Coroners are public ocials, usually elected at the county level of government, whose principal duty is to inquire into the cause of any death, but especially those deaths that may not be due to natural causes. Most coroners are not required to have medical training. Medical examiners have replaced coroners in some jurisdictions. Medical examiners usually are physicians and oen have training in medicolegal death investigation, pathology, and forensic pathology. Medical examiner requirements vary from state to state (U.S. Department of Labor, 2012). Medical examiners generally have greater expertise in unnatural death1.4 Bitemarks and Bitemark Cases 27 1.4.1 William I of England, 1027-1087 27 1.4.2 George Burroughs and the Salem Witch Trials, 1692 27 1.4.3 Ansil L. Robinson Murder Trial, 1870 27 1.4.4 Doyle v. Texas, 1954 28 1.4.5 Public Prosecutor (Norway) v. Torgersen, 1958 28 1.4.6 Crown (Scotland) v. Hay, 1967 28 1.4.7 Illinois v. Johnson, 1972 29 1.4.8 California v. Marx, 1975 29 1.4.9 Illinois v. Milone, 1976 29 1.4.10 Florida v. Bundy, 1979 29 1.4.11 Florida v. Stewart, 1979 30 1.4.12 State of Wisconsin v. Robert Lee Stinson, 1984 30 1.4.13 Louisiana v. Willie Jackson, 1986 30 1.4.14 Oklahoma v. Wilhoit, 1987 30 1.4.15 Commonwealth of Pennsylvania v. Kunco, 1991 31 1.4.16 New York v. Roy Brown, 1992 31 1.4.17 Arizona v. Krone, 1992 and 1996 31 1.4.18 Michigan v. Moldowan and Cristini, 1991 32 1.4.19 Illinois v. Young and Hill, 1992 32 1.4.20 Mississippi v. Brewer, 1995, and Mississippi v. Brooks, 1992 32 1.4.21 West Memphis ree, 1994, Alford Plea 2011 33 1.4.22 New Jersey v. Jesse K. Timmendequas, 1997: Megan's Law 33 1.4.23 Massachusetts v. Edmund Burke, 1998 33 1.4.24 State of New York v. James O'Donnell, 1998 331.5 Age Estimation 34 1.5.1 Louis XVII "e Lost Dauphin," 1894 34 1.5.2 Massler and Shour, 1941 and 1944 34 1.5.3 Moorrees, Fanning and Hunt, 1963 34 1.5.4 Mincer, Harris and Berryman, 1993 34 1.5.5 King Tutankhamen, 2005 351.6 Abuse and Neglect 35 1.6.1 Mary Ellen Wilson, 1874 351.7 Forensic Odontology; Books and Chapters in Books 36 Acknowledgments 37 References 37investigations than do coroners (Hanzlick and Combs, 1998). e American Board of Pathology certies physicians who meet the criteria in anatomic and clinical pathology and in the subspecialty of forensic pathology. For some local and state jurisdictions, certication in forensic pathology is required. Some states have mixed medical examiner/coroner systems. At present, there are insucient numbers of board certied forensic pathologists to serve as medical examiners or coroners at every local level (Hanzlick, 2007).

AbstractClinical experience indicates that newly available portable hand-held x-ray units provide advantages compared to traditional fixed properly installed and operated x-ray units in dental radiography. However, concern that hand-held x-ray units produce higher operator doses than fixed x-ray units has caused regulatory agencies to mandate requirements for use of hand-held units that go beyond those recommended by the manufacturer and can discourage the use of this technology. To assess the need for additional requirements, a hand-held x-ray unit and a pair of manikins were used to measure the dose to a simulated operator under two conditions: exposures made according to the manufacturer’s recommendations and exposures made according to manufacturer’s recommendation except for the removal of the x-ray unit’s protective backscatter shield. Dose to the simulated operator was determined using an array of personal dosimeters and a pair of pressurized ion chambers. The results indicate that the dose to an operator of this equipment will be less than 0.6 mSv y−1 if the device is used according to the manufacturer’s recommendations. This suggests that doses to properly trained operators of well-designed, hand-held dental x-ray units will be below 1.0 mSv y−1 (2% of the annual occupational dose limit) even if additional no additional operational requirements are established by regulatory agencies. This level of annual dose is similar to those reported as typical dental personnel using fixed x-ray units and appears to satisfy the ALARA principal for this class of occupational exposures.

