Article
Ece Eden, Professor of Pedodontics at Ege University in Turkey, has gathered 12 international colleagues to produce 10 chapters giving the evidence-base (or lack of it) for caries prevention; a short book, only 183 pages, of which 30 pages are references.
The first chapter on epidemiology introduces three visual/tactile caries detection/diagnostic systems, ICDAS, Nyvad criteria and a system designed for use in epidemiology called CAST. This system is illustrated with the smallest figures I have ever tried to see, just 14 mm square! Chapter 2 expands on ICDAS with more tiny figures, but majors on detection systems based on light transmission. Chapter 3 introduces the Nyvad criteria where a judgement of lesion activity and cavitation are logically presented, with the validated evidence-base as the relevant factors for caries management. Past caries experience is shown to be the most important predictor for future caries. The disagreements between these chapters are confusing for the reader but perhaps the editor was wise to keep her big beast authors in separate cages to minimize blood on the pages!
Chapter 4 introduces fluoride and a number of products called ‘biometric remineralization agents’ where the evidence-base seems tenuous or nonexistent. Non-existent evidence features in Chapter 5 where the use of antimicrobials in caries prevention is addressed. The words ‘forget it, no evidence’ sum up the discussion although, bizarrely, the final remarks do not reflect this. It seems to be suggested that antimicrobials may have a role! Chapter 6 is a useful discussion of diet and, although there is no evidence of efficacy, I found the section on probiotics most informative.
Chapter 7 reviews occlusal sealants and Chapter 8 gives existing evidence on the relatively new technique of approximal infiltration. Chapter 9 deals with the appropriateness of non-operative caries preventive measures including discussing patient motivation. This chapter is excellent, very thought provoking.
The final chapter is a series of sample cases, over various age ranges, to illustrate the use of preventive techniques. The idea is good but the actuality is a surprise because some techniques suggested have been shown in the preceding chapters to lack evidence-base. It seems the editor is tearing up her text.
This is not a book for the undergraduate. However, those who teach cariology will be interested and likely to direct students selectively to individual chapters. Those involved in caries research will also find the text useful.