IJFMT April June 2018 2
Indian Journal of Forensic Medicine Toxicology
EDITOR Prof. R K Sharma
Formerly at All India Institute of Medical Sciences, New Delhi E-mail: editor.ijfmtgmail.com
INTERNATIONAL EDITORIAL ADVISORY BOARD
NATIONAL EDITORIAL ADVISORY BOARD
1.
1. Dr Nuwadatta Subedi (In Charge) Dept of Forensic Med and
Prof. Shashidhar C Mestri (Professor) Forensic Medicine Toxicology, Karpaga Vinayaga Institute of Medical Sciences,
Toxicology College of Medical Sciences, Bharatpur, Nepal
2. Dr. Birendra Kumar Mandal (In charge) Forensic Medicine and
Palayanoor Kanchipuram Distric, Tamil Nadu
Toxicology, Chitwan Medical College, Bharatpur, Nepal
2. Dr. Madhuri Gawande (Professor) Department of Oral Pathology
3. Dr. Sarathchandra Kodikara (Senior Lecturer) Forensic Medicine,
and Microbiology, Sharad Pawar Dental College, Sawangi,
Department of Forensic Medicine, Faculty of Medicine, University
Wardha.
of Peradeniya,Sri Lanka
3. Dr. T.K.K. Naidu (Prof Head) Dept of Forensic Medicine, Prathima
4. Prof. Elisabetta Bertol (Full Professor) Forensic Toxicology at
Institute of Medical Sciences, Karimnagar, A.P.
the University of Florence, Italy
4. Dr. Shalini Gupta (Head) Faculty of Dental Sciences, King George
5. Babak Mostafazadeh (Associate Professor) Department of
Medical University, Lucknow, Uttar Pradesh
Forensic Medicine Toxicology, Shahid Beheshti University of Medical Sciences, Tehran-Iran
5. Dr. Pratik Patel (Professor Head) Forensic Medicine Dept, Smt NHL Mun Med College, Ahmedabad
6.
6. Dr. Mokhtar Ahmed Alhrani (Specialist) Forensic Medicine
Devinder Singh (Professor) Department of Zoology Environmental Sciences, Punjabi University, Patiala
Clinical Toxicology, Director of Forensic Medicine Unit, Attorney
General’s Office, Sana’a, Yemen
7.
Dr. Rahul Pathak (Lecturer) Forensic Science, Dept of Life 7.
Dr. Pankaj Datta (Principal Head) Department of Prosthodontics,
Sciences Anglia Ruskin University, Cambridge, United Kingdom
Inderprasth Dental College Hospital, Ghaziabad
8.
Dr. Mahindra Nagar (Head) Department of Anatomy, University
8.
Dr. Hareesh (Professor Head) Forensic Medicine, Ayder Referral
College of Medical Science Guru Teg Bahadur Hospital, Delhi
Hospital,College of Health Sciences,Mekelle University, Mekelle Ethiopia East Africa
9. Dr. D Harish (Professor Head) Dept. Forensic Medicine Toxicology, Government Medical College Hospital, Sector 32,
SCIENTIFIC COMMITTEE
Chandigarh
1. Pradeep Bokariya (Assistant Professor) Anatomy Dept.
10. Dr. Dayanand G Gannur (Professor) Department of Forensic
Mahatma Gandhi Institute of Medical Sciences, Wardha,
Medicine Toxicology, Shri B M Patil Medical College, Hospital
Maharashtra
Research centre, Bijapur-586101, Karnataka
2. Dr Anil Rahule (Associate Professor) Dept of Anatomy, Govt
11. Dr. Alok Kumar (Additional Professor Head) Department of
Medical College Nagpur
Forensic Medicine Toxicology, UP Rural Institute of Medical
3.
Sciences and Research, Saifai, Etawah. -206130 (U.P.), India.
MNR Medical College, Hyderabad
12. Prof. SK Dhattarwal, Forensic Medicine, PGIMS, Rohtak,
4. Dr Vandana Mudda (Awati) (Associate Prof) Dept of FMT,
Haryana
M.R.Medical College,Gulbarga, Karnataka,
13. Prof. N K Aggrawal (Head) Forensic Medicine, UCMS, Delhi
5. Dr. Lav Kesharwani (Asst.Prof.) School of Forensic Science, Sam
14. Dr. Virender Kumar Chhoker (Professor) Forensic Medicine and
Higginbottom Institute of Agriculture Technology Sciences,
Toxicology, Santosh Medical College, Ghaziabad, UP
Allahabad U.P, 6. Dr. NIshat Ahmed Sheikh (Associate Professor) Forensic
Print-ISSN:0973-9122 Electronic - ISSn: 0973-9130
Medicine, KIMS Narketpally, Andhra Pradesh
Frequency: Quarterly, © All Rights reserved The views and opinions expressed are of the
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authors and not of the Indian Journal of Forensic Medicine Toxicology. Indian Journal of
Medicine Toxicology, Mediciti Institute of Medical sciences,
Forensic Medicine Toxicology does not guarantee directly or indirectly the quality or efficacy
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State Forensic Science Laboratory, Jaipur, Rajasthan 9. Dr. Amarantha Donna Ropmay (Associate Professor)
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NEIGRIHMS, Shillong 10. Dr Basappa S. Hugar (Associate Professor) Forensic Medicine,
Editor
M.S. Ramaiah Medical College, Bangalore
Dr. R.K. Sharma
11. Dr. Anu Sharma (Associate Prof) Dept of Anatomy, DMCH,
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DOI Number: 10.59580973-9130.2018.00062.2
Socio-demographic Profile of Pattern of Solvent Abuse among Street Children in Bengaluru
Murali Mohan MC 1 , Yadukul s 2 , Satish KV 3
1 Assistant Professor, Department of Forensic Medicine Toxicology, Sri Devaraj Urs Medical College, Kolar,
2 Assistant Professor, Department of Forensic Medicine Toxicology, Chamarajanagar Institute of Medical
Sciences, Chamarajanagar, 3 Professor, Department of Forensic Medicine Toxicology, Bangalore Medical
College Research Institute, Bengaluru
ABSTRACT
Background: Solvent use among children and adolescents is a major concern across the world. Solvents are easily available, convenient to use, relatively inexpensive, and legal for certain uses; and all these factors promote their use and also abuse at later stages in youngsters.
