[Oral healthcare for frail and care-dependent older people in Germany and the Netherlands]. / Mondzorg voor kwetsbare en zorgafhankelijke ouderen in Duitsland en Nederland.

To improve oral health for frail and care-dependent older people, both intra- and extramurally, in the Euregio Rhine-Waal area in the Netherlands and Germany, we inventoried barriers to oral care for the target group according to the literature, the organisation of oral care in both countries and the implications of this organisation for daily and professional (oral) healthcare and oral care. Results show most identified barriers are common to both countries, but the organisation of oral healthcare differs in both countries. The main differences lie in the financing and organisation of oral care in the intramural situation. In the Netherlands, this is to a large degree regulated and organised on the basis of the Chronic Care Act (Wlz), using the Verenso Oral Care Directive for care-dependent clients as a base for enforcement. In Germany, on the other hand, the provision of oral care in the home situation is more effectively facilitated. In both countries, various initiatives have recently been employed to improve, among other things, information supply, education and financing of oral healthcare.

Survival of multiple-surface ART restorations using a zinc-reinforced glass-ionomer restorative after 2 years: A randomized triple-blind clinical trial.

OBJECTIVE: To investigate the effectiveness of a new zinc-reinforced glass-ionomer in comparison to a common high-viscous glass-ionomer cement (HVGIC) used in multiple-surface ART-prepared cavities. The hypothesis tested was that the cumulative survival percentage of the new HVGIC is higher than that of the common HVGIC over 2 years. METHODS: A randomized triple-blind parallel group clinical trial was used. A total of 218 participants, average age 15.4 years (SD=0.2), with an occluso-proximal carious lesion in a permanent (pre-) molar were included. Restorations using test (ChemFil Rock) and control (Fuji IX GP) restoratives were placed according to the ART method by four calibrated operators. Restorations were evaluated after one week (baseline), and at 6-, 12-, 18- and 24 months from replicas and coloured photographs according to the ART restoration assessment criteria by two independent evaluators. Restoration survival curves were estimated using the Kaplan-Meier method and difference between dependent and independent variables tested with a Wald (chi-square) test. RESULTS: There was a statistically significant difference in cumulative survival percentages between the two types of restorations at 2 years (P=0.02). A higher percentage of multiple-surface restorations of Fuji IX GP (95.4%) than ChemFil Rock (85.3%) survived. Gender (P=0.64), operator (P=0.56) and cavity size (P=0.81) had no effect on the survival of the type of restoration observed. Type of tooth (P=0.004) and type of jaw (P=0.05) showed an effect. Severe wear was the major reason for restoration failure (ChemFil Rock=7; Fuji IX GP=1). SIGNIFICANCE: ChemFil Rock appears not to be a viable alternative to Fuji IX GP in restoring ART multiple-surface cavities in permanent posterior teeth.

[Wish fulfilling medicine and wish fulfilling dentistry: legal aspects]. / Wensgeneeskunde en wenstandheelkunde: juridische aspecten.

Wish fulfilling medicine (human enhancement (therapy)) concerns medical treatment without a direct medical need. In traditional medicine, a classical triad applies: 1. after investigation symptoms of illness lead to 2. a diagnosis, followed by 3. a proposal for treatment by the health care provider. In wish fulfilling medicine, the emphasis lies on patient's wishes. Wish fulfilling medicine concerns medical treatment, often at the request of the patient, and should be distinguished from shared decision-making,a form of communication seeking to meet the preferences of the patient and to actively involve the patient in his treatment. In the Netherlands, in accordance with the Healthcare Quality, Complaints and Disputes Act, health care providers have to offer good care at a good level, which is safe, effective, efficient and client-orientated, offered in a timely fashion and geared to the real needs of the client. Good care has to meet professional standards. In this way, fulfilling patients' wishes for treatment without a medical need can be restricted by law.

[Wish fulfilling medicine and wish fulfilling dentistry: -medical-ethical aspects]. / Wensgeneeskunde en wenstandheel­kunde: medisch-ethische aspecten.

