Book Review Textbook of Geriatric Dentistry edited by

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published hy Muiiksgaard, Copenhagen, 1996 Second Edition ... ol Geriatric Dentistry - A Textbook of Oral .... The chapter on Oral and Maxillofacial Surgery.
Book Review Textbook of Geriatric Dentistry edited by Poul Holm-Pedersen and Harald Loe published hy Muiiksgaard, Copenhagen, 1996 Second Edition 5S4 pages, hardcincr, illustrated, ISBN 87-16-10533-8 DKK 7000.00 I hiscoinprchcnsnc text is a completely new edition ol Geriatric Dentistry - A Textbook of Oral Gerodont(Wog\ edited hy the same editors (1st edition, U>86) with 33 updated and entirely new chaiMers by 4S highly respected authors contributing [o \'\\c sections. The new fomiat ot the chapters which includes content subheadings is particularly easily {o follow. It is also generously illustrated with high qualitN diagrams and colour and black and white photographs and well documented with up to date references. This US-Scandina\ ian collaboration aims to pro\ ides a comprehensi\e review of the complex issues of ageing, an account of the current concepts of sNstemic and oral disorders in the older patient, and the appropriate management to resoh e or relieve these conditions. These aims are successfully met, w ith the book carefulh combining scientific theory u ith clinical problems, and dental healthcare for the ageing patient w ith more general geriatric medicine, whilst still maintaining a humanistic and understanding approach. Part I coxers Biological aspects ot Ageing, II Psychological and Behavioural aspects of Ageing, and III General Medical aspects of .\geing. These are re\ iewed by a physician in Healthcare ofthe Elderls. The second, larger half of this comprehensi\e textbook co\ers Pathology, Pre\ention and Treatment of Oral Diseases in the Ageing individual (Part IV) and concludes on Dental ser\ices for elderly populations (Part V).

Parts I-III The book sets out with a comprehensive account of gerontoli^gy, the scientific study of ageing. Broad background intormation on the biological basis and physiology of ageing is covered, together with detailed discussit)n on various theories of ageing mechanisms, mcluding molecular biology, genetics and immunology, before more focused descriptions of the age changes in bone, teeth, gums, etc. The section on gerontology is completed by chapters on the psychological and social aspects of ageing.

Inevitably, in any multi-author publication there will be an overlap of material between chapters. This is particularly evident within part III of the book 'General Medical Aspects of Ageing'. For example: memory impairment and dementia are covered extensively in three chapters, and discussed at some length in three others; communication with deaf patients is discussed in one chapter, and then re-examined more succinctly eleven pages later in another. Overall, the book covered all the principles of geriatric medicine. The excellent chapter, 'clinical assessment of the elderly patient', swiftly covers important aspects ofthe older patient's behaviour, e.g. over-estimating heir own health status and under-reporting their symptoms, and disease behaviour in the elderly, e.g. multiple pathology, disease chronicity, functional presentations ('the geriatric giants'), and associated disability. Some dramatic case histories help to emphasise the author's point on how dental pathology can interact with other medical problems with devastating consequences. The section on selected geriatric problems relevant to dentistry' may appear rather daunting. A dentist may well feel discouraged when facing a partially sighted, osteoporotic, arthritic diabetic, with a history of stroke, angina, atrial fibrillation and cardiac failure. So many factors need to be considered that it is difficult to know where to begin. In addition, limited space in the book means that there will always be some important condition omitted. However, there is sufficient emphasis elsewhere in the text on the principles of managing older patients, with or without multiple problems, to give the dentist inspiration to meet the challenge. The important role of good communication is stressed, and that patience and understanding are vital for formulating a thorough assessment - the keystone of geriatric medicine and dentistry. Focusing not just on the mouth, but the whole individual patient, and understanding the impact of the patient's symptoms and/or treatment on their function and lifestyle are admirably discussed. Ethical issues are also considered, such as decision-making capacity.

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patient autonomy, advance directives and the use of restraints. Throughout the text, a very positive approach is taken towards the care of elderly patients. Treating older patients is promoted as being challenging and rewarding, rather than difficult and demoralising. Unfortunately, the concept of multidisciplinary teamwork is left to the final chapter in the book - and yet it is a hallmark of geriatric medicine. The author recognised the lack of research on the dental team's role in interdisciplinary team care, and indicates their frequent absence from these teams, despite the valuable input they have to offer. As a physician specialising in the care of older people, this book was somewhat of a revelation, reminding me that oral healthcare, so often neglected by physicians, is a vital part of the patient's overall management. Hopefully, with greater collaboration, dental professionals will become readily recognised members of the multidisciplinary team of healthcare professionals, working together to provide the best possible care for each elderly patient. Kris Warren

Parts IV and V These chapters form a sequence through Pathology, Prevention and Treatment in the Older Adult followed finally by a section of five chapters on Dental Services in the Elderly Population. A review of the intemational prevalence of oral diseases in older adults clearly documents the importance of the whole subject and particularly the importance of prevention. Most specialists know their own countries data but there are many lessons to learn from the juxtaposition of intemational data. These lead naturally onto the chapter on Prevention, which includes a valuable emphasis on attitudes of patients, carers and professionals and provides the essential basis for moving to Clinical Decision-Making for the Elderly Dental Patient. This is illustrated, literally, by a case presentation; an easy-to-read way of covering the relevant general principles leading to a

tabulation of medical factt)rs that need to be considered for different aspects of care. A minor disappointment is the use of medicines' product names that vary between countries. A comprehensive, excellently illustrated review of Caries is based on the understanding derived from recent research and precedes chapters on the Pathology and Treatment of Diseases of the Pulp, of Periodontal diseases, and of Oral Mucous Membranes and Salivary Glands. The chapter on Oral and Maxillofacial Surgery very properly concentrates on the medical evaluation, while those on Prosthetic Considerations, Fixed Prosthodontics and Oral Implants lead the reader through the principles of treatment planning to what can be done for patients with compromised dentitions and for those edentate. The final section on Dental Services in the Elderly Population provides an invaluable international perspective on Demography for those needing to convince others ofthe importance of getting services up to speed. Chapters describing services in countries with Mainly Publicly Financed Health Care (Nordic cited) shows contrasts with the next chapter covering situation in the USA. The final two chapters cover the important logistic areas of 'where and who' - the venue for providing care and the Dental Team. So, in all this new edition is a heavy book but only in the physical sense of nearly 600 pages of high quality paper carrying well written text and excellent illustrations. You will enjoy reading it. The overview chapters will serve Gerodontology courses for undergraduates, while specialist teachers should refer their students to it within their course work; relevant post-graduate students certainly need to read it systematically. For practising dentists it will educate those new to any area and stimulate those specialists who are already in the field. Once read, it will live on the reference shelf for those challenges of unfamiliar problems or unusual pathology. If anyone thinks that it is too expensive they can play at dividing the price by 48, the number of authors or we don't know how many for the excellent illustrations.

Volume 14, No.

Vasso Anastassiadou and Robin Heath