Biomedical subjects
Publications and source records attributed to C de Baat.
A case report is presented of a 14-year-old girl with a buccoapical fistula of tooth 22. The radiograph of the tooth revealed a periapical radiolucency and two roots. Endodontic treatment was conducted, followed by normal healing of the periapical area. Root division and additional roots of maxillary lateral incisors are rare phenomena.
A nearly 7-year-old boy suffered from psychosocial problems because of aplasia of the left auricle. The auricle aplasia was a symptom of the VATER association. It was decided to conduct a purely problem-oriented treatment in preparing an auricle prosthesis, firmly fixed using an adhesive. Wearing the auricle prosthesis, the boy improved very quickly and substantially in being more free and self-confident.
Staff members and residents of nursing homes and old people's homes were interviewed about the facilities and provision of oral health care. Clinical examinations were performed to obtain data about the oral health status of the institutionalised elderly. Results show that in most cases the oral health care facilities were insufficient to give care to persons with natural teeth. Of the edentulous elderly 43% reported that the retention of the lower denture was insufficient.
A 55-years-old man visited his family doctor because of a one-day existing, not painful, right-sided swelling of the cheek. It appeared to be a subcutaneous emphysema, caused at an attempt to remove mandibular third molar roots, using a water- and air-cooled air rotor. Rare potential seũelae resulting from subcutaneous emphysema are venous air embolism, airway obstruction because of neck swelling, pneumomediastinum, and mediastinitis. Using air-cooled instruments in surgical orofacial treatments should be avoided because of the possible atrogenic life-threatening complications.
A girl with congenital hemifacial hypertrophy had been observed and treated by a multidisciplinary team for craniofacial disorders in an academic medical centre since birth. At the age of 8 she was treated on account of considerable facial asymmetry and multiple intraoral problems. The two-step surgery involved reduction of the maxilla and the zygoma, reduction of soft tissues, removal of the teeth on the affected side, correction of the alveolar ridges of the maxilla and the mandible and placement of oral implants. After a healing period of 4 months fixed partial dentures were constructed on the implants.
In daily social life, orofacial pain is strongly associated with teeth. However, edentulousness is no lifetime guarantee of being pain-free in the orofacial region. Common oral pains in edentulous people are caused by denture misfits or occlusal errors, by alveolar ridge atrophy, by (sharp) exostoses, and by non-denture-related mucosal lesions. Less common or hard to diagnose pains are caused by burning mouth syndrome, toxic or allergic reactions, nerve injuries, mucosal or skin grafts, and ischaemic heart disease.
In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational programme aims at an increase in dentists serving in geriatric care who are well prepared for delivering care. In the programme attention is paid to the special aspects of care delivery and the special somatic, mental, and social characteristics of frail elderly people. The goal is to formulate an individual oral care programme for every frail elderly person. An individual oral care programme may contain 5 different oral care activities: continuing care, prevention, support, treatments, and evaluation. These activities define the scope of specialists in geriatric dentistry. This scope in turn defines the profile of required knowledge and skills, and the profile is the foundation of the educational objectives of the educational programme. The educational programme contains 7 modules: affinity; somatic and mental disabilities; communicative skills and coping with behavioural disturbances; emergency medical care; history taking, assessment, prevention, treatments and evaluation; organization and legislation; scientific training.
Parkinson's disease is a slowly progressive and irreversible disorder of the nervous system. Drooling is listed as a secondary symptom of Parkinson's disease. Its cause is insufficiently clear. In the literature 2 possible causes are described: hypersalivation and swallowing abnormalities. These parameters have not been measured in a single study before. This article presents a review of the literature on the subject and describes the design for a future clinical study. The aim of this clinical study is to gain an insight into the cause and the prevalence of drooling in Parkinson's patients. A group of 50 Parkinson's patients will be compared to a group of 50 controls. The objectives of this comparative study comprise the assessment of salivary flow volumes, swallowing capacity, subjective experiences with drooling and an objective observation of drooling, the drooling quotient. Finally, the possibilities for treatment will be described.
The aim of health care in sports is to promote, to secure, and to recover general health of sportsmen, taking into consideration the sport's specific loads. In general, a (professional) sports club has a private (para)medical team consisting of a team physician, a physiotherapist, and an attendant or masseur. The team physician organizes the arrangements and the preventive, diagnostic, and curative tasks of the (para)medical team. In sports, sometimes medical emergencies occur, such as tongue bite, cardiac problems, hypoglycaemia in diabetes, anaphylactic shock, and hypo- as well hyperthermia. Sports injuries are caused by acute physical forces, chronic overload or repeated micro-traumas. High-incidence injuries in all sports are injuries of joints, bones, head, neck, back and abdomen. In case of medical emergencies, the team physician has to take action quickly and professionally. If sports injuries occur, the team physician has to provide first aid and to arrange a treatment and rehabilitation plan in consultation with the paramedical members of the team. During the treatment and rehabilitation, the team physician has to be of assistance to sportsmen. In arranging some of his tasks, a team physician can ask for assistance or help from a dentist or an oral and maxillofacial surgeon.
Facial shields are used when practising contact sports, high speed sports, sports using hard balls, sticks or bats, sports using protective shields or covers, and sports using hard boardings around the sports ground. Examples of facial shields are commercially available, per branch of sport standardised helmets. Fabricating individual protective shields is primarily restricted to mouth guards. In individual cases a more extensive facial shield is demanded, for instance in case of a surgically stabilised facial bone fracture. In order to be able to fabricate an extensive individual facial shield, an accurate to the nearest model of the anterior part of the head is required. An accurate model can be provided by making an impression of the face, which is poured in dental stone. Another method is producing a stereolithographic model using computertomography or magnetic resonance imaging. On the accurate model the facial shield can be designed and fabricated from a strictly safe material, such as polyvinylchloride or polycarbonate.
Bones are of crucial importance for the human body, providing skeletal support, serving as a home for the formation of haematopoietic cells, and reservoiring calcium and phosphate. Long bones develop by endochondral ossification. Flat bones develop by intramembranous ossification. Bone tissue contains hydroxyapatite and various extracellular proteins, producing bone matrix. Two biological mechanisms, determining the strength of bone, are modelling and remodelling. Modelling can change bone shape and size through bone formation by osteoblasts at some sites and through bone destruction by osteoclasts at other sites. Remodelling is bone turnover, also performed by osteoclasts and osteoblasts. The processes of modelling and remodelling are induced by mechanical loads, predominantly muscle loads. Osteoblasts develop from mesenchymal stem cells. Many stimulating factors are known to activate the differentiation. Mature osteoblasts synthesize bone matrix and may further differentiate into osteocytes. Osteocytes maintain structural bone integrity and allow bone to adapt to any mechanical and chemical stimulus. Osteoclasts derive from haematopoietic stem cells. A number of transcription and growth factors have been identified essential for osteoclast differentiation and function. Finally, there is a complex interaction between osteoblasts and osteoclasts. Bone destruction starts by attachment of osteoclasts to the bone surface. Following this, osteoclasts undergo specific morphological changes. The process of bone destruction starts by acid dissolution of hydroxyapatite. After that osteoclasts start to destruct the organic matrix.
Treatment of mandibular edentulousness with endosseous permucosal implants has evolved to a common treatment option during the last decades. In The Netherlands, the relative cheap prosthetic treatment of implant-supported overdentures is considered a qualitatively adequate treatment. The aim of the study described in this article was to survey the treatment of edentulous mandibles by fixed implant-supported prostheses and implant-supported overdentures, and to register the different mesostructures used. All clinics of special dental care and all larger clinics for implant dentistry in The Netherlands received a questionnaire. The data provided showed that more than 90% of patients treated with implants because of mandibular edentulousness, were provided with an overdenture. In 85% of cases a bar-clip mesostructure was used. Cost control was the most important reason to choose an overdenture above a fixed implant-supported prosthesis.
