If there is no indication for tooth removal purely based on dental criteria, but the patient requests for removal due to fear of dental treatment, or because of a mental disorder such as posttraumatic stress disorder, a somatoform pain disorder or a disorder of body image perception, then the question is whether the patient is mentally competent to make this decision. In case of a tooth removal request on psychopathologic basis, a dentist has to refuse to carry out such treatment, but he should make an effort to help or guide the patient in some other way.

A 32-year-old female patient was referred to an oral and maxillofacial surgeon with an asymptomatic swelling in the left mandibular premolar region. After extraction of these premolars and enucleation of the lesion histopathological examination confirmed the presence of a giant cell granuloma. This is a benign lesion and enucleation generally results in a permanent cure and is only recurrent in a few cases. Approximately 1 year after treatment, the patient was still free of recurrence and together with a prosthodontist, the appropriate rehabilitation of the resulting defect will be sought.

The impaction of permanent maxillary canines occurs frequently. In recent decades, research has led to 2 methods of treatment: the modified window technique and the closed eruption technique. Although these methods have been described in detail, it is still not clear which method is most effective. In a study involving 73 orthodontic patients with an impacted, palatally displaced permanent maxillary canine, this cuspid was exposed by means of a gingival flap and an orthodontic bracket was immediately fixed on the exposed canine, after which the gingival flap was repositioned using sutures. The patients were clinically and radiographically examined 3 months after the orthodontic treatment. In a control group consisting of 93 orthodontic patients, there were no cases of impacted permanent maxillary cuspids. The overall success rate for the treatment in the study group was 63%. Problems in adjacent teeth were correlated significantly with older age among the patients. There was a significant difference in the number of pockets around the teeth adjacent to the canines in the study group and in the control group.

In the thesis ‘Barriers to effective periodontal care’, published in 1984, an investigation was described on professional periodontal care lagging behind the development of periodontology. The objectives of the investigation were to assess whether dentists were treating periodontal disease as a behavioural problem using effective communication techniques, and whether serious periodontal disease had such low frequency that dentists had not the opportunity to become experienced in recognizing the disease. It was concluded that serious periodontal disease had a low frequency and was not influenced by communication on periodontal care. After 25 years, these conclusions are still valid: the percentage of risk patients is still 5-10% and the correlation between seriousness of periodontal disease and periodontal care provided is still limited. Not all dentists do have affinity to periodontal care, but they do have affinity to practical aspects, such as removing dental calculus deposits. A classification of obvious recognizable diseases and treatments would make periodontal care more manageable for dentists.