Wish fulfilling medicine comprises medical procedures applied without a direct medical need. In such procedures, the medical-ethical principles can come under pressure: the autonomy of the patient, when wishes originate from social pressure; beneficence when the (underlying) aim and consequences are unclear; and 'doing no harm', when that appears to be impossible. The principle of justice, too, could come under threat when especially those with a privileged socio-economic background can take advantage of wish fulfilling medicine. Regardless of whether it concerns wish fulfilling medicine or conventional medicine, respect for human dignity and the individual integrity of the patient continue to be paramount. In care ethics and moral ethics, the qualities necessary in a proper caregiver are emphasised, such as caring, compassion, commitment, honesty and personal dedication. Wish fulfilling medicine is the subject of significant ethical debate. Important aspects arising from this debate are that the risks of harm should be limited, human dignity and integrity should be respected, people should genuinely be helped and the principle of justice should be upheld.

[Wish fulfilling medicine and wish fulfilling dentistry: what does this mean?] / Wensgeneeskunde en wens­tandheelkunde: wat wordt ermee bedoeld?

Wish fulfilling medicine refers to medical procedures applied without a direct medical need. In wish fulfilling medicine, the wish of the patient is dominant, but wish fulfilling medicine is also promoted indirectly by healthcare providers, (pharmaceutical) companies and healthcare insurers. Wish fulfilling medicine often concerns the enhancement of appearance or performance; therefore, wish fulfilling medicine is also referred to as (human) enhancement (therapy). The line between traditional and wish fulfilling medicine is vague: the border between illness and health, normal and abnormal functioning is not sharply defined and is relative to time and place. In the Netherlands, wish fulfilling medicine is not covered in the basic package provided by healthcare insurers and is paid for by the patients themselves. However, 'pay yourself' is not a decisive criterion for wish fulfilling medicine. With new biotechnological developments the domain of wish fulfilling medicine is expanding. Some dental treatments can be considered as wish fulfilling dentistry, for example in the context of cosmetic dentistry, orthodontics, or dental implantology. Although wish fulfilling medical treatments do not cure disease, they can promote health.

[The extra value of training dental students in surgical skills]. / Evaluatie van het Chirurgisch Profiel binnen de 6-jarige opleiding in Nijmegen.

In 2010, the revised 3-year master's programme was introduced in the Netherlands, which meant that the full programme of dental education was extended to 6 years. In Nijmegen, this was structured to include a set of profile programmes, next to the existing curriculum. Three profiles were chosen, one of which was the Surgical Profile. The aim of this programme was that the more complex procedures and the treatment of medically compromised patients would be carried out by those students in the 6-year educational programme who participated in the Surgical Profile. The experiences of students following this profile were evaluated by means of a questionnaire. In a second questionnaire, distributed 1 year after the students had graduated, respondents were asked whether they were still making use of the skills that they had been taught. The conclusion was that the training of master's students in dental surgery results in a high degree of satisfaction. The study revealed moreover that 93% of the students who completed the Surgical Profile put the skills they had been taught to use during the first year as dentists and even wanted to build on that knowledge by means of relevant post-graduate courses.

Caries-preventive Effect of Supervised Toothbrushing and Sealants.

