RESUMO
International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22 years. I3M's original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.
Assuntos
Determinação da Idade pelos Dentes , Dente Serotino , Adolescente , Adulto , Determinação da Idade pelos Dentes/métodos , Brasil , Feminino , Humanos , Masculino , Dente Serotino/diagnóstico por imagem , Radiografia Panorâmica , Estudos Retrospectivos , Adulto JovemRESUMO
The craniological collection at the Human Anatomy Museum of the University of Turin consists of 1090 skulls and 64 postcranial skeletons prepared mostly during the second half of the nineteenth century. The collection presents individuals of both sexes and of different age groups and includes 712 skulls of known age and sex and 378 of which only the sex is known. Most individuals are associated with a documentation that includes sex, age-at-death, dates of birth and a death certificate. The collection comes from several regions of Italy, between 1880 and 1915, received by the former Anatomical Institute of the University of Turin from city's prisons and hospitals. The whole craniological collection of known age was subjected to panoramic radiographs. The craniological collection combined with the panoramic digital X-ray images represents an important contribution in anthropology and forensic odontology, as there is now no craniological collection available in the world available from a radiological perspective, for investigating dental age assessment and sex dimorphism using radiographs as well as other research and teaching potentials.
Assuntos
Museus , Crânio , Masculino , Feminino , Humanos , Radiografia Panorâmica , Crânio/diagnóstico por imagem , Itália , Medicina LegalRESUMO
Forensic genetics is a rapidly evolving science thanks to the growing variety of genetic markers, the establishment of faster, less error-prone sequencing technologies, and the engineering of bioinformatics models, methods, and structures. In the early 2000s, the need emerged to create an international genetic database for forensic purposes. This paper describes a judicial investigation of skeletal remains to identify the subject using various methods. The anthropological examination of the remains allowed identification of the Caucasoid (European) ethnic group, a height of 156 ± 4 cm, and an age between 47 and 50 years. The genetic profiles obtained from typing several microsatellites made it possible to evaluate the compatibility between the skeletal remains and the suspected decedent. To identify the remains, the two extrapolated genetic profiles were compared. The case described highlights the central role of forensic genetics in identifying skeleton remains by means of comparison.
Assuntos
Restos Mortais , Perfil Genético , Humanos , Pessoa de Meia-Idade , Polônia , Marcadores Genéticos , Biologia ComputacionalRESUMO
Purpose of this study was to investigate and compare differences in oral health awareness between Croatian and Italian urban adolescents. The sample consisted of primary school last grade students aged between 13 and 15 years, 300 children from Zagreb (Croatia) and 298 children from Bari (Italy). Oral health awareness was evaluated using a self-administered standardized questionnaire. Self-perception of oral health proved to be different between the two groups (p < 0.001). The Croatians reported that their oral health was "excellent" or "very-good" more often than the Italians (68.6% vs. 50.2%). The reasons given for visiting a dentist were different (p < 0.001). The Italians cleaned their teeth more often than the Croatians ("two or more times a day", 83.1% vs. 72.2%, p < 0.003). Wooden toothpicks were preferred by the Croatians (p < 0.001), while floss was preferred by the Italians (p = 0.03). The awareness regarding the use of fluoridated toothpaste was higher in the Italian group (95.6% vs. 72.5%, p < 0.001). The Croatians were consuming sweetened foods more often than the Italians (p < 0.001). Croatian adolescents reported more indicators of a lower level of oral health awareness than the Italians, while on the contrary Croatians had higher esteem of their oral health. Defining national preventive strategies is essential for improving adolescents' attitudes toward oral health in both countries, particularly in Croatia.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Saúde Bucal/etnologia , Higiene Bucal/psicologia , Higiene Bucal/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Croácia/epidemiologia , Comparação Transcultural , Comportamento Alimentar/etnologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Itália/epidemiologia , Masculino , AutoimagemRESUMO
In December 2017, a decomposed unidentified body was found near the river Tronto in Teramo, Italy. The corpse was found without any identifying documents or specific personal belongings, except for a packet of cigarettes. The medical examiner determined a gastric perforation from the intake of hydrochloric acid to be the cause of death. A jar of muriatic acid found near the body led to suicide being considered the manner of death. The Penal Court in Teramo appointed two forensic odontologists to complete the postmortem assessment and collect dental data for personal identification. The corpse was found wearing a complete set of upper and lower dentures. The dental autopsy and 42 periapical X-ray images helped generate a biological profile of a man totally edentulous with upper and lower dentures, as well as an osteosynthesis with two plates and screws in the left ascending ramus of the mandible. In March 2018, the sister of a missing person reported the disappearance of her brother, and a presumptive identification was performed through visual recognition of the decomposed body. The sister confirmed the presence of two dentures and the location of the maxillo-facial surgery for the treatment of the fractured mandible. A complete dental autopsy was able to establish his identity without any DNA comparison needed. This case highlights the importance of performing a complete dental autopsy inclusive of dental radiographs, and its value in the identification of all unknown human remains even when totally edentulous. A complete dental autopsy should be performed in all cases of human identification.KeypointsDespite a corpse being edentulous, a complete dental autopsy can still be useful.Dental radiographs, such as bitewings, periapical images, panoramic radiographs, and CT scans, are recommended in all identification autopsies.