Bone is continuously remodelled to maintain its strength and structural integrity. Remodelling is the result of an equilibrium between bone formation performed by osteoblasts and bone resorption performed by osteoclasts. In osteopetrosis this equilibrium is disturbed by a defect in the osteoclastogenesis or by disfunction of osteoclasts. Osteopetrosis is divided into four types: malignant infantile osteopetrosis, intermediate osteopetrosis, and two types of autosomal osteopetrosis. Malignant infantile osteopetrosis is usually diagnosed within the first year of birth by bone sclerosis and bone marrow obliteration. This type is very severe and usually results in death within a few years. The intermediate type usually appears before the age of ten and leads to recurrent pathologic fractures and cranial nerve compression. Autosomal dominant osteopetrosis is usually mild and consists of two sybtypes. Type I involves marked thickening of the cranial vault. Type II patients have predominantly sclerosis of the pelvis, the vertebrae and the base of the skull. Type I and II patients may often be long-lasting asymptomatic, but will eventually present with pathologic fractures, bone pain, and the effects of cranial nerve compression. Oral problems of osteopetrosis are delayed tooth eruption, absence of some teeth, malformed teeth, enamel hypoplasia, disturbed dentinogenesis, hypomineralisation of enamel and dentin, propensity for tooth decay, defects of the periodontal membrane, thickened lamina dura, mandibular protrusion, and the presence of odontomas. Tooth removal should be limited as it may induce bone fractures and osteomyelitis.
During the last few years, a 64-years-old man experienced a progressive enlargement of his hands, feet, and tongue and an alteration in the position of his frontal teeth. In a university medical clinic acromegaly was diagnosed, based on external features, serum tests, and an oral glucose tolerance test. A pituitary microadenoma was discovered. The most common oral features of acromegaly are a prognatic mandible, interdental spaces, macroglossy, and everted, swollen lips. In this article the primary treatment and the possible oral sequelae are described.
Delegation of basic dental treatment to well-trained oral hygienists, dental nurses, and dental technicians will result in more time for the general practitioner to treat more specialized dental problems. In two issues of this journal, some surgical treatments which can be delivered by a dentist with special skills on this topic, are discussed. This first issue concentrates on the treatment of odontogenic abscesses, the removal of teeth and roots, the treatment of a perforation of the maxillary sinus floor, and apectomies.
In two issues of the journal, some surgical treatments which can be delivered by a dentist with special skills on this topic, are discussed. This second issue concentrates on interventions occurring less frequently or not treated by every dentist in general practice. It concerns dental traumas, eruption disorders, removal of a hypertrophied frenulum of the upper lip and reconstructive preprosthetic surgery. Finally, some complications of dentoalveolar surgery are discussed.
Retention is not an unambiguous variable. The degree of retention is dependent on biologic and physiologic properties of a complete denture and the denture-bearing and surrounding tissues. Quantifying retention forces of a complete denture can be carried out with three types of methods: subjective methods, methods with clinical more or less objective criteria, and nearly entire objective methods using measurement equipment. The subjective and most of the methods with clinical criteria are not or little reliable. However, for epidemiological research the methods with clinical criteria are very pragmatic. Of all objective methods using measurement equipment, the gnathodynamometer is the only apparatus with proven reliability.
For patients diagnosed with malignant oral lesions invading the mandible, a partial or complete mandibulectomy is unavoidable. In predicting the invasion of the lesion, preoperative imaging techniques are used, such as an orthopantomogram, computed tomography, and magnetic resonance imaging. A mandibular discontinuity can be restored using a stainless steel or titanium reconstruction plate, or using autogenous non-vascularized or vascularized bone grafts. In achieving the goal of complete rehabilitation endosseous permucosal implants can be inserted in order to support a prosthesis. There is a tendency of a higher implant loss frequency among bone-grafted patients who have had implants after irradiation when compared with non-irradiated patients. After a (partial) mandibulectomy, oromandibular reconstruction by non-vascularized or vascularized bone grafts and endosseous implants provides a unique opportunity to restore some oral functions.