To investigate the effectiveness of 3 caries-preventive measures on high- and low-caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-randomized controlled clinical trial covered 242 schoolchildren, 6 to 7 y old, from low socioeconomic areas. At baseline, caries risk was assessed at the tooth surface level, through a combination of ICDAS II (International Caries Detection and Assessment System) and fissure depth codes. High-caries risk occlusal surfaces were treated according to daily supervised toothbrushing (STB) at school and 2 sealants: composite resin (CR) and atraumatic restorative treatment-high-viscosity glass-ionomer cement (ART-GIC). Low-caries risk occlusal surfaces received STB or no intervention. Evaluations were performed after 0.5, 1, 2, and 3 y. A cavitated dentine carious lesion was considered a failure. Data were analyzed according to the proportional hazard rate regression model with frailty correction, Wald test, analysis of variance, and t test, according to the jackknife procedure for calculating standard errors. The cumulative survival rates of cavitated dentine carious lesion-free, high-caries risk occlusal surfaces were 95.6%, 91.4%, and 90.2% for STB, CR, and ART-GIC, respectively, over 3 y, which were not statistically significantly different. For low-caries risk occlusal surfaces, no statistically significant difference was observed between the cumulative survival rate of the STB group (94.8%) and the no-intervention group (92.1%) over 3 y. There was neither a difference among STB, CR, and ART-GIC on school premises in preventing cavitated dentine carious lesions in high-caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low-caries risk occlusal surfaces of first permanent molars over 3 y.

Reduced mandibular range of motion in Duchenne Muscular Dystrophy: predictive factors.

Patients with Duchenne muscular dystrophy (DMD) experience negative effects upon feeding and oral health. We aimed to determine whether the mandibular range of motion in DMD is impaired and to explore predictive factors for the active maximum mouth opening (aMMO). 23 patients with DMD (mean age 16.7 ± 7.7 years) and 23 controls were assessed using a questionnaire about mandibular function and impairments. All participants underwent a clinical examination of the masticatory system, including measurement of mandibular range of motion and variables related to mandibular movements. In all patients, quantitative ultrasound of the digastric muscle and the geniohyoid muscle and the motor function measure (MFM) scale were performed. The patients were divided into early and late ambulatory stage (AS), early non-ambulatory stage (ENAS) and late non-ambulatory stage (LNAS). All mandibular movements were reduced in the patient group (P < 0.001) compared to the controls. Reduction in the aMMO (<40 mm) was found in 26% of the total patient group. LNAS patients had significantly smaller mandibular movements compared to AS and ENAS (P < 0.05). Multiple linear regression analysis for aMMO revealed a positive correlation with the body height and disease progression, with MFM total score as the strongest independent risk factor (R(2) = 0.71). Mandibular movements in DMD are significantly reduced and become more hampered with loss of motor function, including the sitting position, arm function, and neck and head control. We suggest that measurement of the aMMO becomes a part of routine care of patients with DMD.

Occlusal wear and occlusal condition in a convenience sample of young adults.

OBJECTIVE: To study progression of tooth wear quantitatively in a convenient sample of young adults and to assess possible correlations with occlusal conditions. METHODS: Twenty-eight dental students participated in a three-year follow up study on tooth wear. Visible wear facets on full arch gypsum casts were assessed using a flatbed scanner and measuring software. Regression analyses were used to assess possible associations between the registered occlusal conditions 'occlusal guidance scheme', 'vertical overbite', 'horizontal overbite', 'depth of sagittal curve', 'canine Angle class relation', 'history of orthodontic treatment', and 'self-reported grinding/clenching' (independent variables) and increase of wear facets (dependent variable). RESULTS: Mean increase in facet surface areas ranged from 1.2 mm2 (premolars, incisors) to 3.4 mm2 (molars); the relative increase ranged from 15% to 23%. Backward regression analysis showed no significant relation for 'group function', 'vertical overbite', 'depth of sagittal curve', 'history of orthodontic treatment' nor 'self-reported clenching. The final multiple linear regression model showed significant associations amongst 'anterior protected articulation' and 'horizontal overbite' and increase of facet surface areas. For all teeth combined, only 'anterior protected articulation' had a significant effect. 'Self reported grinding' did not have a significant effect (p>0.07). CONCLUSIONS: In this study 'anterior protected articulation' and 'horizontal overbite', were significantly associated with the progression of tooth wear. Self reported grinding was not significantly associated with progression of tooth wear. CLINICAL SIGNIFICANCE: Occlusal conditions such as anterior protected articulation and horizontal overbite seem to have an effect on the progression of occlusal tooth wear in this convenient sample of young adults.

