[Dental focus examination: a proposal for a more nuanced approach]. / Odontogeen focusonderzoek: een voorstel voor een meer genuanceerde benadering.

Oral and maxillofacial surgeons and hospital dentists are often requested to perform a dental focus examination in patients (to be) admitted in a hospital and for whom the state of their teeth is of importance for a medical treatment or situation. The main reasons for a dental focus examination include unexplained fever, heart surgery, chemotherapy, organ or artificial joint transplants, use of oral or intravenous bisphosphonates and radiotherapy of the head and neck. In daily practice, there is a need for a clear algorithm which is easy to apply for the diagnosis and treatment of dentalfoci for the various medical indications. The medical conditions described above have in common that subclinical infections can lead to complications under exceptional conditions. The influence and the nature of the development ofa dental infection varies in each of the situations mentioned. This has consequences for the need to eliminate dentalfoci. The diagnosis and treatment of dental foci in relation to various medical situations therefore requires a nuanced approach.

Low burnout risk and high engagement levels among oral and maxillofacial surgeons.

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels.

[Indicating analgesics in oral health care]. / Het indiceren van analgetica in de mondzorg.

A representative survey amongst Dutch dentists and oral and maxillofacial surgeons showed that almost all of them indicated analgesics regularly. Thirty-five% of the dentists advised their patients in case of one or several tooth extractions to use analgesics. Forty-seven % of these dentists advised using the analgesics before the pain starts. After similar treatments, 89% of the oral and maxillofacial surgeons indicated analgesics and 73% advised taking the analgesic preventatively. Also in the case of other treatments oral and maxillofacial surgeons advised more often than dentists using analgesics preventatively. Dentists usually advised paracetamol and oral and maxillofacial surgeons a non-steroidal anti-inflammatory drug. Most dentists and all oral and maxillofacial surgeons thought that they had enough knowledge about the side-effects and interactions of analgesics. The majority of the dentists and oral and maxillofacial surgeons indicated that they would like to be updated on analgesia by post-graduate education occasionally

[Burn-out and engagement among oral surgeons]. / Burn-out en bevlogenheid bij kaakchirurgen.

The aim of this study was to measure Dutch oral surgeons' levels of burn-out risk and the contributing role of demanding working conditions. In addition, the extent of work engagement was considered, and which stimulating working conditions contributed to it. All 179 Dutch oral surgeons registered in the Dutch Dental Association's files received a questionnaire by means of which burn-out, work engagement and both demanding and stimulating aspects from the work environment could be measured. Based upon a 70% response, it can be concluded that Dutch oral surgeons have a relatively low risk of burn-out and a high degree of engagement. Demanding working conditions which explain the differences in the risk of burn-out are: 'Pressure of work and clinic organization', and 'Lack of variation and perspective in work'. Differences in enthusiasm were best explained by 'Variety in work', and 'Positive effect upon patients'. It is remarkable that the mean for all demanding aspects of work is relatively low and the mean for all stimulating aspects is relatively high.

[Interactions and side-effects of non-steroidal anti-inflammatory drugs]. / Interacties en bijwerkingen van 'non-steroidal anti-inflammatory drugs'.

Non-steroidal anti-inflammatory drugs are often used analgetics in dentistry because of their analgetic and anti-inflammatory effects. Oral health care providers should know their interactions and side-effects meticulously. The automatic prescription of another analgetic just to avoid the side-affects is not always an option, since then the specific properties of NSAID's are missed. A correct patient information, specific medical controls, a combination with other medication or other measures may providefor a safe use of NSAID's. In case of healthy patients younger than 70 years of age and a medication time less than two weeks seldom specific measures are indicated.

[An intense result contract]. / Een inspannende resultaatsverbintenis.

As a consequence of developments in the oral health care profession and in society as a whole horizontally organized oral health care is becoming increasingly widely accepted. For patients, this brings increasing obscurity along with it regarding questions as to whom is responsible for what exactly. In case of conflict it will also become more difficult for lawyers to determine with whom a patient has entered into a (partial) treatment agreement. In order to put an end to such obscurity this article makes a case for legislation prescribing centralized liability for oral health care centres.

[Child abuse]. / Kindermishandeling.

It is estimated that in the Netherlands over 100.000 children per year are victims of child abuse. In more than 50% of the cases of physical abuse there is a trauma of the head and neck area. Therefore, it is likely that (without realizing it) dentists are regularly confronted with cases of child abuse. Dentists have an ethical duty to take positive action in cases of suspected child abuse. They may refer the patient to an oral surgeon, consult the family physician or ask the advice of the 'Advies- en Meldpunt Kindermishandeling' (Advice and Report Centre for Child Abuse). The Dutch Dental Association, the Dutch Association of Family Physicians and the Royal College of Physiotherapists have signed a formal agreement to promote closer cooperation in identifying child abuse more quickly.

