Five-element theory based on traditional Chinese medicine (TCM) and Gosei-ho-ha medicine in traditional Japanese medicine (TJM)
\\n\\n
IntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\\n\\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\\n\\nLaunching 2021
\\n\\nArtificial Intelligence, ISSN 2633-1403
\\n\\nVeterinary Medicine and Science, ISSN 2632-0517
\\n\\nBiochemistry, ISSN 2632-0983
\\n\\nBiomedical Engineering, ISSN 2631-5343
\\n\\nInfectious Diseases, ISSN 2631-6188
\\n\\nPhysiology (Coming Soon)
\\n\\nDentistry (Coming Soon)
\\n\\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\\n\\nNote: Edited in October 2021
\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/132"}},components:[{type:"htmlEditorComponent",content:'With the desire to make book publishing more relevant for the digital age and offer innovative Open Access publishing options, we are thrilled to announce the launch of our new publishing format: IntechOpen Book Series.
\n\nDesigned to cover fast-moving research fields in rapidly expanding areas, our Book Series feature a Topic structure allowing us to present the most relevant sub-disciplines. Book Series are headed by Series Editors, and a team of Topic Editors supported by international Editorial Board members. Topics are always open for submissions, with an Annual Volume published each calendar year.
\n\nAfter a robust peer-review process, accepted works are published quickly, thanks to Online First, ensuring research is made available to the scientific community without delay.
\n\nOur innovative Book Series format brings you:
\n\nIntechOpen Book Series will also publish a program of research-driven Thematic Edited Volumes that focus on specific areas and allow for a more in-depth overview of a particular subject.
\n\nIntechOpen Book Series will be launching regularly to offer our authors and editors exciting opportunities to publish their research Open Access. We will begin by relaunching some of our existing Book Series in this innovative book format, and will expand in 2022 into rapidly growing research fields that are driving and advancing society.
\n\nLaunching 2021
\n\nArtificial Intelligence, ISSN 2633-1403
\n\nVeterinary Medicine and Science, ISSN 2632-0517
\n\nBiochemistry, ISSN 2632-0983
\n\nBiomedical Engineering, ISSN 2631-5343
\n\nInfectious Diseases, ISSN 2631-6188
\n\nPhysiology (Coming Soon)
\n\nDentistry (Coming Soon)
\n\nWe invite you to explore our IntechOpen Book Series, find the right publishing program for you and reach your desired audience in record time.
\n\nNote: Edited in October 2021
\n'}],latestNews:[{slug:"intechopen-supports-asapbio-s-new-initiative-publish-your-reviews-20220729",title:"IntechOpen Supports ASAPbio’s New Initiative Publish Your Reviews"},{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"}]},book:{item:{type:"book",id:"8837",leadTitle:null,fullTitle:"Human Teeth - Key Skills and Clinical Illustrations",title:"Human Teeth",subtitle:"Key Skills and Clinical Illustrations",reviewType:"peer-reviewed",abstract:"This book provides information on nomenclature, tooth numbering systems, tooth morphology, and anatomy and stages of tooth formation. It continues with root canal morphology and anatomy of incisors, canines, premolars, and molars. External and internal anatomies of mandibular permanent incisors and maxillary permanent first molars are presented according to a literature review. Orofacial structures affecting tooth morphology are discussed in detail. The book ends with the evolution of dental implant shapes and today�s custom root analog implants.",isbn:"978-1-78923-840-2",printIsbn:"978-1-78923-839-6",pdfIsbn:"978-1-78984-522-8",doi:"10.5772/intechopen.81278",price:119,priceEur:129,priceUsd:155,slug:"human-teeth-key-skills-and-clinical-illustrations",numberOfPages:258,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"ac055c5801032970123e0a196c2e1d32",bookSignature:"Zühre Akarslan and Farid Bourzgui",publishedDate:"January 22nd 2020",coverURL:"https://cdn.intechopen.com/books/images_new/8837.jpg",numberOfDownloads:16338,numberOfWosCitations:4,numberOfCrossrefCitations:10,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:15,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:29,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"September 3rd 2018",dateEndSecondStepPublish:"September 24th 2018",dateEndThirdStepPublish:"November 23rd 2018",dateEndFourthStepPublish:"February 11th 2019",dateEndFifthStepPublish:"April 12th 2019",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"4",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Gazi University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:{id:"52177",title:"Prof.",name:"Farid",middleName:null,surname:"Bourzgui",slug:"farid-bourzgui",fullName:"Farid Bourzgui",profilePictureURL:"https://mts.intechopen.com/storage/users/52177/images/system/52177.png",biography:"Prof. Farid Bourzgui obtained his DMD and his DNSO option in Orthodontics at the School of Dental Medicine, Casablanca Hassan II University, Morocco, in 1995 and 2000, respectively. Currently, he is a professor of Orthodontics. He holds a Certificate of Advanced Study type A in Technology of Biomaterials used in Dentistry (1995); Certificate of Advanced Study type B in Dento-Facial Orthopaedics (1997) from the Faculty of Dental Surgery, University Denis Diderot-Paris VII, France; Diploma of Advanced Study (DESA) in Biocompatibility of Biomaterials from the Faculty of Medicine and Pharmacy of Casablanca (2002); Certificate of Clinical Occlusodontics from the Faculty of Dentistry of Casablanca (2004); University Diploma of Biostatistics and Perceptual Health Measurement from the Faculty of Medicine and Pharmacy of Casablanca (2011); and a University Diploma of Pedagogy of Odontological Sciences from the Faculty of Dentistry of Casablanca (2013). He is the author of several scientific articles, book chapters, and books.",institutionString:"University of Hassan II Casablanca",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"University of Hassan II Casablanca",institutionURL:null,country:{name:"Morocco"}}},equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"174",title:"Dentistry",slug:"dentistry"}],chapters:[{id:"68734",title:"Can Orofacial Structures Affect Tooth Morphology?",doi:"10.5772/intechopen.88807",slug:"can-orofacial-structures-affect-tooth-morphology-",totalDownloads:877,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"This chapter presents how orofacial muscles can affect teeth positioning, occlusion, and also the size/shape of teeth. Pressures exerted on teeth will be discussed in specific cases such as mouth breathing, chronic mastication disorders, oral habits, like thumb sucking or tongue thrust, and also when there is hyperfunction of masticatory muscles during sleep or wakefulness. In these situations, the imbalance of muscle forces brings undesirable consequences to the dentition. Each condition will be explained, showing which muscle is affected, how it changes, and what consequences to the teeth it brings. It is a chapter that shows how close the relationship is between dentistry and speech language pathology (orofacial myology).",signatures:"Amanda Valentim, Renata Furlan, Mariana Amaral and Fernanda Martins",downloadPdfUrl:"/chapter/pdf-download/68734",previewPdfUrl:"/chapter/pdf-preview/68734",authors:[{id:"106418",title:"BSc.",name:"Amanda",surname:"Valentim",slug:"amanda-valentim",fullName:"Amanda Valentim"},{id:"113857",title:"MSc.",name:"Renata",surname:"Furlan",slug:"renata-furlan",fullName:"Renata Furlan"},{id:"274941",title:"MSc.",name:"Mariana",surname:"Amaral",slug:"mariana-amaral",fullName:"Mariana Amaral"},{id:"274942",title:"BSc.",name:"Fernanda",surname:"Guimarães",slug:"fernanda-guimaraes",fullName:"Fernanda Guimarães"}],corrections:null},{id:"66644",title:"Embryological Development of Human Molars",doi:"10.5772/intechopen.85703",slug:"embryological-development-of-human-molars",totalDownloads:1086,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Dental development is a complex process by which teeth from embryonic cells grow and erupt into the mouth. It is governed by epithelio-mesenchymal interactions. The biological mechanism is the same for all teeth; however, epithelial signaling and homeogenous combinatorics are different from one type of tooth to another. The primary dental blade splits into the vestibular and primary dental blades opposite to the mesenchymal condensation. During dental development, three successive stages are described: bud, cup, and bell. The secondary dental blade responsible for the formation of germs in permanent teeth is formed from the primary dental blade in the bell stage. For the central incisor, lateral incisor, canine, first temporary molar, and second temporary molar, each primary dental blade gives rise to a single secondary dental blade for the corresponding permanent tooth. On the other hand, the primary dental blade of the second temporary molar will cause the formation of four secondary dental blades that will cause the formation of permanent germs of the second premolar, the first permanent molar, the second permanent molar, and the third permanent molar. The objective of this