[Odontogenic pain]. / Dentogene pijnklachten.

A dentist is expected to be able to recognise and treat pain originating from the teeth. When dealing with short-term, acute pain, the cause can sometimes be found quickly, while this can be much harder in the case of chronic pain. Especially in this latter category, one should be even more careful in diagnostics and choose reversible treatments when possible. A focused anamnesis, a pain journal and trial local anaesthesia can help to identify the suspected cause of the pain. Careful extra- and intraoral examination is needed to reach a proper diagnosis. X-ray examination may confirm this diagnosis. Odontogenic pain can be caused by an infection of the pulp or by a periodontal or pericoronal disease. The treatment of the pain may - depending on the cause - consist of an endodontic or periodontal treatment, or extraction of the tooth. In the treatment of orofacial pain of odontogenic origin, the aim is to find and treat the cause of the pain. If this cause is found, proper pain relief can also be prescribed.

[Dental treatment under general anaesthesia in young children]. / Algehele anesthesie bij jonge kinderen in de tandheelkunde.

General anaesthesia in children younger than 4 years of age can cause brain damage with cognitive and behavioral problems as a result. The chance of these side effects is small, but increases with prolonged duration of the anaesthesia or when the general anaesthesia is provided more frequently. It goes without saying that the indication for anaesthesia should be very strictly set. In order to reduce the chance of damage, the anaesthesia itself should be performed in consultation between the anaesthesiologist and care provider, according to a set protocol. The parents need to be informed of the potential risks of general anaesthesia. Delayed treatment (and thereby provision of the anaesthesia) should be considered.

[The risk of general anaesthesia and sedation in the older people]. / Gevaar van algehele anesthesie en sedatie bij ouderen.

Temporary memory problems and aggravation of pre-existing memory disorders may occur after treatment under general anaesthesia. A frequency of postoperative cognition disorders between 10 and 50% has been identified in the literature. Risk factors for the occurrence of postoperative memory disorders are advanced age, low level of education, intellectual comorbidity, the onset of dementia and other neurodegenerative disorders, existing sleep disorders and the experience of postoperative pain. The morphological changes seen in the brain after general anaesthesia are similar to the changes occurring in Alzheimer's disease. In addition to metabolic changes, general anaesthetics directly enhance the apoptosis of brain cells. Older people are already familiar with a decrease in the number of neurons, which provides them with a limited spare capacity. Moreover, older people are often known to have the risk factors for the occurrence of postoperative memory disorders as mentioned before. Caution and restraint in the indication for dental -treatment under general anaesthesia or sedation is therefore required.

Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia.

OBJECTIVES: The aim of the present study was to evaluate the treatment results of CO2 laser vaporisation in a well-defined cohort of patients with oral leukoplakia (OL). MATERIAL AND METHODS: The group consisted of 35 patients. Before treatment, a clinical photograph and an incisional biopsy were performed in all cases. Also posttreatment results were documented with clinical photographs. The assessment of the treatment results was performed by an independent clinician who had not performed the treatment. The mean follow-up period was 61.9 months (range 12-179 months). RESULTS: In 14/35 patients, there was a recurrence between 1 and 43 months (mean 18.7 months), the annual recurrence rate being approximately 8%. In three of these patients, malignant transformation occurred at a later stage. In two other patients, a malignancy occurred without a prior recurrence. In altogether 5 of 35 patients, malignant transformation occurred in a mean period of 54 months, the annual malignant transformation rate being approximately 3%. CONCLUSIONS: The results in the present study are worse than those reported in the literature, perhaps owing to the use of different diagnostic criteria for OL, differences in the employed laser technique and assessment of possible recurrences by an independent clinician.

[Epidemic parotiditis, a reportable disease]. / Parotitis epidemica, een meldingsplichtige ziekte.

Three consecutive patients with an acute swelling of one of the cheeks, were diagnosed with epidemic parotiditis. The first phase of the diagnostic procedure for an acute cheek swelling is to eliminate the possibility of odontogenic causes. When odontogenic problems have been excluded, non-dentition-related causes may be considered. An acute, progressive swelling in the preauricular area can often be attributed to an inflammation of the parotid gland, but epidemic parotiditis should also be considered. Epidemic parotiditis, or mumps, is caused by the mumps virus. Contamination occurs aerogenically. In the Netherlands, mumps vaccine is an ingredient of the governmental combined mump-measles-rubella inoculation programme. However, in recent years several small-scale parotiditis epidemics have broken out, predominantly among young, inoculated adults. Oropharyngeal mucus and blood samples are needed to diagnose the disease. Each case of the disease should be reported to the community healthcare service.

