Adverse drug reactions in dentistry

J. Dent. 1990; 18: 285-288 285

Book Reviews

Section Editor: P. N. Hirschmann

Adverse Drug Reactions in Dentistry. FL A. Seymour and J. G. Walton. Pp. 199. 1988. Oxford, Oxford University Press. Hardback, f 18.95.

The importance of drug complications in clinical dentistry is now widely recognized by the profession. An ever- increasing number of elderly patients in dental practice will be taking, or have recently received, medication which may produce oral disease or modify treatment procedures. The appearance of a book which specifically addresses these matters is therefore most timely. The two authors have already published extensively on the subject, often in collaboration with their colleague John Thompson, Professor of Pharmacology at the University of Newcastle.

The book contains five chapters. The first deals in general with the unwanted effects of drugs used in dentistry. An attractive feature is that the action of these drugs, both desirable and otherwise, is briefly described. The increasingly rapid introduction of new drugs is reflected in the lack of reference to either flumazenil or fluconazole. Adverse drug reactions involving specific orofacial systems are detailed in chapter 2. Despite the omission of fluorosis and rarer complications such as the blistering induced by steroid inhalers, this Chapter provides wide coverage of its topic.

Essential modifications in prescribing for special category patients is covered in Chapter 3. Tables giving details of drugs to be avoided or used with caution during pregnancy and breast feeding are especially helpful. Further sections deal with the particular problems of prescribing for children and the elderly and for patients with liver or renal disease, these again being augmented by clear tables with recommendations and accompanying explanations. The chapter concludes with practical advice on drugs which may be more safely handled by the diabetic and asthmatic patient. Although very evident throughout this book, the fact that the authors are practising dental clinicians is nowhere more evident than in Chapter 4 which deals with drug interactions of immediate relevance to practice. The final chapter presents the practical management of adverse drug reactions in the mouth. The common but complex condition of xerostomia is given cursory consideration, but the clear differentiation between the various hypersensitivity reactions is helpful.

The outstanding attraction of this book for the busy clinician is the ready reference tables and summaries of drug complications in dentistry. In addition, an appendix lists the unwanted drug effects on a regional and symptom basis, while the conventional subject index is augmented by a drug interaction index. The up-to-date comprehensive reference lists at the end of each chapter will appeal to the postgraduate student. This clearly

printed well-bound book meets a long-felt need. A copy should be freely accessible in every general dental practice, clinic and hospital department. D. M. G. Main

The Case for Fluoride-A New Video. 16 min. 1989. Penn, Bucks, Counsellor. No price given.

Increasing the uptake of fluoride supplements so as to improve child dental health is a worthy aim. However, I approached this video, designed to encourage health visitors, with wariness because it is produced for Stafford- Miller who manufacture them. The caution was justified, not so much by overt misinformation-although few experts would now agree with Bill Collins who is seen telling a dental meeting that topical fluoride is not as effective as systemic fluoride-as by the hidden agenda.

Among the questionable points made in the course of the video are:

- Some young children instinctively like lots of sweet things and the answer is to give them fluoride tablets.

- There will always be opposition to water fluoridation, so we should give up and seek alternatives.

- Fluoride tablets are more effective than water fluoridation, and less likely to cause mottling, because of the controlled dosage.

- Fluoride tablets reduce caries by 60 per cent whereas fluoride toothpaste only gives a 25 per cent reduction.

A 25 per cent reduction is, of course, the average achieved in 3-year clinical trials of teenagers. The benefit conferred by using fluoride toothpaste from birth is not known because it would now be impossible to provide a control group, but experience in countries where fluoride toothpaste is not used suggests that the benefit is much more than a 25 per cent reduction.

This review was written just after a series of workshops for over 500 health visitors to update them on the scientific basis of dental health education and to correct their misunderstandings, including those above, which they had demonstrated in a questionnaire. It is to be hoped that promotional use of this video does not reach them. G. 0. Taylor

Internal Fixation of the Mandible-a manual of AO/ ASIF principles. B. Spiessl. Pp. 375. 1989. Heidelberg, Springer. Hardback, DM 498.

This manual is intended to help A0 course participants grasp the theoretical principles of internal fixation and

0 1990 Butterworth-Heinemann Ltd. 0300-5712/90/050285-04