Objectives:
a) To study the socio-demographic pattern of solvent abuse.
b) To describe the patterns and consequences of solvent abuse.
c) To design a better preventive and rehabilitative approach to help these children. Methodology: The present observational study was conducted in the Department of Forensic Medicine
Toxicology, Bangalore Medical College Research Institute, Bengaluru during the study period of 2 years from 1 st Aug 2010 till 31st Aug 2012. The study was done on the street children, who stay in the areas of Railway Station, Kalasipalya and Shivajinagar of Bangalore City; who were interviewed based on a predesigned proforma relating to solvent abuse and the data were analyzed.Totally 200 street children with history of solvent abuse were enrolled into the study.
Results: In the present study, Solvent abuse was common among male children in the age group of 13- 15yrs. Majority of the children were coolie by occupation, started working by the age of 10 years most of them took shelter on foot path. Tobacco was the most common other substance of abuse followed by Gutka, Alcohol Ganja.
Conclusion: This study has identified key issues requiring urgent public health action. The widespread use of solvents is particularly concerning due to easy, cheap availability and unrestricted sales to minors, as well
as detrimental health effects of the same should be a major concern for law and policy makers. It is likely that the use of solvents could impact upon the ability of street children to be integrated into society and resume a normal social life.
Keywords: Solvent; Abuse; Streetchildren; Bengaluru
INTRODUCTION
Corresponding author: Dr. Yadukul s
Streets throughout the world are home to millions
Assistant Professor, Department of Forensic Medicine
of children who endure hardships and injustices while
Toxicology, Chamarajanagar Institute of Medical
struggling to survive 1 . The United Nations Children’s
Sciences, Chamarajanagar, (+91 9986510681)
Emergency Fund (UNICEF) defines children living
Email: yadukul.mysurugmail.com
and working on the street in three categories: ‘children
Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2 2
of the street’,‘children on the street’ and ‘children
RESULTS OBSERVATION
from street families’ 2 . Children on the street spend
In the present study, 93.5 were male and 6.5
a proportion of their time on the street, working to
were female. Among the different age groups (Table
provide an economic contribution to their family, but
1), it was observed that the highest numbers of children
often return home at night, maintaining familial ties.
were aged 14 years (31.5) and the lowest were aged
Children of the streetboth work and sleep on the streets
11 years (1.5). It was observed that, most of the street
and have an absence of regular contact with family
children lived (Table 2) in the premises of Gandhinagar
members. Children from street families live with their families in the street 2
(34); followed by Shivaji nagar(16), K R Market
(14) Magadi (6.5). It is noted that majority of
Although street-involved children and youth
the children were coolie (39) by occupation (Table
(SICY) are a world-wide phenomenon, the dynamics
3) followed by begging (28.5), rag picking (24),
that drive children to the streets are quite diverse and
hotel cleaner (6) and parking toll collector (2.5).
vary between high-income and low to middle-income
Majority of the street children were from Karnataka
countries 3 . While youth in developed countries usually
(91), followed by Tamil Nadu (6.5) and Andhra
become street-involved due to familial conflict and
Pradesh (2.5). In 64.5 of children, the parents were
child abuse 4 , children in resource-constrained settings
uneducated (illiterates).
(RCS) succumb to street life due to abject poverty, child abuse, neglect and familial dysfunction, death of
Table 1: Age wise distribution of cases
one or both parents, warand socio-cultural and religious
number of
beliefs . Additionally, the solvent use habits adopted
by SICY in RCS are often divergent from those of their
counterparts in high income countries 10 . Youth in street
circumstances in high-income settings engage in using
injection drugs and other substances that are not used
commonly among children and youth on the streets in
RCS 10-12 .
There are an estimated 100 million street children
worldwide of which 30 million are in Asia and 10
million in Africa. India alone has an estimated number
Table 2: Place of Living Native Place
of 414,700 street children in its major cities. It is found that about 80,000 street children live in and around
Total number
Bengaluru. Roughly about 60 new children land percentage up on bus stands and railway stations every day in
sl no. Place
of cases
1 Gandhi nagar
Bengaluru 13 .
2 Shivaji nagar
3 K.R. Market
MetHoDooGY
The present observational study was conducted in
6 Srirampura
the Department of Forensic Medicine Toxicology,
7 Hosur
Bangalore Medical College Research Institute,
8 Ananthpur
Bengaluru during the study period of 2 years from 1 st 9 Sunkada katte
Aug 2010 till 31st Aug 2012. The study was done on the
10 Kamakshipalya
13 street children who stay in the areas of Railway Station, 6.5
11 Magadi
12 K.G. Halli
Kalasipalya and Shivajinagar of Bangalore City, who
13 Whitefield
were interviewed based on a predesigned proforma
14 Banashankari
relating to solvent abuse and the data were analyzed.
15 Wilson garden
Totally 200 street children with history of solvent abuse
16 Bannerghatta
were enrolled into the study.
