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.

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.

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 an American hiker.

The skeletonized remains of an American hitch-hiker were recovered from a forest near Knysna in the Cape. There were no recognizable features except the presence of dental restorations. The use of the "fax" to transmit dental records while being a speedy means of communication does have its limitations. Electrical faults on the telephone line can cause the document to become illegible and subsequent duplication of this document aggravates the problem. An appeal is made to standardize the notation of teeth by using the FDI code and to adopt a 2 digit code for restoration morphology.

Exhumation following incorrect identification. A case report.

The exhumation of two victims of a light aircraft accident was performed in February 1991 at Oudtshoorn, Cape. The exhumation was ordered by the magistrate on request of the parents of one of the victims who suspected that their son had been wrongly identified at the postmortem examination. At the pre-burial autopsy all the victims were positively identified, but the identity of two of the victims was subsequently reconsidered and reversed because one of them wore a silver bracelet. Burial then took place. The exhumation was ordered one month after the accident at which stage the bodies were in an advanced state of decomposition. Oral autopsies were performed on each of the victims, the jaws were radiographed and postmortem dental records drawn up. Dental records were obtained from the dentists who treated them and the information from these records was used to draw up ante-mortem dental records. A comparison between the postmortem and ante-mortem records showed that the victims were incorrectly identified and reburial in the correct graves was subsquently carried out. This case again emphasies the importance of dental identification in cases of severe burning, multilation or decomposition in order to avoid mistaken identity and incorrect burial in the future.

Comparison between fingerprint and dental concordant characteristics.

Twelve concordant characteristics are used in fingerprint identification. The South African courts of law are prepared to accept 7 concordant characteristics as being "beyond reasonable doubt" in the case of finger, hand and foot prints. In cases of identification by dental means, 12 concordant features have been advocated. In South Africa, with its mixed population in which a large majority have dental formulae containing normal decayed and missing teeth, these patterns show duplication and triplication. It is feasible to submit 7 concordant dental characteristics as positive identification in a mouth containing dental restorations, but in a mouth which features only missing teeth, pattern duplication demands more than 12 concordant characteristics for positive identification. Seven concordant dental characteristics have not been tested in the South African courts to date.

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.

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.

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.

A grave matter--dental findings of people buried in the 19th and 20th centuries.

The exhumed remains of 181 people, buried during the period 1848-1984 were examined. Because of the carelessness of exhumations, only 125 yielded sufficient information to compare the condition of skulls and jaws with the period in the grave, while 63 yielded information about the teeth. No correlation could be shown between the condition of the skulls and jaws and the period interred, but it was found that the better preserved remains belonged to younger people. Dental findings included the presence of healthy and decayed teeth, gold foil restorations, gold and porcelain inlays, amalgam and silicate fillings, and vulcanite and acrylic dentures. Amalgam restorations were present in people buried from 1875 (114 years ago) and vulcanite dentures from 1882 (107 years ago). The characteristics of the earliest amalgam restorations showed that they could have been placed before 1850. Findings of this study indicate that: (a) one cannot on the appearance of exhumed remains estimate the burial period, (b) dental features were well preserved and can be used for dental identification if antimortem data are available, (c) advanced dentistry could have been practised in South Africa during the last century, and (d) recovery of human skeletal remains from old cemeteries should be undertaken with care to preserve as much information as possible. A plea is made for closer co-operation between developers of old graveyard sites and scientists in order to preserve as much information as possible.

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.

Ameloblastic odontosarcoma with epithelial atypia: a case report.

A case report of an ameloblastic odontosarcoma in which the epithelial component showed a dysplastic change is presented. The epithelium contained pleomorphic cells and numerous mitotic figures.

Odontoameloblastoma: a case report.

Confusion in the early literature regarding the odontoameloblastoma, resulted in this tumour being reported under a variety of names. Many of the reported cases fail to meet the clinical and histological criteria required for classification as odontoameloblastomata. This article attempts to present a case with clinical, radiological and histological features that meet the required criteria. In this case the ameloblastic component intermingled with the dental hard tissues.

The role of forensic dentistry in South Africa.

Forensic dentistry has become an integral part of forensic medicine over the past 100 years. This has been due to the dedication of people like Amoedo, Gustafson, Sognaes, Keiser-Nielsen and Suzuki, to name but a few. They established the essential role which forensic dentistry plays mainly in the identification of human remains. Dental hard tissues are extremely resistant to fire and are usually the only remains after an extended period of burial. If antemortem dental records are available for an individual then dental identification is as certain as those of fingerprints. In South Africa forensic dentistry had its beginning in 1969 during the Windhoek air disaster. Since then there have been several cases of interest throughout the country, one of which was the crash of the Helderberg off the coast of Mauritius. Other aspects of forensic dentistry are the examination of bite marks and the recognition of facial trauma especially in cases of child abuse; the determination of age, sex and race of skeletal remains; dental ethics and jurisprudence as well as malpractice also form part of the duties of the forensic dentist. The five dental schools in South Africa each have a forensic team which is consulted on a regular basis by forensic pathologists and district surgeons. Forensic dentists are active members of the medicolegal team and should be consulted on a regular basis especially in cases where identification is concerned.

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.