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Risk and limits in dental practice: a Portuguese approach to medical-legal evaluation and professional liability
Ana Corte-Real, Catarina Caetano, André Dias Pereira, Salomão Rocha, Sónia Alves, Duarte Nuno-Vieira
Patient safety and quality of healthcare delivery systems are an objective of WHO. This study aims to present and analyse Portuguese clinical data on risk and malpractice in dental practice. Data from the Forensic Dentistry Laboratory (Faculty of Medicine, University of Coimbra) was analysed, between the years of 2013 to 2018. One hundred and seven technical reports were selected, and seventy nine files were included in the iatrogenic sequelae group. Data included the analysis of the performance of dental professionals. Sequelae were divided in descending order of occurrence:1) mandibular dysfunction (53,2%)[(42)79]; 2) neurological deficit (39,2%)[(31)79]; 3) tooth loss (6,3%)[(5)79]; and 4) opening deficit (1,3%)[(1)79].Three major areas with significant expression in the field of expert evaluations were analysed: 1) orthodontic treatment (51,9%), implant rehabilitation (29,1%), and oral surgery. Given the prevalence of malpractice, the need to assess its causes and recognise standards for its prevention is necessary.
(J Forensic Odontostomatol 2020, 38; 1-2:7)
Sex determination in a Brazilian sample from cranial morphometric parameters – a preliminary study
Carlos Sassi, Alicia Picapedra, Ramón Álvarez-Vaz, Cristhiane Martins Schmidt, Viviane Ulbricht, Eduardo Daruge Júnior, Luiz Francesquini Júnior
Sex determination, which is based on the existence of dimorphism between specimens of the same species, plays an important role in the process of human identification. In the absence of pelvic elements, the skull appears to be the best sex indicator, and can also be submitted to quantitative or metric assessments. Eleven measurements were taken for this study, four in the sagittal plane and seven in the horizontal, in two groups of 186 skulls each, with 101 from males and 85 from females for those of the sagittal plane, and 100 and 86, respectively, for those concerning the horizontal, of subjects aged between 18 and 94 years at the time of death. The sample belongs to the Osteological and Tomographic Biobank Professor Doctor Eduardo Daruge of the Piracicaba Dental School of the University of Campinas. The aim of this research was to establish a reliable method to determine sex and elaborate mathematical prototypes capable of assisting in investigation or identification activities, in a preliminary study. Of the measures implemented (Lambda-Nasion, Lambda-Rhinion, Lambda-Nasospinale, Rhinion-Nasospinale, Zygomaxillare-Zygomaxillare, Lambda-Incisive Foramen, Lambda-Right Zygomaxillare, Lambda-Left Zygomaxillare, Basion-Incisive Foramen, Basion-Right Zygomaxillare and Basion-Left Zygomaxillare), only the Lambda-Nasospinale and Rhinion-Nasospinale in the sagittal plane, and the Zygomaxillare-Zygomaxillare and Lambda-Incisive Foramen in the horizontal plane, were significantly dimorphic. Two predictive mathematical models of sex were conceived for each pair of them: one of logistic regression and another of conditional inference trees, displaying accuracy rates of 78.5% and 77.42%, and of 68.28% and 72.04%, respectively. The authors concluded that there is the possibility to apply the aforementioned data in forensic anthropology as an auxiliary tool in investigation or identification tasks.
(J Forensic Odontostomatol 2020, 38; 1_8:17)
Frequency and degree of inter-trait association of maxillary Non-Metric Dental Crown Traits in the permanent dentitions of two states of India
Harish RK Nair, Sumita Mishra, Swagatika Panda, Gunjan Srivastava
Non-metric Dental Crown Traits are a principal source of information in forensic dentistry. However, inadequate data on the prevalence of these traits prompted this study to determine the frequency, sexual dimorphism and degree of inter-trait association in two different populations of India. Dichotomized data on the existence of non-metric features were recorded among individuals from Odisha (n=506) and Kerala (n=536) between 15 to 30 years of age. Cusp of Carabelli is the most common trait to occur (48 %) followed by shovelling of incisors (15%) and Bushman canine (14%). Bushman canine (p=0.045) and Cusp of Carabelli (p = 0.041) were found to be significantly expressed in Odisha and Kerala populations respectively. A strong association between shovelling of central incisor and Bushman canine with a likelihood ratio of 14.041 (p=0.001) was observed. This study will help in characterizing the Indian dentition and post-mortem dental profiling.