17 Other places
3 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
Table 3: Type of Work Occupation among
Table 6: Reason for Using Solvent:
Children:
Reason For Using
sl no.
number Percentage
sl
Work
number of
1. Friends peer pressure 141 70.5
Parking Toll
3. For Kick
4. To Sleep
3. Hotel Cleaner
DISCUSSION
4. Rag Picker
Benegalet al 13 in a similar study in Bangalore
5. Begging
57 28.5 found that 69 of these children preferred to be on the streets and 24 hailed from economically poor
In this study, we found out that majority of the
families. 81.9 of these children were male and earned
children took shelter (Table 4) on foot path (45),
up to 150 rupees a day. Majority of them took to solvent
followed by shelter home (27), railway station (14),
abuse to feel happy, and felt it as form of relief from
market (7) and home (7). It was interesting to note
various problems. They started with tobacco, solvents
that, in 41 of cases, children started to work from an
and proceeded to use of cannabis and alcohol. Pagore et
early age of 10years. Tobacco (59.5) was the most
al 14 in a study of 115 children in Delhi found that 68.7
common other substance of abuse (Table 5), followed
of the children faced some form of abuse at home and
by Gutka (19), Alcohol (19), Ganja (2.5) and
57.4 took to substance abuse on the streets. Earliest
the other major part did not abuse any other substance
age to begin substance abuse was 5.5 years compared
(32.5). Influence of friends (70.5) was the most
to 11 years as in our study. Poonam et al 15 in a study in
common reason for solvent abuse (Table 6) reported by
Mumbai of 217 children found that 44.23 of them on
most of the children followed by curiosity (15), for
the streets reported substance abuse. 11.3 years was the
kick (12) and for sleeping (2).
mean age to start use of these solvents. Males (63.54)
Table 4: Shelter Place
had higher rate of solvent abuse compared to females, which is similar to our study. According to them
sl no
Shelter Place
number
Percentage
39.34 used cannabis, 37.7 used alcohol and 32.8
1 Foot Path
90 45 took to solvent abuse. 70.5 of the children said they
54 27 started use of drugs out of inquisitiveness.
2 Shelter Home
3 Railway Station
28 14 Sharma et al 16 in a study of 487 children in Delhi
4 Home
14 7 showed that 25.7 of them addicted to tobacco. 17
14 7 used alcohol, 15.8 used solvents and 26.3 were involved in poly substance abuse. Peer pressure was
5 Market
Table 5: Other Substances of Abuse Reported:
considered primarily responsible for driving these children to drug abuse. Immaculate Mary et al 17
sl
Other Substances of
number
Percentage
suggests that 32.1 of children below 18 years of
no
Abuse Reported:
age take to sovent abuse on the street. They usually
1. Tobacco
59.5 start with tobacco and proceed to solvents. Cannabis
2. Gutka
38 19 is usually started by bigger children above 13 years of
3. Alcohol
38 19 age. Though lots of laws are existent to prevent use of
4. Ganja
5 2.5 dangerous solvents by children these are not effective
5. Fevi Bond
6 3 enough in controlling the problem. Khan et al 18 in a
65 32.5 study of street children in Pakistan claimed that 90 of the children have taken to glue sniffing as it is cheap
6. None
and easily available without any strict regulations. 40
Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2 4
of these children suffer from some form of ill health due
31: 965–71.
to this habit. Similar conditions have been reported in
4. Hadland SE, Kerr T, Li K, MontanerJS,Wood
various cities of Nepal, East Timor, Vietnam, Hongkong
E. Access to drug and alcohol treatment among
etc. that 65.9 of these children live on the street with
a cohort of streetinvolved youth. Drug Alcohol
their families and 66.8 have some form of physical
Depend 2009; 101: 1–7.
abuse .
5. Olley BO. Social and health behaviors in youth
These children face a variety of personal problems
of the streets of Ibadan, Nigeria. Child Abuse
at their homes and work place. They are exposed to a
Negl2006; 30: 271–82.
variety of risk factors normally considered for substance
6. Ayaya SO, Esamai FO. Health problems of street
abuse. Peer pressure, work stress, easy availability of
children in Eldoret, Kenya. East Afr Med J 2001;
drugs, rebelliousness and development of anti social
78: 624–9.
behavior on the streets push these children into solvent
7. Abdelgalil S, Gurgel RG, Theobald S, Cuevas
and other substance abuse.
LE. Household and family characteristics of street
CONCLUSION
children in Aracaju, Brazil. Arch Dis Child 2004;
89: 817–20.
This study has identified key issues requiring
8. Morakinyo J, Odejide AO. A community based
urgent public health action. The widespread use of
study of patterns of psychoactive substance use
solvents is particularly concerning due to easy, cheap
among street children in a local government area
availability and unrestricted sales to minors, as well
of Nigeria. Drug Alcohol Depend 2003; 71: 109–
as detrimental health effects of the same should be a
major concern for law and policymakers. It is likely that the use of solvents could impact upon the ability of
9. Njord L, Merrill RM., Njord R., Lindsay R.,
street children to be integrated into society and resume
Pachano JD. Drug use among street children and
a normal social life. Additional effort and collaboration
non-street children in the Philippines. Asia Pac J
between policy makers, communities and researchers is
Public Health 2010; 22: 203–11.
essential to understand and implement mechanisms to
10. De Carvalho FT, Neiva-Silva L, Ramos MC,
reduce the harms associated with using inhalants, while
Evans J, Koller SH., Piccinini CA. et al. Sexual
also preventing and stopping solvent use among this
and drug use risk behaviors among children and
vulnerable population.
youth in street circumstances in Porto Alegre, Brazil. AIDS Behav2006; 4: S57–66.