chapter is to focus on the cellular and molecular mechanisms explaining the normal development of molars by presenting the different current data and theories of science illustrating the human molar embryological development.",signatures:"Fatiha Rhrich and Hakima Aghoutan",downloadPdfUrl:"/chapter/pdf-download/66644",previewPdfUrl:"/chapter/pdf-preview/66644",authors:[{id:"172240",title:"Prof.",name:"Hakima",surname:"Aghoutan",slug:"hakima-aghoutan",fullName:"Hakima Aghoutan"},{id:"288550",title:"Prof.",name:"Fatiha",surname:"Rhrich",slug:"fatiha-rhrich",fullName:"Fatiha Rhrich"}],corrections:null},{id:"68957",title:"Prologue: Tooth Anatomy and Morphology",doi:"10.5772/intechopen.89148",slug:"prologue-tooth-anatomy-and-morphology",totalDownloads:932,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:null,signatures:"Zühre Akarslan",downloadPdfUrl:"/chapter/pdf-download/68957",previewPdfUrl:"/chapter/pdf-preview/68957",authors:[{id:"171887",title:"Prof.",name:"Zühre",surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan"}],corrections:null},{id:"65806",title:"External and Internal Anatomy of Mandibular Permanent Incisors",doi:"10.5772/intechopen.84636",slug:"external-and-internal-anatomy-of-mandibular-permanent-incisors",totalDownloads:1206,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"A clear understanding of dental root anatomy, external and internal, is an essential prerequisite to all dental procedures. In periodontology, the external root morphology has been proven to have a clinical significance in the predisposing factors of periodontal diseases. Orthodontic literature shows the importance of radicular anatomy in orthodontic mechanics through the concept of anchorage. The significance of internal root anatomy has been emphasized by studies demonstrating that variations in canal geometry before cleaning, shaping, and obturation procedures had a greater effect on the outcome than the techniques themselves. The mandibular central incisor is the smallest tooth in the mouth, but the buccolingual dimension of its root is very large. This tooth is usually single-rooted; however, the root canal system of this group is unpredictable. The incidence of two canals has been reported as low as 0.3% and as high as 45.3%. The wide range of variation reported in literature regarding the prevalence of a second canal has been related to methodological and racial differences. This chapter will summarize the morphological aspects of the root canal anatomy published in the literature of the anterior mandibular teeth. This will provide precious knowledge regarding root canal morphology and its variation among populations.",signatures:"Mohammed A. Aldawla, Abdulbaset A. Mufadhal and Ahmed A. Madfa",downloadPdfUrl:"/chapter/pdf-download/65806",previewPdfUrl:"/chapter/pdf-preview/65806",authors:[{id:"204110",title:"Dr.",name:"Ahmed A.",surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa"},{id:"281125",title:"Dr.",name:"Mohammed A.",surname:"Aldawla",slug:"mohammed-a.-aldawla",fullName:"Mohammed A. Aldawla"},{id:"281126",title:"Dr.",name:"Abdulbaset A.",surname:"Mufadhal",slug:"abdulbaset-a.-mufadhal",fullName:"Abdulbaset A. Mufadhal"}],corrections:null},{id:"67975",title:"Tooth Morphology Overview",doi:"10.5772/intechopen.87153",slug:"tooth-morphology-overview",totalDownloads:1737,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:1,abstract:"This chapter provides an overview of tooth morphology, including a review of tooth anatomy, tooth development, and associated nomenclature and numbering systems. First, basic tooth morphology nomenclature is presented. Next, various tooth numbering systems are described and discussed, and the Federation Dentaire Internationale (FDI) system is detailed. Third, tooth surfaces and ridges are explained along with terminology, followed by an explanation of tooth crown and root anatomy. Fourth, the stages of tooth formation are described, starting with the bud stage, and followed by the cap stage, bell stage, and maturation. Annotated diagrams are presented for clarity. Finally, two currently accepted hypotheses explaining tooth formation are presented.",signatures:"Abeer ALShami, Shatha ALHarthi, Munerah Binshabaib and Monika Wahi",downloadPdfUrl:"/chapter/pdf-download/67975",previewPdfUrl:"/chapter/pdf-preview/67975",authors:[{id:"190958",title:"Ms.",name:"Monika M.",surname:"Wahi",slug:"monika-m.-wahi",fullName:"Monika M. Wahi"},{id:"280663",title:"Dr.",name:"Shatha",surname:"ALHarthi",slug:"shatha-alharthi",fullName:"Shatha ALHarthi"},{id:"280665",title:"Dr.",name:"Abeer",surname:"Alshami",slug:"abeer-alshami",fullName:"Abeer Alshami"},{id:"280666",title:"Dr.",name:"Munirah",surname:"Binshabaib",slug:"munirah-binshabaib",fullName:"Munirah Binshabaib"}],corrections:null},{id:"65711",title:"External and Internal Anatomy of Maxillary Permanent First Molars",doi:"10.5772/intechopen.84518",slug:"external-and-internal-anatomy-of-maxillary-permanent-first-molars",totalDownloads:1368,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Adequate knowledge of the tooth morphology is of paramount importance for clinicians worked in the different branches of dentistry in order to maintain good oral health. Unfortunately, tooth morphology shows a high level of complexity and variability. These anatomical variations have been reported to be related to many factors including age, gender and ethnicity. The permanent first molars are the largest teeth in the maxilla which play an important role in mastication. Because of their early eruption, they are more vulnerable to caries and subsequent pulp and periapical pathoses. This chapter will summarize the internal and external morphologic features of these teeth with the reported variations in relation to age, gender and population in order to provide clinicians with the morphological knowledge necessary for performing successful dental treatments.",signatures:"Abdulbaset A. Mufadhal, Mohammed A. Aldawla and Ahmed A. Madfa",downloadPdfUrl:"/chapter/pdf-download/65711",previewPdfUrl:"/chapter/pdf-preview/65711",authors:[{id:"204110",title:"Dr.",name:"Ahmed A.",surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa"},{id:"281125",title:"Dr.",name:"Mohammed A.",surname:"Aldawla",slug:"mohammed-a.-aldawla",fullName:"Mohammed A. Aldawla"},{id:"281126",title:"Dr.",name:"Abdulbaset A.",surname:"Mufadhal",slug:"abdulbaset-a.-mufadhal",fullName:"Abdulbaset A. Mufadhal"}],corrections:null},{id:"67177",title:"External and Internal Root Canal Anatomy of the First and Second Permanent Maxillary Molars",doi:"10.5772/intechopen.85746",slug:"external-and-internal-root-canal-anatomy-of-the-first-and-second-permanent-maxillary-molars",totalDownloads:1296,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"A successful endodontic treatment depends on a comprehensive knowledge of the morphology of canal and its variations, an appropriate access cavity, cleaning and shaping, and adequate root canal filling. Lack of knowledge in this regard and missing a root canal are among the most common causes of failure of root canal treatments. Most previous studies on maxillary molars have reported that they usually have three roots and four canals since an extra canal is often found in the mesiobuccal root. Other anatomical variations, such as an extra C-shaped canal, have also been reported in distobuccal and palatal roots. Thus, because of having a more complex anatomy compared to other teeth, maxillary molars have the highest rate of endodontic failure. Several studies have assessed the morphology of root canal anatomy in different populations using different techniques such as sectioning, root canal clearing, association of a dental operating microscope and ultrasonic tips, periapical radiography, and computed tomography scanning. Recently, CBCT was suggested to three-dimensionally explore the root canal details before an endodontic treatment. The purpose of this chapter was to highlight the importance of having a thorough knowledge about the root canal morphology of the permanent first and second maxillary molar.",signatures:"Said Dhaimy, Lamyae Bedida, Hafsa El Merini and Imane Benkiran",downloadPdfUrl:"/chapter/pdf-download/67177",previewPdfUrl:"/chapter/pdf-preview/67177",authors:[{id:"289623",title:"Prof.",name:"Said",surname:"Dhaimy",slug:"said-dhaimy",fullName:"Said Dhaimy"},{id:"297310",title:"Dr.",name:"Lamyae",surname:"Bedida",slug:"lamyae-bedida",fullName:"Lamyae Bedida"},{id:"297367",title:"Dr.",name:"Imane",surname:"Benkiran",slug:"imane-benkiran",fullName:"Imane Benkiran"},{id:"298239",title:"Dr.",name:"Hafsa",surname:"El Merini",slug:"hafsa-el-merini",fullName:"Hafsa El Merini"}],corrections:null},{id:"65451",title:"Morphology of Root Canal System of Maxillary and Mandibular Molars",doi:"10.5772/intechopen.84151",slug:"morphology-of-root-canal-system-of-maxillary-and-mandibular-molars",totalDownloads:1144,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The root canal system is complicated and has many anatomical variations among different populations. It is so important to understand the morphology of root canal system before any endodontic procedure, since the lack of knowledge of root canal system could lead to missing