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Oral care providers frequently prescribe analgesics for the management of dental pain. To get an overview of the analgesics prescribed in the Netherlands from 2016 through 2020, we collected data from the Stichting Farmaceutische Kengetallen (foundation [for] pharmaceutical indicators). Annually, more than 300,000 analgesics are prescribed by dentists in general practice and dental specialists. The largest group concerns NSAIDs (88%), followed by weak opioids (9%), acetaminophen (2%) and strong opioids (1%). Of the NSAIDs, ibuprofen is the most prescribed by all groups of oral care providers (84-91%). Of the weak opioids, dentists and oral and maxillofacial surgeons mainly prescribe codeine and codeine/ acetaminophen (64% and 78%, respectively), while orthodontists mainly prescribe tramadol (53%). Of the strong opioids, oxycodone is the most frequently prescribed by all groups of oral care providers (77-87%). Analgesics are a large part of the prescription medications in Dutch oral care and mainly concern NSAIDs (ibuprofen) and weak opioids (codeine/ acetaminophen). There are no major differences in prescription behaviour among different oral care providers.Mondzorgverleners schrijven frequent pijnstillers voor om dentogene pijn te bestrijden. Om inzicht te krijgen in de pijnstillers die van 2016 tot en met 2020 werden voorgeschreven, werden gegevens van de Stichting Farmaceutische Kengetallen opgevraagd. Jaarlijks worden er ruim 300.000 pijnstillers verstrekt door tandartsen-algemeen practici en tandarts-specialisten. De grootste groep betreft NSAID’s (88%), gevolgd door zwakwerkende opioïden (9%), paracetamol (2%) en sterkwerkende opioïden (1%). Van de NSAID’s wordt ibuprofen door alle mondzorgverleners het meest voorgeschreven (84-91%). Van de zwakwerkende opioïden schrijven tandartsen en mka-chirurgen vooral codeïne en codeïne/paracetamol voor (respectievelijk 64% en 78%), terwijl orthodontisten vooral tramadol voorschrijven (53%). Van de sterkwerkende opioïden wordt oxycodon door alle mondzorgverleners het meest voorgeschreven (77-87%). Pijnstillers maken een groot deel uit van de voorgeschreven geneesmiddelen in de mondzorg. Het betreffen vooral NSAID’s (ibuprofen) en zwakwerkende opioïden (codeïne/paracetamol). Er zijn geen grote verschillen in het voorschrijfgedrag tussen verschillendemondzorgverleners.

Objective Sjögren’s syndrome patients use different dry-mouth interventions for the relieve of their oral dryness. Recently, it was shown that patients with dry-mouth complaints have regional differences in perceived intra-oral dryness. Therefore, the aim of the present study was to investigate whether the use of dry-mouth interventions is related to the perceived regional oral dryness. Materials and methods A cross-sectional study was performed among Sjögren’s patients. Volunteers could anonymously administer various questionnaires, including the Regional Oral Dryness Inventory (RODI), Xerostomia Inventory (XI), Bother Index (BI) and a list of dry-mouth interventions. Results Sjögren’s syndrome patients use a wide variety for the relieve of oral dryness. “Drinking water’’ and “moistening the lips’’ were used most frequently. Dry-mouth interventions, “drinking water’’, “rinsing of the mouth”, and “drinking small volumes” had significant associations with the RODI-scores of the posterior palate, and anterior and posterior tongue, respectively. On the other hand, “using mouth gel’’ had a significant association with the RODI-scores of the inside cheeks. Conclusion Sjögren’s syndrome patients are more likely to use mouth gels when their inside cheeks were experienced as most dry, while they drank water, rinsed their mouth or drank small volumes if the posterior palate, and anterior and posterior tongue were considered as dry. It can be concluded that intra-oral dryness affects dry-mouth perception and thereby also the use of the various dry-mouth interventions. Clinical relevance The therapeutic choice of dry-mouth interventions by Sjögren’s syndrome patients seems to some extent to be related to dryness at specific intra-oral regions.

Diet and nutrition play a fundamental role in general health and oral health in children and adults. Dietary guidelines have been developed to provide evidence-based recommendations for populations promoting a diet that meets the best nutritional requirements and prevents diet-related diseases such as overweight, obesity, diabetes and dental caries. Lifestyle and dietary habits are strongly influenced by the (social) media and the products on offer in the supermarkets. Knowledge of the field of the development of foodstuffs and lifestyle trends contributes to effective, appropriate and individualised advice for a healthy mouth in children. Sugar-free flavoured waters with aroma are a good alternative to fizzy drinks, they are tooth friendly and promote a healthy weight.Het eetpatroon en de voeding spelen een fundamentele rol bij de algehele en de mondgezondheid van kinderen en volwassenen. Voedingsrichtlijnen zijn ontwikkeld om te voorzien in evidence based aanbevelingen voor populaties gericht op de promotie van een voedings-patroon dat het meest voldoet aan de voedingsbehoefte en het voorkomen van voedingsgerelateerde ziekten zoals overgewicht, obesitas, diabetes en cariës. Leefstijl en voedingsgewoonten zijn sterk onderhevig aan de invloed van de (sociale) media en het aanbod in de supermarkten. Om een goed passend individueel advies voor een gezonde mond zo vroeg mogelijk aan kinderen te kunnen geven, draagt kennis op het gebied van de ontwikkelingen van voedingsmiddelen en leefstijltrends bij. Suikervrije smaakwaters met aroma zijn een goed alternatief voor frisdrank, zijn gebitsvriendelijk en dragen bij aan een gezond gewicht.