Ethical Clearance: Taken from Ethics Committee from Bangalore Medical College and Research Institute,
11. Roy E, Boudreau JF, Leclerc P, Boivin JF, Godin
Bengaluru.
G. Trends in injection drug use behaviors over 10 years among street youth. Drug Alcohol Depend
Source of Funding: Self
2007; 89: 170–5.7
Conflict of InteresT: Nil
12. Hadland SE, Marshall BDL, Kerr T, Zhang R., MontanerJS, Wood EA. Comparison of drug use
REFERENCE
and risk behavior profiles among younger and older street youth. Subst Use Misuse 2011; 46:
1. United Nations Children’s Fund (UNICEF). The
1486–94.
State of the World’s Children 2012: Children in an UrbanWorld. NewYork: UNICEF; 2012.
13. Benegal V, Kulbhusan, Seshadri S, Karott M. Drug abuse among street children in Bangalore.
2. World Health Organization (WHO). Working
A project in Collaboration between NIMHANS,
With Street Children: Module 1. A Profile of
Bangalore and the Bangalore Forum for street and
Street Children. In: Dependence. Geneva: World
working children, Monograph funded by CRY.
Health Organization; 2000.
3. Le Roux J. The worldwide phenomenon of street
14. Pagare D, Meena G S, Singh M M, Saha R. Risk
children: conceptual analysis. Adolescence 1996;
Factors of Substance Use Among Street Children
5 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
from Delhi. INDIAN PEDIATRICS 2004 Mar;
Meaningful Achievement of Millennium
41: 221-225.
Development Goals. URL:http:www.ihsnet.
15. Poonam R.Naik, Seema S. BansodeGokhe,
org.inIHSPresentations Protecting Children
RatnendraR.Shinde, AbhayS.Nirgude. Street
FromSubstanceAbuse08Jan09.pdf.
children of Mumbai: Demographic profile and
18. Khan A S, A Situational Analysis of the
substance abuse. Biomedical Research 2011;
Street Child phenomenon in Pakistan: A
22(4): 495-498.
Literature Review. University College London.
16. Sharma S, Lal R. Volatile Substance Misuse
URL:
http:cfsc.trunky.netdownload.
Among Street Children in India: A Preliminary
asp?doc=Publicationsid=405.
Report. Substance Use Misuse 2011; 46:46–49.
19. Street Children Statistics. Consortium for street
children.URL:http:www.streetchildren.org.
from Substance Abuse: A Critical Need for
uk_...Street_Children_Stats_FINAL.pdf.
DOI Number: 10.59580973-9130.2018.00063.4
A Retrospective Analysis of Mandibular Fractures: An Autopsy Study - 2012-2016
Ajay Kumar T S 1 , Deepa C 2
1 Associate Professor, Department of Forensic Medicine and Toxicology,
2 Assistant Professor, Department of Dentistry, Sri Devaraj Urs Medical College, Kolar
ABSTRACT
Background and objectives: Mandibular fracture, also known as fracture of the jaw, is one of the most commonly fractured facial bones and the most commonly fractured sites are the body of the mandible. The cause of the injury may be road traffic accidents, assault, falls, industrial injuries or sports injuries but the relative number of each varies considerably between countries and areas. This study intends to evaluate the age, gender distribution, the cause and anatomical distribution of mandibular fractures among autopsied cases.
Method: A retrospective study was conducted at Sri Devaraj Urs Medical College, Kolar from 2012 to 2016 and a total of 72 cases were studied.
Results: Out of 72 (100) cases, the males 54 (75) outnumbered females with 18 (25) cases. 45.1 of fractured cases were seen in the age group of 21 – 30 years. Road Traffic Accidents 40 (55.6) was the cause of mandibular fractures in majority of the subjects. The most common site of mandibular fracture was body of mandible with 28 (38.8) cases.
Conclusion and interpretation: The results could be useful in interpreting the pattern of mandibular fractures among autopsied cases. Since the high frequency of mandibular fractures are due to RTA, the various preventive measures can be employed to minimize the sequelae of mandibular fractures like creating awareness among public about safety measures.
Keywords: Mandibular fractures, Road Traffic Accidents, Autopsy, Body of mandible.
INTRODUCTION
Accidents (RTA) are now responsible for an equal share of the incidence of such injuries. 2 In terms of
Mandibular fracture, also known as fracture of the
violence, young males are most at risk with alcohol an
jaw, is a break through the mandibular bone.
aggravating factor. Women and children are much less
It was first described by Egyptian Papyrus in 3 at risk but can be from domestic violence. The relative
1650 BC. 1 Given its prominent anatomic location;
number of each varies considerably between countries
the mandible is one of the most commonly fractured
and areas and they can be usually attributed to cultural,
facial bones. Before the invention of the automobile,
social, environmental and economic factors. 4
mandibular fractures were most often caused by assault
The most commonly fractured sites are the body of
or other blunt trauma like falls, industrial injuries
the mandible, condyle, angle, symphysis, ramus and the
or sports injuries to the jaw. However, Road Traffic
coronoid process. Trauma to one side often produces an ipsilateral body fracture and a contralateral subcondylar
Corresponding author:
fracture. A heavy blow to the symphysis produces
Dr. Deepa C
a symphyseal fracture and bilateral subcondylar
Assistant Professor, Sri Devaraj Urs Medical College,
fractures. 3
Kolar. E-mail: drdeepashekargmail.com
7 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
The fracture site depends upon the mechanism
Table 2. Distribution of Mandibular fracture
of injury, magnitude and direction of impact force,
cases according to Etiology
prominence of the mandible and anatomy of site. 4 The
aim of the present study was to assess age and gender
Etiology
Male
Female number of Cases
distribution, etiology and anatomic distribution of mandibular fractures among autopsied cases.