the additional root canals which causes failure of endodontic treatment. The study of root canal anatomy was carried out by many researchers and among different populations using various techniques. The presence of additional root canals was most commonly observed in molars. The aim of this chapter is to provide an overview of the morphology of root canal system of maxillary and mandibular molars and its variation among populations.",signatures:"Svetlana Razumova, Anzhela Brago, Haydar Barakat and Ammar Howijieh",downloadPdfUrl:"/chapter/pdf-download/65451",previewPdfUrl:"/chapter/pdf-preview/65451",authors:[{id:"282099",title:"Ph.D.",name:"Haydar",surname:"Barakat",slug:"haydar-barakat",fullName:"Haydar Barakat"},{id:"282405",title:"Dr.",name:"Ammar",surname:"Howijieh",slug:"ammar-howijieh",fullName:"Ammar Howijieh"},{id:"283571",title:"Prof.",name:"Svetlana",surname:"Razumova",slug:"svetlana-razumova",fullName:"Svetlana Razumova"},{id:"283572",title:"Prof.",name:"Anzhela",surname:"Brago",slug:"anzhela-brago",fullName:"Anzhela Brago"}],corrections:null},{id:"67419",title:"Root Canal Morphology and Anatomy",doi:"10.5772/intechopen.86096",slug:"root-canal-morphology-and-anatomy",totalDownloads:1112,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Success in root canal treatment depends on the proper application of all procedures of root canal treatment. This wholistic approach includes leakproof crown restoration, following ideal instrumentation, irrigation and hermetic obturation. Therefore, the first step of root canal treatment begins with understanding the tooth morphology in detail. The teeth vary according to their localization at the jaws and the gender and race of people. Detection of the extra canals, canal curvatures, isthmuses and lateral and accessory canals plays an important role in the success of root canal treatment. With all this, the academic knowledge and proficiency of the dentist and/or endodontist enable tooth morphology to be more clearly understandable.",signatures:"Esra Pamukcu Guven",downloadPdfUrl:"/chapter/pdf-download/67419",previewPdfUrl:"/chapter/pdf-preview/67419",authors:[{id:"277522",title:"Associate Prof.",name:"Esra",surname:"Pamukcu Guven",slug:"esra-pamukcu-guven",fullName:"Esra Pamukcu Guven"}],corrections:null},{id:"68918",title:"The C-Shaped Root Canal",doi:"10.5772/intechopen.89121",slug:"the-c-shaped-root-canal",totalDownloads:795,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:"A thorough understanding of root canal anatomy is of paramount importance in the field of dentistry. The C-shaped root canal is an anatomical variation occurring mostly in mandibular second molars. In a transverse section, the shape of this canal is observed as the letter C. The presence of a fin or web connecting the individual root canals is another anatomic feature. Due to its complex anatomy, different classifications have been proposed through the years for a better comprehension. In endodontic literature, the C-shaped root canal has been of high interest and its prevalence is reported in different regions of the world. Additionally, its endodontic management has been widely described and analyzed.",signatures:"Jesús Alejandro Quiñones Pedraza",downloadPdfUrl:"/chapter/pdf-download/68918",previewPdfUrl:"/chapter/pdf-preview/68918",authors:[{id:"284538",title:"Dr.",name:"Jesús Alejandro",surname:"Quiñones Pedraza",slug:"jesus-alejandro-quinones-pedraza",fullName:"Jesús Alejandro Quiñones Pedraza"}],corrections:null},{id:"69760",title:"Pathology and Abnormality of the First Permanent Molar among Children",doi:"10.5772/intechopen.89725",slug:"pathology-and-abnormality-of-the-first-permanent-molar-among-children",totalDownloads:1279,totalCrossrefCites:4,totalDimensionsCites:4,hasAltmetrics:0,abstract:"The first permanent molar (FPM) plays an essential role in the masticatory function by contributing to the implementation and the maintenance of the occlusion. However, it is considered as the most frequently affected and the earliest affected tooth by caries; 27.4% of the 6–8 years old children have developed at least one cavity on one of the four first permanent molars, according to a study conducted among 3276 school children in Casablanca .Therefore, the FPM should benefit from special vigilance on the part of the practitioner to ensure that any early carious lesion is intercepted. In addition, the FPM, due to its period of mineralization coinciding with early childhood diseases, can erupt with a structural abnormality. Molar incisor hypomineralization (MIH) is considered to be the most common defects observed on first permanent molars among children. A study conducted among 1077 children aged 7–10 years enrolled in schools in Casablanca showed that 7.9% of children were affected with MIH. About 84.7% of the children had the four molars affected. Children with HIM had a significantly higher prevalence of caries: 78.8 versus 33.5%.These structural abnormalities of the enamel must be carried out earlier to ensure that the coronary anatomy is the least compromised.",signatures:"Mouna Hamza, Amal Chlyah, Bouchra Bousfiha, Bouchra Badre, Maria Mtalsi, Hasna Saih and Samira El Arabi",downloadPdfUrl:"/chapter/pdf-download/69760",previewPdfUrl:"/chapter/pdf-preview/69760",authors:[{id:"52178",title:"Ms.",name:"Mouna",surname:"Hamza",slug:"mouna-hamza",fullName:"Mouna Hamza"},{id:"288350",title:"Prof.",name:"Samira",surname:"El Arabi",slug:"samira-el-arabi",fullName:"Samira El Arabi"},{id:"288775",title:"Prof.",name:"Bouchra",surname:"Bousfiha",slug:"bouchra-bousfiha",fullName:"Bouchra Bousfiha"},{id:"288776",title:"Prof.",name:"Amal",surname:"Chlyah",slug:"amal-chlyah",fullName:"Amal Chlyah"},{id:"288778",title:"Prof.",name:"Bouchra",surname:"Badre",slug:"bouchra-badre",fullName:"Bouchra Badre"},{id:"311623",title:"Prof.",name:"Maria",surname:"Mtalsi",slug:"maria-mtalsi",fullName:"Maria Mtalsi"},{id:"311624",title:"Dr.",name:"Hasna",surname:"Saih",slug:"hasna-saih",fullName:"Hasna Saih"}],corrections:null},{id:"66877",title:"Orthodontic Management of Residual Spaces of Missing Molars: Decision Factors",doi:"10.5772/intechopen.85944",slug:"orthodontic-management-of-residual-spaces-of-missing-molars-decision-factors",totalDownloads:1419,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"In the daily practice, the orthodontist may be confronted with particular clinical situations with one or more missing teeth. This can complicate the therapeutic plan and influence the choice of possible extractions imposed by treatment requirements. In case of permanent molar absence, making decision becomes even more delicate. The practitioner must use his/her critical sense and clinical common sense to make the right choice between closing and redeveloping the residual spaces. Its choice must meet the patient’s expectations and correct the clinical problem without risking overtreatment, or extending duration care. Several factors guide the therapeutic decision, ranging from the patient’s age to economic factors, not to mention the technical complexity, therapeutic predictability, and patient comfort, which determine proper compliance and therefore success. In this chapter, we will focus on these decision-making factors by determining the scientific evidence level in terms of success, survival, and patient-centered outcomes (quality of life and functional efficiency).",signatures:"Hakima Aghoutan, Sanaa Alami, Amal El Aouame and Farid El Quars",downloadPdfUrl:"/chapter/pdf-download/66877",previewPdfUrl:"/chapter/pdf-preview/66877",authors:[{id:"172240",title:"Prof.",name:"Hakima",surname:"Aghoutan",slug:"hakima-aghoutan",fullName:"Hakima Aghoutan"},{id:"172553",title:"Prof.",name:"Sanaa",surname:"Alami",slug:"sanaa-alami",fullName:"Sanaa Alami"},{id:"290814",title:"Dr.",name:"Amal",surname:"El Aouame",slug:"amal-el-aouame",fullName:"Amal El Aouame"},{id:"290815",title:"Prof.",name:"Farid",surname:"El Quars",slug:"farid-el-quars",fullName:"Farid El Quars"}],corrections:null},{id:"69931",title:"Impacted First and Second Permanent Molars: Overview",doi:"10.5772/intechopen.86671",slug:"impacted-first-and-second-permanent-molars-overview",totalDownloads:1356,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Impaction of a permanent tooth is a relatively common clinical occurrence in the human dentition. First mandibular molars and maxillary second molars are rarely impacted with a reported prevalence of 0–2.3% for second molars, 0.02% for the maxillary first molar, and of less than 0.01% for the mandibular first molar. The failures in their eruption mechanism may occur due to an obstacle such as the presence of a supernumerary tooth or an odontoma, lack of adequate space in the arch, an abnormal eruption path, or with idiopathic etiology. It is an asymptomatic pathology which is usually a casual discovery. Early diagnosis and treatment of permanent molars eruption disturbances contributes to optimal outcomes and favorable long-term prognosis by reduction of complication. The purpose of this is chapter is (1) to define prevalence and etiopathogeny of impacted first and second permanent molars, (2) to pinpoint the needs of earlier diagnosis, and finally (3) to highlight the treatment