Human and Animal Bites.

In the United States, nearly 56% of households owned a pet in 2011 according to the 2012 U.S. Pet Ownership & Demographics Sourcebook by the American Veterinary Medical Association. The survey also reports that approximately 70 million dogs and 74 million cats lived in households in the United States during the same year. (1)Human and animal bites are a frequent cause of primary care and emergency department visits for children. It is estimated that 250,000 human bites, 400,000 cat bites, and 4.5 million dog bites occur in the United States each year in both adults and children. (2) In the United States, approximately 10% of all human bites will become infected in a child with a bite wound. The infection rate of dog bites in children is 20%. Cat bite infection rates in children vary but can be up to 50%. Each type of bite wound has a predisposition for sex and/or age. Infected bite wounds manifest with swelling, erythema, and tenderness with or without drainage of the affected site and can lead to serious complications. Most animal bite wounds are polymicrobial in nature. Pasteurella species (spp.) is the most common organism isolated from both cat and dog bites. The microbiology of human bites consists of both aerobic and anaerobic bacteria.Basic medical management of bite wounds includes thorough cleansing and debridement. Irrigation, closure, and need to obtain culture depend on the type of bite wound, the appearance of the wound, the and timing of medical evaluation after the initial injury. Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis and empirical therapy for children who are not allergic to penicillin. With most animal bites being preventable injuries, healthcare providers caring for children have an important role discussing pet safety with the child and the family.

[Matching bite marks using modeling wax plates].

Bite marks are rarely seen in forensic medical examinations. In most cases one can easily differentiate whether a bite mark is of human or animal origin due to the arched shape and crushed character of human bite marks. From a forensic point of view it is more interesting whether a dental imprint has been caused by an adult or a child, because children are often abused for a defensive statement. Two cases of bite injuries in children are presented. In the first case, a two-month-old infant was presented by pediatricians. The second case deals with a one-year-old boy who had allegedly been bitten several times by a two-year-old girl in a nursery school. A comparison could be performed between the bite mark impressions on the victim's skin (based on photographic documentation) and dental imprints of single teeth measuring the tooth width on the one hand and the intercanine distance on the other hand with the help of modeling wax plates. This procedure showed good correlations between the bite marks on the victim and the dental status of the biter. Especially for taking bite impressions on children, modeling wax plates are a simple, fast and cheap alternative to dental impression-taking.

Fight bite injury: emergency department assessment and management.

Human bite wounds to the hand are relatively common injuries and are associated with high infection rates. Given the unique anatomy of the hand, the bite mechanism and the organisms found in human saliva, even the smallest wound can result in an aggressive infection. Failure to recognise and treat human bite wounds appropriately, can therefore have negative outcomes for patients. This article outlines the diagnostic features of, and complications associated with, bite wounds and discusses the recommended treatment options.

[The assessment of bite injuries from a forensic point of view]. / Die Beurteilung von Hundebissverletzungen aus gerichtsärztlicher Sicht.

The identification of a bite injury and its differentiation between human and animal origin demand a high level of special knowledge from the examining physician. The evaluation of bite injuries in terms of their hazard potential, risk profile and origin is usually done by a forensic specialist based on medical record documentation after immediate medical treatment. Therefore, as a first responder, a detailed documentation of the entire injury pattern is essential. If necessary, samples for further DNA analysis should be taken.The present article is intended to give a brief introduction to various aspects of bite injuries as well as to point out possibilities and limitations of the assessment of such cases.

Oral and Dental Aspects of Child Abuse and Neglect: Clinical Report.

In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, pediatricians, dental professionals, and other physicians are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Some physicians may have received less education pertaining to oral health, dental injury, and oral disease. These physicians may not detect the mouth and gum findings possibly related to abuse or neglect as readily as abuse injuries involving other areas of the body. Therefore, pediatricians, dental professionals, and other physicians are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Factors that influence the variability in findings of anogenital injury in adolescent/adult sexual assault victims: a review of the forensic literature.

Sexual violence is a pervasive problem worldwide. Anogenital injuries are one type of injury that may be present because of sexual violence. A review of the forensic literature yielded 13 published studies from 6 countries between 1987 and 2011 that met the inclusion/exclusion criteria, illustrating that anogenital (anal and/or genital) trauma is observed in 16% to 77% of sexual assault victims. Establishing the reliability of the conclusions of these studies is difficult due to a lack of uniformity in methodology to include detection of injury, injury definition, victim age, time window for examination, injury from consensual sex, and training of examiners. Each one of these factors can change the rate of injury observed. The evaluated studies show a disparity due to a lack of uniformity in examination protocols, injury classification, and examiner qualifications. A current, state of the science, evidence-based standardized protocol should be constructed that promotes objective and accurate parameters including the use of colposcopy, staining techniques, digital photography, and adequate training for examiners of sexual assault victims who present with anogenital injury.

Combating child abuse: the role of a dentist.

BACKGROUND AND PURPOSE: Child abuse has serious physical and psychosocial consequences which adversely affect the health and overall well-being of a child. However, in a developing country like India there has been no knowledge of the extent, magnitude and trends of the problem. This study reviews the overall scenario of child abuse in India as well as the role of the dentist in recognising and thereby combating this problem. RESULTS: Among health professionals, dentists are probably in the most favourable position to recognise child abuse, with opportunities to observe and assess not only the physical and the psychological condition of the children, but also the family environment. The high frequency of facial injuries associated with physical abuse places the dentist at the forefront of professionals to detect and treat an abused child. Screening for maltreatment should be an integral part of any clinical examination performed on a child. Although many injuries are not caused by abuse, dentists should always be suspicious of traumatic injuries. The dental professional's role in child abuse and neglect is to know the current state law regarding reporting child abuse and to follow the law. Awareness, identification, documentation and notification should be carried out by the dentist. CONCLUSION: Paediatric dentists can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. Such efforts will strengthen the ability to prevent and detect child abuse and neglect and enhance care and protection for the children.

Child abuse: concerns for oral health practitioners.

Child abuse and neglect are prevalent issues that permeate all ethnic, cultural and socioeconomic segments of society. Parents of abused children frequently change physicians in order to prevent detection, but they are more likely to continue to visit the child's dentist. Most states recognize four major types of maltreatment: neglect; physical abuse; psychological maltreatment; and sexual abuse. The American Academy of Pediatric Dentistry defines dental neglect as "the willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection." The oral health practitioner must uphold his or her legal and ethical responsibility if there is suspicion, record and report the incidence. It may help save a child from further abuse.

Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective.

Tongue biting (TB) may occur both in seizures and in psychogenic non-epileptic events (PNEEs). We undertook a systematic review to determine sensitivity, specificity, and likelihood ratios (LR) of TB. Five studies (222 epilepsy patients and 181 subjects with PNEEs) were included. There was a statistically significant higher prevalence of TB (both without further specifications on site of lesions and lateral TB) in patients with seizures. Pooled accuracy measures of TB (no further specifications) were sensitivity 38%, specificity 75%, pLR 1.479 (95% CI 1.117-1.957), and nLR 0.837 (95% CI 0.736-0.951). Pooled measures of lateral TB were sensitivity 22%, specificity 100%, pLR 21.386 (95% CI 1.325-345.169), and nLR 0.785 (95% CI 0.705-0.875). Only a pooled analysis of data demonstrated a statistically significant pLR for lateral TB. Lateral TB but not 'any' TB has diagnostic significance in distinguishing seizures from PNEEs, supporting the diagnosis of seizures. Tongue biting without further specifications has, therefore, no value in the differential diagnosis between seizures and PNEEs.

[Comparison of bite marks and teeth features using 2D and 3D methods]. / Analiza porównawcza sladów zebów i cech zebów z wykorzystaniem metod 2D i 3D.

UNLABELLED: The nature of bite marks is complex. They are found at the scene of crime on different materials and surfaces - not only on human body and corpse, but also on food products and material objects. Human bites on skin are sometimes difficult to interpret and to analyze because of the specific character of skin--elastic and distortable--and because different areas of human body have different surfaces and curvatures. A bite mark left at the scene of crime can be a highly helpful way to lead investigators to criminals. The study was performed to establish: 1) whether bite marks exhibit variations in the accuracy of impressions on different materials, 2) whether it is possible to use the 3D method in the process of identifying an individual based on the comparison of bite marks revealed at the scene, and 3D scans of dental casts, 3) whether application of the 3D method allows for elimination of secondary photographic distortion of bite marks. The authors carried out experiments on simulated cases. Five volunteers bit various materials with different surfaces. Experimental bite marks were collected with emphasis on differentiations of materials. Subsequently, dental impressions were taken from five volunteers in order to prepare five sets of dental casts (the maxilla and mandible. The biting edges of teeth were impressed in wax to create an imprint. The samples of dental casts, corresponding wax bite impressions and bite marks from different materials were scanned with 2D and 3D scanners and photographs were taken. All of these were examined in detail and then compared using different methods (2D and 3D). RESULT: 1) Bite marks exhibit variations in accuracy of impression on different materials. The most legible reproduction of bite marks was seen on cheese. 2) In comparison of bite marks, the 3D method and 3D scans of dental casts are highly accurate. 3) The 3D method helps to eliminate secondary photographic distortion of bite marks.

Presentation and management of human lip bites at a Kenyan center: a case series.

PURPOSE: To describe the pattern of presentation and management of human lip bites. PATIENTS AND METHODS: Data on patients who presented with human lip bites between 2005 and 2007 were recorded. RESULTS: There were 6 men and 4 women whose ages ranged from 25 to 60 years with varying degrees of lip loss that occurred in different circumstances. Reconstruction using local flaps was carried out in various stages to achieve satisfactory esthetic and functional outcomes. CONCLUSIONS: Human lip bites can be repaired at any time of presentation using local flaps with acceptable results. Wound infection is not a major issue following these injuries.

3D imaging in forensic odontology.

This paper describes the investigation of a new 3D capture method for acquiring and subsequent forensic analysis of bite mark injuries on human skin. When documenting bite marks with standard 2D cameras errors in photographic technique can occur if best practice is not followed. Subsequent forensic analysis of the mark is problematic when a 3D structure is recorded into a 2D space. Although strict guidelines (BAFO) exist, these are time-consuming to follow and, due to their complexity, may produce errors. A 3D image capture and processing system might avoid the problems resulting from the 2D reduction process, simplifying the guidelines and reducing errors. Proposed Solution: a series of experiments are described in this paper to demonstrate that the potential of a 3D system might produce suitable results. The experiments tested precision and accuracy of the traditional 2D and 3D methods. A 3D image capture device minimises the amount of angular distortion, therefore such a system has the potential to create more robust forensic evidence for use in courts. A first set of experiments tested and demonstrated which method of forensic analysis creates the least amount of intra-operator error. A second set tested and demonstrated which method of image capture creates the least amount of inter-operator error and visual distortion. In a third set the effects of angular distortion on 2D and 3D methods of image capture were evaluated.

Pediatric Hand Infections.

Infections are an important source of morbidity in pediatric hands that come from frequent exposure to mouths and other dangers while exploring the world. Although Staphylococcus aureus is still the most common organism in pediatric hand infections, it is less common than in adults because pediatric patients are more likely to develop mixed aerobic/anaerobic infections or group A Streptococcus pyogenes infection. Pediatric patients with open physes potentially may sustain Seymour fractures of the distal phalanges that may become infected and sources for osteomyelitis if not recognized early.

[Cerebral thrombophlebitis: complication of frontotemporoparietal cellulitis in a child victim of human bite]. / Thrombophlébite cérébrale: complication d'une cellulite fronto-temporo pariétale chez un enfant victime d'une morsure humaine.

Cerebral thrombophlebitis is a rare but severe disease whose underestimated frequency is increasingly recognized among children and, unlike adults, management is controversial. We report the case of a 12-year old child bitten by a friend at the level of the scalp, in the frontotemporal region of the head. This bite evolved due to the occurrence of a swelling evoking a frontotemporoparietal cellulitis complicated by cerebral thrombophlebitis, diagnosed based on the clinical feature and imaging. The patient was admitted in our hospital in a state of conscience disorder. Anticoagulant and etiological treatments enabled good clinical evolution.

How best to approach these acute hand infections.

Antimicrobial therapy is not straightforward with the 4 infectious conditions reviewed here. Combination therapy at the start must usually be tailored once an organism is known.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.