Critical decisions in periodontology

  • W. B. Hall
London: BC Decker Inc., 2003 price: USD 99.95, pp324 ISBN 1550091840 | ISBN: 1-550-09184-0

This book is about problem solving and choice. Each of the 153 two-page chapters consists of a decision flow chart and explanatory text. The first eight parts (74 chapters) are about examination, diagnosis and treatment planning, while the remaining six parts expand several aspects of treatment. A few decision charts are banal and best replaced by words, such as those on digital radiographs, overhanging margins and prophylaxis versus root planing.

The problem with any book of this type is that individual reviewers will easily find things they disagree with, because it tries to teach black-and-white decision-making. Although there is considerable periodontal evidence, many areas are not clear-cut, and numerous decisions are a matter of opinion or preference. I tried to put my preferences behind me, reading the book to see whether it interpreted evidence accurately, whether it gave good guidance on decision-making, and whom I would advise to read it.

Interpretation is sometimes unsatisfactory. For instance in chapter five, on microbial tests, the contributors assume the truth of the specific plaque hypothesis. Even today, the evidence is far from conclusive. The habitat may determine the microbiota, instead of specific microbes determining disease. And even if the latter is true, we still know only half the microbes which are present, so it is grossly premature to recommend microbial testing.

Guidance on decision-making lacks an overall philosophy. Too little emphasis is given to the most tested forms of treatment, including oral hygiene and root planing, and some promising recent developments such as enamel matrix derivatives are mentioned too briefly. I would have liked more about the separate responsibilities of patient and operator, and a patient-orientated emphasis: tooth retention and good aesthetics frequently may be achieved with simple treatment.

Some of the illustrations and proof-reading could have been better. The caption to one figure describes deep vertical bone defects, but we are shown a monochrome picture of apparently normal gingival tissues. The captions to another two figures are the same, referring to distal furcation involvement, but the latter figure is of mucogingival surgery.

Overall, the book seems hampered by its approach. The flow charts are not always the help they are intended to be. The book is unlikely to help undergraduates, who may be confused by the uneven emphasis on different subjects, but I would recommend it to postgraduates who are taught to be critical and will be more familiar with the literature. It is always interesting to read views which differ from your own, because it helps you to re-examine your own beliefs again and test their truth.