A growing number of patients go to orthodontic practices to receive orthodontic re-treatment, but their reasons for seeking re-treatment are uncertain. By means of a standardized questionnaire this study investigates the patients’ experiences with the initial orthodontic treatment, applied retention procedures, and the patients’ expectations and motivational reasons for re-treatment. In total 100 patients were asked to complete the questionnaire, 88 of them actually filled it out. The study subjects showed an above average educational level, with a considerably higher percentage of females than males seeking retreatment. Fixed appliances were used most frequently during the first course of treatment and most patients had been fitted with a removable retention plate or fixed retention wire at the conclusion of their first treatment; almost 40% of the patients did not receive any kind of retention appliance. Patients sought re-treatment mostly on their own initiative, as opposed to their initial treatment, when they were mostly referred by dentists or orthodontists. This revealed itself in patients’ high levels of motivation for re-treatment. Moreover, patients appeared to have realistic impressions of the time and cost involved in re-treatment.

The capacity for dental treatment under general anaesthesia is limited. Clearly, the demand for treatment exceeds the supply. A written questionnaire completed by all 403 patients who were treated in 2003 in a centre for special dentistry under general anaesthesia, or their parents or carers, revealed that the median time between referral and the first consultation was 8 weeks. The median time between the first consultation and treatment was also 8 weeks. The waiting period for children was longer than that for adults, with that for 4- and 5- year-olds the longest of all. During the waiting period, 43% of the patients developed complications, such as oral pain and problems with eating and sleeping. Children developed complications more often than adults. With every week of waiting, the likelihood of children developing complications increased by 6.7%.

The guiding principle in postgraduate programmes is to enable dentists to build on and extend the competencies acquired in the basic academic programme. This requires the examination and treatment of sufficient numbers of patients. Given the incidence and prevalence of temporomandibular disorders and orofacial pain, basic academic training will be limited to referral or to diagnosing and treating acute and noncomplex cases, whereas the specialist in temporomandibular disorders(TMD) will focus especially on chronic temporomandibular disorders and orofacial pain, in a multidisciplinary setting. In case of orofacial pain, the general dental practitioner is the obvious person to determine if there may be odontogenic causes. The specialist in TMD can either advise the general practitioner or coordinate the patient’s care him- or herself. In order to be able to perform well within a (partly medical) multidisciplinary setting there is a need for differentiated education, above and beyond the basic academic curriculum. The competencies of the specialist in TMD should comprise care in a broad sense, providing evidence-based care and educating patients, being able to work well within an organization, clinical reasoning and professional development through life-long learning and teaching. The specialist in TMD may either work in private practice or in special dental care clinics.

In a pilot study, the masticatory function of patients with juvenile idiopathic arthritis was studied. The chewing efficiency and maximum bite force were measured in five adult patients and compared with a control group consisting of healthy individuals. The chewing efficiency of the patients with juvenile idiopathic arthritis was statistically significantly compromised compared to that of the control group. The maximum bite force was not statistically significantly smaller within this small group. The results of this pilot study support the hypothesis that the masticatory function of patients with juvenile idiopathic arthritis is compromised.We concluded that a more extensive study is necessary to investigate the masticatory function of patients with juvenile idiopathic arthritis and to evaluate the consequences with regard to the quality of life.

On the basis of the dissertation ‘Sarcomas of the jaws’ from 1982, developments in the imaging and treatment of osteosarcoma in general and of jaws in particular are discussed. The majority of osteosarcomas is found outside the craniofacial skeleton (extracraniofacial). The most frequent primary sites are the distal femur and proximal tibia. Most of these patients are children and adolescents. Only 5% of all osteosarcomas is found within the craniofacial skeleton, especially the jaws. Usually these patients are older. During the past 30 years the treatment of extracraniofacial osteosarcoma has changed from being purely surgical to being surgical in combination with multidrug, multicycle chemotherapy within prospective trials; the 5-year survival rate has risen from 10-20% to 60-70%. For craniofacial osteosarcomas such studies are missing and there is no unanimous opinion about the benefits of chemotherapy. In this group the 5-year survival rate has risen from 25-40% to 60-80%. Factors associated with a good prognosis are tumour size < 4 cm and tumour free resection margins. Developments in imaging have made improvements in preoperative evaluations possible. A plea is made for a prospective study.

A 72-year-old woman was referred to a department of oral and maxillofacial surgery because of a unilateral skin eruption of the face after extraction of the right first upper molar, a few days earlier. She had been diagnosed with chronic lymphocytic leukaemia some years before. It appeared to be herpes zoster or ‘shingles’ from the second branch of the trigeminal nerve. Treatment included hospital admission with intravenous antiviral therapy and analgetics. Herpes zoster of the face is a severe infection and requires early treatment. Post herpetic neuralgia is a serious complication of herpes zoster and may adversely affect the quality of life.

Ecstacy is a frequently used drug, especially by young adults in the big cities. Therefore, it is likely that dentists might be confronted with individuals that use XTC. This review of the literature describes the systemic and oral effects of XTC. Life-threatening complications include hyperthermia, hyponatreaemia and liver failure. In addition, psychotic episodes, depression, panic disorders and impulsive behaviour have been reported. Oral effects include mucosal changes, xerostomia and an increased risk of developing dental erosion and bruxism. Finally, the potential use of saliva for detection of XTC is discussed.