The spectrum and frequency of histopathological diagnosis of oral diseases in Oslo: Implications to oral pathology syllabus.

INTRODUCTION: To assure knowledge and skills in diagnostic work of oral diseases a continuously updated curriculum is essential. The first aim of the present study was to evaluate the spectrum and frequency of oral histopathological diagnoses signed out by oral pathologists at the Department of Pathology, Oslo University Hospital (OUS), Norway during a two-year period. The second aim was to compare the spectrum of histopathological diagnoses with the content of the current syllabus in oral pathology at the Faculty of Dentistry, University of Oslo (UiO). MATERIALS AND METHODS: In this retrospective cross-sectional study, all histological diagnosis signed out during 2015 and 2016 were included. All histopathological reports were analysed with regard to clinical information and histopathological diagnosis. The spectrum of histopathological diagnoses was compared to the diagnoses presented in lectures and courses for dental and dental hygienist students at UiO. RESULTS: Three thousand four hundred and two histopathological reports (47% males and 53% females) were included. The diagnoses were categorised into eight disease groups and the three most frequent disease groups were cysts, benign tumours/reactive lesions, and white, red, ulcerative and vesiculobullous lesions. The lateral periodontal cyst was more frequent than expected. CONCLUSIONS: We conclude that a minor revision of the syllabus is needed, although the most frequent oral conditions presented in this study are well covered in the oral pathology teaching in Oslo. A more clinical related teaching approach should be considered by categorising oral diseases according to, for example location and age groups.

Aggressive external root resorption of the entire dentition accompanied by osteolysis: a case report.

A healthy Caucasian male lost all of his teeth because of aggressive cervical, apical, and lateral root resorption over a period of 11 years. Microscopically, there was no sign of reparative cementum apposition, but cell-rich fibrous connective tissue filling the deep resorptions was seen. The resorbed teeth were surrounded by fibro-osseous tissue of osteolytic appearance, as noted during radiologic examination. Radiography showed the osteolytic processes to regress dramatically with the removal or loss of teeth. No underlying systemic or local factor was identified. In spite of endodontic and surgical treatment, none of the resorptions went into remission.

Human dental age estimation by calculation of pulp-tooth volume ratios yielded on clinically acquired cone beam computed tomography images of monoradicular teeth.

Secondary dentine is responsible for a decrease in the volume of the dental pulp cavity with aging. The aim of this study is to evaluate a human dental age estimation method based on the ratio between the volume of the pulp and the volume of its corresponding tooth, calculated on clinically taken cone beam computed tomography (CBCT) images from monoradicular teeth. On the 3D images of 111 clinically obtained CBCT images (Scanora(®) 3D dental cone beam unit) of 57 female and 54 male patients ranging in age between 10 and 65 years, the pulp-tooth volume ratio of 64 incisors, 32 canines, and 15 premolars was calculated with Simplant(®) Pro software. A linear regression model was fit with age as dependent variable and ratio as predictor, allowing for interactions of specific gender or tooth type. The obtained pulp-tooth volume ratios were the strongest related to age on incisors.

Assessment of the radiographic visibility of the periodontal ligament in the lower third molars for the purpose of forensic age estimation in living individuals.

The main criterion for dental age estimation in living individuals is the mineralisation of third molars. However, the mineralisation of third molars can be completed before the forensically relevant age of 18 years has been attained. In a material of 1,198 orthopantomograms from 629 females and 569 males aged between 15 and 40 years, the radiographic visibility of the periodontal membrane of fully mineralised third molars was assessed according to stages 0, 1, 2 and 3. Stage 0 first appeared at the age of 17.2 years in females and at the age of 17.6 years in males. Stage 1 was first achieved by females between 18.9 and 20.0 years and by males between 20.1 and 20.2 years. The earliest appearance of stage 2 was between 22.5 and 23.1 years in females and at 22.3 years in males. The occurrence of stage 3 was first found between 24.6 and 25.2 years in females and between 25.4 and 26.2 years in males. If stage 1 is determined, it is, therefore, possible to prove that an individual has already attained the legally relevant age of 18 years. For stages 2 and 3, it can be stated beyond reasonable doubt that a person is over 21 years of age.

Evaluation of the radiographic visibility of the root pulp in the lower third molars for the purpose of forensic age estimation in living individuals.

