Sex assessment is an important step of the forensic process. Dental remains are often the only remains left to examine due to their resistance to decay and external factors. Contemporary forensic odontology literature describes multiple methods for sex assessment from mandibular parameters, all of which require manual measurements and expert training. This study aims to explore the applicability of deep learning and image analysis methods to automate this task, thus allowing for easier reproducibility of assessments, reduction of the time experts lose on repetitive tasks, and potentially better performance. We have evaluated state-of-the-art deep learning models and components on the largest dataset of individual adult tooth x-ray images, consisting of 76293 samples. This study also explores the usage of decayed or structurally altered teeth, with which contemporary methods struggle. Two types of models are constructed, a family of models specialized for specific tooth types, and a general model that can assess the sex from any tooth type. We examine the performance of those models per tooth type and age group, as well as the impact of decayed and structurally altered teeth. The specialized models achieve an overall accuracy of 72.40%, and the general model reaches an overall accuracy of 72.68%.

SUMMARY The aim of this cross-sectional study was to investigate the occurrence of chromosomal abnormalities through the frequency of micronuclei and other genomic damage markers in patients with chronic generalized periodontitis and without periodontal disease. Micronucleus assay was performed in exfoliated gingival epithelial cells of 35 patients with generalized chronic periodontitis and 30 control subjects with healthy periodontium. Full mouth clinical examination was performed to define periodontal condition. The mean number of cells with micronuclei observed in chronic periodontitis and control groups was 1.8 (±1.49) and 2.0 (±1.34), respectively. Differences between the groups were not significant (p=0.574). Compared to control subjects, patients with chronic periodontitis showed a significant increase in the number of binucleated cells (p≤0.001) and number of cells with nucleoplasmic bridges (p=0.042). Study results indicated that chronic periodontitis was not associated with higher occurrence of chromosomal damage in gingival cells compared to individuals with healthy periodontium.

Age estimation is an integral part of forensic medical and dental practice. In many countries, the age threshold of 14 years is set to determine the minimum age for criminal responsibility. In the present study, the authors studied the final maturation of the first (IPM1) and second mandibular premolars (IPM2) by Cameriere maturity index and determined cut-offs at the age threshold of 14 years, and validate on the test sample. Orthopantomograms of 960 healthy south Indian children and sub-adults (480 boys and 480 girls) aged between 10 and 18 were analysed, 640 as training sample and 320 as a test sample. The results of logistic regression analysis with age (</≥14 years) as a dependent variable and IPM1, IPM2, and sex as predictor variables on training sample showed that both IPM1 and IPM2 significantly related to the legal age of 14 years but not the sex (p = 0.052). A receiver operating characteristic (ROC) curve analysis was performed to evaluate the specific cut-off values of IPM1 and IPM2 for predicting 14 years. A cut- off value of IPM1 < 0.01 and IPM2 < 0.02 were obtained using the highest Youden index value. Our results on test sample showed that the combined predictor, IPM1 + IPM2 < 0.02, showed the highest specificity (97.5% in boys and 92.5% for girls), better post-test probability, 97.2% in boys and 91.9% for girls, and a smaller number of false positives (6.8%). In conclusion, the combination of IPM1 and IPM2 could be useful in determining the age of over 14 years in south Indian children.

In the context of dental age assessment, two significant factors can be studied; tooth mineralisation and tooth emergence. Little is known about the role of a second molar eruption in forensic age estimation. This paper aims to contribute to forensic age estimation using an age threshold of 14 years, studying the eruption stages of permanent mandibular premolars and second molars. Totally 640 orthopantomograms (OPGs) of south Indian children, aged between 10 and 18 years, were evaluated using Olze et al. staging of tooth eruption stages (A-D). Spearman's rho correlation showed a strong, positive, and statistically significant correlation between the chronological age and the eruption stages of both sexes' teeth. Accuracy, sensitivity, specificity, likelihood ratios, and post-test probability values were calculated for all tested teeth. The best performance to discriminate individuals above or below 14 years showed stage D in second molars. The sensitivity varied between 89% and 94% and specificity between 75% and 84%, respectively. Receiver operating characteristic curve analysis revealed high diagnostic performance for stage D, with area under the ROC curve (AUC) values of 84% and 85% for tooth 37 and 85% and 83% for tooth 47 in males and females, respectively. In conclusion, it is possible to predict age over 14 years in south Indian children using tooth emergence stages from OPGs with a relatively high interobserver agreement and good diagnostic accuracy. However, there are some limitations and, therefore, must be used in conjunction with other methods.

We show a case of endophthalmitis presenting 7 weeks after intravitreal aflibercept injection. An unusual species of viridans streptococci, S. intermedius, was isolated. The case highlights the need to consider infection even in cases of very delayed-onset postinjection inflammation, and the potential wide variability in severity of Streptococcus viridans endophthalmitis. Purpose: Endophthalmitis following intravitreal anti–vascular endothelial growth factor injections is frequently caused by Streptococcus viridans organisms and tends to be aggressive. Herein, we present a case of postinjection Streptococcus viridans endophthalmitis presenting in an atypically delayed fashion with good visual outcome. Methods: Single clinical case report. Results: A 91-year-old woman treated with aflibercept for exudative age-related macular degeneration of the left eye presented to the emergency department with mild pain and visual acuity decline to counting fingers, pigmented anterior chamber cells and vitreous haze 7 weeks after her most recent intravitreal injection. She had no symptoms of systemic infection. The presumptive diagnosis initially was vitreous hemorrhage. Over 10 days of observation, she developed worsening pain and vitritis suggestive of endophthalmitis, leading us to perform vitrectomy with intravitreal vancomycin and ceftazidime. Vitreous biopsy was culture positive for Streptococcus intermedius, a type of viridans streptococcus typically associated with head and neck abscesses. The infection resolved and the patient's visual acuity returned to her baseline of 20/100, with no recurrence of infection after 4 months of follow-up. Conclussion: The virulence of viridans streptococci capable of producing postinjection endophthalmitis may vary widely. Infection ought to be suspected even in cases of delayed-onset intraocular inflammation.