An implantable cardioverter defibrillator (ICD) is often placed in patients at high risk of ventricular tachycardia and ventricular fibrillation. An ICD is potentially sensitive to electromagnetic interference (EMI) from dental equipment. Between 2000 to 2020, this was investigated in 7 in vitro studies and 4 in vivo studies. Most dental equipment appears to be safe for routine use in patients with an ICD. However, caution seems appropriate with regard to the use of piezoelectic and magnetostrictive scalers as some can cause EMI up to a distance of 20 to 45 centimeter. Use of an electrotome appears to be contraindicated in ICD wearers.Bij patiënten met een hoog risico op ventrikeltachycardie en ventrikelfibrilleren wordt vaak een implanteerbare cardiale defibrillator geplaatst. Deze is potentieel gevoelig voor elektromagnetische interferentie door tandheelkundige apparatuur. In de periode 2000 tot 2020 werd dit onderzocht in 7 in vitro-onderzoeken en 4 in vivo-onderzoeken. De meeste tandheelkundige apparatuur lijkt routinematig veilig te kunnen worden toegepast bij patiënten met een ICD. Terughoudendheid lijkt echter gepast bij het gebruik van piëzo-elektrische en magnetorestrictieve scalers, aangezien sommige tot 20 à 45 centimeter afstand elektromagnetische interferentie kunnen veroorzaken. Toepassing van een elektrotoom lijkt gecontra-indiceerd bij dragers van een implanteerbare cardiale defibrillator.

Objectives Recently, it was shown that the Regional Oral Dryness Inventory (RODI) could determine differences in dry-mouth perception at different intra-oral locations. The main aim of this study was to determine whether the RODI might help to discriminate between various causes of oral dryness in dry-mouth patients. The second aim was to ascertain whether the RODI could become an additional diagnostic tool in dry-mouth patients. Materials and methods Data were collected retrospectively from patients who visited a specialized saliva clinic. Salivary flow rates, Xerostomia Inventory scores, and RODI scores were extracted from the medical records. Patients were stratified into subgroups according to their health status. Results Five hundred twenty-eight patients participated in this study (mean age of 59.6 ± 16.0 years; 68.4% female). Specific patient groups differed with regard to the region of the mouth they experienced as the most and least dry. The posterior palate was the area perceived as most dry by controls and Sjögren patients. In patients using limited or multiple medications, it was the anterior tongue. RODI scores also differed significantly among dry-mouth patient groups: whereas controls and patients using limited medication had the lowest RODI scores and experienced less intra-oral dryness, Sjögren patients had the highest RODI scores. Conclusion Our use of the RODI questionnaire showed that perceived intra-oral dryness differed between the various dry-mouth patients. Clinical relevance The RODI can be a valuable clinical diagnostic tool in dry-mouth diagnostics, in which it can be used to discriminate between the various causes of oral dryness in patients.

Purpose: Saliva distribution over the palatal surface plays an important role in the perception of dry mouth. It is envisaged that non-invasive estimation of the palatal surface area by anthropometric measurements of head and face, can be useful in the assessment of oral dryness. For this purpose, the relationship between the palatal surface area and anthropometric measurements of the head and face was investigated. Methods: The palatal surface was measured in 51 healthy volunteers using an intra-oral scanner. The distances between anthropometric landmarks of the head and face were determined using an anatomical sliding caliper. Correlations between the palatal surface area and the anthropometric landmarks were investigated.Results: The median palatal surface area for the total study population was found to be 2120.6 mm2. Virtually all anthropometric measurements showed significant differences between females and males. Various head and face measurements had a significant correlation with the palatal surface area. However, these correlations disappeared when the participants were stratified based on their sex, with the exception of mandibular length and palatal width in females. Conclusion: The surface area of the palate correlates with nearly all anthropometric measurements of the head and face included in this study. Yet, the clinical applicability seems limited to females.

Saliva distribution over the palatal surface plays an important role in the perception of dry mouth. It is envisaged that non-invasive estimation of the palatal surface area by anthropometric measurements of the head and face can be useful in the assessment of oral dryness. For this purpose, the relationship between the palatal surface area and anthropometric measurements of the head and face was investigated.The palatal surface was measured in 51 healthy volunteers using an intra-oral scanner. The distances between anthropometric landmarks of the head and face were determined using an anatomical sliding caliper. Correlations between the palatal surface area and the anthropometric landmarks were investigated.The median palatal surface area for the total study population was found to be 2120.6 mmThe surface area of the palate correlates with nearly all anthropometric measurements of the head and face included in this study. Yet, the clinical applicability seems limited to females.

