RESUMO
Work-related exposures affecting oral health are important factors of morbidity and decreased quality of life, which may emerge from numerous physical, chemical, or mental occupational exposures. Copper (Cu) is an important trace element, however, it may also cause allergies, depose and accumulate in the body, leading to acute and chronic toxicity. In the present report, we describe a rare phenomenon found during the examination of two professional brass players, after incidentally noting an artefact during magnetic resonance imaging (MRI) scans, which were performed to monitor bone healing after bone augmentation procedures in an unrelated clinical study. During a detailed workup of patient characteristics, data on medical history, lifestyle, professional habits related to playing the instrument, and oral health status were collected. Overall, both patients presented with similar histories, and the differences from the context of this study were not relevant; however, both brass players were using an uncoated Cu mouthpiece for over 15 years. Based on the imaging findings (a shadow in the area of the lips on the MRI images) and the organoleptic evaluation of the lips and mucosa of the individuals (temporary faint green discoloration), it is most likely that the brass players were affected by oxidized Cu accumulation in the lip. In contrast to several professions, musicians are usually not required by law to attend obligatory occupational health check-ups, which may facilitate the occurrence of such exposures in musicians. Clinicians should be on the lookout for brass players involved in the profession for a long time, who may have used the mouthpieces for an extended period of time, in addition to musicians affected by Wilson's disease. In patients affected by this phenomenon, diagnostics of oral cancer and prosthodontic procedures may be cumbersome, due to the detrimental impact on the utility of MRI imaging from artefact-formation and scattering.
RESUMO
INTRODUCTION: Documentation and evaluation of dental injuries in forensic medicine are rather problematic. It needs a professional work up why dental injuries are out of focus, and how the diagnosis, pattern and treatment are influenced by novel approaches of dentistry. AIM: The aims of the authors were to characterize dental injuries, to compare their own findings to literature data concerning the type and characteristics of injuries, and propose a diagnostic workflow. METHOD: Expert's reports between 2009 and 2013 at the Department of Forensic Medicine, University of Szeged were reviewed. RESULTS: Review of about 7000 reports revealed only 20 cases with dental injury, which is in contrast with literature data indicating a significantly higher frequency of dental injuries. CONCLUSIONS: Although the number of "dental cases" was low, there were several additional cases where the trauma probably affected the teeth but the injury was not documented. In future more attention is needed in forensic evaluation of the mechanism, therapeutic strategy and prognosis of dental injuries.