ABSTRACT This study evaluated the accuracy of Cameriere’s method based on normalized measurement of open apices of developing permanent teeth (xi ) and a number of teeth with closed apices (N0 ) in a sample of 121 cone-beam computed tomography (CBCT) scans of children (60 males and 61 females), aged between 5 and 13 years from Krakow, Poland. Intra-class correlation coefficient on randomly selected 30 CBCT scans showed good to exceptional intra-observer, and inter-observer agreement of normalized open apices, while Kappa score showed an absolute agreement of the number of teeth with complete maturation. Dental age overestimated by 0.17 years (p = 0.120) and 0.18 years (p = 0.149) in males and females, respectively. The mean absolute errors between dental and chronological age of MAE between dental and chronological age of the complete sample were 0.73 years and 0.77 years in males and females, respectively. In conclusion, the present results support usage of Cameriere’s method for age estimation in Polish children in cases where CBCT scans are available and previously taken for a specific clinical indication and taking into account the more demanding procedure of measuring variables in a non-orthogonal projection of teeth compared to a panoramic image.

BACKGROUND/AIMS With the growing popularity of water polo across the world, there has been rising awareness of the risks for orofacial injures in water polo. The aim of this study was to evaluate knowledge and attitudes of water polo coaches regarding dental trauma, dental emergency procedures and awareness about prevention of such injuries. MATERIALS AND METHODS A specific questionnaire comprising 25 questions regarding knowledge, experiences and behaviors following dental trauma was distributed to 62 water polo coaches during the license renewal seminar held by the Croatian Water Polo Federation, in February 2018 in Split, Croatia. Chi-square with Yates correction when necessary, and Fisher's exact tests were used in statistical analysis, and the results were considered statistically significant when P < 0.05. RESULTS There were 51 water polo coaches who participated in this study. Their ages ranged from 19 to 60 years. Most of the coaches (90.2%) have seen a dental injury in their players during their coaching careers. Concerning the procedure with handling an avulsed tooth, there were 68.6% coaches who would maintain the avulsed tooth in a handkerchief or gauze along with four coaches (7.8%) who would rinse the avulsed tooth under water and wrap it in a handkerchief or gauze afterwards. Only one participant (2%) would maintain the avulsed tooth in saline solution before its replantation. None of the coaches would use milk for maintaining the avulsed tooth. Only seven coaches (13.7%) have previously had education about sports-related dental injuries, dental emergency procedures and prevention of such injuries. CONCLUSIONS The results of this study demonstrated poor level of knowledge of water polo coaches about dental injuries and dental emergency procedures. Their knowledge and attitudes could be improved by educational programs on dental injuries and dental emergency procedures, as well as sports-related dental injuries management.

Key Points Question Does a treat-and-extend approach with potentially less frequent anti-vascular endothelial growth factor injections and visits provide visual outcomes not worse than monthly ranibizumab injections in patients with neovascular acute macular degeneration? Findings In this randomized clinical trial of 580 patients with treatment-naive choroidal neovascularization secondary to acute macular degeneration, at month 24, visual acuity outcomes in the treat-and-extend group were not worse than those in the monthly group. This outcome occurred despite a mean of 17.6 injections and visits in the treat-and-extend group compared with 23.5 in the monthly group. Meaning These 2-year outcomes, combined with those of 1-year trials, appear to support the hypothesis that treat-and-extend regimens are not worse than monthly treatment with ranibizumab for patients with neovascular acute macular degeneration similar to patients enrolled and treated in this trial.

Introduction: Stress is currently ubiquitous in the modern world and dentists are very susceptible to stress. Objectives: The aim of this study was to evaluate subjective perception of stress in dentists, confirm known correlations between stress and various factors, such as gender, age, socioeconomic level, work seniority, and specialization. Material and methods: The research was conducted through an electronic survey, which was sent via email to 800 addresses of actively working dentists in the Republic of Croatia. The survey was completed by 432 respondents. Results: 91.9% of participants considered dentistry a stressful occupation, 46.1% of respondents believed that practicing dentistry may cause problems in mental health, 93% of participants thought that practicing dentistry can endanger their general health. Regarding working experience, the participants’ group with less than 10 years of experience identified fear of unsuccessful outcomes more frequently compared to their colleagues with more experience. Specialists perceived their health risks as lesser than expected. We found that 77.1% of participants were smokers. Conclusions: Chronic stress remains one of the principal factors contributing to the decline in overall health and mental health among dental professionals. No association was found between gender and stress, or stressor perceptions. In regard to working experience, we found that younger dentists with up to 10 years of experience presented with more fear from unsuccessful outcomes. It was also found that general dentists perceived health risks as greater in contrast to specialists. Male participants reported a much greater frequency of consumption of alcoholic beverages than female counterparts. Also, specialists reported consuming strong alcoholic beverages more than expected.