FORENSIC ASSESSMENT OF THE NATURE OF DENTAL INJURIES

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Abstract

According to the analysis of the conclusions of forensic medical examinations of the teeth injuries, it has been established that the trauma of the teeth was caused by a strong blow of a blunt solid object on the tooth crown. The frontal teeth of the upper jaw and, less frequently, the lower jaw were affected. Tooth fractures were localised to the crown, neck and root of the tooth. Injuries to the maxillary central incisors were the most common.

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70

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

70-73

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

ABSTRACT

According to the analysis of the conclusions of forensic medical examinations of the teeth injuries, it has been
established that the trauma of the teeth was caused by a strong blow of a blunt solid object on the tooth crown. The
frontal teeth of the upper jaw and, less frequently, the lower jaw were affected. Tooth fractures were localised to the
crown, neck and root of the tooth. Injuries to the maxillary central incisors were the most common.

KEYWORDS

Dental injuries, types, mechanism of formation, forensic medical examination.

INTRODUCTION

The current global prevalence of injuries to all teeth
(deciduous and permanent) is around 20% (Petti S,
Glendor U, Andersson L., 2018) [10]. Causes of oral and
dental

injuries

can

include

oral

conditions

(malocclusion in which the upper jaw significantly
overlaps the lower jaw); environmental factors (e.g.
unsafe playgrounds and schools); high-risk behaviour;
and violence (Glendor U., 2009) [6,7].

Research Article


FORENSIC ASSESSMENT OF THE NATURE OF DENTAL INJURIES

Submission Date:

February 28, 2022,

Accepted Date:

March 20, 2022,

Published Date:

March 31, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-14


Oydinov Aziz Ergashevich

Assistant Professor, Department of Forensic Medicine and Medical Law, Tashkent State Institute of
Dentistry, Uzbekistan

Shavkat Eryigitovich Islamov

Associate Professor, Doctor of Medical Sciences, Department of Forensic Medicine and Pathological
Anatomy Samarkand State Medical Institute, Uzbekistan

Normakhmatov Ilhom Zainitdinovich

Assistant to the Department of Civil Defence and Physical Education, Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


background image

71

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

70-73

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

Tooth injuries represent an average of 2.4 % of
maxillofacial trauma, according to forensic medical
practice, and mandibular fractures represent 70-85 % of
all non-facial fractures (Moiseychuk S.N., 2004) [4].
Tooth damage can occur due to various pathological
conditions, both in the oral cavity [1,8] and as a result
of associated pathologies [5,9].

At the same time, the introduction into clinical practice
of modern methods of diagnosis and treatment of
injured patients with dental injuries significantly affects
the time of temporary disability of patients and the
outcomes of rehabilitation [2,4]. This necessitates the
development of new approaches to the evaluation of
forensic criteria for the severity of dental injuries,
taking into account both the immediate and long-term
results of their outcomes.

The aim of the study

was to identify the types and

nature of dental lesions.

MATERIALS AND METHODS OF INVESTIGATION

A retrospective analysis of 30 forensic medical
examination reports conducted in the outpatient
department of the Tashkent city branch of the
Republican Scientific and Practical Center of Forensic
Medicine in 2019-2022 was conducted as material.
Generally accepted research methods were used -
macroscopic,

radiological,

statistical

research

methods.

STUDY RESULTS

Blunt trauma to the teeth was identified in all the cases
studied. There were 24 males (80.0%) aged 12 to 62
years and 6 females (20.0%) aged 18 to 45 years. From
the anamnesis they occurred as a result of a strong
blow of a blunt, hard object against the crown of the
tooth. Frontal group of upper jaw teeth was damaged
more often (76,67%) and less often lower jaw teeth

(23,33%). Tooth fractures were localised to the crown,
neck and root of the tooth. Crown-root fractures of the
teeth were very rare. Also, in addition to tooth
fractures, cracks of the teeth were found in 2 cases, i.e.,
fracture of the crown of the tooth without tearing off
part of it.

It was found that injuries mainly occurred to the central
incisors on the upper jaw (93.33%). Also depending on
the size of the broken off part of the crown of the
tooth, we distinguish: - Fracture of tooth crown within
enamel (21.5%); Fracture of tooth crown within dentin
(with and without opening of tooth cavity) (24.7%);
Fracture of tooth crown (54.8%).

The examination revealed that the crown fracture
most often occurred along an oblique line, i.e. at an
angle to its incisal edge. It should be noted that in some
cases (13.33%) crown fractures were caused by
anomalies in tooth position and bite, as well as some
dental hard tissue malformations (fluorosis, enamel
hypoplasia, etc.).

In the case of crown fractures in particular, the victims
complained about tooth pain caused by thermal stimuli
or when eating. The most common complaints,
however, are aesthetic defects or trauma to the soft
tissues caused by the sharp edge of the crown defect.
Examination reveals a change in the shape of the
crown of the tooth, there is often damage to the
mucosa of the lip, and the tooth is relatively stable. In
66.67% of cases there are signs of acute traumatic
periodontitis.

