[Toothache with a neuropathic background]. / Kiespijn met een neuropathische achtergrond.

A 48-year old woman in good general health was referred to the orofacial pain clinic in a centre for special dentistry with a toothache in the premolar region of the left maxillary quadrant. The complaints had existed for 15 years and various dental treatments, including endodontic treatments, apical surgery, extraction and splint therapy, had not helped to alleviate the complaints. As a result of the fact that anti-epileptic drugs were able to reduce the pain it was concluded that this 'toothache' satisfied the criteria of an atypical odontalgia: 'toothache' with a neuropathic background.

[Severe odontalgic pain preceding migraine attacks]. / Ernstige odontogene pijn voorafgaand aan een migraineaanval.

A 30-year-old woman appeared at the gnathology department of a centre for special dentistry complaining of migraine attacks which were preceded each time by severe odontalgic pain. Furthermore, she suffered from an autoimmune disease as well as from tension headaches. The oral health care provider in charge suspected that the episodes of odontalgic pain, which lasted for several hours or even several days, were caused by bruxism. Treatment of the bruxism resulted in reduced pain as well as reduced severity of the migraine attacks.

[Post-academic dental specialties 6. Gnathology: profile and competencies of the specialist in temporomandibular disorders and the general dental practitioner]. / Beroepsdifferentiatie in de tandheelkunde 6. Gnathologie: de competenties van de tandarts-gnatholoog en de tandarts- algemeen practicus.

The guiding principle in postgraduate programmes is to enable dentists to build on and extend the competencies acquired in the basic academic programme. This requires the examination and treatment of sufficient numbers of patients. Given the incidence and prevalence of temporomandibular disorders and orofacial pain, basic academic training will be limited to referral or to diagnosing and treating acute and non-complex cases, whereas the specialist in temporomandibular disorders(TMD) will focus especially on chronic temporomandibular disorders and orofacial pain, in a multidisciplinary setting. In case of orofacial pain, the general dental practitioner is the obvious person to determine if there may be odontogenic causes. The specialist in TMD can either advise the general practitioner or coordinate the patient's care him- or herself. In order to be able to perform well within a (partly medical) multidisciplinary setting there is a need for differentiated education, above and beyond the basic academic curriculum. The competencies of the specialist in TMD should comprise care in a broad sense, providing evidence-based care and educating patients, being able to work well within an organization, clinical reasoning and professional development through life-long learning and teaching. The specialist in TMD may either work in private practice or in special dental care clinics.