RTA
MATERIALS AND METhOD
Fall
This retrospective study was carried out at Sri
01 04 Devaraj Urs Medical College, Kolar from 1 05 (6.9) January 2012 to 31 st December 2016 comprising all cases
which were autopsied in the Department of Forensic Medicine.
In this study, the demographic variables such as age
and gender, etiology and the site of mandibular fractures 72 (100) were noted. The medico-legal records were also referred
Road Traffic Accidents 40 (55.6) was the cause
for additional information.
of mandibular fractures in majority of the subjects,
The data obtained was recorded in the pre-designed
followed by Fall with 23 (31.9) cases.
and pre-tested proforma, which comprised relevant data and analyzed.
Table 3. Distribution of Mandibular fracture cases according to Anatomical site
RESULTS
Anatomical Site
number of
A total of 72 cases presenting with mandibular
Cases
fractures of 1423 number of autopsied cases during
Para symphysis
2012 to 2016 in the Department of Forensic Medicine
were studied. 02 (2.8)
symphysis
Body of Mandible
Table 1. Distribution of Mandibular fracture
cases according to age and sex 08 (11.2)
number of Cases
(in years)
More than one site
The most common site of mandibular fracture was body of mandible with 28 (38.8) cases, followed by
fracture of mandible with more than one sites with 13
(18.1) cases. The fracture of ramus and coronoid were the least common sites with 01 (1.4) cases each.
Out of 72 (100) cases, 54 (75) were males and
DISCUSSION
18 (25) were females. The maximum numbers of fractured cases 39 (45.1) were seen in the age group of
The mandible is the only mobile bone of the facial
21 – 30 years. More than 23 rd of the cases were between
skeleton, and there has been significant increase in the
21 – 40 years.
number of cases in the recent years. It is a membranous bone and is more commonly fractured than the other
Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2 8
bones of the face. Mandibular fractures occur twice
The difference in the main cause of injury is largely
as often as midline fractures. The energy required to
dependent on the cities where studied were conducted,
fracture it being the order of 44.6 – 74.4 kgm, which is
as well as, the population. High incidence of RTA in our
about the same as the zygoma and about half that for the
study may be attributed to reckless driving, insufficient
frontal bone. It is four times as much force is required to
helmet and seatbelt usage and the availability of fracture maxilla. 5 motorcycle for the young generation and consumption of alcohol while drivingriding.
In this study, the males 54 case (75) outnumbered the females with 18 cases (25) and the male to female
With respect to the anatomical site, the commonest
ratio being 3:1. Our results are consistent with the study
fracture region was the body of mandible with 28 cases
conducted by Kamlai U et al, 6 Ansari et al, 7 Kanasakar
(39.8), followed by more than one sites 13 cases et al, 4 adi et al, Shapiro et al. 8 (18.1), parasymphysis with 12 cases (16.7). Similar
results were reported by Brook IM et al 19 and Olson RA
The male dominance may be due to the paternalistic
et al 20 .
nature of our society where males keep themselves most of the time outdoors and lead a more active life.
The anatomic distribution and incidence of mandibular fracture are widely variable. The frequently
It was also observed that 54.1 of the mandibular
fractured site varied from author to author. Chuong R et
fractures occurred in the age group of 21-30 years. More
al opined symphysis as most frequent, Dongas P et al 18
than 23 rd
of the cases were between 21 – 40 years. The
and Ogundare BO et al 22 opined angle as commonest,
least number of cases were seen in the age group less
Kansarkar et al, 4 Vyas A et al, 12 Natu SS 5 reported
than 20 years and more than 40 years with 06 cases
parasymphysis the commonly fractured site.
(8.4) and 08 cases (11.2) respectively.
CONCLUSION
Similar findings were noted in the studies conducted
by Abbas et al 9 and Kansakar et al, 4 but the study
This study helps to interpret the pattern of
conducted by Shapiro et al 8 reported 34.1 years as mean
mandibular fractures among autopsied cases. The
age. This can be explained by the fact that at young age,
mandibular fractures were more common in males
people are more mobile, socially active, in business,
(75) than females (25), with highest number of
sports and high speed transportation, inter personal
cases (45.1) were seen in the age group of 21 – 30
violence, alcohol abuse and so forth.
years. More than 23 rd of the cases were between 21 – 40 years. RTA was the commonest cause for mandibular
The lower frequency of mandible fracture is seen
fractures with (55.6) followed by fall (31.9). The
at very young age which can be due to high elasticity
body of the mandible was the commonest fractured
of bone, poor pneumatization, thick surrounding
site (38.8), followed by more than one site (18.1),
adipose tissue and internal stabilization by unerupted
parasymphysis (16.7).
teeth within maxilla and mandible. In old age, due to lower physical activities mandibular fractures are least
Since the high frequency of mandibular fractures
common.
are due to RTA, the various preventive measures can
be employed to minimize the sequelae of mandibular
Out of 72 cases (100), RTA (55.6) is still
fractures like creating awareness among public about
mainstay as the most common cause of mandibular
safety measures.
fracture in our population, which is in accordance with
Shah et al, 10 Al Ahmed et al, 11 Natu SS et al, 5 Vyas
Conflict of Interest: The authors do not have any
A et al 12 . In this study, the etiology next to RTA was
conflict of interest in publishing this article.
followed by Fall with 23 (31.9) cases.
source of Funding. -Nil Some of the authors, Jung HW et al, 13 Mittal et al 14
Ethical Clearance: Institutional ethical clearance
in their studies opined fall as the commonest cause of
has been obtained. mandibular fractures and others Ellis E et al, 15 Rashid
A, 16 Kirk L, 17 Dongas P 18 stated intentional injury or
violence as the commonest cause.