Operator exposure to backscatter radiation while using an Aribex (TM) NOMAD (TM) radiation emitting device (a portable, self-contained, cordless, hand-held dental X-ray unit) was determined while the operator employed various typical and atypical use scenarios during the exposure of 715 digital and/or film-based dental radiographs and 200 study control exposures. Study data was compared to the radiation safety occupational exposure annual Maximum Permissive Dose (MPD) of 50 mSv (5000 mrem) to determine the possible exposure risk to an unprotected operator using this device. The results showed the reproductive organs received the highest dose and the thyroid the least. The average operator whole body dose for the study was determined to be 0.047 mSv (4.47 mrem) or 0.09% of the annual MPD. Extrapolating the data as an expression of averaged annual operator exposure resulted in a whole body dose of 0.4536 mSv (45.36 mrem) or 0.9% of the annual MPD, These results are well below established occupation exposure limits and are compatible with those published by the manufacturer.

Precise 3-dimensional localization of impacted mandibular third molars relative to the inferior dental canal (IDC) is critical to clinical management and surgical outcomes. Recently introduced dental 3-D volumetric imaging systems coupled with semi-automatic modeling techniques allows 3-D visualization of the IDC and the third-molar. Six impacted third molar sites were imaged with various 3-D volumetric imaging systems (NewTom 9000, Morita Accuitomo and Hitachi Mercuray). The spatial relationship of six impacted third-molars were visualized using imaging data obtained from these units. An interactive virtual model of a proposed third molar surgical site including the third molar and the inferior dental canal was developed.

Precise three-dimensional localization of impacted third molars as it relates to the inferior dental canal (IDC) is critical to their clinical management and highly influences surgical outcomes. Recently introduced dental 3D volumetric imaging systems coupled with semi-automatic modelling techniques allows 3D visualization of the IDC and the third molar. In this study, the spatial relationship of impacted third molars is described using imaging data obtained from various 3D volumetric imaging systems (NewTom 9000, Morita Accuitomo and Hitachi Mercuray).

Background. The risks from potential treatment complications and resultant patient morbidity associated with complex impacted “wisdom teeth” are well known.1Valmaseda-Castellon E. Berini-Aytes L. et al.Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 377-383Google Scholar Further contributing to this problem are the limitations of traditional 2D radiographs. To improve risk assessment evaluation, there has been an increasing use of 3D imaging. Despite 3D images produced in multiple planes, the viewer is still required to organize numerous flat images into a “mental model” of the proposed surgical site. Development of an accurate virtual model would seem a valuable asset for improving risk assessment evaluation. Objective. The objective of this study was to create a virtual image model of a proposed surgical site for a mandibular third molar using data from a 3D imaging device. Methods and materials. The patient is an adult Caucasian female with third molar impactions. The patient was imaged with the NewTom 9000 (QR srl, Verona, Italy), a cone-beam dental volumetric tomograph. The stack of axial images (8-bit 512×512 pixels) were exported to grayscale bitmap images and then imported in Amira software (TGS Inc, San Diego, Calif). The mandibular canal and the third molar were manually segmented using a threshold of 120 for the third molar and 40-60 for the canal. Once these are segmented, the software allows for creation of a mesh or 3D model of each object, which can then be rendered from any point of view and with any color of choice. Results. See Fig 1. Conclusions. An interactive virtual model of a proposed surgical site was developed. Anatomical accuracy, benefit for risk assessment, and cost effectiveness of developing the model require further investigation.

Dentistry continues to “go digital.” Use of digital radiography has increased in private practice, particularly with endodontists. Computed Tomography (CT) is routinely performed for dental implant imaging, and many dental schools are moving toward a paperless and filmless environment. As this trend continues, a question is “What are we trying to achieve?” Is it just a fast way to get an image? A method to reduce patient record storage? Save the environment from processing chemicals? Reduce remakes by digitally adjusting contrast and brightness? Or, is there a greater possibility?