The relationship between xerostomia and reduced saliva secretion is known to occur in patients suffering from dry mouth. These are mainly (frail) older people experiencing reduced saliva secretion as a result of the use of medication. In the current research, we investigated whether the severity of xerostomia could be used as predictor for saliva secretion in young adults. 369 dentistry students participated in this study, of whom 33.4% were male and 66.6% were female, with an average age of 20.2 ± 2.4 years. It was found that the severity of xerostomia in the young adult students had a weak correlation with the unstimulated saliva secretion rate. This indicates that dry mouth complaints in this age group are not a good predictor for saliva secretion. In addition, it is concluded that hyposalivation is not restricted to older people or to specific patient groups, but that even among a trial population of young adults, individuals can suffer from dry mouth and/or reduced saliva secretion.De relatie tussen xerostomie en verminderde speekselsecretie is bekend bij patiënten die drogemondklachten hebben. Dit zijn veelal (kwetsbare) ouderen die ten gevolge van medicijngebruik een verminderde speekselsecretie ervaren. In het huidige onderzoek is juist bij een groep jongvolwassenen onderzocht of de mate van xerostomie ook een voorspellende factor kan zijn voor de speekselsecretie. Aan het onderzoek namen 369 tandheelkundestudenten deel, van wie 33,4% man en 66,6% vrouw was, met een gemiddelde leeftijd van 20,2 ± 2,4 jaar. De mate van xerostomie vertoonde bij hen slechts een zwakke correlatie met de secretiesnelheid van ongestimuleerd speeksel. Dat betekent dat voor deze leeftijdsgroep het drogemondgevoel geen goede voorspeller is voor de speekselsecretie. Daarnaast is gebleken dat hyposialie niet voorbehouden is aan ouderen en specifieke patiëntengroepen, maar dat ook in een jonge onderzoekspopulatie individuen kunnen lijden aan drogemondklachten en/of verminderde speekselsecretie.

Purpose Determination of intra-oral surface areas might contribute to our understanding of the physiology of the oral cavity and oral diseases. In previous studies, the intra-oral surface area was determined using a laborious and technically challenging method. Our aim was to develop an easy and non-invasive method to determine the intra-oral surface areas. Methods In this study, we used cone-beam computed tomography (CBCT) and digital analysis in 20 human cadavers to determine various intra-oral surface areas, based on digital segmentation. Next, we explored whether there was a relationship between various intra-oral surface areas and anthropometric measurements of the head using Pearson correlation coefficient. Results Using CBCT and digital analysis, it was possible to determine various intra-oral surface areas. On average, the total intra-oral surface area was 173 ± 19 cm2. Moderate, statistical significant correlations were observed between (1) the length of the head and the palatal surface area, as well as (2) the depth of the head and the surface area of the tongue. These correlations suggest the feasibility of estimating intra-oral surface areas without relying on CBCT imaging. Conclusions This study presents a technique for measuring the intra-oral surface areas by CBCT imaging in combination with digital analysis. The results of this study suggest that anthropometric measurements of the head might be used to estimate the surface areas of the palate and tongue.

Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication. Aims The aims of this study were to identify and review oral health complications after heart transplantation. Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review. Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer. Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.

Tartar is formed by the precipitation of calcium phosphate on dental plaque, particularly in an alkaline environment. Fruit is acidic and contains a lot of carbohydrates besides, leading to acidification in dental plaque. In a large-scale population study, fruit consumption was therefore associated with a reduced risk of tartar build-up. Protein degradation does create an alkaline environment. However, consumption of dairy products, which are rich in protein and calcium ions, does not lead to increased formation of tartar. Oral care products containing the amino acid arginine or urea, both generating an alkaline environment, do not lead to increased tartar formation either. These studies suggest that the effect of diet on the metabolism in dental plaque is insufficient to cause an increase in tartar formation.Tandsteen ontstaat door het neerslaan van calcium- fosfaten op tandplaque, vooral in een basisch milieu. Fruit is zuur en bevat daarnaast veel koolhydraten, wat leidt tot zuurvorming in tandplaque. In bevolkingsonderzoek bleek fruitconsumptie dan ook geassocieerd met een verlaagd risico op de vorming van tandsteen. Bij eiwitafbraak kan wel een basisch milieu ontstaan. Consumptie van zuivelproducten, die eiwitrijk zijn en ook veel calciumionen bevatten, leidt echter niet tot meer tandsteenvorming. Ook mondverzorgings­producten met het aminozuur arginine of met ureum, die beide een basisch milieu genereren, leiden niet tot meer tandsteenvorming. Op basis van deze onderzoeken kan geconcludeerd worden dat voeding het metabolisme in tandplaque onvoldoende beïnvloedt om te leiden tot meer tandsteenvorming.

Dry-mouth patients use different interventions to relieve their oral dryness. As recent studies showed that various subgroups of dry-mouth patients perceived different intra-oral regions as most dry, the present study investigated whether the use of dry-mouth interventions by various subgroups of dry-mouth patients was related to the perceived oral dryness as well as salivary flow rate.Xerostomia Inventory (XI) scores, Regional Oral Dryness Score (RODI) scores and used dry-mouth interventions were extracted from the medical records of 528 patients visiting a saliva clinic. Based on their medical history, they were allocated into 6 subgroups.The subgroups of dry-mouth patients used a wide range of interventions to relieve their oral dryness. Sjögren's syndrome patients used most interventions more frequently than patients with oral dryness due to use of a limited number of medications and controls. Patients using medications showed associations between the total XI score and dry-mouth interventions aimed at the entire mouth. In medication using patients and controls, the locally applied intervention "using mouth gel" was associated with RODI scores of the anterior tongue.The use of dry-mouth interventions was associated with dry-mouth feelings. Use of interventions aimed to relieve dryness of the entire mouth was significantly associated with total XI score, while locally applied interventions were significantly associated with the severity of dryness at specific intra-oral regions, the anterior tongue in particular.The results will help clinicians to advise dry-mouth patients about the most suitable interventions for relief of oral dryness complaints.

