Nederlands tijdschrift voor tandheelkunde最新文献

Since 2006, the special dentistry scheme applies to everyone. Before that, privately insured persons were dependent on a limited list of deviations and were obliged to have the necessary care provided in a Centre for Special Dentistry (CBT). For health insurance policyholders, the general dentist had primacy for all special dentistry. However, many general dentists were unable (in terms of time, knowledge and experience) to apply the special care in practice. As a result, CBTs were soon established where dentists with a special affinity could provide the care. Nowadays, mainly specialized dentists work at the various larger CBTs. What is the current situation regarding the entitlement to and claiming special dentistry?

People with Down syndrome present unique dental and orthodontic challenges due to abnormalities in growth, craniofacial development, and oral motor function. This article summarizes the specific characteristics of Down syndrome and how they can impact orthodontic care. Children with Down syndrome exhibit growth delays starting from pregnancy and experience delayed, limited craniofacial development, often resulting in Class III malocclusions and a narrow maxilla. Additionally, dental anomalies such as microdontia, agenesis, and taurodontism are more common in this population. Orthodontic treatment is further complicated by comorbidities such as hypotonic muscles, obstructive sleep apnea, gastrointestinal and hematologic disorders, and behavioral challenges. The use of desensitization techniques and a multidisciplinary approach is essential for providing effective care. Early diagnosis, careful monitoring, and the use of appropriate orthodontic appliances are crucial for achieving optimal outcomes. Timely referral to specialized care providers can significantly improve both orthodontic outcomes and the quality of life for individuals with Down syndrome.

It can be helpful for dentists and dental hygienists to learn to look through sensory information processing glasses, both within regular dental practice and within special dentistry. This way of looking helps professionals when they reach a deadlock with a patient. For example, this can happen during a check-up, a treatment, or with persistent inadequate oral hygiene, despite repeated advice and instructions. Many patients may have difficulty processing sensory stimuli such as sounds, light, smells, taste, touch, movements and internal body sensations, which affects their behaviour. By investigating what stimuli cause overstimulation or understimulation, the needs of the patient can be better met and a more positive experience and better treatment results can be ensured.

From mid-December 2024 to mid-February 2025, a poll was conducted among the readers of the NTVT to gain insight into their views on the treatment of people with disabilities or autism. 27,2% of all respondents indicated that there are insufficient options to refer people with disabilities or autism for treatment within a 30-minute travel distance. Moreover, many Centers for Special Care Dentistry have a waiting lists or do not take on new patients anymore. The contribution of general practitioners is therefore much needed to organize the necessary care for these special care groups in the Netherlands. The degree of perceived competence appears to be associated with the self-reported treatment of people with a moderate to severe intellectual disability in the general dental practice. Additional training appears to lead to more competence, and therefore possibly to more treatment of these special care groups in the general dental practice.

In 2020, a new law (Wzd) was introduced to protect individuals with an indication under the Long-Term Care Act from coercion in healthcare. The Wzd applies to the healthcare of anyone with a long-term care act indication (whether they live at home or in a small- or large-scale institution, excluding judicial institutions); people with intellectual and/or multiple disabilities and people with a (psycho-)geriatric condition or similar disability. The Wzd should also apply within dental care if individuals refuse oral care or exhibit resistant behaviour when receiving oral care. By strictly applying the law in practice, ethical dilemmas can arise because it doesn t work for a patient. Oral care within the healthcare for the disabled sometimes requires the application of common sense in order to help a patient in a good way.

Pre-orthodontic orofacial myofunctional therapy is regularly prescribed in young children to correct the function of the tongue as a causative factor of an anterior open bite. Tongue thrusting is thereby identified as a harmful habit that needs to be unlearned. However, the concept that soft tissue dysfunction is the primary cause of orthodontic abnormalities does not appear to be valid. The tongue adapts its function to the abnormal anatomy, which has arisen for other reasons. If the tongue would not do this, food and drink would be squeezed out rather than transported to the oesophagus. Teaching children different swallowing behaviour in order to facilitate or make orthodontic treatment unnecessary is therefore an unnecessary intervention.

A 73-year-old woman was presented at the Accidents and Emergency Department with trismus. The cause was an acute tetanus infection due to a small, superficial wound from bumping her lower leg against a stool. Tetanus is a life-threatening infection caused by the bacterium Clostridium tetani, primarily occurring in contaminated, anaerobic wounds. The infection leads to muscle spasms, often starting with trismus. For oral healthcare providers, it is crucial to check the vaccination status of patients with injuries and to be aware of the Dutch guidelines and protocols regarding tetanus prophylaxis.

People with severe intellectual disabilities are at greater risk of dental trauma. Cooperation in a dental setting is often limited and inadequate oral hygiene is a common concern. When opting for anterior tooth replacement, personal factors must be considered carefully. Choosing an appropriate anterior tooth replacement involves balancing aesthetic outcomes, durability, and the strain on the patient. These cases illustrate how such choices are weighed in practice.

Developments and innovations in the field of all-ceramic restorations in the last 50 years have greatly contributed to much better biocompatibility and aesthetics. The second part of this two-part article describes the development of zirconium dioxide. The problem of chipping of some zirconium dioxide veneers, in particular, has damaged confidence in zirconium dioxide veneering. Thanks to important innovations in material technology, such as digital layering and biomimetic zirconium dioxide veneers, it was possible to improve the quality of fired all-ceramic restorations.

In tooth resorption mineralized tooth tissue is destroyed without the presence of bacteria. Resorption is often very progressive. Timely treatment is key to preventing discomfort for the patient or premature tooth loss. Resorption can be categorized into principal external and internal types of resorption, that are further subdivided. Clinical and especially radiological examination can help determine these different types of resorption, each with its own cause. Each type of resorption requires a specific treatment. It is, then, essential for the practitioner to recognize the condition in a timely manner, make a correct diagnosis, and initiate the appropriate therapy.