options.",signatures:"Sanaa Alami, Hakima Aghoutan, Meriem Bellamine and Farid El Quars",downloadPdfUrl:"/chapter/pdf-download/69931",previewPdfUrl:"/chapter/pdf-preview/69931",authors:[{id:"172241",title:"Dr.",name:"Sana",surname:"Alami",slug:"sana-alami",fullName:"Sana Alami"},{id:"285209",title:"Prof.",name:"Hakima",surname:"Aghoutan",slug:"hakima-aghoutan",fullName:"Hakima Aghoutan"}],corrections:null},{id:"65527",title:"Evolution of Dental Implant Shapes and Today’s Custom Root Analogue Implants",doi:"10.5772/intechopen.83746",slug:"evolution-of-dental-implant-shapes-and-today-s-custom-root-analogue-implants",totalDownloads:733,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Native tooth has a unique design to serve perfect stomatognathic function and esthetics which could never be replaced with another material or apparatus if it is lost. Over the past few decades, screw-type endosseous implants have been considered to be as the gold standard for the rehabilitation of edentulism owing to the similarity with the anatomical root shape and location inside the alveolar bone. They have been widely investigated so as to find out the ideal characteristics. Further researches have focused on the cervical region of the dental implant because the maximum stress is pronounced around the implant neck. The ideal characteristics indicate that a wide implant neck for better stress distribution, and a large surface area with a minimal thread geometry for a better long term crestal bone stability. Along with the growing clinical knowledge and digital technology, an innovative and noteworthy approach for implant dentistry, custom root analogue implant (RAI), has evolved. With the computer aided design and manufacturing (CAD/CAM) methods, original and optimized characteristics could be transferred to the custom dental implants just as performing an original root replacement.",signatures:"Ayse Sumeyye Akay",downloadPdfUrl:"/chapter/pdf-download/65527",previewPdfUrl:"/chapter/pdf-preview/65527",authors:[{id:"217236",title:"Dr.",name:"Ayşe",surname:"Sümeyye Akay",slug:"ayse-sumeyye-akay",fullName:"Ayşe Sümeyye Akay"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:{id:"1",series:{id:"3",title:"Dentistry",issn:"2631-6218",editor:{id:"419588",title:"Ph.D.",name:"Sergio",middleName:"Alexandre",surname:"Gehrke",slug:"sergio-gehrke",fullName:"Sergio Gehrke",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038WgMKQA0/Profile_Picture_2022-06-02T11:44:20.jpg",biography:"Dr. Sergio Alexandre Gehrke is a doctorate holder in two fields. The first is a Ph.D. in Cellular and Molecular Biology from the Pontificia Catholic University, Porto Alegre, Brazil, in 2010 and the other is an International Ph.D. in Bioengineering from the Universidad Miguel Hernandez, Elche/Alicante, Spain, obtained in 2020. In 2018, he completed a postdoctoral fellowship in Materials Engineering in the NUCLEMAT of the Pontificia Catholic University, Porto Alegre, Brazil. He is currently the Director of the Postgraduate Program in Implantology of the Bioface/UCAM/PgO (Montevideo, Uruguay), Director of the Cathedra of Biotechnology of the Catholic University of Murcia (Murcia, Spain), an Extraordinary Full Professor of the Catholic University of Murcia (Murcia, Spain) as well as the Director of the private center of research Biotecnos – Technology and Science (Montevideo, Uruguay). Applied biomaterials, cellular and molecular biology, and dental implants are among his research interests. He has published several original papers in renowned journals. 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Several techniques have been used to perform circumcision including the classic open technique, clamp technique, and laser /electrocautery technique with various safety outcomes. Overtime time, there has been an ongoing debate over the pros and cons of cultural circumcision with a significant dichotomy between the opinions of the experts in the field.
\r\n\r\n\tThe main purpose of this book will aim to present a comprehensive overview of the historic background of circumcision in males and the debate over female circumcision. It is intended to be an addition to a description of the different procedural techniques of circumcision highlighting their potential complications.
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Although modern medicine, based on Western medicine, is practiced in developed countries, traditional medicine is also an important part of treatment in Asian countries.
Traditional Chinese medicine (TCM) influences traditional medicine in Asian countries as a function of the cultural and historical relationships between each country and China. That is, traditional medicine has developed in each country under the influence of TCM in the context of its own cultural background.
This chapter examines traditional Japanese medicine (TJM), an alternative form of medicine used in Japan. Although acupuncture, moxibustion, and several related medical practices also play important roles in TJM, herbal medicine, as the most characteristic treatment within TJM, is the focus of this chapter.
Western medicine often regards patients as sets of individual organs, and illnesses are often attributed to pathogens or morbid organs that should be removed. However, Asian traditional medicine, including TJM and TCM, understand patients from a holistic perspective that emphasizes the importance of balancing and harmonizing the entire patient, including her or his mind and body. Asian forms of medicine explain changes in symptoms in terms of causes, and treatments are prescribed based on a view of diseases as dynamic processes [1,2].
Basic medical concepts are common to both TJM and TCM, and practitioners of these disciplines arrive at diagnoses via four basic approaches.
Visual examination: Observation of the status of the face, tongue, skin, and behavior of the patient.
Auditory examination: Auscultation of the patient speaking, sighing and wheezing and examination of the patient’s olfaction.
Interview: Questions posed to the patient about the history of the illness.
Tactile examination: Evaluation of the pulse and determination of abdominal status.
However, differences between TCM and TJM exist with regard to how each makes diagnoses and prescribes treatment.
Diagnosis in the TCM treatment involves the following steps:
Gathering data about symptoms to determine a diagnosis. Ba-bang-bian-zheng (in Chinese, assignment of body conditions to one of the eight principal states) is an important step in the diagnostic process of TCM and is based on discriminating between members of pairs: ying (negativity/hypo-functioning) and yang (positivity/hyper-functioning), xu (deficiency) and shi (excessiveness), han (cold/chills) and re (heat/fever), and biao (exterior) and li (interior).
Identifying the cause of the illness based on the theory underpinning TCM, including the five-element theory described later.
Determining the appropriate prescription based on the theory underpinning TCM. According to TCM, herbal prescriptions are based on imbalances in the viscera and bowels.
In contrast, TJM diagnoses, particularly those based on the Koho school, involve selecting an appropriate prescription; each prescription corresponds to specific symptoms associated with the constituents of herbal drugs. The most characteristic feature of TJM is that diagnosis is directly linked to selection of a prescription. The differences between TJM and TCM became especially pronounced during the Edo era in the 17th–19th centuries. Indeed, important diagnostic concepts often have different meanings in TJM and TCM. Thus, different uses of the concepts result in confusion, even among apprentices in TJM.
Drug use has long been part of the ethnic traditions in Japan, and various folk medicines have been applied in these contexts. The Geranium herb (over-ground part of
Historical books, such as Koji-ki (Records of Ancient Matters) (712), include descriptions of the use of reed mace (
Cultural exchanges, including those involving envoys to the Tang Dynasty (7th–9th centuries), and trade with China brought various crude drugs to Japan. Some of these drugs are the “Shosoin drugs” of today.TJM was practiced by Buddhism priests during those eras.
Examples of plants used as Japanese folk medicines. (a)
Chinese medicine changed based on historical changes in the dynasties, and the Chinese medicine of each era, until the present one, has influenced Japanese medicine. Chinese medicine was introduced during the Yuan dynasty in Japan and was practiced by Sanki Tashiro (1465–1537) and his successors, including Dosan Manase (1507–1594), who developed the medicines. They were known as the Gosei-ho-ha (the Latter-day Medicine School). The medicine taught by this school was based on two principles [Yin (active/positive) and Yang (inactive/negative)] combined with five elements (wood, fire, earth, metal, and water). The pharmacological characteristics of the herbal/crude drugs were separated into five tastes (pungent, sweet, sour, bitter, and salty) based on the five-element theory. Other characteristics, such as emotions, which may affect illnesses, are also attributed to the five elements (Table 1) [2, 3].
