Single tooth replacement with a dental implant is an increasingly popular solution in patients with loss of an upper anterior tooth. There is a risk, however, of placing the implant prematurely in youths. In a case series the effects of residual maxillary growth on the results of implant treatment in the anterior maxillary region were measured. The results confirm findings from other studies on this subject and indicate that cessation and degree of vertical growth are unpredictable. This may result in infraposition of the implant and lead to periodontal bone loss around the implant region and its neighbouring teeth. Clinicians should be aware of this and inform their patients that these changes may eventually compromise the aesthetic result of the treatment.

The aim of this paper was to explore the diagnostic and treatment tools for patients who gag during oral health care treatment. Reference to such tools is not available in scientific literature. For diagnostic purposes, a questionnaire was developed. In due course the results of its reliability and validity will be published. As yet there is no preferred method of dealing with the problem of patients gagging. A recommended option to treat the problem is based on a cognitive behavioural perspective with gradual exposure in vivo. In cases of extreme gagging, teamwork of oral health care provider and psychologist seems to be a prerequisite for success.

This study compared the level of distress in children during the application of local anaesthesia by a computerized tool (Wand ) and by a traditional syringe. The influence of childrens mild or extreme anxiety regarding the dental procedure was also determined. 125 Children between the ages of 4 and 11 years old participated in this study. Their discomfort was recorded on videotape and marked on the Venham scale and the Observational Scale of Behavioral Distress at 15 second intervals. Parents rated their childs level of anxiety on the Dental Subscale of the Childrens Fear Survey Schedule. The results indicate that mildly anxious children suffered less distress and showed less muscle tension, verbal protest and body movement during the first 2 intervals when the computerized tool was used. However, the maximum distress score at the moment of injection was similar in both methods. There was no difference found in the level of distress in the highly anxious children.

In January 2002 the International Consensus Workshop on Caries Clinical Trials was organised in Scotland. The meeting was an initiative of both academic and industrial partners, in order to arrive at a consensus about ways to modernise the design of clinical trials for caries preventive agents (Caries Clinical Trials or CCTs). All presentations delivered at the workshop and the consensus statements formulated at the end of the workshop were published last year in a special issue of the Journal of Dental Research. In this paper some important aspects are highlighted and the workshop conclusions are presented.

A dental panoramic radiograph of a 56-years-old Sudanese woman revealed calcifications, which could be attributed to atherosclerotic lesions of the carotid artery. The occurence of these lesions is related to the incidence of cardiovascular and cerebrovascular diseases, such as transient ischemic attack or cerebrovascular accident. Carotid calcifications can be detected in 2 to 3.8% of panoramic radiographs of patients over 50 years of age. If detected early, treatment of the disease and the underlying risk factors can significantly reduce vascular related complications. There is a significant role to be played for dentists in early referral of patients.

Defects in the coagulation system increase the risk of excessive bleeding during and after invasive dental procedures. This increased risk of bleeding is irrespective whether the coagulation disorder is inherited or acquired, for example by using anticoagulant medication. However, the cause of the coagulation disorder dictates preventive measures to be taken. Therefore, a careful medical history is crucial to identify and characterize patients with coagulation abnormalities. Recently, the insight in the mechanism of coagulation has increased considerably. This has resulted in specific procedures to adapt the level of coagulation required for specific invasive dental procedures. The dentist must discuss this temporary alteration of the coagulation level with the medical specialist of the patient.