An oroantral perforation can occur with the extraction of a premolar or molar in the upper jaw. Small perforations with a deep extraction alveolus can be treated using sutures only; larger perforations are treated surgically, using a buccal sliding or palatal flap. The distinction between small and large perforations can be difficult to make. As a result, oroantral perforations are usually treated by plastic closure. This pilot study presents a new, simple, time-reducing method for the treatment of oroantral perforations using a biodegradable membrane without primary closure of the wound. Six patients with a positive nose-blowing test after extraction were treated according to the new method. In all 6 patients the oroantral perforation was closed after 2 weeks and each showed adequate wound healing after 6 weeks. More research is needed to confirm the results of this preliminary study and the use of this technique on larger perforations.

The Dutch Drug Bulletin (Geneesmiddelenbulletin) is a monthly journal with a unique approach which, after a hectic period in which its independence and even its right to exist were threatened, has now reached calm water. The continued existence of the Dutch Drug Bulletin is now guaranteed, independently of the pharmaceutical industry, the government, professional organizations and patient organizations. Articles appear in the Dutch Drug Bulletin after extensive consultation among various experts. Conclusions are based on the published (and hence controllable) results of randomized, preferably double-blind, studies with an appropriate control group. Departures from these standards are made only in highly exceptional cases. The Dutch Drug Bulletin determines the place of new drugs amongst the already available drugs and compares their effectiveness and side effects with those of the standard therapy. This approach guarantees that dentists and physicians are kept up to date with respect to developments in the field of pharmacology, without the pharmaceutical industry or the government exerting any influence.

Amyotrophic lateral sclerosis is one of the most severe and disabling diseases of the nervous system. Amyotrophic lateral sclerosis leads to the progressive weakening of the muscles in the arms, legs, face, mouth and trunk. The onset of the disease is insidious, starting with weakness in the hands or feet or with slurred speech. The weakness worsens and patients pass away as a result of weakness of the respiratory muscles on average within 3 years of the onset of the disease. In the Netherlands, approximately 400 patients are diagnosed with amyotrophic lateral sclerosis every year. There is no diagnostic test for this neuro-muscular disease; the diagnosis is established by excluding other disorders that resemble amyotrophic lateral sclerosis. Only one drug is able to inhibit the progression of the disease to any extent: riluzole. Treatment, therefore, is mainly focused on supportive measures and those which enhance the quality of life optimally.

A 90-year old woman attended a department of Oral and Maxillofacial Surgery with a tongue that had been painful for at least 3 months. Clinical examination revealed extensive bullous and ulcerative lesions located on the tongue, the oral vestibule and the buccal mucosa on both sides. A variety of diseases may be causative of ulcerative stomatitis: autoimmune diseases (like Pemphigus vulgaris, Erosive Lichen Planus, SLE or M. Crohn), or a viral, bacterial or mycotical infection, vitamin deficiency, a toxic reaction to medication or an immune deficiency. After an extensive, clinical examination, a definitive diagnosis still had not been achieved. The patient suffered from osteoporosis, for which she used alendronate (Fosamax®). A study of the literature described a possible relationship between the occurrence of oral ulcers and the use of oral biphosphonates. Since a toxic reaction to alendronate was suspected, the use of Fosamax® tablets was suspended. Three months later a complete recovery of the oral mucosa was observed.

In the treatment of patients with an oro-facial anomaly, the functioning of the masticatory system and aesthetic aspects play a role. Recently, the software programme ‘Facial Harmony’, which analyzes the soft tissue contour of the face, appeared. Using this programme, a research project was carried out to find out if the result of the surgical treatment of 40 patients with an oro-facial anomaly satisfied the facial harmony requirements. Only 65% of the treatment results met the requirements. It was especially the patients who had been treated for mandibular deficiency with mandibular and horizontal lines meeting at a wide angle who showed no facial harmony. Only 30% of those patients demonstrated facial harmony postoperatively. If the surgical treatment had been completed by a genioplasty, this percentage would very probably have risen to 85.

Oral health care practices are ever more frequently visited by frail elderly people. Frail elderly people are at risk for fall accidents due to intrinsic and extrinsic factors. Intrinsic factors are patient-related and extrinsic factors are environment-related. Significant intrinsic fall risk factors for elderly people are orthostatic and postprandial hypotension. The most important effect of hypotension is cerebral hypoperfusion, which can induce syncope and fall. Five to ten per cent of fall accidents of elderly people result in trauma. A serious trauma with possible extreme consequences is hip fracture. One year after a surgical hip fracture treatment of elderly people, 25% are experiencing mobility impairment and 25% have died as a result of co-morbidity or complications. Fall prevention deserves serious attention. Provision of information and strengthening and protecting bones are important prevention measures. In an oral health care practice, general risks of falling must be inventoried on a regular basis, and each (frail) elderly patient should be provided with individual fall-prevention guidance.