present textbook. Dr. Okeson succinctly presents the information in a way that the reading will engage the experienced practitioner without overwhelming the dental student or the beginning practitioner. Complementing the text are very clear and useful black and white graphics and illustrations, many of which are original to the illustrator, Allison Lucas Wright, while others are photographs of actual patient cases from the author as well as from others to whom the author provides credit. Still other illustrations and graphics are reective of various imaging modalities of the temporomandibular joint and its associated structures. In addition to the references, the author includes a listing of suggested readings at the end of some of the chapters so that the reader can pursue a study of specic information to a greater depth. The author also offers numerous actual case reports at the end of each of the chapters pertaining to treatment of masticatory muscle disorders, treatment of temporomandibular joint disorders, and treatment of chronic mandibular hypomobility and growth disorders. As such, these case reports reect some very common clinical applications of the information presented in the text, and both the practitioner and dental student will nd these cases to be quite supplemental as he or she strives to understand and employ the diagnosis and treatment of these particular disorders in their practices and training. Also very resourceful for the reader are the inclusions of easily readable and graphic diagnostic algorithms for the different subclasses of masticatory muscle disorders and temporomandibular joint disorders. In summary, this textbook is highly recommended for both the practitioner and for the dental curriculum as it is scientically sound in the authors presentation of the constantly and rapidly

evolving information, particularly in the eld of TMD. The author is deeply committed to his continual contributions to the areas of both TMD and occlusion, and the 5th edition of this text is a testimony to that fact. Ronald Attanasio, DDS, MSEd, MS Professor Department of Dental PracticeManagement University of Nebraska Medical Center College of Dentistry Lincoln, NE

Change Your Smile

Edited by Goldstein, R.E. (author) and (contributing authors) Belinfante, L. and Nahai, F. Quintessence Publishing Co., Inc., Chicago, IL, 1997: ISBN 0-86715-291-5. (328 pages with 575 illustrations, 575 in color; hardcover; price $45.00) This text is now in its 3rd edition since it was initially published in 1984. Change Your Smile serves as a consumer resource for esthetic and cosmetic dentistry services and has been updated with new photographs and illustrations. The authors (Dr. Goldstein) intent for publishing this book is to provide dental patients with the terminology and knowledge of cosmetic dentistry procedures, which will allow them to communicate more effectively with their dentist. Patients can determine whether they are candidates for cosmetic dentistry and get a reasonably good idea of the procedures involved. One of the contributing authors is an Oral Surgeon and another is a Plastic Surgeon. In addition, there are seventy-two consultants in dentistry and related areas that are acknowledged as contributors. The text has a glossary, aimed obviously for use by the patients, al-

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Book Reviews

though pronunciation guidelines are not provided. Additionally, twenty general references are listed for additional reading. References are not provided for the individual chapters, however. Change Your Smile describes several treatment options and has included self-evaluations for patients to use in making informed decisions. The rst chapter contains a simple smile analysis which logically helps patients decide if they are a candidate for cosmetic dentistry. Excellent color illustrations are provided along with respective treatment options. The author encourages patients to carefully select a dentist who is up to date and uses high tech diagnostics and treatment equipment. It is suggested that if the dentist has a copy of this book then, most likely, the dentist practices the techniques described. The second chapter illustrates tooth stains and treatment options including polishing, bleaching, bonding, laminating, and crowning. A summary for each category of treatment options lists treatment time, maintenance, treatment results, life expectancy, and costs. A clever schematic with color illustrations shows how back teeth are commonly rebuilt. Procedural costs are listed, and in the case of a single crown, a cost range of 550-3000 dollars is presented with a degree of risk involved. One could speculate, from the patients perspective, that it would be reasonable that the dentists fees should be somewhere near the entry level of this range. Repairing fractured teeth with cosmetic contouring, bonding, laminates, or crowning is discussed and illustrated in Chapter 3. Treatment summaries are listed along with the advantages and disadvantages of each procedure. The scope of conventional restorative treatment options for missing teeth is described. A ve-page chapter on replacing missing teeth with implant restorations briey describes treatment indications and procedures. The longevity of an implant restoration is stated to be similar to that of a conventional crown (5-15 years). The advantage of conservation of adjacent tooth structure as well as the relative degree of clinical success of implant restorations compared to conventional xed prosthodontics on natural tooth structure was not discussed however. This reviewer recommends that another source