RESUMO
The increasing volume of, and subsequent complexities resulting from, migratory flows in the broader context of globalization has led to a range of problems, not only the protection of human rights and disease control but also the identification of those with the right to apply for refugee status and the age assessment of unaccompanied minors. Italy is a magnet for immigration from other countries bordering the Mediterranean Sea because the Italian coasts are within easy reach. In Italy, as in other western countries, unaccompanied asylum seekers deemed to be younger than 18 years face a very different path through the immigration system from that experienced by adults. Generally, adults are subject to immediate deportation or detention in jail. Minors are processed through the juvenile system, where detection is not mandatory; they will often have access to educational programs and may be granted a residency permit. The Section of Legal Medicine of the University of Bari was approached by immigration police authorities and judges to explore the possibility of examining unaccompanied asylum seekers, who claim do be younger than 18 years, to assess their age. A group of forensic pathologists and odontologists performed this evaluation relying on the skeletal maturation as seen on radiographs of the wrist and the pelvis for iliac crests and on an orthopantomograph, together with background information and clinical examination of each individual. Case studies are presented. This article does not attempt to give a definitive account of the different scientific methods for the assessment of age. It is important to understand some of the methods that may be used in an attempt to assess developmental maturity and from which it may be possible to "read off" an approximate chronological age.
Assuntos
Determinação da Idade pelo Esqueleto , Determinação da Idade pelos Dentes , Emigrantes e Imigrantes , Refugiados , Adolescente , Ossos da Mão/diagnóstico por imagem , Humanos , Ílio/diagnóstico por imagem , Itália , Masculino , Menores de Idade , Dente Serotino/diagnóstico por imagem , Dente Serotino/crescimento & desenvolvimento , Radiografia Panorâmica , Calcificação de Dente , Adulto JovemRESUMO
The identification of human remains can be performed visually through families and next-of-kin, but it is not advisable to rely only on visual recognition; instead, it is preferable to conduct a forensic comparison of antemortem and postmortem data for primary identifiers (fingerprints, DNA, and dental data). A dental autopsy is particularly valuable in the identification process of skeletonized, carbonized, saponified, and fragmented human remains. The principal challenge in the identification process is the search and collection of antemortem data. To this end, all dental information held on a missing person can represent a precious source of individualizing information that families should share with the police or investigating agencies after reporting a disappearance.
Assuntos
Odontologia Legal/métodos , Disseminação de Informação/métodos , Odontologia Legal/tendências , Humanos , Desenvolvimento de Programas/métodosRESUMO
The identification of human remains relies on the comparison of post-mortem data, collected during the autopsy, with the ante-mortem data gathered from the missing persons' reports. DNA, fingerprints, and dental data are considered primary identifiers and are usually collected during any human identification process. Post-mortem dental data should be collected and analyzed by forensic odontologists, as a dental autopsy must not be confused with a dental examination. The virdentopsy project was inaugurated in 2020, during the COVID-19 pandemic, to allow the correct process of human remains by collecting dental data from teeth and jaws, which was then transmitted to forensic odontologists remotely for an expert opinion to achieve a generic profile of the unidentified human remains. The post-mortem dental biography is paramount to narrow the search for compatible missing persons but requires knowledge and experience of forensic odontologists. The virdentopsy process uses radiographic imaging (periapical X-rays, CT scans, panoramics), 2D/3D photos and video recording, photogrammetry documentation, 3D scanning, and live streaming where possible. This registered term was created by merging the terms "virtual" and "dental autopsy" but with no commercial benefits. The proposed process combines research topics under the field of the human rights of the dead and humanitarian forensic odontology services. It should enhance and accelerate the human identification process of the deceased, age estimation of the living, analysis of panoramic X-ray images, and be an educational tool for remote live training in forensic odontology and anatomy of skulls. This paper presents an overview of the virdentopsy process in the field of forensic odontology as a remote consultation as well as an educational tool for undergraduates and postgraduates.