A trend toward a return to the fundamentalism of Confucianism appeared in China during the Ming Dynasty (14th–17th centuries), and an analogous fundamentalism was also seen in Chinese medicine. Some leaders in this field advocated reliance on the ideas or spiritual content related to medicine in the Shokan-zatsubyo-ron (
\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t\t\n\t\t\t\t | \n\t\t
Viscera | \n\t\t\tHeart | \n\t\t\tLiver | \n\t\t\tSpleen | \n\t\t\tLung | \n\t\t\tKidney | \n\t\t
Bowel | \n\t\t\tGallbladder | \n\t\t\tSmall intestine | \n\t\t\tStomach | \n\t\t\tLarge intestine | \n\t\t\tUrinary bladder | \n\t\t
Taste | \n\t\t\tSour | \n\t\t\tBitter | \n\t\t\tSweet | \n\t\t\tPungent | \n\t\t\tSalty | \n\t\t
Emotion | \n\t\t\tJoy | \n\t\t\tAnger | \n\t\t\tAnxiety | \n\t\t\tSorrow | \n\t\t\tFear | \n\t\t
Five-element theory based on traditional Chinese medicine (TCM) and Gosei-ho-ha medicine in traditional Japanese medicine (TJM)
These ideas affected the leading physicians in Japan, who stressed that medicine in Japan should be based on Shokan-zatsubyo-ron, which was established in the Han Dynasty. Gonzan Goto (1659–1733) was such a physician, and he insisted on considering diseases to be based on ki (
Todo Yoshimasu established a new approach to medicine based on the notions described above. He was regarded as a highly skilled physician and contributed to new developments in the area of medical diagnosis. He stressed the importance of the abdomen, in addition to that of the radial artery pulse, in diagnosis. He actually simplified the causes of various diseases based on his unique “one-poison theory” and thereby eliminated conceptual confusion [1, 3-5].
However, Yoshimasu’s most important contribution concerned the use of herbal prescriptions. During the Edo era, Honzo-komoku (
Thus, he first addressed cases in which major prescriptions are used for Shokan-zatsubyo-ron. Shokan-zatsubyo-ron is composed of two parts, which were identified separately. Shokan-ron (
He also added discussion based on his clinical experience concerning the uses of each prescription. These were gathered in Ruiju-ho (“a classified collection of prescriptions”). In Shokan-zatsubyo-ron, the author indicated the uses of each prescription during the course of an illness. However, the author did not explain the reasons for using each prescription, but instead stated that the physician should "just use it in exemplar cases." In this way, Todo Yoshimasu clarified the actions of the prescriptions by analyzing the kind of case in which it should be used.
Yoshimasu then began to collect the herbal drugs to be used in prescriptions. He gathered descriptions of the prescriptions containing each herbal drug from Shokan-zatsubyo-ron and discussed the effects of each herbal drug based on commonalities in the properties of prescriptions containing the drug. In other words, common symptoms referenced in the descriptions of the prescriptions were regarded as related to the herbal drug that was common to the prescriptions. He learned about the efficacy of each of the herbal drugs from Shokan-zatsubyo-ron by comparing it with his clinical experience. Such knowledge was collected in Yaku-cho (“Properties of Herbal Drugs”).
For example, the action of the herbal drug licorice is discussed as follows: Although licorice (root with stolon of
He next listed the effects of each prescription based on the actions of the constituent crude drugs he had examined. These findings are summarized in the book Ho-kyoku (“The Ultimate Properties of the Prescriptions”).
For example, the keishi-to (“cinnamon combination”) prescription, which is composed of cinnamon (bark of
Another example is seen in the addition of peony (i.e., an increase in the amount of peony in keishi-to) to form keishi-ka-shakuyaku-to (“cinnamon and peony combination”). If the patient exhibited intense convulsions of the rectus abdominis in addition to the symptoms of keishi-to, a prescription with an excess amount of peony was used, as per Ho-kyoku.
In summary, Yoshimasu reorganized descriptions of the efficacy of prescriptions using the following analytical procedures:
Collecting information on the uses of prescriptions from Shokan-zatsubyo-ron.
Clarifying the efficacy of the respective herbal drugs based on the uses of the prescriptions containing those herbal drugs.
Identifying the effectiveness of prescriptions based on the efficacy of the constituent herbal drugs.
This simplification by Yoshimasu was quite useful for understanding the uses of herbal prescriptions in TJM today and also for clarifying the pharmacological properties of the herbal drugs constituting the prescriptions. Based on this simplification, herbal drugs can be linked to modern analyses of Oriental medicine to understand drug actions in ways that are analogous to those that enable understanding of Western medicine.
However, such a simplification ignores the notion that an illness should be understood in terms of sequential stages or states of the patient. Considering that, physicians of the Secchu (compromising) School, including Sohaku Asada (1815–1894), avoided extreme simplification and proposed that the good points of the theories underpinning both the Koho and the Gosei-ho should be used. The current major trend in TJM is based on his efforts.
The two forms of herbal medicine differ with respect to prescriptions and crude drugs. Many herbal drugs used in TCM are also used in TJM. However, it had been difficult to import herbal products from China to Japan during the Edo era because of the Japanese national policy of isolation. During this era, Japanese herbalists searched for plant materials that could act as alternatives to Chinese materials. Thus, the following are examples of differences between the plant materials used in TCM and TJM [6].
(Fig. 3a and b) Nin-jin: Japanese ginseng (chiku-setsu-nin-jin in Japanese, rhizome of
(Fig. 3c) To-ki: Root of
(Fig. 3d) Sen-kyu (Kyu-kyu): Rhizome of
Examples of herbal drugs used in traditional Japanese medicine (TJM). (a) chiku-setu-nin-jin (rhizome of
Sai-ko: Root of
Ko-boku: Magnolia bark is used in both TJM and TCM for distension from the chest to the stomach that is due to a digestive organ disorder, which is often accompanied by pain, and also for relief of bronchitis. The bark of
Byaku-jutsu: Rhizomes from the following
O-ren: Rhizome derived from the following
San-sho: Fruit of
Bo-fu: Root (including rhizome) of
In-chin-ko: Spike composed of many minor flowers of
These differences should be understood when these herbal drugs are used clinically and studied in research settings.
This section discusses studies on the constituents of the herbal drugs that are used in TJM and in our laboratory. Yoshimasu’s work on the practical aspects of herbal drugs is quite useful for researchers attempting to understand the uses of herbal drugs in TJM, and the researchers in our laboratory are searching for new constituents based on such materials rather than considering the implications of the complex theories underlying TCM.
Hydrolyzable tannins are esters of galloyl and related polyphenolic acyl groups with glucose or some other sugars/polyalcohols. Although various types of hydrolyzable tannins have been found in plants, geraniin (
Structure of geraniin (
Further examination of this source plant revealed the presence of the co-existing hydrolyzable tannins furosin; didehydrogeraniin; furosinin [11]; geraniinic acids B and C; phyllunthusiins B, C, E, and F [12]; and acalyphidin M1 [13]. However, several compounds are formed after linking with ascorbic acid in the plant; these include ascorgeraniin (= elaeocarpusin) (
Because some hydrolyzable tannins show noticeable effects on β-lactam resistance of methicillin-resistant
The presence of tannins with analogous structures including mallotusinic acid (
Tannins structurally related to geraniin. Compound 6 was isolated from
Structures of proanthocyanidins obtained from
The leaves of
Structures of caffeic acid derivatives found in Artemisia leaf and Perilla herb
The aboveground part of
Caffeoylquinic acids show inhibitory effects on histamine release from rat peritoneal mast cells [25,26] and also on the formation of leukotriene B4 (LTB4) in human polymorphonuclear leukocytes (PMN-L). Rosmarinic acid shows a strong inhibitory effect on the formation of 5-hydroxy-6,8,11,14-eicosatetraenoic acid and LTB4 in PMN-L [25]. Because arachidonate metabolism is related to allergic inflammation and asthma, these results suggest that the effects of these constituents may participate in the actions of the herbal drugs containing them.
Licorice, the root (with stolon) of
Our investigation of licorice constituents revealed the inhibitory effects of flavonoids, including new ones, on xanthine oxidase [28] and monoamine oxidase [29]. Several also effective against the cytopathic effects of human immunodeficiency virus (HIV). The inhibitory effects of those constituents on giant cell formation induced by HIV were constituents are examined using a cell line sensitive to the cytopathic activity of HIV. Licochalcone A (
Structures of licorice phenolics that suppress human immunodeficiency virus (HIV) cytopathic effects.