The coronavirus pandemic is caused by the SARS-CoV-2. Vaccination appears to offer the way out of this pandemic. Vaccines against this virus make use of the SARS-CoV-2's spike protein, an essential protein on the surface of the virus that it uses to attach itself to the host cells. In viral vector vaccines (AstraZeneca, Sputnik, JohnsonJohnson) the gene for the spike protein is introduced into an adenovirus. Following vaccination, the modified adenovirus will infect cells of the host, which will subsequently start to produce the spike protein, causing an immune response. RNA vaccines (Pfizer, Moderna) only introduce messenger RNA for the spike protein into host cells, which the messenger RNA uses to produce spike protein. Viral vector vaccines and RNA vaccines are not only faster to develop and safer to produce than traditional vaccines, they are also easier to modify to new viruses and virus variants. The latter may be of great importance for future pandemics.De COVID-19-pandemie wordt veroorzaakt door het SARS-CoV-2. Vaccinatie lijkt een uitweg uit deze pandemie te bieden. Vaccins tegen dit virus maken gebruik van het spike-eiwit van het SARS-CoV-2, een essentieel eiwit op het oppervlak van het virus waarmee het aan gastheercellen bindt. In virale vectorvaccins (AstraZeneca, Sputnik, Janssen) wordt het gen voor het spike-eiwit in een adenovirus gebracht. Na vaccinatie infecteert het adenovirus gastheercellen, die vervolgens het spike-eiwit gaan produceren waartegen een afweerreactie ontstaat. RNA-vaccins (Pfizer, Moderna) brengen alleen messenger-RNA voor het spike-eiwit in gastheercellen, die het messenger-RNA gebruiken om spike-eiwit te produceren. Virale vectorvaccins en RNA-vaccins zijn niet alleen sneller te ontwikkelen en veiliger te produceren dan traditionele vaccins, maar ook makkelijker aan te passen aan nieuwe virussen en virusvarianten. Dit laatste kan van groot belang zijn voor toekomstige pandemieën.

Current therapies for dry mouth have several drawbacks and limitations. Therefore, some patients turn to alternative medicine, such as acupuncture. Three systematic reviews of the literature found that acupuncture may have a positive effect on reducing complaints. However, in these studies, no effect on the salivary secretion rate was observed. Considering the limited number of studies and the low quality of evidence, caution is advised when recommending acupuncture as an alternative therapy for dry mouth.De huidige therapieën tegen drogemondklachten kennen een aantal bezwaren en beperkingen. Sommige patiënten wijken daarom uit naar alternatieve geneeswijzen, zoals acupunctuur. Uit 3 systematische literatuuronderzoeken blijkt dat acupunctuur mogelijk een positief effect heeft ten aanzien van de vermindering van klachten. Echter, in deze onderzoeken werd geen effect op de speekselsecretie waargenomen. Gezien het beperkte aantal onderzoeken en de lage bewijskracht is daarom voorzichtigheid geboden om acupunctuur als alternatieve therapie tegen een droge mond aan te bevelen.

Cardiovascular diseases are among the most common disorders in the Netherlands. Dental hygienists will often be confronted with patients who suffer from these diseases. The aim of this research was to explore the current knowledge of dental hygienists in the Netherlands about cardiovascular diseases. 979 dental hygienists in the Netherlands received a written questionnaire by post. The results were tested with the Mann-Whitney tests, the chi-square tests and the Kruskal-Wallis-H tests. A total of 150 dental hygienists participated in the study. Of the 12 case-oriented statements, the dental hygienists answered just over half of the questions correctly (on average 6.59 of 12). Dental hygienists who rated their knowledge about cardiovascular diseases high gave significantly more correct answers (average 7.04 of 12) than dental hygienists who rated themselves lower (average 6.16 of 12). This suggests that dental hygienists' knowledge of cardiovascular diseases, particularly concerning blood clotting, could be improved.Hart- en vaatziekten behoren tot de meest voorkomende aandoeningen in Nederland. Mondhygiënisten zullen hierdoor vaak worden geconfronteerd met patiënten die hieraan lijden. Het doel van dit onderzoek was om meer inzicht te verkrijgen in de actuele kennis van mondhygiënisten in Nederland over hart- en vaatziekten. Per post ontvingen 979 mondhygiënisten in Nederland een schriftelijke vragenlijst. De resultaten zijn getoetst met de Mann-Whitney-toetsen, de chi-kwadraattoetsen en de Kruskal-Wallis-H-toetsen. In totaal namen 150 mondhygiënisten deel aan het onderzoek. Van de 12 casus-georiënteerde stellingen hadden de mondhygiënisten gemiddeld iets meer dan de helft van de vragen correct beantwoord (gemiddeld 6,59/12). Mondhygiënisten die zichzelf een hoge score gaven voor hun kennis over hart- en vaatziekten, hadden significant meer antwoorden correct (gemiddeld 7,04/12) dan mondhygiënisten die zichzelf een lagere score gaven (gemiddeld 6,16/12). De kennis van mondhygiënisten over hart- en vaatziekten, vooral over bloedstolling, lijkt voor verbetering vatbaar.