9 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
REFERENCES
12. Vyas A, Mazumdar U, Khan F, Mehra M, Parihar L, Purohit C. A Study of mandibular fractures
1. Lipton JS. Oral Surgery in Ancient Egypt as
over a 5 year period of time: A Retrospective
reflected in the Edwin Smith Papyrus. Bulletin of
Study. Contemporary Clinical Dentistry 2014; 5
the History of Dentistry 1982; 30: 108.
(4): 452-455.
2. William C Soule. Mandibular Fracture Imaging.
13. Jung HW, Lee BS, Kwon YD, Choi BJ, Lee JW,
Medscape. [Cited on Jul 01, 2015]. Available
Lee HW et al. Retrospective clinical study of
from: http:www. http:emedicine.medscape.
mandible fractures. Journal of Korean Association
comarticle391549-overview.
of Oral Maxillofacial Surgery 2014 Feb; 40 (1):
3. Mandibular Fractures and Dislocations. Patient.
21-26.
Available from: https:patient.infoindoctor
14. Mittal G, Mittal S. Mandibular fractures at veer
mandibular-fractures-and-dislocations.
chandra singh garhwali government medical
4. Kansakar N, Budhathoki B, Prabhu N, Yadav
science and research institute, garhwal region,
A. Pattern and Etiology of Mandibular Fractures
uttarakhand, India: a retrospective study.
reported at Nepalgunj Medical College: A
Annals of medical and health sciences research.
Prospective Study. Journal of Nepalgunj Medical
2013;3(2):161-5.
College 2015; 13 (2): 21-24.
15. Ellis E, Moos KF and El-Attar A, Ten years of
5. Natu SS, Pradhan H, Gupta H, Alam S, Gupta
mandibular fractures: an analysis of 2,137 cases,
S, Pradhan R et al. An Epidemiological study on
Oral surgery, oral medicine, oral pathology,
pattern and Incidence of Mandibular Fractures:
59(2), 1985, 120-129.
Plastic Surgery International 2012; (2012, Article
16. Rashid A, Eyeson J, Haider D, Van Gijn D and
ID 834364:1-7.
Fan K, Incidence and patterns of mandibular
6. Kamali U and Pohchi A. Mandibular fracture
fractures during a 5-year period in a London
at HUSM: A 5-year retrospective study. Arch
teaching hospital, Br J Oral Maxillofac Surg,
Orofac Sci. 2009;4:33-5.
51(8), 2013, 794-798.
7. Ansari SR, Khitab U, Qayyum Z, Khattak A.
17. Kirk L. Fridrich, Gustavo Pena-Velasco and
Retrospective analysis of 268 cases of fractures
Robert A.J Olson, Changing Trends with
of mandible. Pak Oral Dent J 2004; 24:135-8.
Mandibular Fractures: A review of 1,067 cases, J
8. A. J. Shapiro, R. M. Johnson, S. F. Miller, and M.
Oral Maxillofac Surg, 50(6),1992,586-589.
C. McCarthy, “Facial fractures in a level I trauma
18. Dongas Pand GM Hall, Mandibular fracture
centre: the importance of protective devices and
patterns in Tasmania, Australia, Australian Dental
alcohol abuse,” Injury, vol. 32, no. 5, pp. 353–
Journal, 47(2), 2002, 131-137.
19. Brook IM, Wood N. Aetiology and incidence
9. Abbas I, Ali K, Mirza YB. Spectrum of mandibular
of facial fractures in adults. Int J Oral
fractures at tertiary care dental hospital in Lahore.
Surg. 1983;12:293–8.
J Ayub Med Coll Abbotabad 2003;15:12-4.
20. Olson RA, Fonseca RJ, Zeitler DL, Osbon DB.
10. A. Shah, A. S. Ali, and S. Abdus, “Pattern and
Fractures of the mandible: A review of 580
management of mandibular fractures: a study
cases. J Oral Maxillofac Surg. 1982;40:23–8.
conducted on 264 patients,” Pakistan Oral
21. Chuong R, Donoff RB, Guralnick WC. A
Dental Journal, vol. 27, no. 1, pp. 103–106,
retrospective analysis of 327 mandibular
fractures. J Oral Maxillofac Surg. 1983;41:305–
11. H. E. A. Ahmed, M. A. Jaber, S. H. Abu Fanas, and
M. Karas, “The pattern of maxillofacial fractures
22. Ogundare BO, Bonnick A, Bayley N. Pattern of
in Sharjah, United Arab Emirates: a review of
mandibular fractures in an urban major trauma
230 cases,” Oral Surgery, Oral Medicine, Oral
center. J Oral Maxillofac Surg. 2003;61:713–8.
Pathology, Oral Radiology and Endodontology, vol. 98, no. 2, pp. 166–170, 2004.
