An unusual case of death using a compacting machine.

ABSTRACT: In the large series of forensic injury, death from accidental me-chanical asphyxiation in adults is rare and is usually secondary to suffocation, aspiration, strangulation caused by entrapment of clothing in machinery (deaths at work) or asphyxiation in the course of erotic maneuvers. Compression asphyxia is a form of violent mechanical asphyxia in which the asphyxiated insult is produced by means of a compression and constriction mechanism of the thoracic cage. The authors report an unusual case of asphyxiated death from chest com-pression resulting from the action of a compacting machine, which occurred in a person who had fallen asleep in a waste bin.

Changes in gingival crevicular fluid inflammatory mediator levels during the induction and resolution of experimental gingivitis in humans.

AIM: The goal of this study is to characterize the changes in 33 biomarkers within the gingival crevicular fluid during the 3-week induction and 4-week resolution of stent-induced, biofilm overgrowth mediated, experimental gingivitis in humans. METHODS: Experimental gingivitis was induced in 25 subjects for 21 days followed by treatment with a sonic powered toothbrush for 28 days. Clinical indices and gingival crevicular fluids were collected weekly during induction and biweekly during resolution. Samples were analysed using a bead-based multiplexing analysis for the simultaneous measurements of 33 biomarkers within each sample including cytokines, matrix-metalloproteinases (MMPs) and adipokines. Prostaglandin-E(2) was measured by enzyme-linked immunoadsorbant assay. Statistical testing using general linear models with structured covariance matrices were performed to compare stent to contralateral (non-stent) changes in clinical signs and in biomarker levels over time. RESULTS: Gingivitis induction was associated with a significant 2.6-fold increase in interleukin 1-beta (IL-beta), a 3.1-fold increase in IL-1alpha and a significant decrease in multiple chemokines as well as MMPs-1, -3 and 13. All changes in clinical signs and mediators rebounded to baseline in response to treatment in the resolution phase. CONCLUSIONS: Stent-induced gingivitis is associated with marked, but reversible increases in IL-alphaa and IL-1beta with suppression of multiple chemokines as well as selected MMPs.

Relationship of periodontal disease to carotid artery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study.

Periodontitis has been linked to clinical cardiovascular disease but not to subclinical atherosclerosis. The purpose of this study was to determine whether periodontitis is associated with carotid artery intima-media wall thickness (IMT). Cross-sectional data on 6017 persons aged 52 to 75 years were obtained from the Atherosclerosis Risk in Communities Study 1996 to 1998 examination. The dependent variable was carotid IMT >/=1 mm. Periodontitis was defined by extent of attachment loss >/=3 mm: none/mild (<10%), moderate (10% to <30%), or severe (>/=30%). Covariates included age, sex, diabetes, LDL cholesterol, HDL cholesterol, triglycerides, hypertension, smoking, waist-hip ratio, education, and race/study center. Odds of IMT >/=1 mm were higher for severe periodontitis (OR 2.09, 95% CI 1.73 to 2.53) and moderate periodontitis (OR 1.40, CI 1.17 to 1.67) compared with no periodontitis. In a multivariable logistic regression model, severe periodontitis (OR 1.31, CI 1.03 to 1.66) was associated with IMT >/=1 mm, while adjusting for the other factors in the model. These results provide the first indication that periodontitis may play a role in the pathogenesis of atheroma formation, as well as in cardiovascular events.

Effect of dental unit waterline biocides on enamel bond strengths.

This study evaluated the effects of chemical biocides used to control dental unit waterline biofilm on the bond strength of resin to enamel. Sixty bovine teeth were randomly assigned to six treatment groups. One-way ANOVA revealed a significant difference in means (p < 0.001) and Tukey's multiple range test indicated that three of the experimental groups had significantly lower mean shear bond strengths than the control (p < 0.05). This finding suggests that dental unit waterline biocides may adversely affect adhesion of resin to enamel.

Dental digital radiographic imaging.

Radiographs are an important adjunct to providing oral health care for the total patient. Historically, radiographic images have been produced using film-based systems. However, in recent years, with the arrival of new technologies, many practitioners have begun to incorporate digital radiographic imaging into their practices. Since dental hygienists are primarily responsible for exposing and processing radiographs in the provision of dental hygiene care, it is imperative that they become knowledgeable on the use and application of digital imaging in patient care and record keeping. The purpose of this course is to provide a comprehensive overview of digital radiography in dentistry. Specific components addressed are technological features, diagnostic software, advantages and disadvantages, technique procedures, and legal implications.

Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction.