(J Forensic Odontostomatol 2020, 38; 1-18:25)
Evaluation of mandibular third molar for age estimation of Filipino population age 9 – 23 years
Joy R. Memorando
Objectives: The study aims to determine the correlation between dental age and chronologic age in the assessment of third molar development among Filipino patients aged 9 to 23 years seen in the Paediatric Dentistry Division (PDD) of the Philippine Children’s Medical Centre (PCMC) between 2012-2017.
Materials and Methods: 384 digital panoramic radiographs of Filipino patients (215 males and 169 females) were gathered. Right mandibular third molars were assessed using Modified Demirjian Scoring System. Mean Absolute Error, Percentage error and Correlation is determined between dental age (DA) and chronologic age (CA) of the population.
Results and Conclusion: Initial development of the third molars is observed to begin at approximately 9 years of age and root completion commences at around 19 years of age. Using Spearman Rank-Order Correlation, a strong positive correlation between CA and DA was observed among the overall population (r=0.9518). The observed correlation was stronger among females (r=0.9595) compared to males (r=0.9445). All correlation coefficients were significant (p-value<0.0001). Low percentage error among males and females is observed indicating no significant difference between the CA and DA values of the population.
(J Forensic Odontostomatol 2020, 38; 1-26:33)
Revisiting autopsies of death by mechanical asphyxia in the search for post-mortem pink teeth
Alyssa Niara Brites, Ana Luísa Rezende Machado, Ademir Franco, Ricardo Henrique Alves Silva
Background: In contemporary forensic practice, Medicine and Dentistry combine forces to improve the search for the cause of death and human identification. The pink tooth phenomenon (PTP) is a cadaveric sign that allegedly manifests more often in victims of asphyxia. However, the scientific literature is scarce and controversial on this aspect.
Objective: This study aimed at screening victims of mechanical asphyxia in order to search for post-mortem pink teeth.
Material and methods: Retrospectively, autopsy reports from a local medico-legal institute in South Brazil were revisited in the search for victims of death by asphyxia. Autopsy reports of twenty one victims aged between 6 and 67 years (mean age: 40.6 years ±19.20; median: 37 years) were found and analyzed.
Results: The different modalities of asphyxia included drowning (n=7; 33.33%), strangulation (n=1; 4.76%) and hanging (n=13; 61.91%). A single case of PTP was detected (4.76%) – a 26-year-old male victim of hanging. Conclusion: This study illustrates and highlights the unspecific aspect of the PTP. In practice, forensic experts must avoid interpretations of this phenomenon as conclusive evidence of the cause of death, such as asphyxia by drowning, strangulation or hanging.
(J Forensic Odontostomatol 2020, 38; 1-34:38)
Comparison of accuracy of age estimation in Indian children by measurement of open apices in teeth with the London Atlas of tooth development
Preeti Sharma, Vijay Wadhwan
Aim: The aim of this study was to evaluate and compare the accuracy of two age estimation methods in Indian children by using the open apex method proposed by Cameriere et al and the London Atlas of Tooth Development.
Materials and method: Three hundred and thirty five archived digitised panoramic radiographs of healthy children (165 males and 170 females) in the age group of 5 to 15.99 years were retrieved and analysed. The observations were entered in the SPSS software (Version 19.0). The paired t-test and independent samples t-test were applied to assess the differences between chronological and estimated age in both genders.
Results and conclusion: Inter-observer reliability was found to be excellent with Cronbach Alpha to be 1.000 and 0.997 for Cameriere’s and London Atlas age estimation methods respectively. The difference of 0.59 years (SD ±1.32 years) was highly significant and indicated a consistent underestimation of age using Cameriere’s method. While, applying the London Atlas, the difference of -0.03 years (SD± 0.69 years) was not significant and indicated a little overestimation of age. No significant difference was observed for both genders with the methods.Our results revealed thatthe methods are reliable for age estimation in Indian children, however, the London Atlas is simpler to use and is more accurate than Cameriere’s method.
(J Forensic Odontostomatol 2020, 38; 1-39:47)
A contribution for the forensic odontologist’s safety in the autopsy room
Francesco Pradella, Ilenia Bianchi, Giulia Vitale, Vilma Pinchi
The Covid 19 pandemic we are currently facing all over the world is undoubtly an emergency condition which exposes all workers to the risks of a serious infection. The personnel working in the autoptic room is at high risk for the possible contact with infected material from corpses, splashes and aerosols diffusion, and must be always prepared to stay safe and healthy. We offer to the forensic odontologists’ community a short summary of some old and new hints on the treatment of dead bodies in the autopsy room during this pandemic emergency time.
(J Forensic Odontostomatol 2020, 38; 1-48:50