The question of whether an individual has reached the age of 18 is of crucial importance in forensic age estimation practice. In some countries, the age threshold of 21 years is relevant as well. A completed mineralization of third molars is not a sufficient criterion for a diagnosis of a minimum age of 18 years with the required probability. In a material of 1,198 orthopantomograms from 629 females and 569 males aged between 15 and 40 years, the visibility of the root pulp of fully mineralized lower third molars was evaluated according to stages 0, 1, 2, and 3. In females, stage 0 was first noticed at age 17.2 years, in males at age 17.6 years. In either sex, the earliest observation of stage 1 was between 21.0 and 22.4 years. Stage 2 was first achieved by males between 22.3 and 22.7 years, by females between 23.4 and 24.7 years. The occurrence of stage 3 was first found in both sexes between 25.1 and 25.9 years. These findings indicate that for stage 0, an age below 18 years cannot be excluded. However, for stage 1, the examined individual must be over 18 years of age and most probably over 21 years of age. For stages 2 and 3, the age can safely be stated to be over 21 years of age. This method may be a powerful tool for forensic dentists in age estimation in asylum and criminal proceedings.

An integrated technique for the analysis of skin bite marks.

The high number of murder, rape, and child abuse cases in South Africa has led to increased numbers of bite mark cases being heard in high courts. Objective analysis to match perpetrators to bite marks at crime scenes must be able to withstand vigorous cross-examination to be of value in conviction of perpetrators. An analysis technique is described in four stages, namely determination of the mark to be a human bite mark, pattern association analysis, metric analysis and comparison with the population data, and illustrated by a real case study. New and accepted techniques are combined to determine the likelihood ratio of guilt expressed as one of a range of conclusions described in the paper. Each stage of the analysis adds to the confirmation (or rejection) of concordance between the dental features present on the victim and the dentition of the suspect. The results illustrate identification to a high degree of certainty.

A technique to capture, analyze, and quantify anterior teeth rotations for application in court cases involving tooth marks.

Anterior teeth within the human dentition have a specific numerical rotation value. Bite marks show an array of angled indentations, abrasions, microlacerations, and contusions. These marks generally represent the incisal surfaces of the suspect's dentition reflecting the rotation values of the teeth in the dental arch. This study described a method for capturing and analyzing anterior dental rotations. The rotations of individual anterior teeth within the study population were categorized as common, uncommon, and very uncommon according to Allen's classification. In the absence of a large number of incisal patterns present in a bite mark, a single but heavily weighted tooth rotation could be of equal discriminatory potential to several common rotation values. No prevalence studies quantifying individual tooth rotations are available. The measurement of each individual tooth rotation together with its individual discrimination potential will enhance the evaluation of the concordant features observed in bite marks.

Dental age estimation, quality assurance and age estimation of asylum seekers in Norway.

The historical development of age estimation and the different techniques are presented. Also it is important to separate individuals below 20 years where tooth development can be used and those above 20 years of age where regressive changes must be used and where the visual assessment may be more important. The recommendations for quality assurance from the International Organization for Forensic Odonto Stomatology (IOFOS) is discussed and also the problems of quality assurance on an international level. Suggestions for changes in these recommendations are presented. Finally the Norwegian dental age estimation project in asylum seekers who claim to be below 18 years of age is described.

Non-destructive dental-age calculation methods in adults: intra- and inter-observer effects.

The aim of the present study was to obtain data on the reliability and reproducibility of two non-destructive dental-age estimation methods in adults by calculating inter- and intra-observer effects. Both a morphological and a radiological technique available in the scientific literature were evaluated on a number of recently extracted teeth: the morphological technique was evaluated on a total of 160 teeth by two examiners, while three examiners applied the radiological technique on apical radiographs of 72 extracted teeth. Paired t-tests were used to calculate intra- and inter-observer differences. For the morphological method, both examiners were able to produce dental-age estimations that did not differ significantly from the real age of the teeth, obtaining a mean error between 0.5 and 1.8 years and a standard deviation of this error between 9.0 and 11.3 years. When using the radiological technique according to the original protocol, all three examiners produced age estimations that were statistically comparable to the real age of the teeth with a mean error of 0.5-2.5 years and a standard deviation of 4.6-9.8 years. For both techniques, intra-observer differences were observed. Based on the results of this study, it can be concluded that both non-destructive dental-age estimation techniques were able to produce reasonably accurate dental-age estimations, at least when these techniques were applied appropriately. However, the forensic odontologist is recommended to use different age estimation techniques and perform repetitive measurements in order to verify the reproducibility of the calculations performed.

A new system for computer aided dental identification in mass disasters

In recent years, several computer programs for dental identification in mass disasters have been developed. Unfortunately, it may be difficult to get access to such programs. The Norwegian police presently utilizes a text retrieval program, NOVA*STATUS, for detection work. This program is based on the British STATUS ONE program, and it enables the user to find from a large pool of postmortem dental registration one or several sets containing specific information about one tooth or several teeth. The complete relevant set(s) can be displayed for visual examination and comparison. A coding system for dental information has been developed as well as a system for interrogating the computer. This system and its efficiency have been tested on a simulated amall scale disaster where various well-known difficulties in dental identification were included>(AU)