RESUMO
Sampling of healthy multi-rooted teeth is recommended for the genetic identification of human skeletal remains. However, this may not always be possible, as in the reported case consisting of an isolated human cranium found in an aggregate crushing and processing plant in Piedmont, Northwest Italy. The cranium displayed significant weathering, suggesting a post-mortem interval of several years, and was edentulous with the exception of the apical root fragment of the upper left canine, consequence of an antemortem horizontal fracture. Prolonged decalcification of the root fragment followed by powder-free DNA extraction from ~10 mg of root tip tissue led to the recovery of >10 ng of high molecular weight human DNA, in comparison with ~0.01 ng of DNA per mg of bone powder obtained from the petrous portion of the temporal bone. Quantity and quality of DNA isolated from apical tooth tissue enabled multiple genotyping, including a reportable female STR profile, mitochondrial DNA analysis, and ancestry-informative insertion/deletion polymorphisms. Although the cranium remained unidentified after DNA comparisons, our findings confirm that apical tooth tissue is a promising source of DNA, easily obtained through a powder-free extraction protocol. Results also indicate that root tips should not be overlooked in challenging identification cases, even in the presence of compromised tooth specimens.
Assuntos
Impressões Digitais de DNA/métodos , DNA/isolamento & purificação , Raiz Dentária/química , DNA Mitocondrial/genética , Feminino , Humanos , Mutação INDEL , Repetições de Microssatélites , Crânio , Ápice DentárioRESUMO
In case of minor migrants, absence of valid identification documents that clearly define age is a critical issue, because without these data the child cannot enjoy the rights provided by the Convention on the Rights of the Child. Differentiation between minors and adults is fundamental when age is disputed in human identification, asylum seeking, criminal liability, and child abuse fields. Few indications are available about qualitative/statistical agreement of different age estimation methods. Ages of 301 individuals were estimated through two dental methods in order to: determine quantitative and statistical agreements in legal age definition; identify practical recommendations. The study pointed out discrepancy between the two methods in 7/301 cases. From a statistical point of view, this finding corresponded to an almost perfect agreement. Thus, authors suggested that the two methods can be alternately used for legal age assessment, but operators should use both methods when the estimated age is 18.5 years.
RESUMO
Unidentified human remains with unknown medical history can always pose biological hazards to forensic pathologists and odontologists, including hepatitis C, HIV infection, Middle East respiratory syndrome (MERS), hemorrhagic fever viruses such as Ebola, meningitis and now Sars-Cov2. The pandemic of the new coronavirus disease (COVID-19) has reached 185 Countries with an increasing number of deaths. Forensic pathologists and odontologists may find themselves having to perform an identification autopsy to confirmed or suspected Sars-Cov2 positive deaths. By respecting the entire set of universal precautions and recommendations the highlighted risks can be minimized, and best practice in human identification should always be a priority for human rights of the dead. The following article is a summary of the recommendations for conducting dental autopsies and management of suspected COVID-19 cases.
RESUMO
Congenital High Airway Obstruction Syndrome is a rare pathology that may conduct the baby to death shortly after delivery. This outcome may cause emotional distress in the parents but it may also generate expensive medical malpractice claims about the reasons why the syndrome was not identified and/or correctly treated. The authors conducted a review of the cases in which Congenital High Airway Obstruction Syndrome caused death of the baby shortly after delivery. Then, they pointed out these ultrasonographic and anatomical reasons why the syndrome may be not identified and/or correctly treated: negative prenatal ultrasonography, recurrence of non-specific findings at prenatal ultrasonography, connection of respiratory and gastrointestinal tracts, tracheal agenesis or atresia, parent's refuse of post-partum therapeutic procedures, multiple malformations of the fetus/child. In conclusion, the authors highlighted that death shortly after delivery is usually caused by specific conditions that are not influenced by healthcare team's practice.
Assuntos
Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/mortalidade , Causas de Morte , Recém-Nascido , Imperícia/legislação & jurisprudência , Humanos , SíndromeRESUMO
The importance and the application of dental science and forensic odontology in the legal system are gradually increasing in India. In a long-term vision, there is a need for a specialized forensic training curriculum not only for the undergraduate and postgraduate dental students but also for the experienced dental surgeons. Dental experts opinion is sought most commonly in forensic casework of human identification, age estimation, and sexual assault cases with patterned injury, by the legal and forensic authorities. As a consequence, there is a demand for dentists trained in forensic and legal dentistry and experienced in forensic, capable of dealing and managing medicolegal cases in dental institutes or state hospitals. Several guidelines and protocols for forensic odontology procedures are drafted and proposed by forensic odontology organizations. However, there are no specific guidelines or recommendations for the establishment of a specialized forensic odontology department or unit in dental institutes. Hence, this article addresses the necessity and requirements for a forensic odontology unit, proposing a model to follow. A comprehensive list of forensic odontology armamentarium and case dependent forensic odontology kits is also highlighted here.
