Consent requirements in the case of adults who are legally unable to give informed consent Based on a published verdict of the Regional Disciplinary Tribunal, the general and special regulations in the Law Governing Medical Treatment Agreements (in Dutch: WGBO) with respect to informed consent are discussed. Patients 16 years and older give consent themselves, after having been informed about treatment; patients from 12 to 16 give their consent together with their parents and parents give consent for patients under 12. Only in cases of patients 18 years or older who are practically (for example, due to coma) or legally (for example, due to guardianship) unable to give consent, do the responsibilities defined in the WGBO have to be carried out by the guardian, the mentor, the partner or the next of kin. It would seem reasonable that in all cases of irreversible dental treatments the express consent is obtained from the legally responsible.

Mandibular fractures are among the most common facial bone injuries. Approximately 50% of the fractures occur in teeth bearing areas. Consequently, the likelihood that a tooth will be in the fracture line is substantial. A review of the literature reveals that there is not a clear guideline for preserving or removing a tooth in a mandibular fracture line. By means of a questionnaire, information was collected about how dental surgeons in The Netherlands deal with this problem. The research sample consisted of 194 active oral and maxillofacial surgeons in The Netherlands in 2005. One hundred and two surgeons responded (52,6%). The response rate was sufficient to allow for reliable deductions and statistical analysis. The results of the questionnaire showed that the respondents were in agreement. Generally, the respondents strove to preserve a tooth in the mandibular fracture line. The respondent’s treatment of a mandibular fracture was in agreement with the state of the art as presented in the current literature. The respondent’s choice of treatment did not depend on age, gender, university clinic at which the respondent was trained to be a dental surgeon, year of registration as a specialist, place of work and position. According to the respondents, the dentist’s role in the aftercare of a mandibular fracture is treatment of the teeth injuries, follow-up of the posttraumatic oral self care, and regularly testing the vitality of the teeth in and around the mandibular fracture line.

Eruption failures in the maxillary frontal region occur during the mixed dentition period. Dislocation and impaction of central incisors are diagnosed during or at the end of the early mixed dentition stage. These failures can be caused by crowding, premature loss of deciduous teeth, trauma or supernumerary teeth. Occasionally, a preventive orthodontic treatment is desirable to release the obstructed eruption path of a canine. Sometimes, a surgical intervention may be indicated to expose an obstructed central incisor and to remove supernumerary teeth. Retention and impaction of canines are generally discovered late in or after the late mixed dentition stage. In the agenesis of the lateral incisors or peg-shaped teeth, there is freuently impaction of the canines. General dental practitioners must be alert for possible deviations in the pattern of change in dentition right from the early mixed dentition period. Conventional two-dimensional radiographs can sometimes unjustifiably suggest a bad prognosis of an impacted tooth. Cone-beam CT scanning, which gives a three-dimensional image, can provide important additional diagnostic information.

Complications occurred in a 41-year-old woman (case 1) following a first attempt to remove a partial denture by oesophagoscopy. These were: laceration of the oesophagus with subsequent mediastinitis, pneumothorax, and pneumopericardium. With a second oesophagoscopy the denture was removed from the oesophagus using a flexible endoscope with a latex hood. Following antibiotic treatment the patient recovered. With a 45-year-old man (case 2) who had also swallowed a denture, the denture initially could not be localized. It was eventually recovered from the gastric antrum using a flexible scope with a latex hood, also in the second attempt. Psychiatric and mentally handicapped patients run a high risk of denture ingestion. Ingested dental prostheses are often radiolucent, and are difficult to visualize using conventional radiological methods. Extraction of the ingested foreign objects can lead to severe complications. This is why in this type of case, we recommend having an expert remove from a foreign object with the use of a flexible scope fitted with a latex hood. It is advisable to make removable dental prostheses radiopaque or to avoid using them with the identified risk-group.

This article presents the case of a 58-year-old woman with diabetes mellitus type 2 who, for one and a half years, had been using paroxetine, a specific serotonin re-uptake inhibitor, to reduce a depression. She complained of xerostomia, dry eyes, and pain of the palate. In the middle of the hard palate a circumscribed, erythemous mucosal lesion was observed. This painful spot had developed, according to the woman, virtually immediately after she had begun to use the medication with paroxetine. The salivary flow rates were reduced when compared with well-known reference values. The diagnosis was hyposalivation. After substitution of paroxetine by lithium, the painful palate and xerogenic complaints disappeared. This case report suggests a causal relationship between, on the one hand, paroxetine and other serotonin re-uptake inhibitors and, on the other, atypical oral pain as well as hyposalivation.