[Orthodontic treatment and root resorption].

Root resorption after orthodontic treatment occurs frequently. The biologic process of tooth movement and root resorption is described. Furthermore, attention is given to the frequency and severity of root resorption, diagnostics and aspects of the orthodontic treatment which aggravate root resorption.

[Local anesthesia in children and mentally handicapped].

Pain belief and pain thresholds vary greatly in children and mentally disabled persons. Whereas adults may tolerate discomfort and remain cooperative, children and mentally disabled persons become frightened when they are hurt and will not cooperate further. Effective pain control is a prerequisite for their successful treatment.

[Chewing with shortened dental arches].

Masticatory performance as measured with (objective) chewing tests is correlated with the number of teeth (the food platform area). In general, however, the masticatory ability (the subjective chewing experience) is sufficient as long as 20 or more 'well-distributed' teeth remain, such as is the case with an SDA, when the anterior teeth and the premolar teeth are present. Research indicates that an SDA does not lead to altered food selection.

[Front tooth replacement and the possible application of implants in young patients].

Oral implantology is a new treatment alternative and is often considered for treating the loss of teeth in patients of all ages. However, care has to be taken when using implants in younger patients, as implants in the growing patient can have considerable disadvantages. In this article indications, contra-indications and risks are discussed and an overview of conventional treatment alternatives is given.

[Prosthetic possibilities in the treatment of missing anterior teeth in adolescents].

Prior to the judgement on the best solution in the treatment of missing teeth in adolescents, an inventory of all problems has to be made. On the basis of this inventory the dentist can search for solutions by means of an analysis of castings and a wax-up. The combination of these solutions is indicative for the therapy which has to follow.

[Orthodontic possibilities for young patients with missing maxillary incisors].

In the orthodontic treatment of young patients with missing maxillary incisors one should make an effort to avoid prosthetic solutions. This not only applies to situations with agenesis of maxillary lateral permanent incisors, but also to those cases in which maxillary incisors cannot be maintained after trauma. Standard solutions are presented for various sagittal jaw relationships and types and number of teeth missing.

[Towards a system of quality care in dentistry in the Netherlands].

Monitoring and improving the quality of rendered health care in a systematic way has been laid down in Dutch legislation. In Dutch family health care particularly, many initiatives have already been taken to improve the quality of health care utilizing a pre-defined systematic approach. In recent years various groups in The Netherlands took initiatives to maintain and improve quality of care in dentistry.

Empirical and normative aspects of medical technology assessment. The case of reduced-size liver transplantations with living donors.

Medical technology assessment deals with the evaluation of novel or existing health care procedures. This paper addresses the interdependence between factual and normative issues, using the controversies about acceptability and desirability of reduced-size liver transplantations with living donors as example.

[Osteoporosis and jaw bone reduction].

The relationship between osteoporosis and residual ridge reduction has been investigated in many studies. As a result it can be concluded that it is not easy to measure the extent of osteoporosis of the jaws. Several studies have shown that individuals with general signs of osteoporosis do not necessary have an osteoporotic mandible or maxilla.

["Prosthetic condition" and satisfaction with dentures].

This study introduces the concept of 'prosthetic condition', combining the professionally assessed complete denture quality and quality of the residual alveolar ridge. In a group of 397 complete maxillary and mandibular denture wearers the prosthetic condition was assessed and the denture satisfaction recorded. The total prosthetic condition (maxillary and mandibular combined) was good in 225 (57%), moderate in 81 (20%), and poor in 91 (23%) subjects; the mandibular prosthetic condition was good in 155 (39%), moderate in 148 (38%), and poor in 94 (23%) subjects; 297 (75%) subjects were satisfied with their dentures.

[Treatment planning. Learning to solve complicated dental problems].

The importance of comprehensive care treatment planning in dental undergraduate and graduate curricula has long been underestimated. With a decreasing prevalence of dental diseases an increasing interest in the subject has been recognized. Comprehensive care treatment planning requires a strategic approach to resolve a patient's problems in a logical sequence and at a a priori estimation of treatment time and costs.

[The condition of crowding and spacing. Measuring or estimation?].

Two methods for the assessment of the amount of crowding or spacing (measuring and assessment by eye) are compared. Both methods are well comparable and reproducible. Assessment by eye has the practical advantage that it takes considerable less time.

[Dental curriculum in Nijmegen].