RESUMO
BACKGROUND: For more than half a century, the risk of physicians participating in torture has received thoughtful attention in the field of medicine, and a number of international organizations have issued declarations decrying such involvement. Despite publications that provide evidence of dentists' having participated in torture as well, until recently the dental profession was quiescent on the subject. METHODS: The authors describe the historical background for a new declaration against dentists' participation in torture developed by the International Dental Ethics and Law Society and the Fédération Dentaire Internationale (FDI) World Dental Federation. They review various levels of involvement by dentists in torture and related activities in reference to existing World Medical Association declarations. Finally, they outline the process of drafting the new dental declaration, which was adopted by the FDI in October 2007. CLINICAL IMPLICATIONS: The authors provide insight and guidance to clinicians who diligently serve their patients, unaware that they may face military or other pressures to participate in torture.
Assuntos
Códigos de Ética/história , Ética Odontológica , Direitos Humanos , Cooperação Internacional , Controle Social Formal , Tortura/história , American Medical Association , História do Século XX , Humanos , Má Conduta Profissional , Controles Informais da Sociedade , Estados UnidosRESUMO
Age estimation is useful in forensic investigations to aid in the process of identifying unknown victims as well as living individuals. In many countries age estimation is commonly used to assist immigration authorities in deciding whether refugees or illegal migrants have reached that designated age that separates a juvenile from an adult. This is particularly important for the protection of unaccompanied minors. Italy is a country of great appeal for immigration as people from other Mediterranean countries can easily reach Italian coasts. In Italy, as in other western world countries, unaccompanied asylum seekers deemed to be under 18 face a very different path through the immigration system. They cannot be deported and are sent through a juvenile system where they have access to education programmes and may be granted a residence permit. The Section of Legal Medicine of the University of Bari was approached by Judges and Immigration Police with the question to assess the age of unaccompanied asylum seekers who claim to be below 18 years of age. The contribution of forensic odontologists for age estimation was recognised and since November 2006 age estimation of asylum seekers in Bari (Italy) relies on clinical and dental examination together with skeletal maturation as seen on radiographs of the left hand and wrist, the pelvis for iliac crests and root development and mineralisation of third molars as seen on an orthopantomogram.
Assuntos
Determinação da Idade pelos Dentes , Emigrantes e Imigrantes , Odontologia Legal/métodos , Menores de Idade/legislação & jurisprudência , Refugiados , Adolescente , Adulto , Emigrantes e Imigrantes/legislação & jurisprudência , Ossos da Mão/diagnóstico por imagem , Humanos , ItáliaRESUMO
Unidentified human remains require the complete collection of data during the autopsy stage to achieve, even belatedly, a positive identification. The very large number of people reported as missing in Italy (36,902) may represent an obstacle in the investigative process leading to the potential identity of the corpse, considering that 76.98% are foreigners. Add to this, the high number (1868) of "unidentified corpses" yet to be identified. A single case of a skeletonized corpse, listed in the list of nameless bodies is presented, with particular attention to odontology assessment. The case presented allows a broader definition of dental autopsy, which can no longer be considered a mere odontogram recorded by the medical examiner and/or a dentist with no forensic background. The case presented is not yet been identified also because no ante mortem (AM) identified data of compatible profiles has not been shared by the Police and consequently, no comparison of AM, and post mortem data could be possible. The failure to routinely employ forensic odontologists in the postmortem collection of identifying data of human remains of uncertain nationality and the reconciliation process will result in a reduction of additional findings, which, together with other circumstantial evidence and DNA profiles, can lead to a delay in positive identification.
RESUMO
Social media applications can be valuable investigative tools in the search for missing and unidentified persons. As yet, no forensic App exists with the aim of assisting the human identification process, through the search of antemortem data to be used as adjunct data in the comparison with postmortem data collected. The aim of this article is to introduce a new application for Smartphones called "Selfie Forensic ID" App which will employ selfie and face photographs as an archive of dental data and dental features of the front teeth of missing persons sharing with Instagram, Tumblr, and Twitter Social Networks (available for free download from both Android and Apple store at http://onelink.to/selfieforensic). Features such as diastema rotated or wrongly positioned teeth, lip anomalies, recognizable fixed prosthetics, dental crown discolorations, dental or cutis piercing could represent strong identifiers in the comparison of AM and PM data. The increased number of terrorist attacks and natural disasters which result in the premature death of innocent people underlines the importance of storing personal identification data to avoid bodies remaining unidentified. The authors believe there will be an increased public willingness to share personal ID information through understanding of the ethical and administrative consequences to the families of deceased persons should bodies remain unidentified.