Complex impacted third molars present potential treatment complications and possible patient morbidity. Objectives of diagnostic imaging are to facilitate diagnosis, decision making, and enhance treatment outcomes. As cases become more complex, advanced multiplane imaging methods allowing for a 3-D view are more likely to meet these objectives than traditional 2-D radiography. Until recently, advanced imaging options were somewhat limited to standard film tomography or medical CT, but development of cone beam volume tomography (CBVT) multiplane 3-D imaging systems specifically for dental use now provides an alternative imaging option. Two cases were utilized to compare the role of CBVT to these other imaging options and to illustrate how multiplane visualization can assist the pretreatment evaluation and decision-making process for complex impacted mandibular third molar cases.

The use of computed tomography for dental imaging procedures has increased recently. Use of CT for even seemingly routine diagnosis and treatment procedures suggests that the desire for 3-D imaging is more than a current trend but rather a shift toward a future of dimensional volume imaging. Recognizing this shift, several imaging manufacturers recently have developed 3-D imaging devices specifically for dental purposes using cone-beam computerized tomography. This technology allows for 3-D imaging similar to CT, but at lower equipment cost, simpler image acquisition and lower patient radiation dose. Herein, an overview of these devices is provided such that potential users can be better informed about this emerging technology.

OBJECTIVE:The purpose of this investigation was to measure the tissue-absorbed dose and to calculate the effective dose for the NewTom 9000, a new generation of computed tomographic devices designed specifically for dental applications. Comparisons are made with existing reports on dose measurement and effective dose estimates for panoramic examinations and other computed tomographic imaging modalities for dental implants.STUDY DESIGN:Thermoluminescent dosimeters were implanted in a tissue-equivalent humanoid phantom at anatomic sites of interest. Absorbed dose measurements were obtained after single and double exposures. The averaged tissue-absorbed doses were used for the calculation of the whole-body effective dose.RESULTS:The effective dose for imaging of maxillomandibular volume with a NewTom 9000 machine is 50.3 muSv.CONCLUSION:The effective dose with the NewTom 9000 machine is significantly less than that achieved with other computed tomographic imaging methods and is within the range of traditional dental imaging modalities.

Objectives. The purpose of this investigation was to measure the tissue-absorbed dose and to calculate the whole-body effective dose (E) for a new generation panoramic machine (Planmeca PM 2002 CC Proline), operating in the panoramic examination mode. Comparisons could then be made with historical panoramic and intraoral radiographic dose measurement values and effective dose estimates. Study design. Thermoluminescent dosimeters were embedded in a humanoid, tissue-equivalent phantom at anatomically significant sites, representing key tissues. Absorbed dose measurements were obtained after every 5 panoramic exposures of a 25-exposure total. The measured average tissue-absorbed doses from a single panoramic exposure were used in the calculation of the whole-body E. Results. The whole-body E for the PM 2002 CC Proline panoramic examination is 3.85 μSv. This is below the panoramic average of 6.7 μSv. The PM 2002 CC Proline panoramic examination delivers approximately 5% to 12% of the E of a complete mouth intraoral radiographic examination. Conclusions. The effective dose from the PM 2002 CC Proline examination is at the low end of the range for other panoramic machines and is far below either a D-speed or E-speed film intraoral radiographic examination. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:236-43)

"Digital Oral and Maxillofacial Imaging: A New Image for a New Age in Dentistry." Journal of the California Dental Association, 27(12), pp. 923–924 Additional informationNotes on contributorsRobert A. DanforthRobert A. Danforth, DDS, is an assistant clinical professor in the Department of Oral and Maxillofacial Imaging at the University of Southern California School of Dentistry.

An axial (SMV) radiograph has been widely used to determine parasagittal head position in TMJ tomograms. The purpose of this study was to investigate the efficacy of alternative anatomic methods for patient positioning in TMJ tomograms. The positioning methods studied included (1) rotation of the patient's head toward the film plane on the basis of the condylar orientation as determined by an SMV radiograph, (2) arbitrary rotation of the patient's head 20-degrees toward the film plane, (3) placement of the zygomatic arch parallel to the film plane, and (4) positioning of the posterior occlusal plane parallel to the film plane. Statistical analysis of the accuracy of the positioning techniques revealed no differences in the SMV, the zygomatic arch, and the arbitrary 20-degrees positioning. Aligning the posterior occlusal plane did not adequately align the mandible into a favorable radiographic position.