Oral Conditions and Pregnancy (OCAP) is a 5-year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full-mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3-level disease classification (health, mild, moderate-severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW < 2,500 g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA < 28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate-severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate-severe disease (n = 45) by pair-wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P < 0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW < 1000 g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate-severe periodontal disease (P = 0.0006 and P < 0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction.

Assessment of online continuing dental education in North Carolina.

BACKGROUND: Dental professionals are discovering the unique advantages of asynchronous lifelong learning through continuing dental education (CDE) opportunities offered online. The purpose of this study was to evaluate both the process and outcomes of online CDE in North Carolina. The assessment was designed to provide a better understanding of practicing dental professionals experiences with online CDE and to determine the effectiveness of this learning strategy. METHODS: Dental professionals from four North Carolina Area Health Education Centers regions evaluated two pilot online CDE modules in 1998. Thirty-one participants were recruited and subsequently enrolled with 23 completing at least one module. Each module included objectives, a multiple-choice pretest, interactive core material, and a post-test. Participants completed three online surveys measuring individual demographics and computer skill level, module design, and use and overall reaction to online learning. RESULTS: Most participants agreed that the modules were comprehensive, were pleasing in appearance, provided clear instructions, provided adequate feedback, and were easy to navigate. Most participants agreed that knowledge of the material increased. This was validated by a significant increase in mean pre- to post-test scores (p = .0001). Participants agreed that convenience was a definite advantage, and they would choose online courses again to meet their CDE needs. The least-liked aspects included technical and formatting issues. IMPLICATIONS: Participants were enthusiastic about online learning and learned effectively with this teaching strategy, but desired much more interactivity than existed in the current design.

Dental anomalies associated with amelogenesis imperfecta: a radiographic assessment.

Amelogenesis imperfecta, a group of hereditary conditions primarily affecting the enamel, has been associated with dental anomalies, including taurodontism, congenitally missing teeth, delayed eruption, crown resorption, and abnormal enamel density. The purpose of this study was to assess the prevalence of these anomalies in an amelogenesis imperfecta population. The study group consisted of members of 9 unrelated families--22 family members with amelogenesis imperfecta and 13 unaffected family members. Panoramic radiographs were evaluated for taurodontism, congenitally missing teeth, delayed tooth eruption, pathologic dental resorption, pulp calcification, and radiographic enamel density. The prevalence of taurodontism was similar in people with amelogenesis imperfecta and normal people; all of the remaining parameters were more commonly observed in people with amelogenesis imperfecta. The radiographic enamel density was quantitatively reduced in teeth affected by amelogenesis imperfecta in comparison with teeth with normal enamel. These findings suggest that some of the features associated with amelogenesis imperfecta result from abnormal enamel formation (eg, decreased enamel density, crown resorption) whereas others may occur as a result of expression of the genetic mutation in cells other than ameloblasts (eg, abnormal eruption, pulp calcification).

Effects of beam collimation on image quality.

PURPOSE: The purpose of this study was to determine the effect of three film-speed/collimator combinations on image quality, based on reviewer preference and diagnostic quality, based on caries detection. METHOD: Two hundred sixteen proximal surfaces were evaluated for the presence and severity of carious lesions on bitewing-simulated projections using D-speed film/circular, E-speed film/rectangular, and E-speed film/circular collimation. Matched films by model type were ranked, based on reviewer preference. Preference data were analyzed using Friedman's test, while the caries detection data were analyzed using a 3 x 3 x 3 x 6 ANOVA model and the kappa statistic. Variability components of the ANOVA were used to determine inter- and intra-rater reliability. RESULTS: Inter- and intra-rater reliability were 90.9 and 98.7%, respectively. Each of the film-speed/collimator combinations had average preference rankings that were significantly different from one another for each criteria (p < 0.001), with E-speed film/rectangular collimation consistently ranking highest and E-speed film/circular collimation consistently ranking lowest. There was excellent agreement in caries detection among the three film-speed/collimator combinations (kw = 0.92, kw = 0.94). CONCLUSION: Results from the subjective comparison indicated that E-speed film with rectangular collimation ranked highest for film resolution, overall appearance, and choice for caries diagnosis, while E-speed film with circular collimation ranked lowest. Caries diagnosis was comparable among the three film-speed/collimator combinations.

[Safety assurance for occupational tumors in agriculture]. / La tutela assicurativa dei tumori professionali in agricoltura.

