[The (putative) pathological impact of fibromyalgia on the orofacial system]. / De (vermeende) pathologische invloed van fibromyalgie op het orofaciale systeem.

Fibromyalgia is a syndrome without apparent aetiology, characterised by pain, fatigue, memory disorders, mood disorders, and sleep disturbances. The syndrome is considered to be one of the rheumatic diseases. In the general population, the prevalence varies from 2 to 8%, with a women-men ratio of about 2:1. Suspicion of fibromyalgia arises when a patient has pain at multiple locations that cannot be attributed to trauma or inflammation, and when the pain is especially musculoskeletal. Primary management includes explaining the syndrome and offering reassurance. In addition, one can also attempt to increase mobility, avoid overloading, and improve physical condition and the level of activity, and to activate problem-solving skills. Subsequently, behavioural therapy and pharmacotherapy may be considered. The most important manifestations of fibromyalgia in the orofacial and occlusal system seem to be temporomandibular dysfunction, headache, xerostomia, hyposalivation, burning mouth and dysgeusia. However, with respect to the precise relation of fibromyalgia with the orofacial system, much needs to be elucidated.

[Scoliosis: review of types, aetiology, diagnostics, and treatment 2]. / Scoliose: overzicht van typen, oorzaken, diagnostiek en behandeling 2.

In congenital scoliosis, an anatomical spine deformity arose during embryonic vertebral development which caused a deformity. Approximately 38-55% of these deformities appear as a syndrome. Prognosis and preferred treatment depend on the type offailure and the severity of the deformity, but surgical correction is often necessary. Neuromuscular scoliosis generally arises at a young age, is often rapidly progressive, and the magnitude of the curve can also progress even in adulthood. The prognosis of the curve together with the symptoms and prognosis of the associated neuromuscular condition determine the preferred treatment. The goal of surgical treatment is to improve the patient's quality of life. Two types of adult scoliosis occur: adult idiopathic scoliosis and adult degenerative scoliosis. The surgical principles for adult idiopathic scoliosis are almost identical to those for adolescent idiopathic scoliosis. In degenerative scoliosis, there is almost always a shorter fusion length. In the case of neurologic impairments, decompression of the spinal cord or nerve roots should be carried out.

[Scoliosis: review of types, aetiology, diagnostics, and treatment 1]. / Scoliose: overzicht van typen, oorzaken, diagnostiek en behandeling 1.

A scoliosis is a flexible or rigid deformity of the spine in the frontal plane. There are several types of scoliosis, each with specific characteristics. The most prevalent types are idiopathic, congenital, and neuromuscular scoliosis and scoliosis in adults. The aetiology is varied and largely undetermined. Essential components of diagnostics are patient history, physical examination, and radiographs. Treatment options are a conservative approach involving observation and follow-up, a conservative approach involving non-surgical treatment, and surgical treatment. Usually, idiopathic scoliosis causes no or only few complaints at a young age. Up to 35% of patients have a certain degree of back pain. The choice of a certain treatment is determined by the likelihood of progression of the spine deformity. The objective of brace treatment is preventing progression of the deformity. Important objectives of surgical treatment are preventing progression of the deformity and correcting the deformity with correction or preservation of physical equilibrium.

[Prevention of falls by elderly people in oral health care practices]. / Vermijden van valincidenten van ouderen in mondzorgpraktijken.

Oral health care practices are ever more frequently visited by frail elderly people. Frail elderly people are at risk for fall accidents due to intrinsic and extrinsic factors. Intrinsic factors are patient-related and extrinsic factors are environment-related. Significant intrinsic fall risk factors for elderly people are orthostatic and postprandial hypotension. The most important effect of hypotension is cerebral hypoperfusion, which can induce syncope and fall. Five to ten per cent of fall accidents of elderly people result in trauma. A serious trauma with possible extreme consequences is hip fracture. One year after a surgical hip fracture treatment of elderly people, 25% are experiencing mobility impairment and 25% have died as a result of co-morbidity or complications. Fall prevention deserves serious attention. Provision of information and strengthening and protecting bones are important prevention measures. In an oral health care practice, general risks of falling must be inventoried on a regular basis, and each (frail) elderly patient should be provided with individual fall-prevention guidance.

[Distraction osteogenesis in orthopaedics]. / Distractieosteogenese in de orthopedie.

For several decades, distraction osteogenesis has been applied in orthopaedics for lengthening limbs. Other indications for distraction osteogenesis in orthopaedics are nonunions, open fractures, oncologic defects, and ankle osteoarthritis. The main principle of distraction osteogenesis is that, with a certain degree of distraction of 2 bone segments, linear bone generation will take place between the 2 segments. The most frequent complications are infection, loosening and breaking of the introduced pins, osteomyelitis, and fracture of the newly generated bone. Disadvantages of distraction appliances are expensiveness, degree of technical difficulty, and a long training period. Distraction osteogenesis in orthopaedics is a very intensive treatment. Therefore, only patients who are motivated and well instructed and who are physically and mentally capable of coping with the fixtures are suitable.

Successful endoscopic treatment of chronic groin pain in athletes.