[Consent requirements in the case of adults who are legally unable to give informed consent]. / Toestemmingsvereisten bij volwassen wilsonbekwame patiënten.

Based on a published verdict of the Regional Disciplinary Tribunal, the general and special regulations in the Law Governing Medical Treatment Agreements (in Dutch: WGBO) with respect to informed consent are discussed. Patients 16 years and older give consent themselves, after having been informed about treatment; patients from 12 to 16 give their consent together with their parents and parents give consent for patients under 12. Only in cases of patients 18 years or older who are practically (for example, due to coma) or legally (for example, due to guardianship) unable to give consent, do the responsibilities defined in the WGBO have to be carried out by the guardian, the mentor, the partner or the next of kin. It would seem reasonable that in all cases of irreversible dental treatments the express consent is obtained from the legally responsible.

[Carotid calcification on a panoramic radiograph: what to do?]. / Een opaciteit in de hals op het orthopantomogram: wat te doen?

A 71-year-old man is discussed in whom the oral and maxillofacial surgeon observed, by chance, a radiopacity on the panoramic radiograph that was highly suggestive of a calcification at the bifurcation of the internal and external carotid artery. While, on the basis of international literature, various treatments are advanced with respect to the importance of vascular investigation and possible surgical removal of significant calcification, at present the view in The Netherlands is that the family doctor has the responsibility to assess whether such patient should be referred for further evaluation by the neurologist or vascular surgeon. The same applies to the possible indication for prescription of antitrombotics.

[Stop smoking advice for patients who smoke: feasible in the dental practice?]. / Stopadvies aan rokende patiënten: haalbaar in de tandartspraktijk?

Smoking may cause periodontal diseases and raises the chance of getting oral cancer. The Dutch Guideline for the Treatment of Tobacco Addiction recommends that dental professionals explicitly advise all patients who smoke to stop smoking. In 12 dental practices a study was made of how the guidelines could be implemented. The strategy consisted of a patient protocol for minimal, one-time cessation advice or for more intensive supervision, a patient leaflet, centralized training for the dental team, and repeated monitoring with feedback on the patients' experience of the behaviour that they have been advised to follow. Before the training and again 3 months after, professionals (n = 38) and an a-select sample of smoking patients (n = 197) completed questionnaires. A majority of patients was receptive to cessation advice of a dentist (95%) or counseling (68%). After 3 months it appeared that patient behaviour as reported by patients with respect to all points of the patient protocol had significantly improved.

[Diagnosing and treatment of dental foci in Dutch medical centres]. / Odontogeen focusonderzoek in een selectie van Nederlandse medische centra.

Although not scientifically proven, dental foci are believed to result in severe local or systemic disease. Eradicating dental foci in order to prevent possible interference with a medical treatment may be important in specific patient groups. To gain insight in the number of dental focus examinations, the medical evidence, the number of potential foci determined, as well as the treatment eradicating the focus, all dental focus examinations in 16 Dutch hospitals were registered during 3 months. A total number of 470 examinations were performed. Scheduled heart(valve)surgery and radiotherapy of the head and neck were the main reasons for a dental focus examination. Dental foci were found and treated in more than 50% of the patients examined. There was a significant difference between dentate and edentulous patients in the percentage of patients diagnosed and treated for a dental focus. More than 80% of dentate and less than 20% of edentulous patients were treated.

[Bisphosphonate-associated osteonecrosis of the jaws 1]. / Bisfosfonaatgerelateerde osteonecrose van de kaak 1.

Bisphosphonates are generally administered either orally or intravenously. Orally administered bisphosphonates are primarilly used in the treatment of postmenopausal osteoporosis, glucocorticoid-induced osteoporosis, and Paget's disease. When orally administered, only about 1% is absorbed from the tractus from the tractus digestivus. With intravenous administration, higher blood levels levels are reached. Intravenously administered bisphosphonates are used in the treatment of hypercalcaemia, Kahler's disease, and bone metastases of other malignancies. A few cases of osteonecrosis of the jaw(s) are seen especially when more powerful bisphosphonates are administered intravenously. This osteonecrosis is most often provoked by means of an invasive oral treatment. Bisphosphonate-associated osteonecrosis is very difficult to treat. Therefore, dental preventive measures and treatment of dental foci and other inflammations are recommended before starting bisphosphonate therapy.

[Dissertations 25 years after date 8. Non-odontogenic cysts of the oral regions]. / Proefschriften 25 jaar na dato 8. Niet-dentogene cysten in het hoofd-hals-gebied.