Cancer risk in farming is characterized by:-multiple exposure varying in time, space and between crops;-poor knowledge of agrochemical used by workers;-interset of both sellers and users mainly or acute toxicity of pesticides;-availibility of sufficient evidence of carcinogenicity in humans only for arsenical insecticides and for benzene used as solvent. The frequency of both claims for compensation and recognized cased is extremely low. Referral to exper agronomists operations in the area of interest can turn out to be of great value in assessing exposures. In case of exposure to carcinogenic agents defined as possible or probable, the following criteria may be adopted:-duration of exposure and latency time in agreement with findings from scientific literature;-biological plausibility of the association of interest;-evaluation of the interaction in the frame of multiple exposure, with special reference to the role of brief and/or low exposures. The above mentioned items are discussed by examining practical cases.

Clinical evaluation of a samarium compound filter and E-speed film.

Producing radiographs of good diagnostic quality while keeping the dose as low as possible is the goal of the dental radiographer. Rare earth compound filters reduce the dose, but few clinical studies have evaluated the diagnostic yield. The diagnostic quality of a samarium compound filter used with E-speed film was compared with that of a conventional aluminum filter used with E-speed film. Bitewing projections with the test and standard filters were exposed for 39 patients. Agreement was evaluated with kappa statistics. The results indicated a substantial level of agreement between the two filter types. The combination of samarium compound filter and E-speed film appears to be a good mechanism for achieving dose reduction without compromising the diagnostic yield of the film.

Effects of focal spot size on caries diagnosis with D and E speed images.

Annual measurement of the x-ray unit focal spot size has been recommended by the American Academy of Oral and Maxillofacial radiology as part of the dental radiographic quality control program. This study compares the effects of focal spot size on caries diagnosis. Three x-ray units with small, medium, and large focal spot sizes were used to produce bite-wing images on extracted teeth mounted in acrylic bases. Randomized films were scored for lesion presence and depth by two general dentists. Weighted kappa statistics were used to evaluate the agreement of reviewer caries diagnosis by film speed and focal spot size. Comparisons of caries cells with small versus medium and small versus large focal spot size produced weighted kappa statistics = 0.72 and 0.70, respectively. Differences in caries calls were greater because of film speed rather than focal spot size. The results of this study suggest that the clinical significance of varied focal spot size is negligible. The value of annual measurement of focal spot size is questionable, and its recommendation should be revisited.

[Medico-legal aspects of the 89/931 act of the EEC]. / Gli aspetti medico legali della direttiva quadro 89/931 della CEE.

The act 391/89 which introduces some substantial news regarding the protection of public welfare and the safety of workers, will be taken in account in a next future. The A.A. examine these innovations and underline the way they will reassert the importance of a concrete application of the principles of primary prevention. Moreover, this act will have a large impact on forensic medicine as it will allow the acquisition of objective elements to asses the casual nexus between occupational exposure and injury, while evaluating the occupational etiology of the damage.

Pre-admission credentials and dental school performance of dental hygienists.

This study examined the effect of dental hygiene preparation prior to entering dental school on dental school performance. Study participants included 203 female students who entered a public dental school from 1980-1989. Groups 1 and 2 had completed dental school prerequisites and a dental hygiene curriculum in a community college setting (n = 19) or university setting (n = 22) respectively, and Group 3 (n = 162) were traditional students with no dental hygiene education. Preadmission variables were predental science and non-science grade point averages (GPA) and Dental Admission Test (DAT) scores. Performance variables were GPA of years one and two of dental school and National Board scores (Part 1). Results showed that Group 2 hygienists had significantly lower predental science GPAs than Group 1 or 3 and significantly lower non-science GPAs than Group 3 (p < 0). Both groups of hygienists had significantly lower DAT scores than Group 3 (p < 0). No difference was seen in first and second year GPAs or the National Board average. Adjusting performance scores to compensate for deficiencies in preadmission variables showed that Group 2 hygienists had significantly higher adjusted first-year GPAs and National Board averages than Group 3 (p < 0). Thus, hygienists performed as well as non-hygienists in spite of weaker admission credentials.

Comparative effectiveness of visual/tactile and simplified screening examinations in caries risk assessment.

