Injuries of non-lethal child physical abuse to the crania and orofacial regions: a scientific review

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited."The literature states that maltreatment in childhood and youth make up a problem on a global scale that exceeds ethnicities, religions, cultures, social and economic classes. It is also said that more than half of the injuries from maltreatment occur in the head and face. Assuming the particular relevance of orofacial structures, the dentist must know how to observe and recognize the indicators and properly diagnose the injury by maltreatment. This scientific review aimed to understand what types of intraoral lesions, signs or external lesions of the head or neck can be associated with child maltreatment. One primary database was searched so that systematic review articles and meta-analysis, case reports or case series of intraoral lesions, signs or external lesions of the head or neck by child maltreatment could be acquired. The references in the works acquired by electronic search were manually researched and the authors of all possibly relevant papers were contacted. In all searches inclusion and exclusion criteria were applied. Of the twenty two papers included two were systematic reviews and twenty were case reports or case series. The twenty articles of case reports or case series exposed information from thirty-five clinical cases included. Despite the limitations of scientific evidence it can be concluded that oral cavity, head and neck regions are home to multiple and diverse injuries by maltreatment of children and youngsters.

Medico-legal age estimation in a sub-adult portuguese population: validation of Atlas Schour and Massler and London

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited."Introduction: Age estimation in children and adolescents often depends on morphological methods, such as examination of dental development. Objectives: The aim of this project was to validate, in a Portuguese population, two forensic methods of dental age estimation – Schour and Massler charts and the London atlas. Materials and Methods: The test sample was composed by 108 dental radiographs of living and known-age individuals. Dental age was estimated according to each method. Chronological age was then compared to the estimated dental age using individual t-test and paired t-test. Results: Results showed that the Schour and Massler charts underestimated age and the London atlas overestimated age. Nevertheless, the London atlas performed better in all measures. Mean differences for both the London atlas and Schour and Massler were 0,1389 and -5,4167 months respectively. Schour and Massler charts showed significant statistical difference between dental age and chronological age (p <0.05). Discussion and Conclusions: We conclude that, in the evaluated sample, age estimation using the London atlas represents an improvement in forensic age estimation from developing teeth. Further studies should be done with a larger Portuguese population sample.

The medico-legal importance of establishing human identity by palatal rugoscopy: evaluation of the immutability and individuality of palatal rugae under the influence of ante mortem orthodontic treatment

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited."Introduction: The palatal rugae can be an alternative method of forensic identification. Through the years, several investigations focused on the effect of orthodontic treatment in the palatal rugae pattern. Objectives: Evaluate the concepts of immutability and individuality of the palatal rugae in a Portuguese adult population submitted to orthodontic treatment, for the purpose of medico-legal identification through Thomas and Kotze classification system. Additionally, we wanted to establish comparison of the palatal rugae of each subject, and between genders. Materials and Methods: Thirty three pairs of study dental casts, from thirty three patients submitted to orthodontic treatment in the Department of Orthodontics in College of Dentistry - University of Lisbon, were photographed and classified according to the classification system described by Thomas and Kotze. We proceeded to a statistical analysis running SPSS for Windows, version 20.0, using descriptive analysis and tests, with an inclusion level p <0.05. The tests applied were normality tests and T Student for paired samples. Results: The number and length of primary rugae remain identical when comparing the situation before and after orthodontic treatment. The number of secondary rugae decreases after orthodontic treatment. The variation of the angle of divergence was not statistically significant. The area of primary rugae presented statistically significant reduction after orthodontic treatment. There has no statistically significant differences between genders for total number number of rugae or average length of primary rugae (p <0.05). Discussion and Conclusion: The palatal rugae pattern does not remain stable after orthodontic treatment, and this refutes the supposed long term stability of the palatal rugae pattern. Therefore, it influences the ability to establish a positive medico-legal identification of a recent copse, if the person was submitted to ante mortem orthodontic treatment. The identification might still be possible if we possess a last ante mortem palatal record in these situations, to allow identification based on positive individual characteristics, through comparison with the post-mortem record. Considering gender, no statistically significant differences were found. This subject remains controversial and deserves further research.

Portuguese legal age thresholds of 12 and 14 years old

Objective: Better understanding of dental age assessment may help in cases of age estimation in Forensic Clinics. The first aim was to provide essential information on method reliability for upcoming studies using dental age assessment by second molar index (I2M), and third molar index (I3M) for age estimation on legal ages of 12 - 14 years. The second aim was to document forensic method outcomes of the Demirjian method which has already been used in forensic clinic. Material and methods: Two samples were used for this purpose: for I2M, 633 orthopantomographs (270 females / 363 males), the age range from 7 to 17 years and for I3M, 471 orthopantomographs (253 females / 218 males), the age range from 10 to 23 years, from the database population of Lisbon North University Hospital Center, approved by the Ethic Committee. Results: The I3M cut-off point (1.133) for 12- year- olds obtained better results than the cut-off point stated by the I2M (0.135). Besides, I2M cut-off point (0.001) for 14- year- olds showed better results when compared with the cut-off point (0.705) established by the I3M. Both methods are reliable for the legal age thresholds of 12 and 14 years. However, using I2M and I3M allows us to vary the cut-off value to privilege sensitivities or specificity, depending on which is more appropriate to the intended application. Conclusions: The accuracy (88.94%) of I3M obtained better results for the 12- year- old cut-off point (1.133) and the accuracy (90.21%) of the I2M performed better for the 14- year- old cut-off point (0.001).info:eu-repo/semantics/publishedVersio

a multi-ethnic study sample

info:eu-repo/semantics/publishedVersio

Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample.

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority

Third molar maturity index (I _3M) assessment according to different geographical zones:a large multi-ethnic study sample

Identification of living undocumented individuals highlights the need for accurate, precise, and reproducible age estimation methods, especially in those cases involving minors. However, when their country of origin is unknown, or it can be only roughly estimated, it is extremely difficult to apply assessment policies, procedures, and practices that are accurate and child-sensitive. The main aim of this research is to optimize the correct classification of adults and minors by establishing new cut-off values for four different continents (Africa, America, Asia, and Europe). For this purpose, a vast sample of 10,701 orthopantomographs (OPTs) from four continents was evaluated. For determination and subsequent validation of the new third molar maturity index (I3M) cut-off values by world regions, a cross-validation by holdout method was used and contingency tables (confusion matrices) were generated. The lower third molar maturity indexes, from both left and right side (I3ML and I3MR) and the combination of both sides (I3ML_I3MR) were calculated. The new cut-off values, that aim to differentiate between a minor and an adult, with more than 74.00% accuracy for all populations were as follows (I3ML; I3MR; I3ML_I3MR, respectively): Africa = (0.10; 0.10; 0.10), America = (0.10; 0.09; 0.09), Asia = (0.15; 0.17; 0.14), and Europe = (0.09; 0.09; 0.09). The higher sensitivity (Se) was detected for the I3ML for male African people (91%) and the higher specificity (Sp) of all the parameters (I3ML; I3MR; I3ML_I3MR) for Europeans both male and female (&gt; 91%). The original cut-off value (0.08) is still useful, especially in discriminating individuals younger than 18 years old which is the goal of the forensic methods used for justice.</p