[Swallowing or inhaling? An instrument that disappears in the throat]. / Inslikken of aaspireren van een voorwerp dat in de keel verdwijnt.

Swallowing or inhaling a foreign object does not often happen in a dental practice. If however, an instrument disappears in the throat of a patient during dental treatment, an adequate response on the part of the oral healthcare provider is required. On the basis of 2 cases, the consequences and procedure appropriate when a foreign object disappears in the throat are discussed.

[Oral medicine 6. Ulcerations of the oral mucosa]. / Oral medicine 6. Ulceraties van de oral mucosa.

An ulcer can be defined as a superficial defect of the skin or the mucosa, caused by tissue degeneration, and having little tendency to heal. With a careful review of the medical history and the findings of inspection of the oral cavity, including palpation of the ulcer, the dentist will in many cases be able to determine the diagnosis and also the treatment. There are, however, also ulcerations which require referral to a specialist, most often the oral and maxillofacial surgeon.

[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.

[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

[A gingival hyperplasia in a patient suffering from neurofibromatosis]. / Een gingivahyperplasie op basis van neurofibromatose.

A 30-year-old woman suffering from neurofibromatosis type 1 was referred by her dentist to the department of oral and maxillofacial surgery of a university medical centre for excision of a gingival hyperplasia in the mandibular frontal region. The hyperplasia was a neurofibroma, which was surgically removed, as were 2 neurofibromas of the tongue, a postauricular neurofibroma and 2 neurofibromas of the feet.

[Diseases of the maxillary sinus: an overview]. / Afwijkingen van de sinus maxillaris: een overzicht.

Because of the intimate relationship between the maxillary teeth and the maxillary sinus, it is no surprise that odontogenic infections, odontogenic cysts and tumours which have their origin in the mucosa and the bone of the maxilla may extend into the maxillary sinus and, occasionally, into the nasal cavity. Diseases of the maxillary sinus can also extend into the oral cavity and can cause symptoms that mimic those of odontogenic diseases. Important diseases of the maxillary sinus are maxillary sinusitis, oroantral communications, antroliths, cysts and neoplasms.

European dental students' opinions on their local anaesthesia education.

OBJECTIVE: To investigate students' opinion about theoretical and clinical training in local anaesthesia at different European dental schools. MATERIALS AND METHODS: A questionnaire was designed to collect information about local anaesthesia teaching. Students' opinion was quantified with five-point Likert scales. The web-based questionnaire was distributed through European Dental Students Association contacts amongst students of 25 different dental schools. Eight hundred and eighteen completed questionnaires from students of 12 dental schools were analyzed statistically. RESULTS: Dental schools showed a wide variation in the beginning of the theoretical teaching of local anaesthesia and the practical teaching. A preclinical training model was used by a small number of students, but these students found it a useful preparation. Many students felt insufficiently prepared when they administered their first injection in a human (17-81%). In dental schools from the UK, Ireland, Sweden and the Netherlands, this first injection is administered to a fellow dental student, whilst in the other countries the first injection is usually performed in a patient. Instruction in mandibular block anaesthesia was frequently reported (81-100%) as well as in infiltration anaesthesia of the upper and lower jaws (78-100% and 30-93% respectively). Many students expressed that they like to receive teaching in intraligamentary anaesthesia (13-70%). Other changes in the curriculum were also frequently suggested (33-100%), especially the introduction of preclinical training models and practical teaching earlier in the curriculum. CONCLUSION: Local anaesthesia teaching programmes and the rating of this teaching by dental students show a considerable variation across European dental schools. Students considered better preparation highly desirable. The variability in programmes may have implications for mobility of students between European dental schools.

Genetic screening for nevoid basal cell carcinoma syndrome in patients with a solitary keratocystic odontogenic tumour is not useful.

AIM: The aim of this study was to investigate the need for routine genetic counselling for identification of features of nevoid basal cell carcinoma syndrome (NBCCS) in patients presenting with a solitairy keratocystic odontogenic tumour (KCOT) of the jaws. METHODS: Sixty-nine patients treated for a solitary KCOT have been followed for the possible development of second KCOTs or other signs indicative of NBCCS. In addition, 11 randomly selected patients of this group were referred for genetic counselling, including identification of germ-line mutations in the Patched gene (PTCH gene). RESULTS: In none of the 69 patients clinical and radiographic manifestations of second KCOTs and/or other features associated with NBCCS were found during a follow-up period of 49.8 months. In the 11 patients referred for genetic counselling, there were no features indicative of the presence of NBCCS. No mutations in the PTCH gene could be identified. CONCLUSION: This study does not support the need for routine genetic counselling in patients presenting with a solitairy keratocystic odontogenic tumour of the jaws.