BACKGROUND: Chronic groin pain, especially in professional sportsmen, is a difficult clinical problem. METHODS: From January 1999 to August 2005, 55 professional and semiprofessional sportsmen (53 males; mean age, 25 +/- 4.5 years; range, 17-36 years) with undiagnosed chronic groin pain were followed prospectively. All the patients underwent an endoscopic total extraperitoneal (TEP) mesh placement. RESULTS: Incipient hernia was diagnosed in the study athletes: 15 on the right side (27%), 12 on the left side (22%), and 9 bilaterally (16%). In 20 patients (36%), an inguinal hernia was found: 3 direct inguinal hernias (5%) and 17 indirect hernias (31%). All the athletes returned to their normal sports level within 3 months after the operation. CONCLUSIONS: A TEP repair must be proposed to patients with prolonged groin pain unresponsive to conservative treatment. If no clear pathology is identified, reinforcement of the wall using a mesh offers good clinical results for athletes with idiopathic groin pain.

[Development, physiology, and cell activity of bone]. / Ontwikkeling, fysiologie en celactiviteit van bot.

Bones are of crucial importance for the human body, providing skeletal support, serving as a home for the formation of haematopoietic cells, and reservoiring calcium and phosphate. Long bones develop by endochondral ossification. Flat bones develop by intramembranous ossification. Bone tissue contains hydroxyapatite and various extracellular proteins, producing bone matrix. Two biological mechanisms, determining the strength of bone, are modelling and remodelling. Modelling can change bone shape and size through bone formation by osteoblasts at some sites and through bone destruction by osteoclasts at other sites. Remodelling is bone turnover, also performed by osteoclasts and osteoblasts. The processes of modelling and remodelling are induced by mechanical loads, predominantly muscle loads. Osteoblasts develop from mesenchymal stem cells. Many stimulating factors are known to activate the differentiation. Mature osteoblasts synthesize bone matrix and may further differentiate into osteocytes. Osteocytes maintain structural bone integrity and allow bone to adapt to any mechanical and chemical stimulus. Osteoclasts derive from haematopoietic stem cells. A number of transcription and growth factors have been identified essential for osteoclast differentiation and function. Finally, there is a complex interaction between osteoblasts and osteoclasts. Bone destruction starts by attachment of osteoclasts to the bone surface. Following this, osteoclasts undergo specific morphological changes. The process of bone destruction starts by acid dissolution of hydroxyapatite. After that osteoclasts start to destruct the organic matrix.

[Health care in sports by a team physician, especially in soccer]. / Medische begeleiding in de sport, in het bijzonder in de voetbalsport.

The aim of health care in sports is to promote, to secure, and to recover general health of sportsmen, taking into consideration the sport's specific loads. In general, a (professional) sports club has a private (para)medical team consisting of a team physician, a physiotherapist, and an attendant or masseur. The team physician organizes the arrangements and the preventive, diagnostic, and curative tasks of the (para)medical team. In sports, sometimes medical emergencies occur, such as tongue bite, cardiac problems, hypoglycaemia in diabetes, anaphylactic shock, and hypo- as well hyperthermia. Sports injuries are caused by acute physical forces, chronic overload or repeated micro-traumas. High-incidence injuries in all sports are injuries of joints, bones, head, neck, back and abdomen. In case of medical emergencies, the team physician has to take action quickly and professionally. If sports injuries occur, the team physician has to provide first aid and to arrange a treatment and rehabilitation plan in consultation with the paramedical members of the team. During the treatment and rehabilitation, the team physician has to be of assistance to sportsmen. In arranging some of his tasks, a team physician can ask for assistance or help from a dentist or an oral and maxillofacial surgeon.

[Osteopetrosis. Classification, etiology, treatment options and implications for oral health]. / Osteopetrose. Classificatie, etiologie, behandelmogelijkheden en implicaties voor de mondgezondheid.

Bone is continuously remodelled to maintain its strength and structural integrity. Remodelling is the result of an equilibrium between bone formation performed by osteoblasts and bone resorption performed by osteoclasts. In osteopetrosis this equilibrium is disturbed by a defect in the osteoclastogenesis or by disfunction of osteoclasts. Osteopetrosis is divided into four types: malignant infantile osteopetrosis, intermediate osteopetrosis, and two types of autosomal osteopetrosis. Malignant infantile osteopetrosis is usually diagnosed within the first year of birth by bone sclerosis and bone marrow obliteration. This type is very severe and usually results in death within a few years. The intermediate type usually appears before the age of ten and leads to recurrent pathologic fractures and cranial nerve compression. Autosomal dominant osteopetrosis is usually mild and consists of two sybtypes. Type I involves marked thickening of the cranial vault. Type II patients have predominantly sclerosis of the pelvis, the vertebrae and the base of the skull. Type I and II patients may often be long-lasting asymptomatic, but will eventually present with pathologic fractures, bone pain, and the effects of cranial nerve compression. Oral problems of osteopetrosis are delayed tooth eruption, absence of some teeth, malformed teeth, enamel hypoplasia, disturbed dentinogenesis, hypomineralisation of enamel and dentin, propensity for tooth decay, defects of the periodontal membrane, thickened lamina dura, mandibular protrusion, and the presence of odontomas. Tooth removal should be limited as it may induce bone fractures and osteomyelitis.

[Microstomia as a complication of scleroderma]. / Microstomie als gevolg van sclerodermie.

Scleroderma is a rare connective tissue disease of unknown origin. It is characterized by increased collagen deposition leading to fibrosis and degeneration of the skin and sometimes of internal organs. There are two main groups of scleroderma: circumscribed scleroderma and systemic sclerosis. Circumscribed scleroderma is limited to the skin and systemic sclerosis has involvement of internal organs. The main oral manifestation of scleroderma is microstoma, which is a limiting factor in oral selfcare and professional oral health care. A case report is presented of the treatment of a 15-year-old female scleroderma patient with microstoma.