Patients with orofacial pains are generally treated by physicians. A small number of patients are treated for pain in the temporomandibular joint, the masticatory and the neck muscles, by dentists and orofacial surgeons. Among half of the patients being treated in neurological headache clinics, the temporomandibular joint and the masticatory muscles are the source of the pain. In order to achieve better research and a classification, the International Headache Society, consisting largely of neurologists, developed a classification system. A comparable development occurred among oral health specialists. Employing these 2 methods with the same patients leads to different diagnoses and treatments. Both the International Classification of Headache Disorders II and the Research Diagnostic Criteria for Temporomandibular Disorders are being revised. This creates the opportunity to establish a single classification for these orofacial pains, preferably within the new International Classification of Headache Disorders.

The oral mucosa is frequently exposed to mechanical forces, which may result in tissue damage. Saliva contributes to the repair of the oral mucosa in several ways. In the first place, it creates a humid environment to improve the function of inflammatory cells. During the last few years, it has been shown that saliva also contains a large number of proteins with a role in wound healing. Saliva contains growth factors, especially Epidermal Growth Factor, which promotes the proliferation of epithelial cells. Trefoil factor 3 and histatin promote the process of wound closure. The importance of Secretory Leucocyte Protease Inhibitor is demonstrated by the fact that in the absence of this salivary protein, oral wound healing is considerably delayed. Understanding these salivary proteins opens the way for the development of new wound healing medications.

Late in the last decade of the previous century, an orthodontic-surgical treatment was elected for a 31-years-old woman, who had severe malocclusion and temporomandibular complaints. The skeletal pattern (high angled mandibula) and degenerating joints were considered risk factors for relapse and condylar lysis. Nevertheless, the severity of the malocclusion justified the treatment. The goal was a stable occlusion and the creation of a smooth articulation to eliminate dysfunction and facilitate later temporomandibular joint treatment with splints if necessary. In the 1990s this was consideredstate of the art treatment. Eliminating the scissors bite of 27 seemed instrumental in the eliminination of the symptoms. Surgery brought the face and the occlusion further in harmony. The final occlusion features only one lower incisor.

A swelling in the neck is often caused by one or more enlarged lymph nodes, usually due to a harmless disorder. Particularly in adults, a swelling in the neck may represent a metastasis of a malignancy in the head and neck region, for instance a squamous cell carcinoma arising from the oral mucosa. Palpation of the neck can provide valuable information, although its reliability is restricted, even when executed by an experienced clinician. Therefore, additional examination is required, for instance by fine needle aspiration cytology, ultrasound examination with or without guided fine needle aspiration, computertomography and magnetic resonance imaging. In case a malignant tumour has been diagnosed in the upper aerodigestive tract, a sentinel node procedure may be performed. The question arises whether general practicing dentists should examine routinely every patient’s neck, or only the necks of patients older than 40 years of age.

In order to determine the effects of a new approach to preventive oral health treatment for forensic psychiatric patients, 3 studies were carried out using a Dutch version of the Oral Health Impact Profile-14 (OHIP-14-NL), among Dutch forensic psychiatric patients. In the first study, it was determined that the psychometric characteristics of the OHIP-14-NL were good and that attention to oral healthcare contributed positively to quality of life. The second study, which made use of an improved version of the OHIP-14-NL indicated that patients with a high level of anxiety for dental treatment and poor oral health reported a lesser quality of life. The third study showed that an effectively carried out programme of personal oral care can play an important role in the reduction of halitosis and in the improvement of quality of life. Moreover, it appeared that the retrospective version of the OHIP-14-NL was a useful method for determining the correlation between quality of life and oral health and for evaluating change therein within a relatively short period of time.

‘Dentures: a question of grinning and bearing it’ is not just the title of a 25-year-old thesis, but it also reflects the content well. Dissatisfaction with complete dentures is not only determined by the quality of the dentures and the oral conditions, but also and just as much by the patient’s capacity to adapt to and accept the dentures. In order to treat an edentulous patient adequately, an oral healthcare provider should pay special attention to these aspects. After 25 years of further scientific study, this conclusion is still true. The current care standard for edentulous patients with atrophy of the residual mandibular alveolar ridge is an overdenture supported by 2 implants. For edentulous patients with a solid residual mandibular alveolar ridge, conventional complete dentures are the first choice of treatment. Only in cases of obvious remaining complaints, should an implant-supported overdenture be considered.