DOI Number: 10.59580973-9130.2018.00064.6
Infection Control in Orthodontics: A Review
Mithun K 1 , Ashith M V 2 , harshitha V 3 , Valerie Anithra Pereira 4 , Deesha Kumari 5
1 Assistant Professor, Department of orthodontics, A.J institute of Dental Sciences, Mangalore, 2 Reader, Department of Orthodontics, Manipal College of Dental Sciences Mangalore, 3 Reader, Department of Orthodontics, A.J
Institute of Dental Sciences. Mangalore, 4 Post graduate Student, Department of Periodontics and Implantology,
Coorg Institute of Dental Sciences, 5 Assistant Professor, Department of Public Health Dentistry,
AB Shetty Memorial Institute of Dental Sciences
ABSTRACT
Dental care professionals are at an increased risk of cross infection while treating patients.This occupational potential for disease transmission become evident initially when one realises that most human microbial pathogens have been isolated from oral secretions. Because of repeated exposure to micro-organisms in blood and saliva, incidence of certain infectious diseases has been significantly higher among dental professionals than observed for general population.
Keywords: Infection control, Sterilization, Disinfection, Orthodontic office, Waste management
INFECTION CONTROL IN
means
ORThODONTICS
1) Direct contact : With patient’s saliva or blood
Dental care professionals are at an increased risk
2) Droplet infection: They occur as a result of
of cross infection while treating patients. Incidence
sprays, spatter or aerosols from patients mouth.
of infectious diseases has been significantly higher among dental professionals than observed for general
3) Indirect contact: involves transfer of
population. Orthodontists are exposed to a wide variety
microorganisms from the source (e.g., the patient’s
of microorganisms in orthodontic office by contaminated
mouth) to an item.
instruments, inhalation of aerosols or via percutaneous injuries with archwires, ligature wires, band material
2. Dental Team to Patient:If the hands of dental
and other sharp cutting instruments. 1 A study found
team member contain lesions or other nonintactskin.If
that orthodontists have the second highest incidence of
a member of the dental team bleeds on instruments or
hepatitis B among dental professionals. 2 New materials
other items that are then used in the patient’s mouth,
“as received” from the manufacturers are not free from
cross infection may result.
bacterial contamination before use in patients. Further
3. Dental Office to CommunityMicroorganisms
studies would be required to determine the level of risk
3 that this poses. from the patient contaminate items that are sent out or
are transported away from the office. Dental laboratory
Means of transmission
technicians have been occupationally infected with hepatitis B virus (HBV). Also, regulated waste that
1. Patient to Dental Team: It can be by three
contains infectious agents and is transported from the
Corresponding author:
office may contaminate waste handlers if it is not done
Mithun K
in proper containers.
Assistant Professor, Department of Orthodontics, A.J
Goals of infection control 4
institute of Dental Sciences, NH-66, Near Kuntikana Road, Kuntikana Mangalore: 575004.
ADA council on dental therapeutics has
Mob. +919902355948,
recommended the following
Email: dr.mithunknaikgmail.com
11 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
1. Decrease the number of pathogenic microbes to
sterilization. Hence cleaning reduces this bio burden to
the level where normal body resistance mechanisms can
facilitate sterilization.
prevent infection .
- Manual cleaning or hand scrubbing: Time
2. Break the cycle of infection from dentist,
consuming and increases the chances of accidental
assistant patient eliminate cross infection.
puncture or cuts through direct handling of sharp and pointed instruments. Complete personal protective
3. Treat all the patient instrument as though
equipment should be worn. Instruments should be
they could transmit an infectious disease
immersed in a detergent and cleaned under running
4. Protect patient personnel from infection
water using a soft brush with a long handle.
protect all dental personnel from threat of malpractice.
- Ultrasonic cleaning: It is effective, time saving
Infection control stratergy
and much more safe than hand scrubbing. A cleaning solution that is specifically recommended by the
Each clinical practice must have a written infection
manufacturer for use in ultrasonic cleaner should be
control policy which must be upgraded with the latest
used. 5
recommendations. Infection control strategy involves various steps
Presoaked instruments contained in the basket should be immersed in the cleaning solution of ultrasonic
1. Patient screening: A patient with subclinical
cleaner. The cleaner should be covered and operated for
infection is a potential source of cross-contamination.
atleast 6-10 mins. After cleaning, instruments should be
Therefore, all the patients must be screened by obtaining
thoroughly rinsed. 6
the relevant medical and dental history from them and a physician must be consulted if doubt arises
d. Corrosion control, drying and lubrication: Before subjecting the instruments for sterilization,
2.Instrument processing:
the instruments must first be cleaned thoroughly with no debris and dried to reduce chances of corrosion
a. Containment: During and after each procedure,
and a rust inhibitor (dip or spray) should be applied.
every effort should be made to confine all instruments
Lubrication of instruments with movable parts like
and devices that have come in contact with the patient
hinges of orthodontic pliers should be done prior to
to a well-defined and limited area. Rationale: when
steam sterilization with a water based lubricant. A
contaminated instruments are confined to a limited area,
sodium nitrite rust inhibitor can also be used. Corrosion
microorganisms are not spread unnecessarily. Utility
resistance is directly proportional to its chromium
gloves, protective eyewear and clinic garment should be
content and inversely proportional to its carbon content.
worn
Disinfectants, or detergents with pH greater than 8.5
b. holding (presoaking): All contaminated
can disrupt the chromium oxide layer. Blood saliva and
instruments should be stored in a presoak solution
debris if not rinsed and directly autoclaved can cause
immediately after the procedure. Rationale: It is seldom
pitting corrosion. Chrome plated instruments should be
possible to clean the instruments used on each patient
processed separately from stainless steel ones, because
immediately after the procedure. The debris on such
of electrolytic action which can carry carbon particles
instruments may dry, making them more difficult
from exposed metal of a chrome plated instrument and
to clean. Recommendations:Use presoak solutions
deposit them on stainless steel. Chrome plated pliers are
which consists of detergents or detergents containing
more resistant to corrosion than stainless steel pliers.
disinfectants like phenolic compounds. Thepre-soaking
e. Packaging: Packaging involves organizing the
solution should be discarded at the end of the day.