Objectives Several questionnaires, such as the internationally validated and frequently used Xerostomia Inventory (XI), have been developed to quantify the subjective feeling of a dry mouth. These questionnaires quantify the overall perception of dry mouth but lack the possibility to differentiate between various intra-oral regions. In this light, a novel questionnaire, the Regional Oral Dryness Inventory (RODI), which quantifies the severity of dryness at various locations in the mouth, was evaluated. Materials and methods A retrospective case report study was designed. Data were collected from patients who visited the saliva clinic for Special Care Dentistry in Amsterdam. Data, including the saliva secretion rates, RODI scores, the Xerostomia Inventory (XI) score, and Clinical Oral Dryness Score (CODS), were extracted from the electronic health record system Oase Dental. Results A total of 337 patients participated in this study with an average age of 54 ± 17 years. The majority of the patients were female (68.5%). The perceived dryness as determined by the RODI was the highest for the posterior palate and the lowest for the floor of the mouth. The highest correlations were found between the corresponding regions in the RODI and regionally related individual items of the XI and CODS. Conclusion There is a significant difference in dry-mouth feeling at different intra-oral locations. Clinical relevance Regional evaluation of xerostomia with RODI might improve diagnosis of xerostomia by helping to discriminate between different potential causes of oral dryness in patients and for evaluating the efficacy of mouth-moistening products. RODI is highly accessible and easy to perform in dental practices during routine clinical assessment.

A sensation of dry mouth can be determined with a general questionnaire, the Xerostomia Inventory (XI). This questionnaire, however, does not distinguish among regional differences of oral dryness. In this study, therefore, a new questionnaire was evaluated, the Regional Oral Dryness Inventory (RODI), quantifying the severity of dryness in various intraoral locations. 337 patients participated in this study with an average age of 54 ± 17 years. It appeared there is a significant difference in the sensation of dry mouth between different intraoral locations; the perceived dryness scored highest for the posterior palate and lowest for the floor of the mouth. Introduction of the RODI might help to discriminate among different potential causes of oral dryness in patients. The RODI is highly accessible and easy to carry out in dental practices during routine clinical assessment.Een drogemondgevoel kan worden vastgesteld met een algemene vragenlijst, de Xerostomia Inventory. Deze vragenlijst maakt echter geen onderscheid in regionale verschillen van monddroogte. In dit onderzoek is daarom een nieuwe vragenlijst geëvalueerd, de Regional Oral Dryness Inventory (RODI), die de ernst van de droogte op verschillende intraorale regio’s kwantificeert. Aan het onderzoek 337 hebben patiënten deelgenomen, de gemiddelde leeftijd was 54 ± 17 jaar. Er bleek een significant verschil in monddroogte tussen verschillende intraorale regio’s, waarbij het achterste deel van het verhemelte het droogst en de mondbodem het minst droog werd ervaren. Introductie van de RODI kan helpen om onderscheid te maken tussen verschillende oorzaken van monddroogte bij patiënten. De RODI is eenvoudig af te nemen in mondzorgpraktijken tijdens routinematig klinisch onderzoek.

In the present study, the extent to which dental students in Amsterdam, Groningen and Nijmegen consult scientific journals and professional periodicals was explored by means of a digital questionnaire. 333 dental students (20% response rate) participated in this study, 69% of whom had experience in conducting scientific research. 65% of the students had a subscription to a dental journal. Of the Dutch-language dental journals, the 'Nederlands Tijdschrift voor Tandheelkunde' [Netherlands Journal for Dentistry] and the 'Nederlands Tandartsenblad' [Dutch Dentists' Journal] are frequently consulted journals. International publications are consulted especially by masters students, although less frequently than Dutch dental journals. The study revealed that 77% of the students consider it important that attention is paid to the development of scientific skills early in the dental curriculum in order to adequately prepare students to select and interpret publications.In welke mate raadplegen tandheelkundestudenten in Amsterdam, Groningen en Nijmegen wetenschappelijke tijdschriften en vakbladen? In onderhavig onderzoek werd dit geïnventariseerd door middel van een digitale vragenlijst. Aan het onderzoek hebben 333 tandheelkundestudenten (respons 20%) deelgenomen, waarvan 69% ervaring had met het uitvoeren van wetenschappelijk onderzoek. Van de studenten was 65% geabonneerd op een tandheelkundig tijdschrift. Van de Nederlandstalige tijdschriften werden het Nederlands Tijdschrift voor Tandheelkunde en het Nederlands Tandartsenblad frequent door studenten geraadpleegd. Internationale publicaties werden vooral door masterstudenten geraadpleegd, zij het minder frequent dan Nederlandse publicaties. Uit het onderzoek bleek dat 77% van de studenten het belangrijk vindt dat aandacht wordt geschonken aan het ontwikkelen van wetenschappelijke vaardigheden tijdens de studie. Het lijkt dan ook aan te raden vroeg in het tandheelkundig curriculum aandacht te besteden aan het ontwikkelen van wetenschappelijke vaardig­heden, zodat tandheelkundestudenten leren adequaat publicaties te selecteren en te interpreteren.

