Epidermis and Enamel: Insights Into Gnawing Criticisms of Human Bitemark Evidence.

Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system.

Density measurements of dentin by dual-energy radiography.

OBJECTIVES: The aim of this study was to apply the dual-energy radiographic technique to teeth and to soft tissue simulated with Lucite and report the visual and quantitative results. STUDY DESIGN: High- and low-energy image pairs were exposed of aluminum and Lucite calibration wedges and human teeth sections. Reconstructed images of the calibration wedges and teeth sections were viewed and measured. RESULTS: The aluminum reconstruction images accentuated the aluminum wedge and the teeth, whereas the Lucite reconstruction images minimized them. Correlations between the nominal direct and dual-energy measurements of the wedges and teeth thicknesses were found to be very good. The root-mean-square deviation of the dual-energy reconstructions from the measured nominal thicknesses was found to be no greater than 0.6 mm. CONCLUSION: These results demonstrate the feasibility of using dual energy as a means of selective cancellation of unwanted tissues and the measurement of posterior tooth density.

Practice characteristics associated with patient-specific receipt of dental diagnostic radiographs.

OBJECTIVE: To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services. DATA SOURCE/STUDY SETTING: Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics. DATA COLLECTION/EXTRACTION METHODS: In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts. PRINCIPAL FINDINGS: These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type. CONCLUSIONS: Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.

Patient characteristics associated with receipt of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVE: The objective was to test hypotheses that patient characteristics are associated with receipt of specific types of radiographic procedures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of dentate adults. RESULTS: From 19% to 59% of participants received a full-mouth series, panoramic, bitewing, or periapical radiograph(s), depending on procedure type. Receipt varied with reason(s) for dental visit(s), baseline clinical condition, race, approach to care (problem-oriented or regular dental attender), and socioeconomic status. CONCLUSION: These findings underscore the distinction between what dentists hypothetically would prescribe, compared to what is actually received, receipt that results from the interaction between dentist recommendations and what patients will accept and pay for. Blacks and lower-income persons received dental radiograph types that were consistent with less comprehensive dental treatment, even with entry into the dental care system, reason(s) for incident dental visit(s), baseline clinical status, and regular versus problem-oriented attendance taken into account.

Incidence of dental radiographic procedures during a 48-month population-based study of dentate adults.

OBJECTIVES: The purpose of this population-based study was to quantify the incidence of radiographic procedures and the intervals between radiographic exposures. STUDY DESIGN: The Florida Dental Care Study was a prospective cohort study of a representative sample of dentate adults. In-person interviews and dental examinations were conducted at baseline, with subsequent interviews every 6 months during 48 months of follow-up. Dental record information was abstracted afterward. RESULTS: Thirteen percent of all dental procedures, and 42% of all diagnostic procedures, were radiographic. Annual person-level incidence of receipt of any radiograph was 48%. Incidence of specific types of radiographic procedures ranged from 5% to 30%. Among the 45% of the sample population who had had more than 1 bitewing procedure, 70% of the intervals between bitewing exposures were 1 year or longer. Receiving more than 1 full-mouth series or panoramic radiographic in any 24-month period was very rare. CONCLUSIONS: Annual incidence of radiographic procedures was substantially higher than the incidence reported in previous studies based on responses by dentists to hypothetical situations, but was stable during the 4 years of follow-up. On the basis only of intervals between exposures, and not of clinical status on the day of service, there was no substantial evidence of inappropriately frequent radiographic examinations.