Digitalised exercise material in forensic odontology.

INTRODUCTION: This paper presents digital educational material in forensic odontology, including dental identification after multiple fatalities and dental age estimation from different age groups. MATERIAL AND METHOD: Electronic patient records consisting of intraoral scans of the dentition, digital radiographs, photographs and written dental records were collected. Exercises in age estimations contained digital radiographs and photographs of ground tooth sections, with digital measuring tools and tables according to age groups. The teaching material was organised as a module in an electronic Learning Management System with external links to all relevant teaching material. RESULTS: For the identification exercises, intraoral scans and the latest digital radiographs simulated the postmortem examination of the deceased. For comparison, all other radiographs, photographs and dental records were available as antemortem material. The exercise was to match postmortem findings with the antemortem records using the Interpol standard and reconciliation. Age assessment of children used designated tables to grade tooth development on digital radiographs. For adults, non-destructive methods, digital radiographs, photographs and measuring tools were used. DISCUSSION: The teaching concept was hybrid, but it can easily be adapted as a fully digital exercise. The instructions and written material can be translated into different languages. The level of difficulty in the exercises can be adjusted according to the participant's level of knowledge. CONCLUSION: The educational material embraces the new possibilities for digitalisation and intraoral scanning. This might be a valuable tool for motivating and engaging the students in their participation and understanding of the subject.

Photodynamic therapy of oral lichen planus.

Oral lichen planus (OLP) is a chronic inflammatory and immune-mediated disease affecting the oral mucosa. OLP presents with asymptomatic, lacelike white stripes and/or symptomatic red, ulcerated mucous membranes. Eating, drinking and oral hygiene procedures may be painful resulting in reduced quality of life (QOL). The histopathological picture is a zone of cellular infiltrate, mainly CD8+ cells, in the superficial layer of the connective tissue and signs of liquefaction degeneration of the basal membrane. Conventional treatment is corticosteroids. Local and systemic side effects are common, and patients may develop drug resistance. The intention with this article is to demonstrate the heterogeneity in photodynamic therapy (PDT) of OLP. A search in PubMed, Embase (Ovid) and Medline (Ovid) identified seventeen clinical studies investigating PDT of OLP. Only five were randomised controlled studies and the study groups varied from 5 to 50 patients. Five different photosensitisers or precursors were tested. Both broadband spectrum lamps, lasers and light-emitting-diodes (LEDs), with wavelengths from 420 nm to 682 nm, were used. The number of treatment sessions varied from one to ten. The patients were followed up for 0 to 48 months, but in thirteen studies the post treatment observation time was ≤6 months. Single arm studies demonstrated improvement of OLP except in one study. In all controlled studies except for one, PDT was superior or equal to conventional treatment. The majority of patients experienced a slight burning sensation during light activation, but no serious adverse events were reported. Only few studies examined the effect of PDT on a cellular level.

Photodynamic treatment of oral lichen planus.

OBJECTIVES: The aim of this study was to examine the clinical behavior and response to topical methyl 5-aminolevulinate (MAL) photodynamic therapy (PDT) of oral lichen planus and to describe the buildup and biodistribution of photoactive porphyrins in normal and lichen planus-affected oral mucosa after MAL application. STUDY DESIGN: The difference in clinical expression in 14 patients with buccal oral lichen planus was compared before and after treatment. MAL-induced photoactive porphyrins were monitored using noninvasive in situ fluorescence measurements. Microfluorometry was used to study the biodistribution. RESULTS: The absorption and conversion of protoporphyrin IX (PpIX) in epithelial and subepithelial T cells was demonstrated in histologic sections. As a result of 1 treatment session, there was a significant improvement of oral lichen planus after 6 months (P = 0.02) and during a 4-year follow-up period. CONCLUSIONS: MAL is absorbed and converted to PpIX in T cells. Oral lichen planus treated with MAL-PDT showed lasting improvement after a single treatment.

Ethical and legal considerations in a case of research fraud.

In 2006 a researcher at the main hospital in Norway admitted that he had forged data in a study published in the medical journal The Lancetthat was co-authored by 13 others from both Europe and America. The researcher, dually qualified in dentistry and medicine, immediately admitted fabricating the results. A Commission of Enquiry reported that most of his publications were fabricated or manipulated and that he was alone in the fraud. As a result, the researcher lost his authorization to practice medicine and dentistry. His action has shaken the trustworthiness of science and the trust for the scientific community, both in the institutions that support the research and in the review process in science publications. Following this revelation, the management of scientific fraud has been widely discussed, including concerns about the dual role of a Commission of Enquiry as both investigator and judge, and also the legal rights of fraudulent scientists. Other issues concern the responsibilities of supervisors and institutions in the guidance of candidates in research procedures and ethics. In addition, commentaries have appeared in national newspapers as well as in medical and dental scientific journals. Various issues have been discussed, including the fact that editors and referees in scientific publications rarely have the opportunity to check raw data, which emphasizes the need for data confirmation by independent groups. These reflections have been fruitful for the community, although it will not, nor can it, prevent fraud in the future.

Photodynamic treatment of oral lesions.

Photodynamic treatment (PDT) was first started in the oral cavity in the mid 1980s. Hematoporphyrins were rapidly replaced by Photofrin and meta-tetrahydroxyphenylchlorin (mTHPC) as photosensitisers of choice, and over the years these two have been approved by several health authorities for PDT. 5-aminolevulinic acid (ALA) and some dyes (e.g., toluidine and methyene blue) have also been tested. Several different nonthermal lasers have been used and lately light-emitting diodes (LEDs) have been tried. Most of the clinical treatments have been carried out on oral squamous cell carcinoma (OSSC), either primary or metastatic lesions, with good results. The treatment leaves little scarring and can be used before, in conjunction with, and adjunctive to other treatment modalities. The greatest disadvantage is that the patients are photosensitive for several weeks following systemic administration of the photosensitiser. PDT is now an accepted palliative treatment. Systemic administration of ALA has been more successful than local application in the treatment of precancerous lesions such as oral leukoplakia. PDT following topical application of photosensitiser (metylene blue and methyl-ALA) has shown improvement in cutaneous diseases of the oral mucous membrane such as oral lichen planus. The bactericidal effect of PDT has also been tested on oral plaque, but little clinical work has been performed so far. Instead of mechanical cleaning or antibiotic therapy, PDT may also play a role in dental diseases.

Collection of post mortem data: DVI protocols and quality assurance.

In many countries forensic odontologists are members of the Disaster Victim Identification (DVI) team. As part of their post mortem (PM) tasks work on the incident site may include securing and preserving the dental material and evidence before transport to the mortuary. In the autopsy room the main aim is to register the PM dental status. Photographs and radiographs are essential documentations in addition to a conventional registration of the dental status. Abbreviations in the registration may be used if agreed with the ante mortem (AM) team. Dental age estimation may be an aid in the sorting process and especially in victims without previous dental treatment. Interpol has a form set as part of their DVI manual. Forensic odontologists working in pairs and checking each other will act as quality assurance (QA) as suggested by International Organization for Forensic Odonto-Stomatology (IOFOS). Direct entry into the computer program as part of the registration in the autopsy room may save time and manpower.