[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.

[Dental students on instruction in local anaesthesia]. / Tandheelkundestudenten over onderwijs in lokale anesthesie.

In order to find out how dental students feel about their education in the application of local anaesthesia, a questionnaire was distributed via e-mail among all dental students in the Netherlands. A total of 397 completed questionnaires were analyzed statistically. At all 3 dental schools in the second year instruction in theoretical aspects of local anaesthesia began. Practical teaching began in the second or third study year. A preclinical training model was used by 15% of the students in Amsterdam, 20% of the students in Nijmegen and 35% of the students in Groningen. When they administered their first injection in a human, a fellow dental student in 91-98% of all cases, 24-74% of the students felt that they were insufficiently prepared. 35-52% of the students said that they would also like to receive instruction in intraligamentary anaesthesia in the dental curriculum. Other changes in the curriculum were also frequently suggested, especially the introduction of preclinical training models (29%, 55% and 56% for Groningen, Nijmegen and Amsterdam respectively).

Complications of local anaesthesia. An observational study.

OBJECTIVES: Local anaesthesia is increasingly used by dental hygienists. As little is known about the incidence of adverse effects during and after the administration of local anaesthetics, we evaluated side-effects associated with local anaesthesia. METHODS: A prospective observational study was conducted using standard criteria among a group of 103 patients receiving mandibular block anaesthesia. RESULTS: Physical reactions like clenching fists (14.5%), moaning (12.6%) and turning pale (7.8%) were frequently observed. Patients (3.8%) showed a painful reaction because of needle contact with a nerve or the periosteum. Systemic complications were not observed. After the injection, 41.7% said they felt tense during the administration; 4.9% of the patients reported swallowing problems and 3.9% a tachycardia. CONCLUSIONS: These results suggest that administration of local anaesthesia has a small risk of adverse events. Complications, if they occur, seem minor and transient in nature.

[Prevalence of carotid artery calcification on panoramic radiographs]. / Prevalentie van verkalkingen van de arteria carotis op een panoramische röntgenopname.

In a retrospective study, the prevalence of carotid artery calcifications on routine screening panoramic radiographs of a Dutch Oral & Maxillofacial Surgery department was investigated. Individuals older than 45 without a history of CVA, TIA or head and neck radiotherapy were included.Technically useful radiographs were available for 145 males (mean age 59.6 years) and 303 females (mean age 58.5 years). Both a dentist and an oral maxillofacial surgeon examined these radiographs for radio-opaque lesions adjacent or below the C3-C4 intervertebral space. Forty-two individuals with asymptomatic carotid artery calcifications were identified (9.4% of the study population; mean age 68.2 years): 18 men (12.4%; mean age 66.2 years) and 24 women (7.9%; mean age 69.7 years). In 90% of cases the calcifications were bilateral. These results indicate that panoramic radiographs obtained during the course of routine dental treatment may identify calcified carotid atheromas in asymptomatic subjects.

[Correlations between the presence of a mesiodens and position abnormalities, diastemas, and eruption disturbances of maxillary frontal teeth]. / Relatie tussen mesiodens en standafwijkingen, diastemen en eruptiestoornissen van frontelementen.

A mesiodens is often diagnosed coincidentally during a radiological examination. However, a mesiodens may also be diagnosed in relation to a clinically identified central diastema and an eruption disturbance, or a rotation of a central incisor. In this study of a group of 162 children and adolescents varying in age from 4 to 18 years, with a mesiodens, the frequency of position abnormalities, diastemas, and eruption disturbances of the maxillary frontal teeth was registered retrospectively. One or more of these complications was diagnosed in 72% of the patients. Usually, removal of the mesiodens in children and adolescents results in spontaneous recovery of the complications. Early diagnosis and early treatment are therefore important.

[Adverse effect of local anaesthetics]. / Ongewenste neveneffecten van lokale anesthesie.

Local anaesthetics are frequently administered preceding oral treatment. Since little is known about the incidence of adverse effects after administration of local anaesthetics, a prospective study involving a group of 219 patients was performed. The most frequently observed complications were insufficient anaesthesia (17%) and positive blood aspiration (3%). Pain during administration, paralysis, blanching, haematoma, and vasovagal collapse occurred each in less than 1% of the patients. The results suggested that administration of local anaesthetics involves a limited risk of adverse events and that the adverse events are usually minor and transient.

[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.