The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3–6) compared with 3 (IQR 2–5) in the low salivation group, 2 (IQR 1–4) in the normal salivation group and 2 (IQR 1–2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = − 0.513; p

The biochemical composition of articaine differs from other amide anaesthetics. The lipophilic part of articaine consists of a thiophene ring, whereas other amide anaesthetics contain a benzene ring. When used correctly, local anaesthetics are remarkably safe. However, all local anaesthetics are potentially neurotoxic. In rare cases a prolonged abnormal perception/sensation may be present after the expected duration of action (paraesthesia). In several countries retrospective studies have been conducted that examined the incidence of persistent paraesthesia after the use of local anaesthetics. In most studies the number of paraesthesia cases after the use of articaine was higher than the market share of this anaesthetic. In animal studies and in cell culture experiments, however, articaine did not have a higher toxicity compared to other amide anaesthetics. Further studies of the cause of paraesthesia after administration of local anaesthetics seem to be warranted.

Speekselstenen zijn gecalcificeerde structuren die met name voorkomen in de submandibulaire speekselklieren en de afvoergangen daarvan. De afmetingen en het gewicht van speekselstenen variëren sterk. De etiologie is onbekend. Gesuggereerd wordt dat het ontstaan van speekselstenen is gerelateerd aan een gewijzigde samenstelling van speeksel, de anatomie van de afvoergang van de speekselklier en/of het fuseren van microscopisch kleine speekselsteentjes. Speekselstenen bestaan met name uit anorganische bestanddelen zoals hydroxyapatiet, whitlockiet en calciumfosfaat, maar bevatten ook organische componenten zoals eiwitten en lipiden. De behandeling kan bestaan uit masseren van de speekselklier in combinatie met een zuur dieet, ultrasone vergruizing, en chirurgische of sialoendoscopische verwijdering.

Purpose Sialendoscopy of the major salivary glands could alleviate the oral symptoms of Sjogren syndrome (SS) and restore salivary function. The aim of this pilot study was to evaluate the effect of sialendoscopy of the major salivary glands on salivary flow, saliva composition, and mouthfeel in patients with SS and to collect data for sample size analysis for a larger clinical trial. Materials and Methods Twenty patients diagnosed with SS were randomly assigned to a nonintervention control group or a sialendoscopy group. Unstimulated whole saliva flow, stimulated whole saliva flow, Clinical Oral Dryness Score, Xerostomia Inventory score, and EULAR Sjogren's Syndrome Patient Reported Index score were obtained 1 week before (T0), 1 week after (T2), and 8 weeks after (T3) sialendoscopy. Unstimulated whole saliva was analyzed for amylase concentration, activity, and mucin 5B concentration. Amylase and mucin 5B output were calculated. Results In the sialendoscopy group, unstimulated and stimulated whole saliva flows were numerically higher at T2 and T3 compared with T0. Xerostomia Inventory score was significantly lower in the sialendoscopy group at T2 compared with T0 ( P = .03). Unstimulated and stimulated whole saliva flows were higher in the sialendoscopy group compared with the control group at T2 and T3 (not meaningful). Significant differences were found between groups for the EULAR Sjogren's Syndrome Patient Reported Index score at T2 ( P = .03) and T3 ( P = .001). Xerostomia Inventory score and Clinical Oral Dryness Score in the sialendoscopy group were lower compared with the control group at T2 ( P = .02) and at T3 ( P = .04), indicating less oral dryness. Conclusion This pilot study indicates a positive effect of sialendoscopy on some parameters, but it cannot yet be concluded that it has a positive effect on salivary flow in patients with SS. These preliminary results need to be verified in a randomized controlled trial with a larger sample and longer follow-up period.

H. S. Brand of the Academic Centre for Dentistry Amsterdam, and movie buff, continues his new series of columns on films featuring dentists with Pearl Harbor (2001), directed by Michael Bay.

Objective: A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students.Materials and methods: A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%.Results: Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non-human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra-orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models.Conclusion: Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.

Patients with familial adenomatous polyposis (FAP) develop multiple premalignant colorectal adenomas. Untreated, one or more of these polyps will progress to colorectal carcinoma in middle-aged adults. Extra-intestinal manifestations of FAP are frequently observed and this combination has been called Gardner's syndrome. Oral and maxillofacial symptoms of FAP include an increased risk of jaw osteomas, odontomas and supernumerary or unerupted teeth. Early diagnosis of FAP is crucial and may be life saving. As oral signs usually precede gastrointestinal symptoms, the dentist may play an important role in the diagnosis of FAP.