Non-odontogenic cysts are rare. Today, only 2 of the 18 non-odontogenic cysts that were described in 1982 are still classified as such: the nasopalatine duct cyst and the nasolabial cyst. The others are now classified in other groups. In the general practice the nasopalatine duct cyst is mostly seen as a swelling of the palate, just behind the central incisors. The nasolabial cyst is more rare and can be characterized as a paranasal swelling. Treatment of both cysts consists of surgical removal by intraoral approach. It is advisable to refer all cases of suspected non-odontogenic cysts, with the exception of the mucosal antral cyst, to an oral and maxillofacial surgeon in order to have the diagnosis confirmed.

[Needle breakage during mandibular block anaesthesia: prevention and retrieval]. / Naaldbreuk tijdens mandibulaire blokanesthesie. Preventie en behandeling.

Disposable needles for dental local anaesthesia do not break easily. Still, needle breakage does occur, and is mainly caused by unexpected movements of the patient or pre-use bending of the needle by the dentist. If a dental needle breaks while administering local anaesthesia, the dentist should prevent panic. If the patient opens his mouth wide the needle might still be visible. If so, the needle is removed. If the needle is no longer visible, the site where the needle has penetrated the mucosa should be marked with a permanent marker. The dentist will contact a maxillofacial surgeon for immediate consultation. The maxillofacial surgeon will try to retrieve the broken dental needle under general anaesthesia.

[The practice guideline 'Treatment of tobacco addiction']. / De richtlijn 'Behandeling van tabaksverslaving'.

The practice guidelines 'Treatment of tobacco dependence' are drawn up by collaboration of all medical and paramedical professional associations and aim at assisting patients who would like to quit smoking. The dental team has a barrier-free opportunity to discuss smoking habits. The relation between smoking and oral health is quite obvious. Dental practitioners should ask about smoking habits regularly and smokers should be advised at least once a year to stop smoking. More intensive strategies for treatment of tobacco addiction in dental settings will be developed in the near future.

[Legal aspects of sports injuries]. / Juridische aspecten van sportletsels.

Victims of sports injuries have to be advised about aspects of legal liablity, especially in case of luxation or avulsion of teeth, since there still may be dental consequences years later. The transference of information by the first-aid-dentist to the sportsman's own dentist should take place with care. If the patient has no family dentist, the first-aid-dentist should at least keep the sportsman free of pain, for example by starting endodontic treatment. Because sports injuries mostly occur beyond normal practice-hours, there may be reasons to deviate from the clinical guideline.

[Using corticosteroids to prevent postoperative oedema]. / Gebruik van corticosteroïden ter preventie van postoperatief oedeem.

Corticosteroids are produced in the adrenal gland cortex and are subdivided in mineralocorticosteroids and glucocorticosteroids. Usually, corticosteroids are prescribed as drugs to replace natural corticosteroids in case of insufficient functioning adrenal glands and in numerous diseases because of their anti-inflammatory and immunosuppressive effects. Based on literature data, it was concluded in this article that corticosteroids are never indicated as a preventive measure in regular dentistry and oral and maxillofacial surgery. Only in cases of major elective oral and maxillofacial surgery, prescription of corticosteroids may be considered.

[The role of health professionals in discouraging tobacco use]. / De rol van zorgverleners bij ontmoediging van tabaksgebruik.

In Central and Eastern Europe the morbidity and mortality rates as a result of tobacco use are high. Based on the premise that the health professional can play an important role in dealing with this epidemic of tobacco use, a series of workshops was organized in 2000 and 2001 for dentists and physicians. This article contains a summary of the proceedings of the workshop 'The role of the health professional and health school curriculum in tobacco control', that have been earlier published in the European Journal of Dental Education. The role of the Dutch dentist in assisting their patients to quit smoking is discussed.

[Diagnosis and management in case of (suspicion of) child abuse]. / Diagnostiek en beleid bij (verdenking op) kindermishandeling.

About 5% of all children presented at a First Aid Unit in the Netherlands is a victim of child abuse. It is estimated that in the Netherlands yearly about 50.000 to 80.000 children are victims of child abuse, which is about ten children per dental practice per annum. In more than 50% of the cases there is a trauma of the head- and neck-area. Therefore, it is likely that dentists are regularly confronted with cases of child abuse. This high percentage of oro-facial trauma puts a high responsibility on the dental profession. Dentists have an ethical duty to act actively in cases of child-abuse. They may refer to an oral surgeon, consult the family physician or ask advice of the 'Advies- en Meldpunt Kindermishandeling' (Advice- and Report Centre for Child Abuse). This article describes the symptoms of child abuse and the recommended procedure for action.