Licorice phenolics that show the most potent antibacterial effects on methicillin-resistant
\n\t\t\t\t | \n\t\t|||||
Licoricidin | \n\t\t\tMRSA strains | \n\t\t\t\n\t\t\t | \n\t\t\t | \n\t\t\t | MSSA | \n\t\t
concentration | \n\t\t\tOM481 | \n\t\t\tOM505 | \n\t\t\tOM584 | \n\t\t\tOM623 | \n\t\t\t209P | \n\t\t
None | \n\t\t\t512 | \n\t\t\t64 | \n\t\t\t256 | \n\t\t\t512 | \n\t\t\t<0.5 | \n\t\t
8 μg/ml | \n\t\t\t<0.5 | \n\t\t\t<0.5 | \n\t\t\t<0.5 | \n\t\t\t<0.5 | \n\t\t\t<0.5 | \n\t\t
4 μg/ml | \n\t\t\t16 | \n\t\t\t8 | \n\t\t\t16 | \n\t\t\t16 | \n\t\t\t<0.5 | \n\t\t
Effect of licoricidin on the antibacterial activity of oxacillin.
The effects of licorice phenolics on MRSA were also investigated. Two flavonoids, 8-(γ,γ-dimethyally)-wighteone (
These findings suggest that licorice is a useful herbal source for the development of the primary constituents of the compounds used in modern medicine.
It is very important to develop new drugs for the treatment of patients with dementia as the number of individuals with this condition is now rapidly increasing due to the increase in the elderly population. The root of
Structure of 3’,6-di-O-sinapoyl-sucrose contained in
Explanations of the pharmacological properties of herbal drugs based on TJM concepts have been useful for identifying new compounds with various structures. These explanations are also useful for understanding the roles of herbal prescriptions and applications in modern medicine. Modern medicine should consider some of the basic concepts of traditional medicine as they may contain wisdom.
Schools are widely acknowledged as a vital setting to develop a child’s physical activity participation [1], with a comprehensive review from over 25 years discovering the positive links between a child attending school and participating in greater levels of physical activity [2]. Not only is the school context where children spend the majority of their time each week (+ 30 hours in many cases), but the school is also a resource full of outdoor recreational options for children to develop physical activity, cognitive and social habits. Such outdoor recreational pursuits could include non-curricular (e.g., after school, active transportation), co-curricular recreational opportunities (via recess, school sporting carnivals) and curricular programs (via outdoor learning/recreational programs). The importance of these outdoor recreational settings in school become underscored by the continual reductions in the ability of children to experience opportunities to play around the home and neighbourhoods (e.g., concerns of neighbourhood safety, pollution, restrictions and non-play values at home) [3, 4]. Moreover, it is vital that a child experiences a multitude of opportunities to be physically active during school recreation to meet national activity guidelines. International guidelines recommend children participate in 1 hour of moderate to vigorous physical activity (e.g., activity which makes you sweat and puff) to develop positive physical activity habits to protect against chronic diseases such as Type 2 diabetes, cardiovascular disease and osteoporosis [5].
\nIn addition to the physical benefits that can be derived from outdoor recreational strategies within schools, research over the past two decades continues to unveil the interconnections between both the body and the mind [6]. For example, Santrock [7] makes the statement “biological processes can influence cognitive processes and vice versa … we are talking about the development of an integrated individual with a mind and body that are interdependent” (p. 16). The brain is one of the busiest organs in the human body by processing around one fifth of the body’s metabolism during cognitive processes. Therefore, it should be no surprise that cognitive processes require a steady stream of oxygen and energy from physical activities to meet such mental demands [8] and why sedentary pursuits of sitting/standing should be avoided to ensure that mental demands are optimally catered for [9]. So if a child is undertaking vigorous outdoor recreational pursuits at school, it is expected that a child’s capacity to be able to remember, perceive, concentrate and attend to academic tasks should be improved [6].
\nThis chapter will begin by discussing how children can be physiologically effected from outdoor recreation in schools. The discussion will commence with an exploration of both structured (e.g., a set purpose, location) and unstructured (e.g., less pre-determined purpose) playground strategies during school recess. The discussion continues with exploration into before- and after-school outdoor recreational strategies that have been introduced to influence school children’s physical activity participation and development. The next section considers the psychological context of recess, before detailing the specific and intersecting dimensions of children’s cognitive and social development during outdoor recreation in schools. Finally, an overview is provided with key insights that have emerged from the literature in relation to the physiological and psychological effects that have been measured within outdoor recreational school contexts.
\nThe provision of a catalogue of outdoor recreational opportunities in schools is vital to ensure that children develop healthy habits and strong minds to take with them into both adolescence and adulthood [1, 10]. The impact and level of quality of earlier life experiences in physical and recreational pursuits often tracks into adulthood [11, 12]. Despite physical activity options being required to be delivered in various capacities of the school system, research continues to recognise that children will engage or prefer to engage in more sedentary-type behaviours of sitting and standing [13]. Large proportions of children exceed national screen time recommendations [14] and not meeting child physical activity guidelines has become the norm across most countries worldwide [15, 16]. For instance, a major international report on adolescent physical activity participation from decades of population data revealed that in most countries, just one (lowest) or two (highest) out of 5 children will meet national physical activity guidelines [17]. These guidelines are designed to ensure children are optimally healthy to prevent disease. Despite such dire health results, there has been continual research to try and promote positive outdoor recreational strategies in schools to have an impact on school children’s physical activities. With the positive links of physical activity participation on biological improvements well established [18, 19], most research focusing on the physiological effects from outdoor recreation in schools has been concerned with improving physical activity levels [20].
\nThe school playground during recess is a powerful outdoor recreational school context to enhance children’s physical abilities. The school playground has a combination of supervision, access and safety which allows wide ranging physical activities for children [10]. In many jurisdictions, the school playground during recess time has become the main option for children’s physical activity participation, as PE time allocations have been reduced and eradicated [21]. Earlier work researching the impact of children engaging in school playgrounds during recess has suggested that almost half of a child’s daily physical activity is sourced from the school playground [22]. The importance of discovering customisable strategies within the school playground recreational context is therefore vital.
\nThere have been a number of strategies trialled within school playgrounds during recess to improve outdoor recreational activity levels such as themed activity weeks, providing games equipment, loose parts, surface markings, fitness ideas and providing more natural features [20]. Most of these strategies have been successful on participation levels from short-term measurements, which is likely due to the novelty of introducing new strategies compared to constant playground agendas and the desire from the children to expand their play options with variety [10]. Themed activity weeks of having alternating weeks with an obstacle course, frisbee activities, fitness circuits and a week with normal activities is one of the playground intervention packages mentioned [23]. This alternating recreational strategy unveiled that physical activity participation levels were greatest during the two weeks in which the children participated in a fitness themed week or their normal playground activities. Fitness-focused playgrounds during recess have also had a positive impact on children’s physical activity levels compared to recess periods with no set playground agenda being implemented [24]. The implementation of games equipment with providing activity details and instructions for a range of games and activities for the children to perform in the school playground has also been introduced. Scholars discovered that providing the game cards increased the physical activity levels in the school children [25]. The implementation of other recreational games have also had success on children’s physical activity levels such as via interactive bowling and running games [26], alongside games offered by trained staff in recreational sports [27] such as in softball, tag, basketball and relay games. The painting of school surfaces with markings [28, 29, 30, 31] to encourage the outdoor recreational pursuits with jumping lines, board games, agility snakes and hopscotch have seen the physical benefits of energy expenditure increases (can help with obesity), duration engaged in physical activity, improved compliance with national physical activity guidelines and overall increases in the intensity of a child’s physical activity participation over a 2 year period. Moreover, combining a range of strategies such as training staff to facilitate children’s activities within the school playground, breaking up the playground into activity zones (e.g., soccer, tag games) and the introduction of loose sporting equipment (e.g., balls, markers) have had a positive impact on the intensities children’s engaged in their outdoor recreational activities at school [32]. Additionally, even the simple redesign of playgrounds for outdoor recreation with equipment such as climbing structures, slides, and a spinning apparatus have had a positive impact on children’s physical activity levels [33] or reducing sedentary behaviour [34].
\nLess structured recreational strategies without a set location, time or purpose have been found to have quite holistic benefits on children’s physical health. For instance, these strategies have simply involved getting rid of school playground rules/regulation, providing more natural features (such as rocks, trees, gardens) and implementing sparable, movable household items known as loose parts. Although not directly measuring physical activity participation, a New Zealand primary school principal reported on the amount of new physical activities taking place for children’s physical development when he removed excess school playground rules and regulations [35, 36]. The Principal described how the allowance of play which was perceived as more risky unlocked a variety of physical activities such as climbing structures like hand rails and trees, skating across hard surfaced areas and sliding in the mud. Moreover, the Principal noticed a dramatic reduction in physical injury from providing more play freedom. The recreational pursuit of climbing can have a multitude of benefits on a developing child, including muscular strength, endurance and flexibility [37]. Although tree climbing is perceived by many as being risky [38], the introduction of features such as trees, rocks, gardens and grass areas has seen school children vary their outdoor recreational physical activities, enhance the amount of space and opportunities for physical activity, play freedom and have had an impact on moderate levels of children’s physical activity [39, 40, 41]. By greening outdoor recreational areas in schools, the ability to improve children’s self-reported wellness is also enhanced [42, 43].
