Oral health management of a medically compromised patient with medication induced xerostomia--a case study.

An ageing population requires dental professionals to be aware of the oral effects of medications taken by their patients. This case study will present the challenges faced by the hygienist in the oral health management of a 79-year-old medically compromised patient over a 2-year period. The interrelationship between the ageing process, medical conditions and medications taken, and specific treatment modalities are considered.

The discrimination potential of amalgam restorations for identification: part 1.

The dental identification of human remains utilizes the matching of dental restorations. The radiographic images of amalgam restorations are paramount in this process. The compound amalgam restoration has a unique radiographic morphology and can be readily identified in both antemortem and postmortem data. To test the radiographic morphology of compound amalgam restorations, 10 out of 40 Typodont teeth, restored by students, were tested for their discriminatory potential by 12 examiners. The results showed that the radiographic morphology of compound amalgam restorations can be accurately matched by dentally trained personnel. This suggests that in cases where accurate radiographic material is used for dental comparison, less than 12 concordant features are necessary for positive dental identification. If the antemortem and postmortem radiographic images of a compound amalgam restoration are exactly the same then this feature is unique and identification can be achieved by a single concordant feature.

The discrimination potential of amalgam restorations for identification: part 2.

The standard dental bitewing radiograph is used to detect interproximal caries but it also provides a specific view of the dental restorations that can be duplicated for identification purposes. The antemortem and postmortem bitewing radiographs are often not at the same angle and result in distorted images of the restorations. The aim of this study was to investigate the progressive increase in angulations of a bitewing radiograph of the same restoration and to determine at what angle the image is distorted sufficiently as not to be recognized. Bitewing radiographs were taken of the same two restorations at 5 ̊, 10 ̊, 15 ̊ and 20 ̊ superior, inferior, mesial and distal to the original 0 ̊bitewing radiograph. Twenty examiners were required to determine at what angle the distortion prevented matching of the image with the original bitewing radiograph. The results showed that the image distortion at 15 ̊became suspect but at 20 ̊none of the images could be matched to the original bitewing radiograph.

The discrimination potential of radio-opaque composite restorations for identification: part 3.

The methods used for disaster victim identification is comparative postmortem profiling of dental and fingerprint data. Twelve dental concordant features are normally required for dental identification. The radiographic image of dental amalgam restorations has been shown to be highly significant for identification purposes. The aim of this study was to investigate the radiological morphology of standardized radio-opaque composite fillings in premolar teeth with regard to their discriminatory potential for identification purposes. Thirty lower first premolar teeth ("Typodont" acrylic teeth) that were filled with 3- surface fillings (MOD) radio-opaque composite resin (Z100) by 4th year dental students were used for this study. Bitewing radiographs were taken of all thirty fillings and labeled Set 1. A second set (Set 2) consisted of 10 randomly selected duplicate radiographs of Set 1, plus 2 other radiographic images not from Set 1. Instructions were given to 20 dentally trained examiners to match the 12 radiographic images of Set 2 with the 30 images of Set 1. The results showed that 18 of the 20 examiners correctly matched the 12 radiographic images, one scored 11 out of 12 and one scored 10 out of 12. This study shows that if the ante-mortem and post-mortem radiographs of a single composite filling have exactly the same morphology, this image is unique and 12 concordant features are not necessary for dental identification.

Dental age related tables for children of various ethnic groups in South Africa.

The standard age estimation methods of Moorrees, Fanning & Hunt (1963) and that of Demirjian, Goldstein & Tanner (1973) have been shown by several authors to be inaccurate when applied to their juvenile population. This was similarly found to be true in South African children. Pantomographic radiographs of samples of South African children of White, Coloured, Indian and Black origin were used to develop dental age related tables for these ethnic groups. These dental age estimation tables were tested and are presented.

Testing standard methods of dental age estimation by Moorrees, Fanning and Hunt and Demirjian, Goldstein and Tanner on three South African children samples.

Dental age estimation of juvenile skeletal remains has utilized the methods of Moorrees ,Fanning and Hunt (1963) [MFH] and Demirjian,Goldstein and Tanner (1973) [DGT] for many years with various results. The Demirjian et al method has been tested by several authors on their population groups with varying results.The use of these methods to age the skeletal remains of South African children by the author has not been successful. The aim of this study was to test the accuracy of the dental age estimation methods of MFH and DGT on samples of children of different ethnic groups.The study showed that the MFH method consistently under-estimates the age and the method of Demirjian et al over-estimates theages.

Oro-facial trauma in child abuse fatalities.

Many children die as a result of abuse and neglect each year. Early recognition and effective intervention are crucial factors in the fight against this. Child mortality rates increased in South Africa between 1998 and 2004, with child abuse deaths constituting part of these statistics. Autopsies on children who have died of unnatural causes are often not specific as to the possibility of child abuse. This article presents the extra-oral and intra-oral signs of child abuse from a study of the autopsies of child mortality cases seen at Salt River Medico-Legal Laboratory in Cape Town from 1998 to 2004 with reference to the South African child mortality rates.

Mass disasters. Part 2. Role of the general and forensic dentists as team members.

Part 1 of this two-part article dealt with mass disasters in general, their characteristics and the agencies involved in their management. This part looks at the specific role of the forensic dentist, as well as the general dentist, in a mass disaster as member of an 'away' or 'home' team.