Endodontic patients are sometimes concerned about the risks of tumors or cataracts from radiation exposure during root canal therapy. By using established dose and risk information, we calculated the extent of these risks. The chance of getting leukemia from an endodontic x-ray survey using 90 kVp was found to be 1 in 7.69 million, the same as the risk of dying from cancer from smoking 0.94 cigarettes or from an auto accident when driving 3.7 km. Risk of thyroid gland neoplasia was 1 in 667,000 (smoking 11.6 cigarettes, driving 45 km) and risk of salivary gland neoplasia 1 in 1.35 million (smoking 5.4 cigarettes, driving 21.1 km). Use of 70 kVp radiography reduced these risks only slightly. To receive the threshold dose to eyes to produce cataract changes, a patient would have to undergo 10,900 endodontic surveys.

Endodontic patients are sometimes concerned about the risks of tumors or cataracts from radiation exposure during root canal therapy. By using established dose and risk information, we calculated the extent of these risks. The chance of getting leukemia from an endodontic x-ray survey using 90 kVp was found to be 1 in 7.69 million, the same as the risk of dying from cancer from smoking 0.94 cigarettes or from an auto accident when driving 3.7 km. Risk of thyroid gland neoplasia was 1 in 667,000 (smoking 11.6 cigarettes, driving 45 km) and risk of salivary gland neoplasia 1 in 1.35 million (smoking 5.4 cigarettes, driving 21.1 km). Use of 70 kVp radiography reduced these risks only slightly. To receive the threshold dose to eyes to produce cataract changes, a patient would have to undergo 10,900 endodontic surveys.

In degenerative diseases of the temporomandibular joint the mandibular condyle demonstrates changes in contour, including flattening and enlargement, resulting in an increased diameter of the articular surface. The purpose of this study was to determine if such alterations in the shape of the mandibular condyle can be visualized in submentovertex (axial) radiographs and correlated with pathologic changes of the temporomandibular joint. Submentovertex radiographs of 18 human cadaver specimens were made. The radiographic condylar dimensions, morphologic condylar outline, and angle of the condylar axis with respect to the transmeatal line were determined. The specimens were dissected and disarticulated, and radiographic findings were compared to anatomic structure. Osseous abnormalities were found in 21 of the 36 joints studied (58%). Perforations of the disk were found in nine of 31 joints (29%) investigated. No statistically significant differences between the normal condyles and condyles displaying osseous abnormalities were found in any of the radiographic parameters studied.

Absorbed radiation dose in bone marrow, thyroid, salivary gland, eye, and skin entrance was determined by placement of lithium fluoride thermoluminescent dosimeters (TLD's) at selected anatomical sites within and on a human-like x-ray phantom. The phantom was exposed to radiation from linear tomographic and computer-assisted tomographic (CT) simulated dental implant radiographic examinations. The mean dose was determined for each anatomical site. Resulting dose measurements from linear tomography and computer-assisted tomography are compared with reported panoramic and intra-oral doses. CT examination delivered the greatest dose, while linear tomography was generally lowest. Panoramic and intra-oral doses were similar to those of linear tomography.

Epithelial dysplasias and squamous carcinomas were experimentally produced in the cheek pouches of Syrian hamsters. These lesions were observed and photographed in the living animals with the aid of a stereoscopic microscope at magnifications of 20 and 40 times. Very apparent similarities were noted in the vascular patterns and epithelial configurations between the hamster oral dysplasias and carcinomas and the corresponding lesions seen in published cases of cervical intraepithlial neoplasia and invasive squamous carcinoma. It is speculated that these similarities reflect common factors in the interaction between neoplastic squamous epithelium and its blood supply. These findings are important in understanding the biology of cervical neoplasia and may be useful in the diagnosis and management of human oral neoplasia.