A 67-year-old woman suffered from a burning mouth feeling for 1.5 years and was referred by her dentist to a saliva clinic. At the clinic persistent xerostomia was diagnosed, and Sjögren's syndrome was suspected. After 1 year, a new measurement of the saliva secretion was carried out, which revealed a further decline in saliva secretion rate. The patient was consequently treated with an intra-oral electrostimulating device in order to stimulate the saliva secretion rate and reduce the feeling of a dry mouth. After 2 weeks, the patient experienced a considerable improvement of the subjective oral dryness.Een 67-jarige vrouw had 1,5 jaar een gevoel van mondbranden en werd door haar tandarts doorverwezen naar een speekselcentrum. Daar stelde men de diagnose ‘persisterende xerostomie’; tevens was er verdenking voor de ziekte van Sjögren. Na 1 jaar werd een nieuwe meting van de speekselsecretie uitgevoerd, waarbij een afname van de secretiesnelheid werd vastgesteld. Hierop werd de patiënt behandeld met intraorale elektrostimulatie om de speekselsecretie te stimuleren, waardoor het subjectieve gevoel van monddroogte zou moeten verminderen. Na 2 weken ervoer de patiënt aanzienlijke verbetering van het subjectieve monddroogtegevoel.

Wetenschappelijk onderzoek, zoals elke maand beschreven in het Nederlands Tijdschrift voor Tandheelkunde, begint met een idee. Om het idee te kunnen onderzoeken is vervolgens geld nodig. Hierbij gaat het meestal om grote bedragen. Zo kost een promotieonderzoek van 4 jaar een paar ton aan salariskosten en materialen.

Salivary stones or sialoliths, are calcified concrements which are most frequently located in the submandibular glands and their ducts. Their size and weight show considerable variation. The aetiology is unknown. It has been suggested that salivary stones could be related to an altered saliva composition, the anatomy of the ducts of the salivary gland and/or the fusion of microsialoliths. Salivary stones consist mainly of anorganic material such as hydroxyapatite, whitlockite and calciumphosphate, but they also contain organic components such as proteins and lipids. Treatment can consist of salivary gland massage combined with an acid diet, ultrasonic pulverisation, and surgical or sialendoscopical removal.Speekselstenen zijn gecalcificeerde structuren die met name voorkomen in de submandibulaire speekselklieren en de afvoergangen daarvan. De afmetingen en het gewicht van speekselstenen variëren sterk. De etiologie is onbekend. Gesuggereerd wordt dat het ontstaan van speekselstenen is gerelateerd aan een gewijzigde samenstelling van speeksel, de anatomie van de afvoergang van de speekselklier en/of het fuseren van microscopisch kleine speekselsteentjes. Speekselstenen bestaan met name uit anorganische bestanddelen zoals hydroxyapatiet, whitlockiet en calciumfosfaat, maar bevatten ook organische componenten zoals eiwitten en lipiden. De behandeling kan bestaan uit masseren van de speekselklier in combinatie met een zuur dieet, ultrasone vergruizing, en chirurgische of sialoendoscopische verwijdering.

Millions of individuals in Europe and the United States use cocaine regularly. Use of cocaine may have several orofacial effects such as perforation of nasal septum and palate, gingival lesions and erosion of tooth surfaces. Recent use of cocaine may also increase medical risks during dental treatment, especially when local anaesthetics with epinephrine or epinephrine-impregnated retraction cords are used. Therefore, it is recommended to postpone dental treatment at least 6 to 24 hours after the use of cocaine.

Porphyria is a disease of specific enzymes in the biosynthesis of heme, caused by either genetic defects or environmental factors. This review of the literature presents the different types of porphyria and describes their possible causes, clinical signs, diagnosis and therapy. In addition, oral findings observed in patients with porphyria and the potential implications of the disease for dental treatment are discussed.

In 2013, a dental practice without a website is almost unthinkable. Using a sample of309 dentists drawn from the list of members of the Dutch Dental Association in 2012, a study was carried out to find out whether the dental practice of the general dental practitioner had a website. The content of each website was subsequently inventoried using a questionnaire. Eighty-nine percent of the dental practices had a website. The content of the websites, however, varied enormously. An element such as the professional registration number with a reference to the professional register were absent in 73% of the websites and the date of the most recent update of the website was mentioned only once. The name of the dentist, his or her professional qualification and an email address were missing on respectively 9%, 20% and 9% of the websites. Contracts of the practice with insurance companies were rarely clearly indicated. The websites of many practices would benefit considerably from a significant improvement.

The aim of the present study was to investigate whether in healthy volunteers acute changes in plasma free amino acid composition after a protein-rich test meal are reflected in the urinary and salivary concentrations of the corresponding amino acids. The ingestion of a protein-rich meal elicited a significant increase of plasma and urine amino acid concentrations. The postprandial salivary amino acid excretion showed only minor changes. For several amino acids (alanine, arginine, asparagine, glycine, threonine and valine) significant relations were observed between the increase in concentration of these amino acids in venous plasma and urine. In whole saliva, only threonine and valine showed a significant relationship with the corresponding plasma concentration. Our data suggest that the urinary amino acid excretion of several amino acids has the potential for estimating short-term changes in plasma concentrations. Determination of salivary amino acid concentrations seems less appropriate for this purpose.

At the request of the editorial board, H.S. Brand offers a reaction from the perspective of dental care professionals to G.H.I.M. Walenkamp's article about the present regulations for antibiotic prophylaxis for patients with prosthetic joints.

