In this article the principles of child oral health care in the Netherlands and the consequences of cariological principals of oral health care delivery to children are described. First of all the age of the child plays a very significant role in decisions concerning prevention and restoration. In addition, the combination of a positive attitude on the part of the dentist and a pain-free treatment can prevent fear of treatment and avoidance behaviour of the children. In the treatment of carious lesions, moreover, the oral health care provider should consider to what extent the problem is related to behaviour and fits in the multi-factorial caries model. Restorative treatments should be considered as supporting prevention, reducing caries activity and eliminating the effects of neglected oral health care. Prevention has to be seen as an essential element of the treatment model and it should start early from the standpoint of habit formation and the rapid demineralization process in the deciduous dentition which results from failed preventive care.

A 61-years-old woman had macroglossia due to acromegaly with complaints of dyspneu at a lying sleeping position and complaints of speech and dysphagia. At the age of 55 years she was diagnosed with acromegaly induced by a adenoma of the pituitary gland, which had been removed surgically. The treatment of macroglossia included tongue reduction, removal of the remaining mandibular teeth with severe periodontal attachment loss, huge reduction of the residual alveolar ridge, immediate implant insertion, fabrication of implant- supported overdentures, and logopedic treatment. The speech improved significantly and the patient could sleep again in a lying position. Clinically, acromegaly is diagnosed on clinical signs, such as the morphology and the protrusion of the tongue. Often, macroglossia is a secondary symptom of a systemic disease, needing causal treatment. If surgical reduction of the tongue is indicated, also enlargment of the oral cavity should be considered.

A 4-year old girl was referred with a chronically enlarged left cervical lymphadenitis of the neck. This swelling appeared to be caused by a Mycobacterium avium infection. Mycobacterium avium belongs to the group of nontuberculous mycobacteria. These micro- organisms can cause a cervicofacial lymphadenitis in children in the head and neck region. The children are healthy, and are seen to have a submandibular or preauricular swelling. Early recognition of the disease is important because it gives the best chance that treatment will result in a successful outcome.

Tooth development disturbances following haematopoietic stem cell transplantation
Forty children treated with allogenic haematopoietic stem cell transplantation for haematological malignancies, were examined at least 2 years after transplantation. The researchers collected information concerning subjective oral symptoms, the results of a panoramic radiograph and the findings of an oral examination. Nearly all children had tooth development disturbances, including missing teeth, shortened roots, and arrested root development. The study group showed a significantly higher prevalence of missing teeth than the standard values for first and second premolars in both maxilla and mandible, as well as for second molars in the mandible. Children younger than 3 years of age at the start of the treatment missed significantly more teeth than older children. The mean root-crown length ratios of several tooth types were lower when compared with a control group of healthy Finnish children. The mean dental age was higher than the mean chronological age due to early final apical root formation.

Sensory impairment of the inferior alveolar nerve in the region undergoing treatment is an unfortunate complication after the surgical removal of a mandibular third molar. Coronectomy is a treatment in which only the crown portion and part of the roots of the tooth are removed. The apical portion of the roots is deliberately left in place in order to avoid damage to the nerve. In a group of 34 patients, a total of 38 coronectomies was carried out, because these patients had a radiologically determined increased risk of inferior alveolar nerve damage in case of surgical removal. The mean follow-up period was 16.7 months, ranging from 3-62 months. None of the patients experienced sensory impairment of the alveolar nerve in the region under treatment. In the case of 3 patients, roots left in place appeared to cause complaints and were removed after all. The conclusion of the study was that coronectomy seems a useful and safe treatment option.