Instruments in functional sets and wrapping them or
c. Pre-cleaningpre-sterilization: All contaminated
placing them in sterilization pouches, bags, trays, or
instruments should be properly cleaned before the
cassettes. Rationale: Packaging Instruments before
process of sterilization. Rationale: Blood, Saliva and
processing through the sterilizer prevents them from
material on instruments can insulate microorganisms
environmental contamination after sterilization, and
from sterilizing agents, and interfere with effective
maintains sterility during storage or when being
Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2 12
distributed to chairside. Recommendations: Only a
the American Dental association (ADA) and Centers for
wrapping material that is designed as a sterilization
Disease control and prevention (CDC) as an acceptable
wrap for a particular type of sterilizer should be used.
method of sterilization for the following items that can
Trays and cassettes are very good options for packaging
be damaged by heat and or moisture, and those that can
orthodontic instruments and bands, because they retain
be cleaned and dried thoroughly.
instruments during pre-soaking, ultrasonic cleaning, sterilization and storage, and finally for use at chairside.
MECHANISM: A gas with very high penetrating
They eliminate the potential risks like puncturing or cuts
ability. It acts by alkylating the amino, carboxyl,
while handling sharp contaminated instruments
sulphhydril groups in protein molecules thus reacts with RNA and DNA.
Autoclave sterilization must allow steam to
Recommendation for materials in orthodontics
penetrate inside it and reach every instrument contained in it and all its surfaces. Requirements of packaging
a. Impression trays:
materials: Dry heat sterilization must not insulate items from heat, must not get destroyed by temperature used.
Aluminium or chrome plated: heat or gas
Unsaturated chemical vapor sterilization must allow
sterilization can be used. Custom acrylic trays:
vapour to precipitate on contents and not react with the
disinfect by NaOCl or iodophor or to discard. Plastic
vapour.
trays: ethylene oxide sterilization or disinfection by NaOCl or iodophor. Alginates are relatively less stable,
3. Sterilization
hence ADA recommends disinfection of alginates by
1)heat sterilization
immersion in diluted sodium hypochlorite or iodophors with minimal disinfection time. After disinfection
a.Dry heat sterilization: This method uses hot air
the impressions should be rinsed to remove residual
to kill microorganisms and has the advantage of not
disinfectant.
causing corrosion. It dehydrates the bacterial protein
b . Disinfection of removable appliances: Immerse
and decreases its resistance to denaturation
completely into a disinfectant for the time recommended
At a given temperature, dry heat is less efficient
for tuberculocidal disinfection. ADA reccomends
than moist heat, because dry heat is not as efficient a
immersion in iodophors or sodium hypochlorite for
heat conductor as moist heat.
10 mins. Disinfection of baseplates of removable orthodontic appliances by using 0.12 chlorhexidine
Rapid heat transfer Sterilizer: Also called as
spray once or twice a week reduced the contamination
forced air convention units. The mechanism of bacterial
by Mutans Streptococci on the acrylic surface. 7
killing is similar to conventional dry heat unit. They use higher temperature than other dry heat units and there
c. . Disinfection of wax bites: ADA recommends
is a controlled internal air flow within the chamber. As
disinfection of wax bites by a spray-wipe-spray
a result, they have a substantially shorter sterilization
techniqueShould remain wet after the second spray
intervals.
for atleast 10 mins. Rinsed again to remove residual disinfectant.
b.Steam pressure sterilization: Steam sterilization is the oldest and most commonly used of acceptable
d. Stone cast disinfection:ADA recommends
methods for instrument sterilization in dentistry since
disinfection of wax bites by a spray-wipe-spray
many years. Sterilization is accomplished by making
technique should remain wet after the second spray for
use of steam under pressure which causes denaturation
atleast 10 mins.
and coagulation of microbial proteins.Mechanism:
e. Orthodontic pliers: High quality stainless
When water heated under pressure, its boiling point is
steel can be treated with dry heat, autoclave, chemical
raised together with the temperature of the generated
vapour, ethylene oxide. Plier with plastic parts can be
steam.
treated with ethylene oxide, chemical disinfection or
c. Gas or ethylene oxide sterilization
sterilization. 8
Ethylene oxide: The use of ETO is recognized by
13 Indian Journal of Forensic Medicine Toxicology, April-June 2018, Vol. 12, No. 2
f. Orthodontic bands: Thread the bands to be
indicators. Atleast one item per load should contain an
sterilized on the auxiliary wire, and suspend the wire
internal indicator.
across the rack to dry heat or autoclave sterilization
c. Physical Monitoring: Physical monitoring of the
g. Orthodontic wires: TMA wires treated with
sterilization process involves observing the gauges and
ethylene oxide, autoclaving . NiTi wires treated with
displays on the sterilizer and recording the sterilizing
ethylene oxide. Stainless steel wires treated with
temperature, pressure and exposure time. Thus, physical autoclave , dry heat and ethylene oxide. 9 monitoring may not detect problems resulting from overloading, improper packaging material or use of
h. Orthodontic marking pencils:Conventional
closed containers.
orthodontic pencils can not be autoclaved. Gas
sterilization can be done. 10 handling processed instruments
i. Elastomeric Chains and Ligatures: Chemicals
a. Drying and Cooling : Packs, pouches or
are not suitable for disinfection of elastomeric ligatures
cassettes processed through steam sterilizer may be wet
and E-chains because they alter the physical properties
and must be allowed to dry before handling