[Technical aspects of treatments with single- and multi-unit fixed dental prostheses]. / Tandtechnische aspecten van de vervaardiging van kronen en bruggen.

For the manufacture of single- and multi-unit fixed dental prostheses, effective communication between dentist and dental technician is required. Mutual insight concerning the (im)possibilities of available treatments and technical options is prerequisitefor this communication. The manufacture of single- and multi-unit fixed dental prostheses involves 4 phases: recording the required detailed information on the relevant teeth and the occlusal system, the technical adjustments, the technical design and the technical fabrication. These phases can be accomplished through an analogue or (semi)digital procedure. Pioneering developments are computer aided design and computer aided manufacturing (CAD/CAM), and computerised milling machines. Associated with this are 3 manufacturing methods which can be distinguished: the dental practice method, the dental laboratory method and the milling centre method. Materials applied are metal alloys and ceramics, while resins are used for provisional and transitional constructions. Due to the fact that the choice of material in the analogue procedure is limited, CAD/CAM offers more options, the digital procedure is expected to gain ground gradually. It is expected that this development will provide an impulse to higher quality.

[Loading and strength of single- and multi-unit fixed dental prostheses 2. Strength]. / Op kronen en bruggen uitgeoefende krachten en het weerstaan daarvan 2. Mechanische belastbaarheid.

The ultimate strength of a dental prosthesis is defined as the strongest loading force applied to the prosthesis until afracture failure occurs. Important key terms are strength, hardness, toughness and fatigue. Relatively prevalent complications of single- and multi-unit fixed dental prostheses are porcelain and ceramic fractures. Afactor which also plays a role is the functional loading force from the entire orofacial system. With respect to the strength of multi-unit fixed dental prostheses, the length of the arch span between the abutment teeth, the pontic with the connectors and the possible cantilevers are the critical components. Components of the configuration ofabutment teeth of single- and multi-unit fixed dental prostheses which are relevant for its strength are the convergence angle and the design of(the area above) the (cervical) outline. Finally, the thickness of the porcelain or the ceramic (veneers) ofmetal-ceramic and all-ceramic single- and multi-unit fixed dental prostheses is of importance.

Predictive factors for masticatory performance in Duchenne muscular dystrophy.

Patients with Duchenne muscular dystrophy (DMD) report masticatory and swallowing problems. Such problems may cause complications such as choking, and feeling of food sticking in the throat. We investigated whether masticatory performance in DMD is objectively impaired, and explored predictive factors for compromised mastication. Twenty-three patients and 23 controls filled out two questionnaires about mandibular function, and underwent a clinical examination of the masticatory system and measurements of anterior bite force and masticatory performance. In the patients, moreover, quantitative ultrasound of the tongue and motor function measurement was performed. The patients were categorized into ambulatory stage (early or late), early non-ambulatory stage, or late non-ambulatory stage. Masticatory performance, anterior bite force and occlusal contacts were all reduced in the patient group compared to the controls (all p < 0.001). Mastication abnormalities were present early in the disease process prior to a reduction of motor function measurement. The early non-ambulatory and late non-ambulatory stage groups showed less masticatory performance compared to the ambulatory stage group (p < 0.028 and p < 0.010, respectively). Multiple linear regression analysis revealed that stage of the disease was the strongest independent risk factor for the masticatory performance (R(2) = 0.52). Anterior bite force, occlusal contacts and masticatory performance in DMD are severely reduced.

[Loading and strength of single- and multi-unit fixed dental prostheses. 1. Retention and resistance]. / Op kronen en bruggen uitgeoefende krachten en het weerstaan daarvan. 1. Retentie en resistentie.

