Medicolegal Aspect/issues of Dental Injuries

Prof: Dr. Ghullam Sarwar PirzadaHead & Chairman Department of Forensic Medicine & Toxicology, PUMHSw, Nawabshah, SBA.

IntroductionThe examination of injured is the integral part of medical investigation.

Because

Various major offences affecting on the human body in different forms i.e 1. Physical Trauma (Wounding)2. Sexual Trauma (Natural / Un-Natural)3. Psychological Trauma ( Torture)4. Inducing Poisoning / Drugs5. Ending Life (Killing / Miscarriage)

So

For Providing the justice to the community crystal clear / meticulous examination in respect to injured must be conducted out according to the law of land.

But

Lot of Deficiencies / missing are done by MLO’s during examination give rise various medicolegal issues.

Forensic Dentistry It is the application of Dental expertise to

the legal system or dental evidence for furthering of justice.

Nowadays the Forensic Dentistry enjoy the active role in Forensic Science by obtaining the various achievements

Aims & Objectives of examination of

injured.

Aims:Extent of injury (Size) in length x breath

Nature of injury

Age of injury (Duration)

Manner (Accidental / Non-Accidental)

Causative agent

Objectives:Testify before the court

Certify / Verify the injuries

Interpretations of injuries according to legal dictums

Occurrence of Dental Injuries

a) AccidentalExamples: Vehicular Accidents, Fall from

height, Sport injuries, eating hard food.

b) Non-accidental1. Suicidal

2. Homicidal (With ulterior motive).

3. Fabricated. (Self inflected / Self Suffered)

4. During some Medical / Surgical intervention

5. Dental torture

6. Child abuse

Homicidal

Accidental

Fabricated

Sucidal

Miscellaneous

CausativeAgent

Blunt force trauma

Sharpe force trauma

By other means

Fast Force Trauma

Score

Blunt force trauma

Sharp force trauma

By other means

Fast force trauma

60%20%

15%

5%

Incidence Rate of Dental Trauma

Overall rate of dental trauma is 5% in relation to other mechanical injuries affecting on human body depending upon the surface area as the oral area is 1% of the total body area.

Ratio

Dental Injuries

Mechanical Injuries

5%

95%

Gender Differentiation

Male 80%Female 20%

Male Female

20%

80%

AgeFactor

Children: 5 – 10 yearsAdult: 25 – 50 yearsOld Ages: above 50 Years

Series 1

Series 2

Pattern ofDental Injuries

Pattern of Dental injuries usually depends upon manner of infliction, the causative agent & its fatal outcome. Therefore the pattern of dental injuries may be.

1. Extra oral.

Facial injuries in the form of either abrasion, bruise, laceration, incised wound & punctured wound.

Fracture: Nasal Bone / Facial Bones.

2. Oral

a) Soft tissue

Include contusion or laceration to the inner side of lip, gingival mucosa, tongue, soft plate & uvula. The location & extent of injury will depend upon the magnitude of force & duration of below.

b) Hard tissue

Tooth include either broken / fracture tooth, displaced tooth, knocked out tooth & loosed tooth.

Lower Jaw fracture

Medicolegal Examination of

injured

1. By 1st MLO

2. By Members of Special Medical Board

Observation of 1st MLO,

Bio Data

Physical examination.

Local examination of injuries.

Investigation.

Opinion / Conclusion of 1st MLO

• Deficiencies Done By MLO1. Incomplete description.

2. Improper section.

3. Improper investigation including X-Ray, CT-Scan etc.

4. Lack of expert opinion.

5. Issuing of medical certificate in hurry up position.

Ratio of Correctness or otherwise of issued

Medicolegal Certificate

Ratio

Correct

In-correct

Un decided65%

5%

30%

Challenged medicolegal certificate

Observation of Medical Board Depends upon

a) History of incidence.

b) Clinical examination of injuries

c) Documentation

Difficulties in interpretation of challenged medicolegal

certificatei. Sub standard description.

ii. Un skill MLO.

iii. Time factor.

iv. Lack of facilities.

v. Expert opinion.

vi. Exaggerated injuries

Suggestions

1.Trend MLO.

2.Photography.

3.Proper History in relation to incidence.

4.Proper investigations

(X-Rays, CT-Scan).

5. Expert opinion in doubtful cases.

6. Proper section.

7. Age & orohygenic conditions must kept in mind.

8. Detail examination of injuries regarding nature, causative agent & manner may be included.

9. Training to the Dental Surgeons.

10.Lectures of Forensic Odentology in Final Year BDS