of information on implant restorations should be provided to patients in addition to this book. This chapter should be expanded and more appropriately emphasized in future editions. Tooth alignment and bite problems are discussed in the next two chapters. Cosmetic contouring and bonding are presented as conservative techniques that are less expensive than orthodontics, laminate veneers, or crowns. The author describes cosmetic contouring as the reshaping of tooth structure, which makes crowded teeth appear the appropriate size. It is emphasized that contouring for esthetics must not compromise the functional relationships of the dentition, and it is not indicated for young children. Orthodontics, however, is the treatment of choice when the top priority is maintaining natural, unaltered tooth structure. As a summary to these chapters, color-coded tables listing treatment options are presented for the conditions of open bite, overbite, protrusion, and crossbite. One of the contributing authors (Dr. Belinfante) describes the indications and procedures for orthognathic surgery in Chapter 8. It is pointed out that severely complicated bite problems may require surgical intervention for correction. An array of color patient photographs is provided for the reader which illustrates the need for such surgical therapy and the expected treatment outcomes. It is well noted that the completion of treatment after surgery typically requires additional management by the Orthodontist and Restorative Dentist or Prosthodontics specialist. In the following chapter, the author describes how gums affect a patients smile. The gingival and periodontal disease processes as well as cosmetic, resective and regenerative surgeries are illustrated. A separate chapter in this book is also devoted to cosmetic dentistry procedures for elderly patients. All of the previously mentioned cosmetic procedures can obviously be benecial for dentate elderly patients. Perhaps the intent here was to inform these patients visiting the dentist that they are also candidates for changing their smile. Special attention in this chapter is devoted to how new dentures may provide better stability, increased lip support, and a more youthful smile line.

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The second contributing author (Dr. Nahai) discusses the role of plastic surgery in enhancing your smile. Facial conditions such as lip lines, facial wrinkles, heavy cheeks, a prominent nose, protruding chin, baggy eyelids, frown lines, drooping brow, and their respective plastic surgery treatment summaries are provided in a similar manner as the other chapters of the book. Change Your Smile can surely help enhance communication between the patient and the dentist. If a practitioner decides to add this book to the waiting room area, both the dentist and staff should be prepared for questions related to specic cosmetic dentistry services. Therefore, it is recommended that the dentist and staff be thoroughly familiar with the books contents. In addition to being a valuable resource for patients, this book could be recommended for dental students as an introduction to the scope and treatment rationales for esthetic and cosmetic dentistry treatment. Henry A. St. Germain, Jr., DMD, MSD, MAEd Associate Professor and Chairman Department of Adult Restorative Dentistry University of Nebraska Medical Center College of Dentistry Lincoln, NE

Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach

Edited by Pascal Magne and Urs Belser. Quintessence Publishing Co., Inc. Chicago, IL, 2002:ISBN 0-86715422-5 (406pp; 1,037 illustrations (mostly color); hardbound; price $189.00) This text contains an extensive review of the use of porcelain restorations for the restoration of the anterior dentition. The authors present a broad-based discussion that includes the intro-

duction of biomimetic principles as applied to tooth restoration, natural tooth esthetics, diagnosis, treatment planning, tooth preparation, laboratory procedures, adhesive luting procedures, as well as maintenance protocols. This text is a valuable resource for several individuals: the dental student interested in learning the fundamentals of esthetic dentistry, the experienced dentist wanting to incorporate new and rened operative and diagnostic techniques, and the dental technician seeking to improve his or her skills. The book is lavishly detailed with over one thousand illustrations. The quality of the macrophotography is excellent. The depth of eld and color presentation of the intraoral and laboratory images is exceptional. Many photographs feature overlays that highlight salient points. Written text is kept to a minimum, yet it is readable and well-referenced. The general format of the book is to present the general concepts and descriptions on even-numbered pages and to supply a photograph and/or an illustration about the text material on the facing page. Illustration legends are detailed and comprehensive and are a signicant source of information. The authors begin the book with the introduction of the concept of biomimetics (i.e., the use of materials and techniques that produce restorations that mimic the physical and mechanical properties of the natural dentition). This includes a review of the biomechanics and physical properties of enamel, dentin and the dentinoenamel junction. Numerous examples of the effects external forces have on the hard tissue structures of anterior teeth are illustrated using data from nite element analysis studies. A signicant portion of the book is dedicated to diagnosis and treatment planning. To aid in the proper diagnosis of the esthetic characteristics of the patients dentition, the author offers a list of 14 fundamental criteria (a laminated copy of this guide, suitable for chair-side use, is included). The criteria cover both soft and hard tissues and include methods for evaluating morphology, optical properties and alignment. While a majority of text covers the use and fabrication of bonded porcelain restorations, the authors cover the topics of vital and non-