RESUMO
The dentists' main job is to restore health and function to the oral cavity. However, dental professionals can also be involved in medico legal activities as forensic odontologists or by being Expert Witnesses (EW) to testify in professional liability cases, car accidents and work-related injuries. When called to act as an expert witness by the Court, the appointed dentist has to combine both biological and technical knowledge with equivalent medico-legal and forensic knowledge. Spontaneous involvement in medico-legal matters without an adequate training and experience can lead to mistakes with irreversible consequences. As an expert witness, the dentist has precise responsibility with civil and/or penal consequences, depending on the national judicial system. Dental Expert Witness, working either privately or appointed by the Court, has defined responsibilities and is subjected to civil or criminal proceedings (depending on the judicial system) if found wanting. Keeping in mind that there are significant differences regarding the requirements of becoming eligible to be a Dental Expert Witness in different legal systems. In this work the authors investigated the Judicial Systems regarding the appointment of Dental Expert Witnesses in Brazil, Croatia, Indonesia, Italy, Saudi Arabia and the United Kingdom (Table 1), in order to marshal knowledge towards harmonization and the attainment of best practice. This premise acknowledges the fact that forensic odontology must encompass the necessity for robust systems of audit and accreditation for it to be accepted as an "evidence based" forensic discipline. Further steps to ensure quality assurance in legal dentistry and forensic odontology training should be considered to prevent the spontaneous involvement of inappropriately trained dentists to become involved in making decisions that are beyond their competence and expertise.
RESUMO
INTRODUCTION: "Bolus death" or "Café Coronary syndrome" refers to death due to asphyxia caused by an occlusion of the upper airways due to food. In this kind of asphyxia, the food bolus obstructs the larynx or the bronchial branches. This kind of event often affects subjects with acute intoxication due to alcohol or drugs, or with edentulism and with neurological or psychiatric diseases. CASE REPORT: An elderly woman, suffering from schizophrenia, was found dead in her house due to food bolus asphyxia. The post-mortem toxicological analysis on the deceased's biological fluids revealed the presence of tricyclic antidepressants, antipsychotics and neuroleptics. Study of the oral cavity showed the presence of partial edentulism and periodontal disease. HYPOTHESIS: We hypothesize that this kind of asphyxia in adults can be prevented. We believe that there are two major preventable factors: edentulism and salivation disorders in elderly and neuropsychiatric patients. The primary prevention of these pathologies would deal with the basic physician, similarly to other screenings already effectively in place. CONCLUSIONS: It is possible to prevent fatal asphyxia in subjects who suffer from this kind of diseases through appropriate screening. This prevention strategy would greatly reduce the amount of choking deaths in adults.
Assuntos
Asfixia/etiologia , Idoso , Obstrução das Vias Respiratórias/complicações , Antipsicóticos/efeitos adversos , Asfixia/prevenção & controle , Autopsia , Causas de Morte , Feminino , Alimentos/efeitos adversos , Patologia Legal , Humanos , Arcada Parcialmente Edêntula/complicações , Modelos Biológicos , Saúde Bucal , Esquizofrenia Paranoide/complicações , Esquizofrenia Paranoide/tratamento farmacológico , Xerostomia/induzido quimicamente , Xerostomia/complicaçõesRESUMO
The world has experienced a plethora of mass disasters in recent years: acts of terrorism, bombings, earthquakes, hurricanes, typhoons, air crashes and other transportation mishaps, not to mention armed conflicts and migrants drowned in the Mediterranean Sea. In reviewing mass disasters to date, the principal difficulties have not changed: (1) large numbers of humans fragmented, co-mingled, and burned remains; (2) difficulty in determining who was involved in the disaster; (3) acquisition of useful medical and dental records and radiographs; (4) legal, jurisdictional, organisational, and political issues; (5) internal and external documentation and communication problems; (6) application of universal human forensic identification codes. Forensic dentistry plays a major role in victim identification. DNA and dental identification of human remains depends on sufficient availability of ante mortem information, existence of sufficient post mortem material and a comparison or match between ante and post mortem details. Forensic odontology is a specialty with a specific training, and cannot simply be carried out by dentists without such training. Strategies for developing an international forensic odontology capacity and resources are needed for the management of dead bodies following a mass disaster, together with universal guidelines and codes. To this end, Interpol's forms have proved to be a good starting point to meet these requirements.