The number of children with cleft lip and/or palate needing care in and the possibilities of care delivering to these patients by multidisciplinary teams are described. The data are compared with data from other European countries. The improvements in quality of care and patients are elucidated by research data.

The American Academy of Pediatric Dentistry is regularly publishing updates of protocols and guidelines. This article is a Dutch summary of and comment on a special issue of the journal Pediatric Dentistry with evaluated protocols and articles on guidelines for dentists. The protocols have been adapted to modern insights, but not very practical described. To use these protocols and guideliness in Dutch pediatric dentistry, it is advocated to take into consideration the individual childs age and behaviour and to base ones strategies on data of randomized clinical trials.

In 1979 the thesis ‘The dentist and patient education’ was published. Based on theory and research, it was the aim of the thesis to provide physicians, dentists, dental students, and dental hygienists theoretical and practical tools to be of assistance in daily patient education. During the last 25 years the insights in patient education and shared decision making were further developed. Two literature studies were published in books. Some research projects were carried out and published in articles. Nowadays, individual based patient education is an essential part of dentists’ and dental hygienists’ daily work. When compared with the period 1970-1985, at present, multimedia campaigns on oral disease prevention are extremely scarce. Communication skills of dentists appeared to be strongly related to patients’ satisfaction of oral care delivery. In the Netherlands, the ethical principle of informed consent has been legislated in 1995 and, as a consequence, activities in the field of patient education are more juridically characterized.

A 51-year-old man was referred to an oral and maxillofacial surgeon because of persistent complaints after endodontic treatment of tooth 22. Apical endodontic surgery was performed and periapical tissue was examined histopathologically, showing an osteosarcoma. In retrospect, signs of malignancy were already present on the radiograph taken prior to the endodontic treatment.

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.