Assertive patients will, in the future, more readily appear with their own diagnosis. As a result, dentists will more often be confronted with sometimes rather unusual requests from patients. An extreme request from a patient is the removal of (all) teeth. The central issue in this article is how to deal with such a request. The conclusion is that the patient’s autonomy is limited by the professional standards of the dentist and the patient’s capacity to assess in a reasonable way what is in his own best interests.

A bipolar disorder is a mood disorder characterized by recurrent occurrences of manic, depressive or mixed episodes, separated by shorter or longer relatively symptom-free periods. In the Netherlands, the incidence of bipolar disorders is 1.9%. Bipolar disorders are usually treated with a combination of psycho-education, self-management and pharmacotherapy. Both the bipolar disorder and the drugs for treating this disorder have negative effects on oral health. Patients have, among other things, an increased risk of caries, xerostomia, taste abnormalities and bruxism. Extensive instruction in oral hygiene, supported frequently by professional oral health care, is therefore essential. Considering the possible interaction among different kinds of drugs, NSAIDs should only be prescribed after consulting the patient’s psychiatrist.

A 56-year-old woman was referred to an oral and maxillofacial surgeon because of facial stiffness and restricted mouth opening, 13 years after receiving multiple mandible fractures in a car accident. After clinical investigation and computer tomography, ankylosis of the right temporomandibular joint was diagnosed. The patient was treated by means of gap-arthroplasty, in which a myofascial flap of the temporalis muscle was used as an interposition transplant. After a period of physiotherapy, an acceptable recovery of the mouth opening was achieved. Traumatic injury is by far the most prevalent etiology of temporomandibular joint ankylosis, followed by an infection of the temporomandibular joint. Treatment consists basically of a gap-arthroplasty, with or without interposing a transplant between the ramus mandibulae and the joint socket or resection of the ankylotic tissues followed by reconstruction of the mandibular caput with an autologue transplant or an alloplastic material.

Gingival enlargement commonly occurs in patients treated with fixed orthodontic appliances. In a study, 25 patients were monitored during and after treatment with fixed orthodontic appliances. The extent of the enlargement of the gingiva was determined by means of intra-oral photographs made shortly before the placement of the appliances, immediately after their removal and at 3 and 6 months after the appliances had been removed. The enlargement of the gingival was determined using a Visual Analogue Scale. During orthodontic treatment the average degree of gingival enlargement increased significantly. After removal of the appliances a significant decrease in the degree of gingival enlargement occurred. Within 3 months after debonding the gingival enlargement was at the same level as before starting the orthodontic treatment. The conclusion was that the enlargement of the gingiva that takes place during treatment with fixed orthodontic appliances was reversible.

In 2008, in a workshop of the European Federation on Periodontology, a consensus was reached concerning oral peri-implant infections on the basis of the state of the art in the relevant sciences. Important conclusions were that peri-implant mucositis occurs in 80% of subjects with oral implants, and that peri-implantitis occurs in 28-56% of subjects studied. Important risk factors for developing peri-implant infections seem to be insufficient oral hygiene, a history of periodontitis and cigarette smoking. There are insufficient research findings available to support a definitive conclusion about the role of genetic factors, diabetes mellitus, alcohol consumption and implant surface properties. Mechanical treatment in combination with antimicrobial oral mouth rinses may be effective in the treatment of mucositis. No evidence has been found that mechanical treatment of peri-implantitis is effective. To control the infection of peri-implantitis, surgical treatment, often in combination with the use of local or systemic antibiotics, is necessary. Validated protocols for the treatment of peri-implant infections are not available due to lack of clinical scientific evidence.