A mesiodens is often diagnosed coincidentally during a radiological examination. However, a mesiodens may also be diagnosed in relation to a clinically identified central diastema and an eruption disturbance, or a rotation of a central incisor. In this study of a group of 162 children and adolescents varying in age from 4 to 18 years, with a mesiodens, the frequency of position abnormalities, diastemas, and eruption disturbances of the maxillary frontal teeth was registered retrospectively. One or more of these complications was diagnosed in 72% of the patients. Usually, removal of the mesiodens in children and adolescents results in spontaneous recovery of the complications. Early diagnosis and early treatment are therefore important.

As part of a broader study of the restorative care index of 5- and 6-year-olds and 11- and 12-year-olds, a sample study was carried out among 1,361 dentists, who were surveyed by means of a web-questionnaire concerning this issue. In total 447 dentists (33%) filled in the questionnaire completely. Concerning the development of dental care of children, opinions differed widely: 46% of those questioned spoke of an increase in the incidence of caries during the past 5 years and 44% reported no change. Furthermore, dentists hold different views on the treatment of the primary dentition. There was no consensus of opinion about the necessity of treating caries in young children and there was a comparable lack of agreement about how and when treatment should be given. The majority of dentists express a need for support in their practice (possibilities for referral, protocols, informational material) concerning routine oral examination, the preventive and/or curative treatment of (young) children.

The maintenance costs for implant-retained overdentures are the subject of this study. A Pubmed Medline search was performed on the basis of the combination of the mesh terms ‘maintenance’, ‘implant’ and ‘overdenture’. Eventually 85 publications were identified that met the initial selection criteria. For a subsequent selection, maintenance had to be the primary outcome measure, an observation period of 5 year or more was required and it had to be possible to capitalise the maintenance costs. Four articles remained as a result of this filtering procedure, 2 of which came from Dutch institutes. The findings were reasonably consistent. The structural costs for maintenance of implant-retained overdentures during the first 10 years was estimated at 1.400 Euro. It is expected that an overdenture on implants in the mandible will be replaced after a mean period of 12 years. For both outcome measures considerable individual variance applies.

The treatment of dental caries can be approached from more perspectives than just restoration. At a recent congress of the Dutch Society of Paediatric Dentistry and the Dutch Society for Dental health of the Disabled, various visions for the treatment of caries in young children were extensively discussed. This article is a report on congress papers concerning the (im)possibility of preventive approaches, the prerequisites for restorative care and the complications and obstacles in treatment. In the case of all selected strategies, it appears that the strong cooperative support of (the parents of) the patient is necessary, whether it is preventive or only restorative or a combination of the two. It also became clear that the Dutch approach to the deciduous dentition leaves room for structural improvement, for example by an expansion of dental health care for the youngest group.

A 45-year-old woman attended a centre for special dental care. Initially, it seemed that the patient suffered from an extreme form of dental anxiety. However, the fact that she displayed ‘dissociations’ suggested that she had a severe psychiatric disorder, in this case Dissociative Identity Disorder. The key feature of this condition is a dysfunction of the normal integrative functions of identity, memory and consciousness. In such instances it is recommended to contact a psychologist or psychiatrist and the referring care provider to consider the consequences of the psychiatric condition regarding informed consent, treatment plan and actual treatment. Because it was not likely that the patient would respond to an intervention specifically aimed to reduce anxiety in the dental setting, dental treatment under general anesthesia was the best suited option.

The revised practice guideline ‘Bacterial skin infections’ developed by the Dutch College of General Practitioners replaces the previous practice guideline from 1998. Most bacterial skin infections can be diagnosed based on the patient history and clinical findings. Skin cultures and serologic analysis (in the case of erythema migrans) are not necessary. Exceptions are made for patients with bacterial skin infection and a high risk of MRSA involvement, or if nasal treatment is indicated for patients with recurring furunculosis. A superficial skin infection can be treated with local therapy. In case of a deep skin infection, oral antibiotics or surgical intervention is recommended. Antibiotic prophylaxis after a tick bite is not recommended. Erysipelas is considered a specific type of cellulitis and is treated as such.