The degree to which single- and multi-unit fixed dental prostheses are able to withstand loading forces is dependent, among other things, on the quality of their retention and resistance. The quality of the retention and resistance of the configuration of an abutment tooth prepared for a metal and metal-ceramic single-unit fixed dental prosthesis is determined by the configuration's convergence angle, the height, the volume, the interocclusal space, the cervical outline design, the additional preparations, the quality of the (build-up) restoration, and the surface roughness. A silicate ceramic single-unit fixed dental prosthesis is attached through adhesion using a composite cement, but the retention and resistance of an oxide ceramic single-unit fixed dental prosthesis is dependent on the abutment tooth configuration. Most types of multi-unit fixed dental prosthesis have the following additional retention and resistance determining factors: the position in the occlusal system, the number of abutment teeth and their mutual configurations, and the length of (cantilever) pontics. A resin-bonded fixed partial denture's retention and resistance are determined by its bonding as well as its enamel surface coverage and its resistance preparations.

[Preprosthetic orthodontic treatments]. / Preprothetische orthodonti- sche behandelingen.

The objective of a preprosthetic orthodontic treatment is to position the teeth in such a way that a treatment with (fixed) dental prostheses is made possible or simplified or to affect the result of this treatment positively. Conceivable preprosthetic orthodontic treatments are: correcting primary orthodontic anomalies, closing or reducing interdental spaces and correcting the migration of teeth. In the case of unfavourable maxillomandibular relations, a preprosthetic surgical treatment is usually needed together with a preprosthetic orthodontic treatment. For children with agenesis and/or early loss of teeth and/or aberrant morphology of teeth, a treatment with fixed dental prostheses, either implant-supported or not, may be indicated after the tooth development or in some cases earlier. Until that time, preprosthetic orthodontic treatments may be indicated to offer an aesthetically sound provisional solution and to achieve optimal teeth positions for the final fixed dental prostheses.

[Prosthetic replacement of missing teeth. Indications for fixed and removable dental prostheses]. / Prothetische vervanging van afwezige gebitselementen. Indicaties voor vaste en uitneembare prothetische constructies.

Prosthetic replacement of missing teeth aims to improve health. This can be achieved by improving the patient's well-being and quality of life and by restoring the biological balance in terms ofocclusal and mandibular stability in the occlusal and the orofacial system. In occlusal systems with a complete anterior region and 'satisfactory' premolar and molar regions, prosthetic replacement of missing teeth is not indicated generally. In case ofa restricted number of missing teeth in the anterior region and/or a not 'satisfactory' premolar region, fixed dental prostheses may be indicated. In case of an incomplete anterior region and no 'satisfactory'premolar as well as molar regions, removable dental prostheses are usually indicated. These guidelines are presented in the absence of sufficient scientific evidence. Therefore, in clinical decision making, the question whether prosthetic replacement of missing teeth is sensible, and if so, by which type of dental prosthesis, can only be answered after a dialogue with mutual respect between care provider and patient.

Randomized control trial of composite cuspal restorations: five-year results.

The objective of this randomized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps. In 157 patients, 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp. Ninety-two direct and 84 indirect resin composite restorations were placed by two operators, following a strict protocol. Treatment technique and operator were assigned randomly. Follow-up period was at least 4.5 yrs. Survival rates were determined with time to reparable failure and complete failure as endpoints. Kaplan-Meier five-year survival rates were 86.6% (SE 0.27%) for reparable failure and 87.2% (SE 0.27%) for complete failure. Differences between survival rates of direct and indirect restorations [89.9% (SE 0.34%) vs. 83.2% (SE 0.42%) for reparable failure and 91.2% (SE 0.32%) vs. 83.2% (SE 0.42%) for complete failure] were not statistically significant (p = .23 for reparable failure; p = .15 for complete failure). Mode of failure was predominantly adhesive. The results suggest that direct and indirect techniques provide comparable results over the long term (trial registration number: ISRCTN29200848).

Occlusal tooth wear in Chinese adults with shortened dental arches.