Central to the development of a model for identifying children at high risk to caries is a clinical evaluation to assess dental status and other conditions potentially useful in caries prediction. Traditionally, this evaluation has been based on a relatively lengthy visual/tactile examination conducted by a dentist. Replacing the dentist examination with a dental auxiliary conducted screening evaluation could lead to reduced time and costs. The 4-yr University of North Carolina Caries Risk Assessment Study involved approximately 5000 schoolchildren initially in Grades 1 and 5 living near Aiken, South Carolina, and Portland, Maine. The effectiveness of caries prediction models using visual/tactile examination data were compared with the same models using simplified screening evaluation data. Results showed sensitivity ranged from 0.57 to 0.61 for the visual/tactile and screening models by site and grade cohort. Specificity for the models ranged from 0.80 to 0.83. None of these differences in sensitivity and specificity between visual/tactile (dentist) and screening (hygienist) models was statistically significant. Findings show that for the prediction of children at high risk to dental caries the clinical evaluation may be conducted with no reduction of precision by using dental hygienist performed screening evaluations rather than dentist conducted visual/tactile examinations. While no cost data were collected, these results imply that costs to future prediction programs could be reduced by using screening evaluations.

Factors influencing the selection of dental hygiene as a profession.

Since the mid-1970s, the dental hygiene profession has experienced a decline in the number of applicants. Reasons cited for this decline are fewer traditional college-age students, an increase in the career opportunities available to women, and a decrease in student financial aid. Four-year dental hygiene programs have experienced applicant decline faster than two-year programs. The purpose of this study was to determine factors that influenced university freshmen to designate dental hygiene as a career choice. Factors examined included reasons for choosing or not choosing a career in dental hygiene, and retention in the college major chosen. A questionnaire was mailed to three groups of students who entered the University of North Carolina-Chapel Hill as freshmen from 1985 through 1987: (1) all students who designated dental hygiene as a major on their entrance application; (2) a random sample who did not; and (3) all the freshman during that time period who subsequently matriculated into the dental hygiene program. The overall response rate was 78% (n = 80). Subjects began to explore career opportunities at a mean age of 16. Having a family member/friend in the selected field was found to be the most influential factor in career selection. Among dental hygiene students, contact with a dental hygienist was perceived to be influential in their career choice. Entering college freshmen exhibited a lack of knowledge about the dental hygiene profession, and most had not received any information about dental hygiene in high school. These findings can be used to develop recruitment strategies.

Examiner agreement between hygienists and dentists for caries prevalence examinations.

Dentists have been used as examiners in caries prevalence examinations almost exclusively. Only rarely have dental hygienists been reported as examiners in these types of studies. This article describes the degree of agreement for prevalence data (DMFT, dmft) and specific caries prediction information collected by hygienist-screeners and dentist-examiners. A total of 5,233 first- and fifth-grade children were screened by hygienist-screeners using a tongue blade only and then examined by dentist-examiners using an explorer and mirror. Agreement was analyzed in terms of percent agreement and the kappa statistic. The values for screener-hygienist dentist-examiner agreement were compared to interexaminer and interscreener reliability values. Means were also calculated for the caries indices. The results indicated good agreement for the caries indices between the screener-hygienist and dentist-examiner. Agreement for the prediction indices tended to be lower. The results suggest that hygienists can be used as examiners in caries prevalence studies.

Clinical evaluation of a samarium/aluminum compound filter.

Rare earth compound filters, which offer reduced patient exposure during intraoral radiography, have not been clinically evaluated for their effect on diagnostic yield. This clinical study was conducted to compare the diagnostic yield of bitewing radiographs exposed with a conventional aluminum filter with matched bitewing radiographs exposed with a samarium/aluminum compound filter. One hundred sixty-three pairs of bitewing radiographs were read independently by two reviewers for absence or presence and depth of proximal carious lesions. Degree of agreement between films was assessed by means of the kappa statistic. Results showed good agreement between the radiographs exposed with each filter type. Thus, x-ray machines modified with a samarium/aluminum rare earth compound filter produce bitewing radiographs of comparable diagnostic yield and lower dose when compared with radiographs exposed with a conventional aluminum filter.

Six-month effects of a sanguinarine dentifrice on plaque and gingivitis.

A six-month, double-blind clinical trial was conducted to determine the effectiveness of a sanguinarine-containing dentifrice in reducing plaque and gingival inflammation. One hundred twenty adult volunteers were randomly assigned to a control or experimental group. The test dentifrice contained 750 mcg/g of sanguinaria extract. A dentifrice of similar composition without sanguinarine was used as the placebo. Plaque and gingival inflammation scores were recorded for four surfaces on each of 12 index teeth at baseline, one-, three, and six-months. Matched pair t-test analyses showed no significant differences between experimental and control groups for mean six-month changes in plaque and gingival inflammation scores in analyses using all 48 sites per subject or in analyses of only the 24 interproximal sites. No long-term reduction was demonstrated in plaque or gingival inflammation with the use of a sanguinarine-containing dentifrice.