The dental curriculum at the University of Nijmegen is based on what the dentist should know and be able to do after his graduation. The programme is divided up into cognitive, behavioural and motoric modules. These modules are vertically connected through subsequent course years by thematically related lines.

[Xerostomia in the elderly: causes, consequences and treatment possibilities of dry mouth].

Xerostomia is in most cases caused by a decrease or discontinuity of salivation (hyposalivation). A physiological decrease in salivary gland function is not the main cause of hyposalivation. According to recent publications the general state of health plays a major role.

The hyperreality of clinical ethics: a unitary theory and hermeneutics.

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics.

[Efficient preventive dentistry. Concluding article].

In this concluding article by the Dutch Advisory Council on Prevention of Oral Diseases, the relative importance of various aspects of prevention is sorted out. A guideline is presented to dentists, dental hygienists and oral health educators, regarding the contents of an efficient and comprehensive package of basic preventive measures. Subsequently, supplementary measures of prevention are discussed, which should be considered for certain age categories and high-risk groups.

[Oral hygiene: effective and safe].

Daily oral hygiene is a matter-of-course. However, many people disregard the difficulties of effective cleansing of the dentition and need to be made aware of the problems; in everyday practice, more attention must be given to detailed individual instruction and recall. A systematic order of cleansing, the use of the proper instruments in the proper way and particularly the avoidance of traumatic forces are important to prevent damaging side effects, such as gingival recession, abrasion and erosion.

[Performance of family practitioners according to the guideline otitis media acuta of the Dutch College of Family Practitioners].

Objective: To establish to which degree the guidelines of the Otitis media acuta standard of the Netherlands college of general practitioners (NHG) are followed in practice and what is GPs' opinion of them.

Design: Survey.

Setting: 65 general practitioners settled throughout the Netherlands.

[Jawbone reduction in immediate prostheses. A comparison between overdentures and complete dentures].

In a randomized controlled clinical trial 74 patients who required immediate dentures were randomly treated with immediate overdentures on 2 lower canines or immediate complete dentures. Mandibular bone reduction was measured using oblique lateral cephalometric radiographs made at base-line and the results compared with those of one year and two years after denture treatment. Analysis of the data showed that the average bone reduction in the lower canine regions in the first year was 0.

[Family stress for parents of girls with precocious puberty].

This study addresses whether precocious puberty influences the child-rearing practices of parents. Three patients groups, girls with idiopathic precocious puberty, with premature thelarche and with premature pubarche were studied. These groups were compared with each other, and with reference groups of 'normal' school children and children referred for asthma or referred for behavioural problems.

[Homes for the aged: a source of increasing concern? (5). The last stage of life].

The object of this study was the physical and psycho-social functioning of residents of an old people's home in the last period of their life. Because of the size of the sample, it was possible to distinguish residents who died before from residents who died after changes in the organisation had been implemented. All residents declined physically over the last eight months or over the last twenty months before dying.

[Effects of support groups for caregivers of aged patients with dementia at home: a literature review].

In the early years of the support groups for caregivers of dementia patients, publications mentioned very positive evaluations and effects of the groups. In the second half of the eighties, nine studies with a methodologically better design, showed that despite the positive evaluations by participants, the groups seem to have no or little effects on general dimensions as burden, well-being and health of participants. But this is probably in part caused by methodological problems and it can be assumed that in some categories caregivers, especially those who are severely burdened and depressed, positive effects do occur.

[Treatment of (pre)-edentulous patients. After care and directives].

It can be expected that the percentage of edentulous people wil decrease in the coming decades as a result of an improved oral health, whereas the number of edentulous people will not decrease as a result of the strong increase of the ageing population. If the preservation of the natural dentition is no longer possible, the remaining teeth of a mutilated dentition have to be extracted according to some specific principles. But also the aftercare of the edentulous patient has to be extended according to some specific guidelines, within the framework of the so-called "preventive-prosthetic-treatment-strategy".

Does addition of low-dose flupentixol enhance the analgetic effects of low-dose amitriptyline in somatoform pain disorder?

In a double-blind, crossover study, the effects of 75 mg amitriptyline alone during 5 weeks on pain intensity were compared with the effects of a combination of 75 mg amitriptyline and 3 mg flupentixol during 5 weeks in 34 patients with somatoform pain disorder. Both treatments resulted in a statistically significant reduction in pain. However, pain reduction in the combined treatment did not differ from that in the treatment with amitriptyline as a single drug.