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Book Reviews

vital bleaching, enamel abrasion and the use of direct placement composite resin restorations for the correction of esthetic defects. Clinical case presentations of the each of the above mentioned topics add greatly to the effectiveness of the discussions. The next section of the book deals with the indications for and treatment planning of anterior bonded porcelain restorations (BPR). The authors present a new classication model for BPRs. These include Type I teeth that are resistant to bleaching (i.e. dark tetracycline staining); Type II teeth that require correction of major morphologic defects (i.e. diastemata or peg laterals) and Type III teeth that need extensive restoration (i.e. coronal fracture or wear). The use of diagnostic waxups of the patients study casts is a key element of the authors treatment planning and restoration philosophy. Detailed clinical examples of additive waxup techniques are presented with emphasis on identifying the patients dental perceptions, enamel wear patterns, tooth volume, and anatomy. The diagnostic waxup is used to then make a silicon index of the anterior dentition. The silicon index allows the dentist to fabricate an acrylic mockup of the anticipated denitive porcelain restorations. The acrylic mockup can provide the dentist and patient with a realistic preview of the treatment outcome. A short review of tooth shade selection and a discussion on intraoral photography techniques complete this section of the book. The next section is composed of a detailed presentation of tooth preparation, impressiontaking, and provisionalization methods. The reduction of labial enamel using standardized calibrated depth-cutting burs is not recommended. In its place, the authors emphasize the use of a silicon index made from the additive waxup model of the anterior dentition. Horizontal sectioning of the silicon index provides the dentists with a multilayered template that serves as a guide for targeted reductions of tooth structure. An extensive discussion of the cutting, geometry, and location of preparation nish lines is provided. Topics include the novel use of electric, oscillating hand pieces for the creation of proximal nish lines and the effects of incisal edge preparation designs on the distribution of stresses within the tooth. Also ad-

dressed are the preparation designs needed to correct commonly encountered clinical situations such as pre-existing Class III restorations, Class IV defects and diastemata. The advantages of treating exposed dentin with dentin bonding agents, prior to nal impressions, are also discussed. Illustrations of impression techniques and customized provisional restorations are provided. A separate chapter is devoted to describing the laboratory phase of a bonded porcelain restoration. Color photographs of the step-bystep laboratory fabrication of a BPR provide the reader with an appreciation of the skill and attention to detail needed to produce life-like porcelain restorations. Additional challenges of masking intrinsic stains and correcting tooth shape deciencies are well-presented. The next section covers restoration try-in and adhesive luting procedures. Emphasis is placed on the use of feldspathic porcelain restorations. Topics covered include hydrouoric etching, silanization, rubber dam isolation, tooth surface conditioning, dentin bonding, luting agent placement, and stress formation due to luting agents. The authors recommend the use of light-cured hybrid restorative-type composite resin instead of dual-cured low viscosity luting-type resins. The nal section of the book deals with the maintenance and repair of the bonded porcelain restoration. Precautions involving the use of hand-held and ultrasonic scalers, air-abrasive polishers and topical uorides as well as the correction of chips and fractures are covered. An index of all the clinical cases presented in the text, including pre-op and post-op black and white pictures with a reference list to corresponding color pictures, is provided. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach is a book that will appeal to anyone interested in producing high quality porcelain restorations. The text is concise and informative, and the photographs and illustrations are of superior quality. David A. Covey, DDS, MS, MS Associate Professor Department of Adult Restorative Dentistry University of Nebraska Medical Center College of Dentistry Lincoln, NE

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Oral HealthRelated Quality of Life

Edited by Marita Rohr Inglehart and Robert A. Bagramian. Quintessence Publishing Co, Inc, Chicago IL, 2002: ISBN 0-86715-421-7 (pbk) (30 contributors, 208 pages, 88 B&W illustrations; price $42.00) This text, the rst of its kind, was inspired from proceedings of a weeklong, multidisciplinary workshop held at Ann Arbor, Michigan in May 2000. It explores the role of oral healthrelated quality of life (OHRQOL) in dental education, dental research, and clinical practice in light of the growing emphasis on patient-centered care and quality of life issues. As such, this text is an excellent resource for experienced and novice oral health researchers, academicians, patient and public health advocates, and dental clinicians who aspire to place more emphasis on patients quality of life in dental practice, advocacy, research, and education. In short, this text has something for everyone. The editors, Marita Rohr Inglehart and Robert A. Bagramian, and 28 other expert contributors have assembled a text covering a wide-range of OHRQOL topics from a multidisciplinary perspective. The 17 chapters address quality of life (QOL) issues such as QOL assessment, basic research and application, psychology, public health, and sociodemographic inuences including age, gender, race, and ethnicity. The text also discusses oral health and quality of life in children, adolescents, and older adults, as well as the impact of tooth loss, dental caries, systemic disease, oral cancer, and chronic pain on OHRQOL. It also explores how OHRQOL can be used to redirect the focus of dental education and chart the future direction of such research. In keeping with the World Health Organizations 1946 denition of health as a state of