Mass disasters. Part 1. Role of the general dentist.

In this article, the first of two on the involvement of dentists in a mass disaster, the focus is primarily on mass disasters in general, some common characteristics and types of disasters, those agencies or individuals involved in the management of a disaster, the different phases of a disaster and the position of the forensic dental identification team (FDIT). Part 2 will deal with the functions, responsibilities and jurisdiction of the FDIT during the various phases of a disaster and more specifically immediately after the disaster.

The effects of extreme temperatures on composite, compomer and ionomer restorations.

The composite resin, compomer and glass ionomer restorative materials used in modern dental practice are fire resistant and remain radiopaque. They shrink significantly and are likely to fall out of the cavities after being burnt, but they remain extremely important for identification purposes and it may be possible to identify the white filling materials used to restore teeth by their radiopacity and morphology. The radiographic density of these filling materials do not change significantly when exposed to heat and although they may be difficult to see with the naked eye, they will remain visible when radiographed. Furthermore, special care has to be taken when handling heated materials as their compressive strengths decrease significantly depending on temperature and time of exposure and damage is possible.

Person identification by means of a single unique dental feature.

The combination of restorative procedures, developmental or acquired defects, or abnormalities of teeth enables the forensic dentist to make a meaningful comparison of ante- and postmortem data in search of the identity of a person. Dental records are not always sufficiently accurate to supply 12 concordant points from which a positive identification can be made. Under certain circumstances a single feature may be so extraordinary or unique that it alone can be sufficient to make a positive identification. Two cases of identification in which only one unique feature was used are reported.

Muti or ritual murder.

Ritual or muti murders are a form of human sacrifice practised by some African tribes. The murder is carried out after body parts are removed while the victim is still alive. This case report describes the methods of identification of a young child who was murdered by a traditional healer (isangoma) in Cape Town, and the practice of the traditional healer.

Identification of a suicide victim by facial reconstruction.

Facial reconstruction is used in an attempt to identify an individual by a three dimensional representation of the facial features using the skull as the foundation after metrical and non-metrical analysis to determine age, race and gender. The skeletonized remains of a female who was reported missing six years previously were recovered from the summit of Table Mountain in Cape Town. Some personal possessions were also recovered, one of which was a shark tooth pendant which the victim's parents recognized. Although there were distinctive dental features, the antemortem dental records had been lost during the initial investigation which therefore precluded identification by this means. However, positive identification was required and facial reconstruction on the skull was undertaken which the parents duly identified. The method used for facial reconstruction is described.

Facial reconstruction: utilization of computerized tomography to measure facial tissue thickness in a mixed racial population.

Reconstruction of human faces on skeletal remains is dependent on the facial tissue thickness measurements most of which have been derived from cadaver material using the needle probe technique. Dehydration of soft tissue after death casts doubt on the efficacy of these measurements. No study exists in which the facial tissues of a mixed population group in South Africa have been measured. The utilization of computerized tomography to measure facial tissue thickness as an adjunct to scans for facial sinus disease was employed and allowed the measurement of the thickness of facial soft tissues according to Rhine and Campbell (J. Forensic Sci. 1980: 25; 847-858). The sample consisted of 32 patients, 16 M and 16 F, age range 12 to 71 years. Comparison between the facial tissue thickness of American whites and blacks with South Africans of mixed racial origin showed marked differences in certain anatomical areas. The faces of the blacks were thicker in most areas, those of the whites were thicker in the forehead and periocular area, but thinner in the perioral and gonial areas. It is concluded that the use of the computerized tomography scanning procedure to measure soft tissue depth is more accurate than the needle probe technique. The results obtained from this study are therefore representative of the variation in facial tissue thickness of South Africans of mixed racial origin for facial reconstruction purposes.

Desmoplastic ameloblastoma: correlative histopathology, radiology and CT-MR imaging.

A desmoplastic variant of ameloblastoma with osteoplasia in the stroma is reported. This tumour presented in the canine/premolar region of the left maxilla of a 31-year-old woman. It was treated by partial hemimaxillectomy and immediate reconstruction with a non-vascularised iliac graft. The location of this lesion, its histology and radiological features differ from those of the conventional ameloblastoma. The behaviour and prognosis of the desmoplastic ameloblastoma (DA) cannot at this stage be predicted due to the small number of cases that have been reported and a lack of long-term follow-up. To our knowledge this is the first documentation of the CT and MRI features of desmoplastic ameloblastoma with pathologic correlation.

Synovial chondromatosis: Report of a rare surgical problem of the temporomandibular joint.

Synovial chondromatosis of the joint is a rare benign condition characterized by the formation of metaplastic cartilage in the synovium of the joint resulting in numerous attached and unattached osteocartilagenous bodies. It may recur after surgical intervention. For this reason removal of the synovium and the bodies is advocated. This is a report of a case which occurred in the temporomandibular joint which had numerous loose bodies and exhibited features of degenerative joint disease as well. The loose bodies were removed, a high condylar shave performed and the synovium left intact. The patient is still free from joint problems five years later.

A bitemark case with a twist.

This is a case report in which the bite patterns of two suspects were compared to a bitemark on the breast of a murder victim. Each suspect had sufficient concordant features to have been found guilty of producing the bitemark. The irony in this case is that the bitemark was not inflicted by the murderer.