To assess associations between occlusal tooth wear and shortened dental arches (SDA) in Chinese 40 years and older subjects. From a sample of 1462 urban and rural adults, those presenting with SDA (n = 150) were compared with a control group of 65 randomly selected subjects with complete dentitions (CDA). Occlusal wear was assessed using a modified Smith and Knight index - the occlusal tooth wear index (OWTI) - and analysed using multivariate (logistic) regression. There was no significant effect from SDA on severe occlusal wear (OTWI score 3 or 4: OR = 2.016; 95% CI = 0.960-4.231; P = 0.064). Higher age was associated with severe occlusal wear (P values ≤0.007) and with higher mean OTWI scores; urban had less often severe occlusal wear than rural residents (OR = 0.519; P = 0.008). Higher mean OTWI scores were associated with rural residents, except for anterior teeth. Females had lower mean OTWI score for anterior teeth (effect = -0.153; P = 0.030). Premolars in SDA had higher mean OTWI scores compared with those in CDA (effect = +0.213; P = 0.006). In SDA, more posterior occluding pairs (POPs) were associated with lower mean OTWI sores for anterior teeth (effect: -0.158; P = 0.008) and higher scores for molars (effect: +0.249, P = 0.003). Subjects with SDA or CDA presented comparable occlusal wear, but premolars in SDA tend to have higher probability for having occlusal wear. Fewer numbers of POPs were associated with more wear in anterior teeth.

[Determining and recording maxillomandibular relationships for the fabrication of single-unit and multi-unit fixed dental prostheses]. / Bepaling en registratie van de maxillomandibulaire relatie bij de vervaardiging van kronen en bruggen.

In a correctly functioning occlusal system, the design of the occlusal parts of single-unit and multi-unit fixed dental prostheses is generally determined by the maximum intercuspation. Determining and recording the maxillomandibular relationships is only required in case the adjacent teeth do not offer adequate support or reference to put the maxillary and mandibular cast in maximum intercuspation or in case the existing occlusion needs a well-structured alteration. The maxillomandibular relationships can be determined and registered analogously and digitally and on that basis the maxillary and mandibular casts can be mounted in a (virtual) occludator or articulator. In the absence of a distinct occlusal plane, one may consider first carrying out a facebow recording and transfer. Usually, the accuracy of determining and recording the maxillomandibular relationships does not increase when using more complicated methods.

[Attaching single- and multi-unit fixed dental prostheses]. / Bevestiging van kronen en bruggen.

A single- or multi-unit fixed dental prosthesis can be attached to the abutment teeth through mechanical retention and gap sealing or by adhesion. For sealing the gap, water-soluble cements are appropriate, such as zinc phosphate, polycarboxylate, and (resin-modified) glasionomer cement. Attachment through adhesion can be performed with composite cement. If the hard tooth tissue is prepared adequately, composite cement provides sufficient adhesion, but self-adhesive composite cement is now also available. For the adhesion of the composite cement to the restorative materials of the single- or multi-unit fixed dental prosthesis, surface sandblasting, silanizing, and tin coating and the application of a metal primer or chemically active composite are available. Cementing a single- or multi-unit dental prosthesis involves 3 phases: 1. Cleansing the single- or multi-unit dental prosthesis and the abutment tooth/teeth; 2. Preparing the hard tooth tissue, mixing the cement and placing the single- or multi-unit dental prosthesis; 3. Removing the excess cement.

[The conventional and the digital impression method for single-unit and multi-unit fixed dental prostheses]. / De conventionele en de digitale afdrukmethode voor kronen en bruggen.

To manufacture single-unit and multi-unit fixed dental prostheses, an accurate cast is required. Casts can be obtained either by the conventional or the digital impression method. For both methods, dry tooth surfaces and a well exposed finish line of the tooth preparation are required. The conventional impression method requires an elastic impression material. Elastomers have a high detail accuracy, which can produce, in combination with a good fitting and rigid impression tray, an impression with reliable dimensional stability. Based on the number of different impression material consistencies used and the number ofphases of the impression procedure, several options of the conventional impression method can be distinguished. For the digital impression method, teeth or implants are scanned to produce a digital cast which can be used directly with the help of computer technology to produce single-unit or multi-unit fixed dental prostheses. The digital impression method has a number of advantages when compared to the conventional impression method, but is not applicable for all prosthetic cases.