Radiographic Applications in Forensic Dental Identification
Michael J. Thali M.D., Mark D. Viner, B. G. Brogdon in Brogdon's Forensic Radiology, 2010
Carbonized (burned) teeth and bone are friable and can crumble with the least disturbance. Teeth might disintegrate when the jaws are removed but can be made more stabile by applying cyanoacrylate or spray acrylic. Even with stabiliza-tion, photographs and as many radiographs as possible should be made before removal. One successful technique is to remove the mandible with tree and shrub trimming shears just below the condyles. This produces less vibration than vibrating saws and gains easy access to the maxilla without disturbing the more fragile structures. If the maxilla is to be removed, care should be taken to ensure that the section is made well above the apicies of the third molars since the formation of the roots may be of importance in estimating the victim's age. Also, the third molar is usually located higher in the tuberosity than the first and second molars.
Anatomy and Embryology of the Mouth and Dentition
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The first deciduous teeth to erupt into the mouth appear at approximately 6 months after birth and, by around the age of 3 years, all the deciduous teeth have erupted. By 6 years of age, the first permanent teeth appear (lower incisors and first molars) and thence the deciduous teeth are exfoliated one by one as they are replaced by their permanent successors. A complete permanent dentition is present when the third molars erupt at around the age of 18–21 years. Information on the sequence of development and eruption of teeth into the oral cavity may be important in forensic medicine and archaeology in helping to age individuals. The data provided in Tables 41.3 and 41.4 concerning the chronology of tooth development are largely based on European-derived populations and there is evidence of ethnic variation. When a permanent tooth erupts, approximately two-thirds of the root is formed and it takes approximately another 3 years for the root to be completed. For deciduous teeth, root completion is more rapid. The developmental stages of initial calcification and crown completion are less affected by environmental influences than eruption, the timing of which may be modified by several factors such as early tooth loss and severe malnutrition.
Clinical trials: dental pain
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
Adequate and homogeneous baseline pain intensity is an important factor in determining the outcome of a trial of analgesic drugs.34 Even in standardized forms of surgery, such as the surgical removal of impacted third molars, patients vary tremendously in their reported discomfort.17[II] Mild pain may be sufficient in a trial where the aim is to document that a weak analgesic drug is superior to placebo.17[II] However, patients who enter the study suffering from severe pain have a greater potential for pain relief, as measured by the decrease in pain intensity, than patients who enter the study with a lower pain intensity. Thus, in trials designed to document whether two or more analgesic drugs are significantly different from each other, at least moderate to strong pain intensity is required.20[II], 34[II]
Planned and unplanned follow-up visits after mandibular third molar surgery in the Public Dental Service in Örebro
Published in Acta Odontologica Scandinavica, 2021
Third molar surgery is the most common surgical procedure in dentistry in Sweden [1]. Surgical removal of third molars is performed by both specialized surgeons and general dentists in the Public Dental Service. A Norwegian study from 1994 found that about 75,000 third molars were removed every year [2]. Of these, approximately 55,000 were removed by general dentists and the rest by specialized surgeons [2]. There are multiple reasons why a third molar may need to be surgically removed, including caries in the third or second molars, pericoronitis, periodontal defects posterior to the second molars, pathological bone degradation, occurrence of cysts, unopposed/hyper/nonfunctional third molars, neurogenic and myofascial pain, and orthodontic indications [3,4]. When mandibular third molar surgery is performed, it is reportedly associated with less frequent postoperative complications in patients under the age of 25 years [5,6]. Surgical removal of third molars is associated with several common and generally accepted postoperative complications, so adequate preoperative information is important. The most common postoperative complications described in the literature include pain, swelling, trismus and alveolitis [7–10]; more unusual and severe complications include bleeding, loss of sensation, infections, jaw fractures, leftover parts of instruments, and root fragments [11,12]. Patients undergoing third molar surgery may need to stay home from school, work and other social activities due to complications after surgery [13].
Is the third molar erupting at a younger age than before?
Published in Acta Odontologica Scandinavica, 2022
Eveliina Tuovinen, Marja Ekholm, Irja Ventä
A few parts of the estimation of states of eruption in DPTs turned out to be challenging. As expected, the estimation between alveolar and gingival emergence of vertical teeth (stages B and C) was difficult in some cases because of poor visibility of soft tissues in DPTs. Despite the contrasting tools of the Digora software, the soft tissues were not always discernible. In such cases, the location of the gingiva was estimated to be 2–3 mm above the alveolar cortex based on Gargiulo et al. [34]. Secondly, maxillary third molars often tend to erupt buccally, which cannot be seen in DPTs. Thus, the gingival emergence in maxillary third molars likely occurs at an earlier age than the present results indicate. In these difficult cases, a clinical examination would have offered more accurate results, as was done in the study by Rantanen [1] in which the age of eruption for subjects ≥18 years was determined with clinical examination alone. The precise age for gingival emergence could be determined by using both clinical and radiographic examinations [19]. Thirdly, in a recent systematic review on agreement between Demirjian’s [35] developmental stages of third molars and chronological age, a concern about sample sizes was raised [36]. According to the review, in most studies the material is biased because of unequal numbers of cases in each analysed stage. In our Figures 2–5, the number of third molars in each age group varied between 16 and 66. However, similar variation in sample size occurred in the study of Rantanen [1] as well as in several other studies using the method of Olze.
Provider-directed analgesia for dental pain
Published in Expert Review of Clinical Pharmacology, 2023
Pain is a common complication following extraction of impacted third molar teeth. The pathophysiology of pain following surgical incisions is complex, involving both peripheral and central sensitization, which often necessitates multi-modal therapies for optimal resolution. The mainstay analgesics used by dentists include acetaminophen, NSAIDs, and opioids. Opioid combinations have traditionally been used to manage postoperative dental pain, but the epidemic rise of opioid-related misuse, abuse, and fatalities in society has limited the scope of opioid prescribing. However, there are certain clinical scenarios in which opioid prescription may be justified. When prescribing an opioid, dentists commonly select a codeine-acetaminophen product. However, systematic reviews do not support the routine use of codeine or codeine-acetaminophen combinations for acute postoperative dental pain, and there are no systematic reviews and meta-analyses of the comparative efficacy of hydrocodone, the opioid found in combination with acetaminophen in various pharmaceutical products. Furthermore, both codeine and hydrocodone are prodrugs, and ~ 10% of the population have impaired ability to bioactivate these drugs after ingestion, thus, in essence, any pain relief for these patients is largely due to the acetaminophen content. This may be insufficient to treat severe pain cases unless there is a therapeutic switch or an adjuvant analgesic is administered. Taken together, this information, combined with findings from systematic reviews, supports the recommendation of oxycodone for acute dental pain when opioid therapy is warranted.
Related Knowledge Centers
- Hyperdontia
- Tooth Decay
- Molar
- Tooth
- Tooth Eruption
- Impacted Wisdom Teeth
- Pericoronitis
- Conservative Management
- Dental Extraction
- Preventive Healthcare