The spleen plays a significant role in the defence against infections, especially infections caused by encapsulated bacteria, such as Streptococcus pneumoniae. In case of (functional) asplenia, a fulminant sepsis with a high mortality rate may develop in a short time. Preventive measures are therefore recommended for people without a spleen or who have a dysfunctional spleen. A dysfunctional spleen may be present in diseases such as sickle cell anaemia, ulcerative colitis, Crohn’s disease and coeliac disease. Preventive measures consist of vaccinations, antibiotics and patient education. Unfortunately, however, it has been shown that these preventive measures are not adequately followed. Currently, a Dutch guideline for healthcare providers is being developed.

A 26-year-old man was suffering from pericoronitis of his mandibular third molars. To determine the position of the mandibular canal in relation to the roots of the third molars, a panoramic radiograph was made. The radiograph revealed at the right side a bifid mandibular canal and the upper part of the canal seemed to be related to the third molar. Additionally, a cone beam CT was made, which revealed a bifid mandibular canal at the left side and a trifid mandibular canal at the right side. Anatomical anomalies of the mandibular canal may have clinical implications, such as an increased risk of injury to the inferior alveolar nerve in case of removing a mandibular third molar and inadequate local anesthetics. Trailer home De centrale reuscellaesie is een weinig voorkomende benigne tumor die zich veelal in de premolaar- en molaarstreek van de mandibula manifesteert als een blauw-doorschemerende, pijnloze zwelling.

A 41-year old man was admitted to a university medical centre with a belly ache, bloody diarrhoea and fever with peaks rising up to 39° C. The differential diagnosis included among others infectious bowel disease, tuberculosis and amoeba- infection. After the exclusion of other pathologies the diagnosis morbus Crohn was given. A few days later the patient complained about toothache and severe periodontal disease was diagnosed. Instantly after extraction of the entire dentition the fever disappeared.

In recent years various studies have been published which indicate that adverse events in health care facilities are the result of structural factors. In 2009 a national study was carried out in the Netherlands to gain insight into patient safety in primary care settings, including general dental practices. In 20 randomly selected practices, patient records were investigated and oral care professionals reported, during a period of 2 weeks, adverse events which occurred. For each practice, 2 researchers screened, with the help of a checklist, 50 randomly selected patient records covering a period of 1 year. A total of 8 preventable adverse events were found in the 1000 patient records (0.8%). Anonymous reports made during the 2 weeks of the research period resulted in 7 adverse events. Practically all of the adverse events had to do with diagnostics and treatment and resulted in limited harmful consequences for patients. On the basis of these results, oral care in general dental practice would appear to be safe, but the concept ‘patient safety’ is not at all or only minimally active among general dental practitioners. Regarding patient safety performance, improvement in the quality of record-keeping would be desirable.