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Background: and Overview. Dentists frequently are faced with patients' requests for an extraction, sometimes of the entire dentition. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction., Conclusions: In most cases of patients' requesting extractions, the ethical principle of nonmaleficence will play a decisive role in the dentist's decision making. In cases in which the request appears influenced by a specific mental condition such as a phobia of dental treatment, extraction rarely is justifiable. Practice Implications. Dental professionals should keep in mind that they cannot be forced to carry out treatment that is at odds with the ethical principle of nonmaleficence or that is outside of the bounds of accepted treatment. To aid dentists in making treatment decisions in such cases, the authors present a flowchart that integrates possible considerations.

In the 1990s the Dutch government imposed several laws to strengthen the position of the patient and to improve the quality of care. These laws did not always have the intended outcome. Recently the Ministry of Public Health, Welfare and Sport launched the programme, 'The 7 rights of the patient in health care: investing in health care relations'. Three of these rights will have a strong influence on Dutch general dental practices: the right to choice and choice-information, the right concerning coordination among oral health care providers, and the right to low-threshold complaint and disagreement procedures. Most of these rights already exist in current legislation. Especially the right to choice and choice-information means that the dentist has to provide his patients not only with information concerning treatment but also with information on his dental practice, such as waiting times, the experience of other patients and opening times.

Concerning cases of liability, dentists in the future will probably have to call on expert help or act as experts on behalf of a colleague with increasing frequency. Dentists who consider acting as experts in liability cases will have to develop their expertise especially in civil law and disciplinary law. Matters which in this respect should receive special attention are: the expert must act in conformity with the law on Medical Treatment Agreement; the expert's report must make clear what the legal basis is of the report's conclusions; the legal basis must be substantially supported by the facts, conditions and findings that are mentioned in the report; the expert must act independently and refrain from subjective judgments, assumptions and unprofessional and prejudicial qualifications.

Background: For more than half a century, the risk of physicians participating in torture has received thoughtful attention in the field of medicine, and a number of international organizations have issued declarations decrying such involvement. Despite publications that provide evidence of dentists' having participated in torture as well, until recently the dental profession was quiescent on the subject., Methods: The authors describe the historical background for a new declaration against dentists' participation in torture developed by the International Dental Ethics and Law Society and the Fédération Dentaire Internationale (FDI) World Dental Federation. They review various levels of involvement by dentists in torture and related activities in reference to existing World Medical Association declarations. Finally, they outline the process of drafting the new dental declaration, which was adopted by the FDI in October 2007., Clinical Implications: The authors provide insight and guidance to clinicians who diligently serve their patients, unaware that they may face military or other pressures to participate in torture.

Dutch legislation allows paramedics to perform certain dental treatments. At least an important part of the dentists and paramedics in this study does not meet the legal conditions for bringing in paramedics into daily dental practice. As the relevant Dutch law on this subject makes it possible to prosecute both the dentist and the paramedic who goes beyond their professional competence, it is advised to consult the law before exploring the possibilities of the team concept.

Complaints or claims against dentists by dissatisfied patients usually consist of three parts: the dentist did not perform the treatment as s/he should have done; the dentist did not inform the patient properly about the risks involved with the treatment; the dentist did not keep records. In most cases it is not too difficult for a judge or dental board member, if necessary with the aid of an expert witness, to decide whether the treatment was indeed below standard. The same applies to dentist's record keeping. The recrimination concerning the information given is something else. This deals with the extent of the duty to inform a patient as well as the proof that sufficient information was given. These difficulties do not only appear in court, but also in dental surgeries. This article will focus on the evolution in the jurisprudence concerning the duty to inform patients about risks as well as on the recently changed guidelines of the General Dental Council (GDC) regarding informed consent. Finally some simple tests will show that informing patients about risks does not have to be a risky and time consuming business for the dentist.

Dental records are more than a small part of the bookkeeping. In most dental practises, keeping records is the task of a dental assistant. In civil court, the dentist is in most countries liable for the mistakes of his employees. In disciplinary court however there may be doubt whether the dentist is responsible for the mistakes of his assistant. Contrary to their American colleagues, Dutch dental assistants and dental hygienists cannot be summoned before a disciplinary court. As these para-medics perform more and more dental treatment, independently or after delegation, they should be assigned there own disciplinary responsibility.

According to some people, the renewed Dutch civil disciplinary law is not fulfilling the expectations. Some procedures seem to be reductant for accused dentists. Besides the civil disciplinary law, also the professional disciplinary law of Dutch Dental Association is questionable. The Association is planning to change the current professional disciplinary law. However, the proposed amendments may have the consequence that a Dutch dentist more frequently will be faced with a civil disciplinary law procedure or normal civil law procedure.

For Dutch physicians being sued is one of their worst nightmares in professional life. Dutch dentists as a group do not seem to bother. This article shows that the light-heartedness of the dental profession is incorrect. A Dutch dentist has the same reason for being worried about the chance of facing a (disciplinary) council, about the procedure and about (disciplinary) measures as Dutch physicians have. For dentists who actually had to face a disciplinary council, their experience was very frightening and affected their professional satisfaction. Knowledge of public health legislation and a basic knowledge of legal procedures can be useful weapons in the battle against burnout.

Background: It is not clear which closed drainage technique is preferred as initial therapy for mediastinitis as soon as it is detected after cardiac surgery. A comparison is made between a continuous irrigation system and vacuum drainage using redon catheters., Methods: A retrospective cohort study of patients undergoing cardiac surgery between January 1, 1989 and January 1, 1997 was made. Patients who developed a deep surgical site infection at the sternotomy site and who were treated with one of the two closed drainage techniques were included. Patient characteristics and procedure-related variables were analyzed. Also, variables related to the drainage procedure were included. Outcome parameters were treatment failure, total hospital stay, postoperative hospital stay and in-hospital mortality., Results: The study population consisted of 11,488 patients, of whom 102 developed a deep surgical site infection (0.89%). The final study population consisted of 60 patients who fulfilled the inclusion criteria. From those, 29 were treated with continuous irrigation and 31 were treated with vacuum drainage. Both groups were comparable for patient characteristics and procedure-related variables. Treatment failure was more than three times as likely in the continuous irrigation group (relative risk: 3.2, 95% confidence interval: 1.3 to 7.7). Also, postoperative (p = 0.03) and total hospital stay (p = 0.03) were significantly longer in the group treated with continuous irrigation (mean prolongation of 14 and 13 days, respectively). After correcting for confounding, using multivariate analysis, the treatment method employed was found to be an independent and statistically significant variable associated with treatment failure (p = 0.04)., Conclusions: Closed drainage using vacuum-drainage system is the initial therapy of choice for patients with mediastinitis after cardiac surgery, because it is associated with significantly less treatment failure and a shorter stay in hospital.

Objective: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon bileaflet valve., Methods: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4 +/- 12.4, underwent valve implantation., Operations: aortic valve replacement (AVR), 726; mitral valve replacement (MVR), 475; double valve replacement (DVR), 150. Additional procedures: CABG, 211; TV repair, 64; other, 152., Results: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24., Conclusions: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications.