Developmental dental anomalies and their potential role in establishing identity in post-mortem cases: a review.

Teeth may provide useful forensic evidence owing to features like uniqueness, stability and comparability. Moreover, the human dentition is heterodont, i.e. all the teeth have different morphology - incisors, canines, premolars and molars. There are sometimes deviations from normal morphology, such as the presence of extra teeth, variation in their shape and size eg the presence of an extra cusp, fractured crown/root, Carabelli's cusp, peg laterals, transpositions, fusion, etc. These differences can help forensic personnel identify bodies, especially where other methods of identification like facial features, fingerprints or DNA typing cannot yield satisfactory results as in cases of badly decomposed bodies, burnt remains, mass disasters, etc. Identification from dentition is based on the direct comparison of post-mortem dental profiles with ante-mortem dental records of the deceased. This article aims to review these developmental and morphological dental traits and their role in post-mortem identification.

Dental avoidance among adolescents - a retrospective case -control study based on dental records in the public dental service in a Swedish county.

Objective: This study aimed to investigate the occurrence of missed dental appointments among 16-19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009-2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents' individual situation and be observant of early signs of avoidance.

Estudio comparativo de la diversidad de las características clínicas dentales en poblaciones militares de Portugal y España / Diversity in dental clinical characteristics in Portuguese and Spanish military populations

Introducción: Se ha realizado una comparación de las características dentales de 2poblaciones militares de Portugal y España. El objetivo principal de esta investigación fue identificar aquellas características dentales que podrían ser de utilidad para diferenciar estas poblaciones en un análisis forense. Material y métodos: El estudio se realizó en una muestra compuesta por 5.136 militares profesionales de las fuerzas armadas, el 31,9% eran militares portugueses y el 68,1% del total de la muestra pertenecían a las fuerzas armadas españolas. Los datos dentales se registraron empleando los símbolos dentales descritos en Forensic Dental Symbols(R), gestionados con la base de datos Dental Encoder(R). Resultados: La población de estudio estaba constituida por un 86,6% de hombres (88,1% en la muestra española y 83,4% en la muestra portuguesa) y un 13,4% de mujeres (11,9% en la muestra española y 16,6% en la muestra portuguesa). La frecuencia de dientes no restaurados fue menor para los primeros molares en todos los cuadrantes, mientras que la mayor frecuencia de esta característica (>90%) se observó en los dientes anteriores, superiores e inferiores, y en los primeros premolares inferiores. Las frecuencias más altas de tratamientos restauradores fueron encontradas para los primeros y segundos molares en todos los cuadrantes, y las mayores frecuencias de ausencias dentarias se observaron en los terceros molares (superior al 28% en todos los cuadrantes). El análisis de concordancia mostró que las correlaciones entre los dientes contralaterales fueron significativamente mayores que entre los dientes antagonistas, para ambas muestras poblacionales de estudio. Conclusiones: Nuestros resultados proporcionan información potencialmente útil sobre la importancia de las bases de datos de registros dentales y el análisis de las características dentales con fines de identificación

Introduction: Dental characteristics were compared in population samples of Spanish and Portuguese military personnel. The main aim of this study was to identify those dental characteristics that could potentially serve to differentiate between these populations in a forensic analysis. Material and methods: A sample of 5136 individuals belonging to the professional military staff of the Portuguese and Spanish armed forces was studied. Dental data were recorded with the Forensic Dental Symbols(R) for the Dental Encoder(R) database. The population sample analysed in this study consisted of 68.1% Spanish and 31.9% Portuguese individuals. Results: The population was mostly male, with 86.6% men (88.1% in the Spanish sample versus 83.4% in the Portuguese sample), and 13.4% women (11.9% Spanish and 16.6% Portuguese). The frequency of unrestored teeth was lowest for first molars in all quadrants, and the highest frequency of unrestored teeth (>90%) was for the upper and lower anterior teeth and lower first premolars. The highest frequencies of restorative treatment were found for the first and second molars in all quadrants, and the highest frequencies of missing teeth were found for the third molars (always >28%). Concordance analysis showed that correlations between contralateral teeth were significantly higher than between antagonist teeth in both samples. Conclusions: Our findings provide potentially useful information on the importance of dental record databases and their value for identification purposes

Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States.

This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.

Medication discrepancies in the dental record and impact of pharmacist-led intervention.

BACKGROUND: Patients frequently use medications with potential implications for oral health and dental procedures, yet little is known about the accuracy of medication lists available to dentists. The aims of this study were to describe the frequency and clinical implications of medication discrepancies in the dental record (phase 1) and to evaluate the impact of pharmacist intervention on medication reconciliation processes in dental practice (phase 2). METHODS: A prospective, single-centre study evaluating adults receiving dental care was conducted. Discrepancies between the dental record and patient-reported medications were identified through a pharmacist-led medication review and were further evaluated for potential clinical significance based on drug-induced orofacial adverse-effect profiles. A multifaceted pharmacist-led intervention was implemented. Data were analysed using Poisson regression with a significance level set at 0.05. RESULTS: One-hundred and thirty patients (48% women; mean age 57 years) were interviewed by a clinical pharmacist (100 before intervention and 30 at follow-up). Of 860 medications reported, 618 discrepancies were identified, medication omission being the most common (71.7%). Of medications omitted, 64.6% had potential oral adverse effects, 7.9% could interact with local anaesthetics/vasoconstrictors and 19.1% had potential bleeding effects. The intervention resulted in a reduction in the number of medication discrepancies and medication omissions (P < 0.001). CONCLUSIONS: Medication discrepancies in the dental record occur at an alarming rate and frequently involve medications known to cause oral health problems or complications with dental procedures. A pharmacist-led intervention targeting medication reconciliation processes is an effective strategy for improving the accuracy of the dentist's medication list.

Linking medical and dental health record data: a partnership with the Rochester Epidemiology Project.

PURPOSE: The purpose of this project was to expand the Rochester Epidemiology Project (REP) medical records linkage infrastructure to include data from oral healthcare providers. The goal of this linkage is to facilitate research studies examining the role of oral health in overall health and quality of life. PARTICIPANTS: Eight dental practices joined the REP between 2011 and 2015. The REP study team has linked oral healthcare information with medical record information from local healthcare providers for 31 750 participants who have resided in Olmsted County, Minnesota. Overall, 17 718 (56%) participants are women, 14 318 (45%) are 40 years of age or older and 26 090 (82%) are white. FINDINGS TO DATE: A first study using this new information was recently completed. This resource was used to determine whether the 2007 guidelines from the American Heart Association affected prescription rates of antibiotics to patients with moderate-risk cardiac conditions prior to dental procedures. The REP infrastructure was used to identify a series of patients diagnosed with moderate-risk cardiac conditions by the local healthcare providers (n=1351), and to abstract antibiotic prescriptions from dental records both pre-2007 and post-2007. Antibiotic prescriptions prior to dental procedures declined from 62% to 7% following the change in guidelines. FUTURE PLANS: Dental data from participating practitioners will be updated on an annual basis, and new dental data will be linked to patient medical records. In addition, we will continue to invite new dental practices to participate in the REP. Finally, we will continue to use this research infrastructure to investigate associations between oral and medical health, and will present findings at conferences and in the scientific literature.

Racial disparities in orthodontic service use for Medicaid-enrolled children: An evaluation of the Washington Medicaid program.

INTRODUCTION: We assessed the relationship between race and orthodontic service use for Medicaid-enrolled children. METHODS: This cross-sectional study focused on 570,364 Medicaid-enrolled children in Washington state, ages 6 to 19 years. The main predictor variable was self-reported race (white vs nonwhite). The outcome variable was orthodontic service use, defined as children who were preauthorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that nonwhites are less likely to use orthodontic care than are whites. RESULTS: A total of 8223 children were approved by Medicaid for orthodontic treatment, and 7313 received records and began treatment. Nonwhites were significantly more likely to use orthodontic care than were whites (odds ratio [OR] = 1.18; 95% confidence interval [CI] = 1.02, 1.36; P = 0.031). Hispanic nonwhite children were more likely to use orthodontic care than were non-Hispanic white children (OR = 1.42; 95% CI = 1.18, 1.70; P <0.001). CONCLUSIONS: In 2012, nonwhite children in the Washington Medicaid program were significantly more likely to use orthodontic care than were white children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service use. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service use for minority children in Medicaid.

Demographic factors and dental health of Swedish children and adolescents.

OBJECTIVE: To investigate the dental health of Swedish children and adolescents with reference to age, gender and residence. MATERIAL AND METHODS: Electronic dental records from 300,988 3-19-year-olds in one Swedish region were derived in a cross-sectional study in years 2007-2009. The DMFT system was used. Age was categorized into 3-6/7-9/10-12/13-15/16-17/18-19-year-olds and residence into 'metropolitan', 'urban' and 'rural' areas. ANOVA, generalized linear regression models and Fisher's exact test were used. RESULTS: Among 7-9-year-old children, nine out of 10 were free from fillings and manifest caries, while for 18-19-year-olds; this proportion was one third. Girls (18-19-year-olds) had a significantly lower risk of caries compared to boys of the same age, RR for the DT index = 0.83 (95% CI = 0.81-0.85). This pattern was reversed in 7-12-year-old children. Children and adolescents in metropolitan and urban areas had significantly more caries than subjects in rural areas, for instance the RR for the DT index in metropolitan 7-9-year-olds was 2.26 (95% CI = 2.11-2.42) compared to their rural counterparts. CONCLUSIONS: In the permanent dentition, the overall pattern revealed that girls ≤ 12 years had a higher risk of caries, while adolescent girls had a lower risk of caries, both compared with boys of corresponding ages. Living in an urban or metropolitan area entailed a higher risk of caries than living in a rural area. A greater occurrence of dental caries in adolescents than in children was confirmed. The findings should have implications for planning and evaluation of oral health promotion and disease prevention activities.

Importância pericial dos sistemas de notação dental – revisão de literatura / Forensic importance of the dental notation systems – a review

Em algumas circunstâncias, o conhecimento de sistemas de notação dentais utilizados internacionalmente pode ser importante para a avaliação dos documentos odontológicos apresentados. O objetivo desse trabalho é revisar a literatura, exemplificando e descrevendo os principais sistemas,permitindo a sua identificação e compreensão. Com as informações apresentadas será possível atranscrição de prontuários que utilizem sistemas diferentes dos encontrados no Brasil. Devido àsemelhança entre os sistemas e sua utilização restrita aos profissionais da odontologia, recomenda-seque sempre seja avaliado o sistema presente nas documentações como etapa inicial. Também deve serdescrita, de maneira objetiva, qual a notação dental utilizada em laudos e pareceres.

In some circumstances, the knowledge of dental numbering that are in use internationally maybe useful when analyzing dental charts presented. The objective of this study is to review theliterature, to give examples and to describe the main numbering systems, allowing itsidentification and comprehension when necessary. With this information it will be possible toread and transcribe the dental records that present other numbering system than the onesfound in Brazil. Due to similarity between systems, and it’s restrict use by dental professionals, itis recommended that one always analyze the notation system as a first step. In addition, thesystem is in use should be clearly described, when writing forensic reports.

Utilizing Dental Electronic Health Records Data to Predict Risk for Periodontal Disease.

Periodontal disease is a major cause for tooth loss and adversely affects individuals' oral health and quality of life. Research shows its potential association with systemic diseases like diabetes and cardiovascular disease, and social habits such as smoking. This study explores mining potential risk factors from dental electronic health records to predict and display patients' contextualized risk for periodontal disease. We retrieved relevant risk factors from structured and unstructured data on 2,370 patients who underwent comprehensive oral examinations at the Indiana University School of Dentistry, Indianapolis, IN, USA. Predicting overall risk and displaying relationships between risk factors and their influence on the patient's oral and general health can be a powerful educational and disease management tool for patients and clinicians at the point of care.

Electronic Dental Records System Adoption.

The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community.

Gender trends in authorship in oral and maxillofacial surgery literature: A 30-year analysis.

The aim of the present study was to perform a bibliometric analysis of the gender distribution of first and senior authorships in important oral and maxillofacial journals over the 30-year period from 1980 to 2010. Articles published in three representative oral and maxillofacial surgery journals were selected. The years 1980, 1990, 2000, and 2010 were chosen as representative points in time for article selection. Original research, case reports, technical notes, and reviews were included in the analysis. Case reports and technical notes were pooled in one group. For each article, the gender of the first author as well as that of the senior author was determined, based on the inspection of their first name. The type of article was determined and the country of origin of the article was documented. A total 1412 articles were subjected to the data analysis. A significant increase in female authorship in oral and maxillofacial surgery could be identified over the chosen 30-year period. However, the number of publications by male authors was still significantly higher at all points of time, exceeding those of female authors by at least 3.8 fold in 2010. As there is a trend towards feminization of medicine and dentistry, the results of the present study may serve as the basis for further analysis of the current situation, and the identification of necessary actions to accelerate the closure of the gender gap in publishing in oral and maxillofacial surgery.

Reporting dental trauma and its inclusion in an injury surveillance system in Victoria, Australia.

BACKGROUND: This study investigated the frequency, patterns and causes of dental trauma in patients seeking emergency treatment at a dental hospital, and evaluated the impact of an electronic structured injury history form to collect key information. METHODS: A retrospective audit was undertaken of all emergency presentations at the Royal Dental Hospital of Melbourne from 2009 to 2012. Dental trauma and injury surveillance data were collected and evaluated with reference to the criteria of the Victorian Emergency Minimum Dataset. Statistical analysis included chi-squared and Fisher's exact tests. RESULTS: A total of 88,610 new emergency courses of care were created, with 3642 (4.1%) identified as new dental trauma cases in 3574 patients. A total of 6001 teeth were injured with a mean of 1.7 teeth per patient (range: 1-8 teeth). The improvement of injury surveillance information collected using the electronic form compared with the paper form was statistically significant (p<0.001). CONCLUSIONS: The dental trauma findings of this study are consistent with other studies regarding age, gender, location, cause and injury type. This study also confirmed the benefits of electronic collection of dental injury surveillance data that can assist policy planners and health service providers in designing and delivering effective dental injury prevention and management services.

Prevalence of dental anomalies on panoramic radiographs in a population of the state of Pará, Brazil.

INTRODUCTION: Dental anomalies (DAs) are the result of disorders that are able to modify the shape, number, size, and structure of teeth. This study aimed to evaluate the prevalence of DAs using panoramic radiographs in a population of the City of Belém, northern Brazil. MATERIALS AND METHODS: In this study, 487 panoramic radiographs were evaluated searching for DAs. Dental records were reviewed for diagnostic confirmation. DAs related to the shape, number, size, and structure of teeth were investigated. RESULTS: Our results showed a DA prevalence of 56.9%. The most prevalent DA was taurodontism, which was present in 27.19% of cases. Root dilaceration was the second most prevalent DA in adults, whereas hypodontia was the second most prevalent DA in children. A total of 13 DAs were found. CONCLUSIONS: Dental anomalies were present in over half of the sample, and most of them were related to the shape of the teeth. Although there was a high prevalence of shape-related DAs, these alterations are generally of lower severity, and most do not require specific treatment. However, in 19.25% of cases, DAs were found involving the number, size and structure of the teeth. These DAs should be diagnosed and treated early, avoiding thus more serious complications.

Electronic Dental Record (EDR) Use in Saudi Arabia: An Exploratory Study.

The purpose of this exploratory study is to provide an overview of the electronic dental records (EDR) systems used at National Guard Health Affair (NGHA) hospitals in the Kingdom of Saudi Arabia (KSA). Different sources of data were collected between February 18 and March 16, 2014. Sources of data included interviews with key informants. Key informants interviews included one 30 minute interview with an information technology specialist working at NGHA; seven 30-40 minute interview with dentists working in both the NGHA hospital and affiliated NGHA Primary Healthcare Clinics (PHCs). Two dental ward clerks were interviewed for 30 minutes and two dental directors were interviewed for 1 hour each. Four main themes emerged as a result of the analysis of the data. The main themes that emerged centered on staff satisfaction and workload, incomplete information, missing files, and adoption of EDRs. There were several challenges identified with the use of EDRs in Saudi Arabia. The challenges related to resistance to use the EDRs by clinical staff; lack of computer skills by clinical staff; usability of the systems; lack of interest in using EDRs; and lack of a clear management change strategy. Moving forward, these issues should be addressed so that more EDRs are implemented in all healthcare institutions in Saudi Arabia.

Exploring the publications in three major orthodontic journals: a comparative analysis of two 5-year periods.

OBJECTIVE: To analyze the types of articles and authorship characteristics of three orthodontic journals--American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), The Angle Orthodontist (AO), and European Journal of Orthodontics (EJO)--published between 2008 and 2012 and to assess the differences in content within this period and an earlier period of 1998 to 2002. MATERIALS AND METHODS: Each journal's content was accessed through the web edition. From each article, the following parameters were recorded: article type, number of authors, number of affiliations, source of article (referring to the first author's affiliation), and geographic origin. Descriptive statistics were performed and selected parameters were analyzed with the Pearson chi-square or Fisher exact test for independence at the .05 level of significance. RESULTS: Review of differences between the two periods showed that the number of publications was almost double. The percentages of multi-authored articles increased. Fewer studies derived from the United States/Canada and European Union countries. Increases for articles from non-European Union countries, Asia, and other countries were found. Characteristics of the second period showed that the EJO and AO published more research articles, whereas the AJODO regularly published case reports and other articles. Approximately 75% of all studies derived from orthodontic departments. CONCLUSIONS: The publications from 1998-2002 and 2008-2012 were significantly different both in terms of numbers and characteristics. Within 2008-2012 there were notable differences between the three journals concerning the type and origin of the publications.

Adverse events in Public Dental Service in a Swedish county--a survey of reported cases over two years.

Adverse events cause suffering and increased costs in health care. The main way of registering adverse event is through dental personnel's reports, but reports from patients can also contribute to the knowledge of such occurrences. This study aimed to analyse the adverse events reported by dental personnel and patients in public dental service (PDS) in a Swedish county. The PDS has an electronic system for reporting and processing adverse events and, in addition, patients can report shortcomings, as regards to reception and treatment, to a patient committee or to an insurance company. The study material consisted of all adverse events reported in 2010 and 2011, including 273 events reported by dental personnel, 53 events reported by patients to the insurance company and 53 events reported by patients to the patient committee. Data concerning patients' age and gender, the nature, severity and cause of the event and the dental personnel's age gender and profession were collected and analysed. Furthermore the records describing the dental personnel's reports from 2011 were studied to investigate if the event had been documented and the patient informed. Age groups 0 to 9 and 20 to 39 years were underrepresented while those between the ages 10 to 19 and 60 to 69 years were overrepresented in dental personnel's reports. Among young patients delayed diagnosis and therapy dominated and among patients over 20 years the most frequent reports dealt with inadequate treatments, especially endodontic treatments. In 29% of the events there was no documentation of the adverse event in the records and 49% of cases had no report about patient information. The majority of the reports from dental personnel were made by dentists (69%). Reporting adverse events can be seen as a reactive way of working with patient safety, but knowledge about frequencies and causes of incidents is the basis of proactive patient safety work.

Qualities of dental chart recording and coding.

Chart recording and coding are the important processes in the healthcare informatics system, but there were only a few reports in the dentistry field. The objectives of this study are to study the qualities of dental chart recording and coding, as well as the achievement of lecture/workshop on this topic. The study was performed by auditing the patient's charts at the TU Dental Student Clinic from July 2011-August 2012. The chart recording mean scores ranged from 51.0-55.7%, whereas the errors in the coding process were presented in the coder part more than the doctor part. The lecture/workshop could improve the scores only in some topics.

Use of electronic dental records in Brazil.

This study aims to provide both a quantitative and a qualitative analysis of the usability of the most popular electronic dental records in Brazil regarding its clinical and administrative features. The softwares not only will be evaluated regarding their usage among the Brazilian dental professionals but also regarding their functionalities (present, used and desired) and the difficulties encountered by the dentists during their use.