Systemic sclerosis is a relatively rare connective tissue disorder, in which a severe and progressive fibrosis of the skin and sometimes also of internal organs often develops as a result of an increased deposition of collagen. Fibrosis of the salivary glands may cause hyposalivation and xerostomia. Fibrosis of the perioral skin reduces the maximum opening of the mouth, thereby hampering dental treatment and the maintenance of oral hygiene. Periodontitis and bone resorption ofthe jaws are more frequently observed in systemic sclerosis patients.

Head and neck tumours possess several mechanisms to hinder an appropriate immune response against the tumour cell. In the first place, the tumour cells attempt to suppress the presentation of tumour-associated antigens to the cells of the immune system. Tumours also have a negative effect on the surface structures of the efferent blood vessel epithelium, thereby inhibiting the recruitment of immune cells. In addition, proteins are secreted capable of inactivating immune cells. These immunosuppressive activities of the tumour result in a deterioration of life expectancy. Several experimental methods to improve the immune response of the patient against tumour cells are currently being explored.

Erosive tooth wear was diagnosed in the dentition of a 15-year-old girl with a Moroccan background. After an anamnesis, extensive analysis of possible risk factors and a study of the pattern of erosion, it was concluded that the erosive tooth wear was induced by daily consumption of a glass of apple cider vinegar Further investigation revealed that in North-African culture, women have used apple cider vinegar to achieve weight loss for generations. Bodybuilders are also known to make use of this method of weight reduction.

Education in fabricating single-tooth fixed prostheses and multi-teeth fixed prostheses is an important component of the dental curriculum. To explore the opinion of dental students on this component of the curriculum, a web-based survey was carried out among the students of the 3 dental schools in the Netherlands. The 389 completed questionnaires revealed that the education in fabricating single-tooth fixed prostheses and multi-teeth fixed prostheses started in different years of study at the 3 dental schools. Another striking difference is that the methods of preparation and the choice of materials for single-tooth fixed prostheses and multi-teeth fixed prostheses in the pre-clinical practicum in the programmes was not the same. The students of the 3 dental schools seemed to have a reasonably positive opinion of their preclinical training preparation for treating patients. The opinions of the Nijmegen Dental School students were significantly more positive than the opinions of the students at the 2 other dental schools.

Patients with non-odontogenic oral diseases may be referred to an oral and maxillofacial surgeon by a dentist, a general medical practitioner or a medical specialist. At the department of Oral and Maxillofacial Surgery of a medical centre, a survey involving 96 referred patients with a non-odontogenic oral disease addressed the clinician who was responsible for the referral, the patient characteristics, and the nature and location of the oral disease. From the patients who regularly visited a dentist, 53% were referred by a dentist. From the patients who visited a dentist irregularly, 73% were referred by a general medical practitioner. No significant correlation was found between the nature and location of the non-odontogenic oral disease and the profession of the clinician who was responsible for the referral, with an exception for the tongue, for which a medical specialist was more often responsible for the referral.

The consumption of acidic beverages may cause dental erosion. The consumption of such beverages during school hours may contribute to the development of erosion. In order to study the extent to which children of secondary schools are exposed to potentially erosive beverages, 43 locations in 37 schools in the Netherlands were visited. In each school, all available types of beverages were registered and classified as non-erosive or potentially erosive. In addition, the number of students, type of school, opening times of the canteens and the number of vending machines were recorded. It was revealed that a wide variety of beverages is available in school canteens, of which a large number are potentially erosive (71.8 +/- 12.9%). The number of different products available, the number of different beverages available and the number of potentially erosive drinks all correlated with the number of students per school, but not with the type of education. The number of drinks available and the number of potentially erosive drinks correlated with the opening hours of the canteens and the number of vending machines.

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.

To investigate students' opinion about theoretical and clinical training in local anaesthesia at different European dental schools.A questionnaire was designed to collect information about local anaesthesia teaching. Students' opinion was quantified with five-point Likert scales. The web-based questionnaire was distributed through European Dental Students Association contacts amongst students of 25 different dental schools. Eight hundred and eighteen completed questionnaires from students of 12 dental schools were analyzed statistically.Dental schools showed a wide variation in the beginning of the theoretical teaching of local anaesthesia and the practical teaching. A preclinical training model was used by a small number of students, but these students found it a useful preparation. Many students felt insufficiently prepared when they administered their first injection in a human (17-81%). In dental schools from the UK, Ireland, Sweden and the Netherlands, this first injection is administered to a fellow dental student, whilst in the other countries the first injection is usually performed in a patient. Instruction in mandibular block anaesthesia was frequently reported (81-100%) as well as in infiltration anaesthesia of the upper and lower jaws (78-100% and 30-93% respectively). Many students expressed that they like to receive teaching in intraligamentary anaesthesia (13-70%). Other changes in the curriculum were also frequently suggested (33-100%), especially the introduction of preclinical training models and practical teaching earlier in the curriculum.Local anaesthesia teaching programmes and the rating of this teaching by dental students show a considerable variation across European dental schools. Students considered better preparation highly desirable. The variability in programmes may have implications for mobility of students between European dental schools.