\nOvercoming adult perceptions of risky play [44] also reignited a multitude of larger studies on the provision of loose parts on children’s physical development. Most of this more modern research stemmed from Bundy and colleagues’ pilot study [44] research which recognised that adults perceived loose parts materials (e.g., sticks, crates, hay bales) as too risky, yet the findings demonstrated the entire opposite in very young children. The loose parts were able to transform the school playgrounds into rich childhood developmental hubs via outdoor recreation and reigniting the momentum of loose parts from the 1970’s [45]. The resulting physical activity outcomes from introducing loose parts have seen increases in primary school children’s (of a range of year levels) physical activity enjoyment, intensities, steps/distance, activity types, playability, durations, complexity and many of these physical activity developments were sustained for long-term follow-up studies (e.g., 1–2½ years) [20]. The earlier findings were also supported by studies across other locations such as the United Kingdom [46] and New Zealand [47] with positive teacher reports of similar developments. Moreover, “relocatable” sports equipment are also reported to have positive effects on children’s physical activity [48].
\nBy investigating the school playground strategies above, it becomes clear that continuing to consider strategies which will not burden teachers’ curricular commitments can be powerful on a child’s physical development. It is also vital to consider a holistic approach to outdoor recreation during school days for children’s physical development with additional strategies, particularly with curricular physical activity opportunities being constrained [49]. Beyond the school playground, the most prevalent outdoor recreation school avenues are through after school programs, school camps/excursions, and active transport (to and from school via movement).
\nAfter school programs typically involve collaboration between the community and the school. Internationally, there have been a number of extracurricular recreational programs, commonly focused on increasing physical activity through sports. For instance, in Hungary, physical education teachers coordinate and organise physical activities outside of school as a formal requirement [50]. In Taiwan, there are opportunities for children to connect, learn from and interact with adults from training institutions in how to undertake and participate in sports [51]. The Australian Sporting Schools program has been a significant recreational strategy introduced to schools which has been intended to increase children’s participation in local sport with the delivery of programs by a national sporting organisation [52]. Whilst many of the after-school and extracurricular programs which are implemented worldwide have little research data showcasing program effectiveness, the reach of the Sporting Schools program from 4000 [53] to almost 7500 schools [54] nationwide shows some impact of the program.
\nAlthough much of the research of this chapter showcases programs to develop school children’s health via outdoor recreational strategies within the school setting, it should be acknowledged that there has been some research with school children outside of schools. Summer camps for instance are highly popular in places such as Canada and the USA with large summer breaks [55]. Such camps can offer chances for outdoor recreational activities in areas of sport and adventure and have been identified as having a positive impact on school children’s physical health [56], physical activity levels and meeting daily physical activity recommendations [57, 58]. Another outdoor recreational pursuit for school children is to walk or ride to school via active transportation [59]. Scholars describe active transportation as creating important physical activity habits in school children, environmentally friendly travel habits and a valuable opportunity to invigorate children’s physical activity participation rates and levels [60, 61]. Although scholars caution school communities about potential safety risks such as road traffic and strangers, it is acknowledged internationally that school communities can consider programs such as a walking school bus concept in which adults lead a group of children [62, 63]. This can be achieved by considering stakeholder partnerships and the level of infrastructure and resources around a school’s transportation networks to actively transport to and from school. Although this extra-curricular strategy to encourage physical activity has widespread support, there still remains a gap in the data relating to long-term insights and standardised outcome measures of physical activity [64, 65]. As detailed earlier in the chapter, if physical activity levels can be increased, this can also have a positive impact on the flow of nutrients to the brain to enhance cognitive performance. In the next section of this chapter, we unpack a range of the outdoor recreational strategies in schools which have had an impact on psychological functioning.
\nWe begin this next section by considering the psychological context of recess before moving to specific areas of cognitive and social development. The psychological context of outdoor recreation in schools is rarely acknowledged, yet can be a major contributor to cognitive and social outcomes. One way to consider the psychological context is in terms of structure versus autonomy (e.g., ensuring more choice in how things are done). Structure can be imposed in a variety of ways including clearly articulated rules negotiated with children through to non-negotiable top-down rules or quick decisions by teachers on duty during recess regarding the rule boundaries and positive or negative play [66]. An increase in banning of activities that children consider to be fun has been found in a large UK study [67] and is likely to extend to other countries given the heightened concern expressed by teachers about risky play during recess [44, 68]. Teachers often face the dilemma of allowing children more autonomy or acting in accordance with their perceived duty of care which can involve imposing excessive rules and safety requirements.
\nStructure has sometimes been introduced as a means of increasing physical activity. There is speculation that an emphasis on sports and other structured physical activity can change the social hierarchy of the playground, elevating the status of children with better physical skills [69]. It is possible that high levels of structure to achieve physical activity outcomes may have a negative impact on children’s autonomous decision making and social interaction processes. With less choices and opportunities for decision making during play, children suggest such restriction can cause boredom, misbehaviours (and injury) and a desire to lash out during school recess periods [70].
\nMany researchers and teachers argue that children need more elements of choice from the psychological component of autonomy to learn life skills. It is known that recess times are some the best times to offer such opportunities with minimum structure or intervention. As noted previously, loose parts have been offered to children during recess as a means of promoting physical activity through imaginative play. One of the adult-perceived difficulties with loose parts play is the potential for accidents and injuries. Interestingly, both parents [71] and teachers [72] seem to have a lower tolerance for risky play when a child has a disability. Interventions involving loose parts have helped to overcome many of the concerns related to risky play. Some interventions have included risk-reframing workshops to support shifts in thinking of teachers and parents about risks in play [73]. Interventions without these workshops have also succeeded in shifting adult behaviour from enforcing playground rules to granting children greater autonomy to make decisions about their play [47]. Hyndman and colleagues discovered that the introduction of loose parts can help facilitate outdoor school recreation activities which aligned with both national curriculum objectives [74] and key criterions of creativity [75]. This was achieved by encouraging children to learn and undertake more complexity with their recess activities with loose parts equipment. Loose parts have also been reported by teachers to have a positive impact on children’s cognitive engagement during outdoor recreation activities [76] with impacts on short-term enjoyment levels [77], a key psychosocial influence for sustained participation.
\nOther interventions have provided more explicit play goals, but these have been negotiated with school personnel and children. The Health Active Peaceful Playgrounds for Youth (HAPPY) intervention [78] is an example of this type of approach. Some children were offered specific training relating to physical activity and social inclusion with peers. Children in this study were found to value clear rules for games that were known to all children. It is perhaps the arbitrariness of rules in some contexts that causes difficulties for children. For example, a staff member in one of the loose parts studies [46] mentioned that prior to the introduction of loose parts, children were held back by having to remember the recess rules. Emerging evidence also suggests that psychological benefits may be amplified if recess occurs in natural environments. This is mainly due to the stress-reductions experienced by children when in nature [79].
\nSome of the research questions regarding cognition and academic skills are relatively standard and relate to the possibility that recess provides a context for promotion and development of these skills. Surprisingly, some researchers are also interested in a null result, showing no effect. The reason for the latter interest is that time spent in recess is often perceived as time that could be better spent on direct instruction on academic tasks. Current evidence indicates that school recess does not have a negative impact and may have a positive impact in some areas of cognition and academic achievement.
\nThere are sound reasons to believe that short-term or habitual physical activity will promote cognitive skills with a flow-on effect to academic skills. Children’s enjoyment of more vigorous recreation activities during school recess has also been linked to improved quality of life [80]. Nonetheless, results have not been as clear as expected. Recent systematic reviews [81, 82] have shown mixed results and have called for high quality studies to address this question.
\nPhysical activity in adults has been found to promote higher order cognition known as executive functions (EF). The core EFs are working memory, inhibitory control and cognitive flexibility [83]. Performance on EF tasks is predictive of academic performance [84]. Working memory involves holding and manipulating information in memory, such as when solving mental arithmetic problems. Inhibitory control is the ability to suppress a prepotent response. In academic work, the first response that comes to mind may not be the correct one and inability to suppress competing responses may interfere with task completion. Cognitive flexibility involves the ability to shift strategies when the one used becomes unproductive. A strategy may be effective in solving simple problems, for example, but no longer works when problems become more complex. Inability to change strategy makes it difficult to progress to higher level school work.
