[Root resection: tooth preservation by targeting the root of the problem]. / Wortelresectie: tandbehoud door problemen bij de wortel aan te pakken.

When problems occur in multirooted teeth, such as persistent endodontic problems following endodontic treatment, problems involving fracture or furcation, extraction may be decided on. However, removal of the tooth will result in loss of occlusal units and the alveolar process. By removing the compromised root and preserving the healthy part, the tooth can remain functional, but only after restorative treatment. A correct indication or diagnosis, a properly performed endodontic, restorative and surgical treatment and proper follow-up are mandatory for a successful treatment outcome.

[Calculus removal as the cornerstone of periodontal treatment]. / Het verwijderen van tandsteen als hoeksteen van de parodontale behandeling.

The removal of calculus is a major part of periodontal treatment, in order to improve the clinical situation. Calculus develops on hard tissues in the oral cavity. This can occur both supra- and subgingivally. The rate of its development depends on a variety of factors. Due to the rough surface, calculus is an ideal basis for a (harmful) biofilm. It is therefore a point of debate whether the calculus or the overlaying biofilm can lead to the periodontal inflammation. This in turn raises the question whether only this biofilm needs to be removed or whether the calculus also needs to be removed. As long as ten centuries ago, the removal of calculus was used as a treatment for improving oral health and that is not very different today.

Periodontal breakdown inter-tooth relationships in estimating periodontitis-related tooth loss.

OBJECTIVES: The reasons for tooth extraction are rarely recorded in epidemiological datasets. It poses a diagnostic challenge to determine if tooth loss is related to periodontal disease (TLPD). The present study aimed to assess the inter-tooth relationships based on the periodontal characteristics of existing teeth. METHODS: A cross-sectional dataset of 8,978 participants with complete periodontal examination (including probing pocket depth [PPD] and clinical attachment loss [CAL]) in the NHANES 2009-2014 was used in this study. Spearman rank correlation was applied to assess the inter-tooth correlations of PPD/CAL among 28 teeth after adjustment for relevant confounders. We further verify our findings in the Java Project on Periodontal Disease with TLPD information available (the number of TLPD = 12). RESULTS: Strong PPD/CAL correlations were observed in adjacent teeth (r for PPD = 0.652, r for CAL = 0.597; false discovery rate [FDR] <0.05) rather than those on non-adjacent teeth (r for PPD = 0.515, r for CAL = 0.476; FDR <0.05). The correlations increased among severe periodontitis cases (CAL ≥5 mm or PPD ≥6 mm). In line with this, we further observed that the teeth adjacent to the TLPD tooth had the most alveolar bone loss in the Java dataset. CONCLUSION: The periodontitis parameters (PPD/CAL) of adjacent teeth could be a potential indicator to estimate TLPD when actual reasons for tooth extraction are unknown. CLINICAL SIGNIFICANCE: Periodontally compromised teeth adjacent to a lost tooth may help estimate whether the loss could be related to periodontal disease when the actual extraction reasons are unknown.

Classification of chronic orofacial pain using an intravenous diagnostic test.

The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of conducted pharmacodiagnostic tests, consisting of the consecutive intravenous administration of drugs. Visual analogue scale scores were retrieved from all patients, based on which they were classified into different responder groups. In total, 46 pain profiles were analysed. Of these, 16 patients (35%) could be classified into one or more pain categories, while 30 patients (65%) could not be classified into any pain category. The pain duration or medication use did not influence the classification. Based on the results of this retrospective study, it seems that classification into subgroups is possible after intravenous testing in a minority of clinically unclassifiable patients. In patients where there is a substantial need for additional diagnostic information, these results may be of value. Recommendations are made for further research, which should include validation in patients with known pain mechanisms.

[A patient with glossopharyngeal neuralgia: a (un)known trap]. / Een patiënt met glossofaryngeusneuralgie: een (on)bekende valkuil.

A man visited the dentist regularly during the past 6 years with a complaint about severe pain. Treatment met with uneven success. The patient now complained about severe, radiating pain which resulted from contact between the tongue and the bridge. The teeth that seemed to be involved were inspected and, after diagnostic testing, restoratively and endodontically treated. When the pain persisted, an oral and maxillofacial surgeon was consulted; the surgeon diagnosed the problem as a glossopharyngeal neuralgia. The neuralgia was treated with carbazamzepine, after which the pain diminished. Pain that seems to be pulpitis pain may be caused by a neuralgia, in this case a glossopharyngeal neuralgia. Triggers for the pain can be swallowing, chewing, talking, coughing or yawning. Although the incidence is low, when pain persists after initial treatment, a (glossopharyngeus) neuralgia should be seriously considered.