Halitosis is a frequently occurring problem, the cause of which is generally to be found in the mouth. The challenge for oral health care providers is to diagnose it correctly and treat it effectively. Differential diagnosis is of great importance in making a distinction between halitosis which originates in the mouth and which does not originate in the mouth. Oral halitosis can be treated effectively by good oral health care. Plaque accumulation on the tongue is the most common cause of oral halitosis. Tongue cleansing, possibly in combination with a specific mouth wash, is consequently recommended as an element of oral hygiene care. Other oral health problems, such as periodontal disease, caries and ill-fitting removable dentures should be treated adequately to eliminate these problems as potential causes of halitosis.

A 42-year-old patient with cardiac problems had periodontal disease. The required periodontal treatment was only carried out after a period of 6 months. During this time, the patient was at risk of endocarditis due to a bacteraemia, a problem which was not recognized by any of the oral healthcare providers. When treating a patient who is at risk of developing endocarditis, the guidelines of the Dutch Heart Foundation (Nederlandse Hartstichting) must be observed. Deviation from the guidelines is only permissible under appropriate conditions. If treatment is being carried out by a team, then there is not only a question of shared responsibility, but also of shared liability. Adequate communication and record-keeping are vital in cases of patients who are medically compromised.

The provision of complete removable dentures can, in legal terms, be defined as a commitment to perform the best of one’s abilities. Indeed, the result or patient’s satisfaction with the new dentures, is difficult to predict and is apparently not only dependent upon the dentist/denturist   and variations in materials and techniques. The relationship between the dentist/denturist and the patient is complex, but influences to a large extent patient satisfaction. This is especially true in cases of patients with reduced residual alveolar ridges or other (oral) problems. When a complete removable denture is being prepared, the patient should be thought of as the dentist/denturists most reliable contributor. By way of preventing or preparing for possible legal procedures, a good patient record is of importance. The patient record should contain the information which the patient has provided, the patient’s request for help, and the character of the patient’s expectations for treatment.

Frail older people who wear complete dentures may have denture-related complaints which are more pronounced due to their somatic, psychological and/or social problems. On the other hand, it often happens that serious complaints are not or cannot be expressed. In those cases, members of the individual’s social network or care providers may request treatment. According to the authors’ experience, managing technical denture disorders by carrying out standard treatments or inserting oral implants is not always successful. Basic principles of providing oral healthcare to frail older people are: restraint in carrying out treatments, avoiding standard treatments, taking into consideration the limited adaptability of older people, continuous awareness of one’s own functioning in the decision-making process, and paying attention to the role of family members, voluntary and professional care providers, and physicians.

Patients with an edentulous mandible often have difficulty retaining conventional dentures. It was formerly the case that, as a rule, 4 implants were placed in the interforaminal area of the mandible in order to provide retention for the mandibular denture. A large body of research, however, revealed good results with 2 implants with various mesostructures. The 2 implant overdenture in the mandible has since become standard for edentulous patients. Research results indicate that this treatment should be the primary option under certain conditions. The appropriate types of care which are indicated by these conditions should, however, be carefully distinguished. Under certain anatomical conditions, such as a low and narrow alveolar ridge, exposed mandibular nerves, very low density alveolar bone (Class IV bone) and very sensitive mucous membranes, 4 implants are indicated. Patients who are less manually dextrous might be better served with 2 implants and a single mesostructure.

In removable complete dentures, the occlusal vertical dimension is an important factor for patients’ satisfaction with aesthetics. An excessively reduced occlusal vertical dimension is especially likely to lead to complaints about aesthetics, whereas an increased occlusal vertical dimension may lead to discomfort and a decision not to wear the complete dentures. There are various methods for determining the occlusal vertical dimension in complete dentures, based on the vertical dimension in the rest position of the mandible or on phonetics. However, none of the methods have proven to be clearly superior, in terms of reliability, than the others. The assessment of the occlusal vertical dimension will become more reliable if several methods are used simultaneously. Moreover, knowledge of the characteristics of the ageing face is essential.

Fabricating removable complete dentures is a rather complicated treatment. The quality of the care delivered is broadly determined by 2 factors: the technical result and the way in which the individual patient experiences and evaluates the treatment. Healthcare professionals who carry out this treatment are subject, with respect to their capability, to the Dutch Individual Healthcare Professions Act. In cases of persisting complaints or problems, edentulous individuals are often treated with an overdenture on oral implants. Several oral healthcare providers are then involved in the treatment. In order to clarify procedures, a trajectory of care is presented in which all of these oral healthcare providers are located. It is expected that the number of edentulous individuals will decline and that the degree of treatment complexity will increase. To guarantee future efficiency and quality of care delivery, a number of regionally distributed national centres of expertise should be established.