\nThe EFs are known to be quite malleable during childhood. Researchers have therefore attempted to understand the mechanisms that support improvements in EFs. Physical activity has been identified as a potential contributor to brain plasticity, neurogenesis and resilience to damage. This is achieved through processes such as promoting blood vessel growth that support the brain’s increased energy needs [85]. Research studies have not had a clear focus on recess, physical activity and EFs. Studies that might help understand the outdoor recreation in schools, physical activity and EF relationship have not always taken place during outdoor recreation in schools. For example, the FITKids randomised controlled trial [86] took place after school, but included games, teaching of skills and other challenges that could be available during outdoor recreation in schools. The FITKids trial was conducted with 7–9 year olds, with the intervention group showing improvements in two core EFS, inhibition and flexibility. This continues to be a promising area of investigation and more studies are needed. Current systematic reviews indicate that the results of studies are mixed, but importantly no studies show a decline in EFs following increased in physical activity [87, 88, 89].
\nMathematics and literacy are the most common academic areas investigated by researchers. Time spent in physical activity during recess has not been found to adversely impact academic performance [15]. This has been demonstrated in a range of studies including a large cross-sectional Spanish study with 1780 participants aged 6–18 years [90]. There are also studies that have found a positive impact of physical activity on academic skills. A recent meta-analysis of 26 studies with participants aged 4–13 years found physical activity to lead to improvements in mathematics, reading and classroom behaviour. Mathematics was also found to improve in a recess study with Grades 3–5 involving exergaming [91]. Children in this study participated in “Dance-Dance-Revolution” (DDR), which involved aerobic activity and choreographed footwork and was appealing to the participants in the study.
\nOne hypothesis regarding the mixed findings for EFs and academic performance is that physical activity alone is not enough to promote cognitive or academic development. What is needed is the addition of cognitive or social demands [88]. For example, DDR placed pressure on memory for the choreographed steps. It is also important to note that these interventions were offered during some recess sessions (e.g., DDR was 90 minutes per week), but children also had access to free play time.
\nTo our knowledge there are no high-quality studies of unstructured recess interventions and EFs or academic outcomes. There is potential for future research as some researchers argue that structured activity during recess may interfere with academic performance, particularly for younger children who may need a break to during recess to reduce interference with preceding and following class instruction [89].
\nFor many children, school recess is the only opportunity to engage in peer activities with minimal adult supervision. Ideally, school recess offers opportunities for children to practice social interaction skills, negotiate with others to achieve goals, form enduring friendships, support peers experiencing difficulties and learn to manage their own risk-taking behaviours. Although social time on the playground may appear to be nothing more than a break from class, the quality and quantity of social time may have important implications for psychosocial development and academic achievement. For young children, level of social interaction with peers has been found to be positively associated with academic achievement whereas level of social interaction with teachers was negatively associated [92].
\nSocial interactions are often different for girls and boys during outdoor recess. Girls have been reported to have higher levels of enjoyment for social and imaginative play [93], alongside more time in pretend play which requires planning with peers. Boys are more likely to engage in rough and tumble play, particularly in the early school years. Rough and tumble generally involves play fighting, wrestling and other behaviours that are sometimes mistaken for aggression [66]. Rough and tumble is therefore often banned or restricted on school playgrounds. Rough and tumble is developmentally important for the development of self-control, conflict resolution and affiliation. It is a positive behavior for most children with the exception of boys with a “rejected” sociometric status for whom it can predict antisocial behaviours. It is important to note that the gender differences observed during outdoor recess in western schools may not be universal. For example, there is evidence that rough and tumble play occurs equally for both genders in forager societies [94].
\nThe majority of school children look forward to recess time and see it as an opportunity to engage in fun activities with friends. For a significant minority of children however, recess is a time when they are isolated, rejected or bullied. Elementary school children have nominated outside recess as particularly problematic for bullying [95]. Recess should offer an opportunity to promote psychosocial development, but this is currently not true for all children. Many of the issues that contribute to negative social outcomes are the same as those that contribute to social outcomes, including poor supervision, lack of materials and lack of space [96].
\nSome of the difficulties children have on outdoor school playgrounds relate to the spaces available. Children typically have the choice of large open spaces that are easy for adult surveillance or seeking privacy behind buildings where they may feel vulnerable. A recent study has shown that many children prefer “in-between” spaces for at least some of their outdoor play [97]. These spaces include under staircases, under trees and edges of buildings. Importantly, these spaces maintained a visual line to the main play areas and therefore did not incur the vulnerabilities of being out-of-sight. Some children said they worried about the boisterous play on the main playground. The in-between spaces meant they were less likely to be hit by a ball or knocked over by another child. Children also used these spaces for imaginative play or to define boundaries such as goal posts. In-between spaces provided greater opportunities for children to self-select their play and define their peer groups. Unfortunately, these spaces were often considered to be out-of-bounds.
\nDifficulties for children can stem from underlying psychological problems. Children with internalising or externalising disorders may have difficulties with social interactions on the playground. In recent years, social skills interventions have targeted peer interactions on the playground to support children’s access to a complex social environment and with the goal of achieving the flow-on effect of improved academic outcomes [98].
\nUnfortunately, recess is often perceived as a privilege rather than an essential part of the school day. Consequently, there is a widespread practice of restricting or removing recess privileges from students for misbehaviour or to catch up on schoolwork [67]. Recess restriction continues to be a recommended behaviour management technique [99]. When asked, children indicate a preference for longer recess periods [67, 100]. Clearly, recess is valued by children which makes it an easy target for disciplinary practices. Children from third and fifth grade in two US schools indicated that they understood the reasons for teachers restricting outdoor recess, but largely considered it unfair and argued that it exacerbates antisocial behaviour for some children [100]. The children in this study valued the autonomy experienced during recess which included being able to run around and talk to peers about their chosen topics.
\nLoose parts play during outdoor recess has been hypothesised to have a positive impact on social interaction and social skills [101]. There are many reports from teachers to indicate that children’s play is more cooperative and more inclusive when loose parts are introduced [76, 102]. A recent systematic review of loose parts play interventions found that high quality studies have not demonstrated significant changes in children’s social competence and social skills [103]. One of the issues is that children in these studies may already be functioning well in terms of social competence and social skills [104]. This assumption is reinforced by social play often generating extremely high levels of enjoyment for children compared to other play categories [93, 105]. More research is needed to determine if children with poor social skills make improvements when negotiating with others in loose parts play and if fewer children are rejected or neglected during loose parts play.
\nUnderstanding of social development outcomes related to outdoor recess remains under-researched. There is criticism that the strong claims from authoritative organisations about the benefits of recess for social development have not been matched by strong evidence [106]. At a minimum, the current evidence suggests that outdoor recess has little impact on the social development for the majority of children. Recess is valued by children as autonomous time to spend with peers and provides teachers with opportunities to observe children’s abilities to manage risks and negotiate with peers to achieve complex goals.
\nWith the increasing burdens facing teachers (curriculum demands, professional development, student engagement/inclusion and workload intensification), it is more important than ever to ensure that there are quality outdoor recreational opportunities provided for school children. The chapter has detailed how the outdoor recreation setting during school recess is having an impact on children’s physiological and psychological outcomes. Interestingly, it is clear that due to well-known biological benefits of physical activity on the human body, most physiological research investigating outdoor recreation in schools has simply focused on how to increase physical activity participation. Although a focus on participation levels is important to help children meet physical activity guidelines in order to prevent lifestyle diseases such as Type 2 diabetes, cardiovascular disease and osteoporosis. Yet what this chapter also uncovers is the strong interlinking nature between the physical, psychological and social outcomes of health. There were clear overlaps and insights gained between investigations across health dimensions. It becomes clear that the substantial amount of time children will be exposed to during “critical windows” of recess time in schools is vital to develop positive and holistic behavioural habits. Further investigations into school recreational contexts have the potential to continue to shed light on the developmental potential and possibilities that could be achieved for outdoor school recreational settings to be prioritised and protected into the future. There are numerous key messages from this chapter. First, it is the important to maintain or extend children’s opportunities for outdoor recreation during recess due to the physiological and psychological benefits of extended outdoor interactions with peers. Second, allowing time for high quality outdoor recreation during recess does not interfere with academic outcomes. Third, many changes to school playgrounds, such as introduction of loose parts, are effective in bringing about change without adding to teacher workload. Finally, children look forward to outdoor recreation during recess, it improves their overall school experience.
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'Copyright is the term used to describe the rights related to the publication and distribution of original Works. Most importantly from a publisher's perspective, copyright governs how Authors, publishers and the general public can use, publish, and distribute publications.
\n\nIntechOpen only publishes manuscripts for which it has publishing rights. This is governed by a publication agreement between the Author and IntechOpen. This agreement is accepted by the Author when the manuscript is submitted and deals with both the rights of the publisher and Author, as well as any obligations concerning a particular manuscript. However, in accepting this agreement, Authors continue to retain significant rights to use and share their publications.
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