complete physical, mental, and social well-being and not merely the absence of disease and inrmity, several contributors emphasize dentistrys need to include social and psychologic well-being to its more traditional oral health goals. The authors cite the rst Surgeon Generals Report on Oral Health (year 2000), which acknowledged the relationship between oral health and quality of life. Similarly, the book refers to the rst goal of the US Department of Health and Human Services initiative Healthy People 2010, which is to increase the life expectancy and quality of life of all individuals. From this momentum, the editors and collaborators have written this book with two goals in mind: to inform readers about OHRQOL research and to challenge researchers and clinicians to make OHRQOL the ultimate focus of all their work. An appreciation for OHRQOL and its importance to dentistry cannot be achieved without working denitions. This text does a ne job of dening terms and identifying and discussing the many limitations inherent in OHRQOL assessment, research, and clinical application. OHRQOL is a complex multifactorial concept inuenced by myriad functional, psychological, social, and physical factors specic to each person and the personal situations that arise. The authors adeptly address these factors in light of their inuences on research, patient advocacy and public health, clinical practice, and dental education. The text describes OHRQOL research as a developing eld requiring international collaboration. The authors assume a formidable task in reviewing quantitative and qualitative OHRQOL assessment methods used by QOL researchers. Appropriately, the authors acknowledge that future improvements in OHRQOL will require valid, reliable, and rigorous assessment measures. The importance of including pain in quality of life studies is also emphasized. Non-researchers may nd the chapters on OHRQOL somewhat dry, given the plethora of rating scales and questionnaires critiqued by the authors and the descriptions of several observational and longitudinal studies used to date. Given the intimate relationship between oral and systemic health, the inclusion of systemic health and disease to the QOL discussion

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Book Reviews

cannot be overlooked. Fortunately, two chapters provide a general overview of the impact of systemic disease and oral cancer to individuals QOL. In addition, QOL considerations for older adults as well as children and adolescents with special health care needs are presented in other chapters. The discussion on systemic disease is limited to the six most frequently occurring systemic health problems known to affect oral health: heart disease, cerebrovascular disease, hypertension, diabetes, arthritis and cancer. The authors review the epidemiology, systemic manifestations, and associated oral complications, as well as treatment modalities and their oral side effects of these six conditions. Clinicians will nd the oral health care strategies offered to be helpful for the alleviation or elimination of the oral manifestations, symptoms, and complications of systemic disease and oral cancer. The thorough and succinct review of oral cancer includes an exceptional discussion on the preservation of quality of life for patients with oral cancer. There are only 14 clinical photographs in this textbook and all are black and white. The photos selected for this text are quite compelling but their lack of color diminishes their impact somewhat. Of particular value are the intraoral photographs in chapter nine that illustrate oral complications of systemic disease in children and adolescents with special needs. The use of color photographs would be ideal but would no doubt increase the cost considerably. Since photographs are an exceptional motivational tool and clearly demonstrate, in ways that words cannot, the relationship between

oral health and QOL, more clinical pictures of the various intraoral manifestations of systemic disease in adults would be preferred. Another limitation of the text is its rather paltry discussion of dental esthetics and its impact on OHRQOL. The text has 36 gures, 31 tables and 7 boxes to compliment the narratives and make for easy reference. The chapters are arranged in an appropriate sequence, beginning with introductory quality of life concepts (including assessment and research), followed by the various sociodemographic, psychologic, physiologic, pathologic, and pain inuences on OHRQOL. The last two chapters sum up the textbook and address future goals for dental education and research. Because this is the rst textbook devoted to oral health-related quality of life, comparisons cannot be made with other textbooks of its kind in dentistry at this time. However, this book is very well written, well organized, and of exceptional value. The editors have assembled a distinguished group of contributors whose efforts have advanced the cause of oral healthrelated quality of life. Todays clinicians, researchers, academicians, public health ofcials, and policy advocates would benet from familiarity with this timely reference. Teresa E. Johnson, DDS, MS, MPH Associate Professor Department of Dental Practice Management University of Nebraska Medical Center College of Dentistry Lincoln, NE