On

radiological

examination,

a

combination of crown fracture and root fracture was
observed in 16.67%.

And with crown fractures within the dentin without
opening the tooth cavity, the examinees complain of
pain in the tooth from mechanical and thermal stimuli.
Examination reveals a defect in the crown of the tooth


background image

72

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

70-73

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

and changes in its shape. In some cases (13.33%), when
the crown is fractured, the pulp is seen as a pink spot
through a thin layer of preserved dentin. When
scraping the fracture surface with a probe, pain is
noted. The tooth is stable and painful on percussion
(traumatic periodontitis). A combination of crown
fracture and root fracture was observed on x-ray in
6.67% of cases.

It was noted that when the crown of a tooth was
fractured within the dentin with the opening of the
patient's tooth cavity, after consultation with the
dentist, signs of acute traumatic pulpitis were
revealed.

A complete breakage of the crown of the tooth was
diagnosed both by examination of the victim and by
radiological examination. As with X-rays it is possible to
assess the condition of the root of the tooth and
exclude its fracture.

Depending on the direction of the tooth root fracture
line, oblique, longitudinal, transverse and splintering
were distinguished. Root fractures in the lower (closer
to the neck), middle and upper (closer to the apex)
thirds were also distinguished according to their
localisation. Root fractures, like all fractures, were
either non-displaced or displaced. In the latter case, the
root fracture was sometimes combined with an
incomplete dislocation of the tooth.

The damage (fracture) to the root of the tooth was
determined on the basis of the examiner's examination
and radiological data. Most often after injury, the
victim complains of pain in the tooth when biting, and
percussion of the tooth is painful. At the same time,
tooth mobility depended on the location of the
fracture - the closer the root fracture to the neck of the
tooth, the greater the degree of mobility of the crown
of the tooth. Radiological examination revealed the

disturbance of the root integrity, the localisation and
direction of the fracture, the presence of fragment
displacement, etc. In this case the root fracture line is
more clearly defined on repeated X-ray examination
one week after injury.

Almost a quarter of the cases involved combined
trauma, i.e. a combination of two or more types of
dental trauma. The most common types of combined
dental trauma were: incomplete tooth dislocation with
crown fracture; incomplete tooth dislocation with root
fracture; incisional tooth dislocation with crown
fracture; incisional tooth dislocation with root fracture;
crown and root fracture; complete tooth dislocation
with crown fracture, etc.

And in one-third of the cases, fractures of the alveolar
process of the jaw were detected, which were mainly
caused by direct impact of a blunt, hard object on a
group of teeth. The alveolar process of the upper jaw
is damaged most frequently (93.33%), because the
upper teeth are located in front of the lower teeth in
the sagittal plane. Examination reveals a malformation
of the dental arch in the anterior region or a bite
disorder. Macroscopically, the oral cavity shows
bleeding wounds in the mucosa of the upper lip and
gingiva, as well as wounds or haemorrhages in the area
of the transitional fold. The alveolar process along with
the teeth is pathologically movable and painful to the
touch. In some cases, dislocations and fractures of the
teeth located in the mobile fragment of the alveolar
process (16.67%) were detected. In most cases, the
fracture was retained by the soft tissues and
periosteum on the palatine (oral) side, although it
could

be

completely

detached.

Radiological

examination can clarify the localisation of the fracture
in relation to the roots of the teeth, the condition and
integrity of the tooth roots, and the condition of the
permanent tooth buds. It should be noted that


background image

73

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

70-73

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

radiographically, the fracture line runs more often in a
horizontal direction at or above the roots of the teeth.

CONCLUSIONS

Consequently, the findings indicate that men of
working age predominated among the forensic
medical examiners. Injuries to the teeth occurred as a
result of a strong blow to the crown of the tooth by a
blunt, hard object. The frontal group of the upper jaw
and, less frequently, the lower jaw were affected.
Tooth fractures were localised to the crown, neck and
root of the tooth. Injuries to the maxillary central
incisors were the most common. Depending on the
size of the broken off crown, we also distinguish
between crown fractures in the enamel region, crown
fractures in the dentine region (with or without
opening the dental cavity), and crown fractures.

REFERENCES

1.

Iordanishvili A.K., Tolmachev I.A., Sagalatyi A.M.
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2.

iordanishvili A.K., Barinov E.Kh., Salmanov I.B.
Algorithm of forensic examination of endodontic
treatment // Forensic medicine. - 2019. - Vol. 5, No.
4, - P.20-25.

3.

Moiseychuk

S.N.

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substantiation of severity of harm to health at
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Yakovenko L.L., Yakovenko O.O., Gonchar D.G.
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