Eftersom medellivslängden ökar och de egna tänderna behålls högre upp i åldrarna finns det en ökad kariesrisk hos de äldre. Syftet med litteraturstudien var att redogöra för riskfaktorer som påverkar kariessituationen hos äldre personer. Ytterligare ett syfte var att ta reda på vilka tänder och tandytor som främst drabbas av karies. Studien genomfördes som en allmän litteraturstudie. Databaserna PubMed och Cinahl användes. Artiklar publicerade år 2000-2010 inkluderades. Total ingick 15 artiklar i resultatet. Resultatet visade att kost, mediciner, saliv, bakterier, gingivala retraktioner, egenvård, rökning, avtagbara proteser, protetiska kronor och antalet kvarvarande tänder var riskfaktorer som kunde orsaka både kron- och rotytekaries hos äldre. Rotytan, ocklusalytan och lingualytan samt de ytor som var belägna i direkt relation med lagningar var de ytor som främst drabbades av karies. De mest utsatta tänderna för kariesangrepp var molarerna, premolarerna samt caninerna. Många olika faktorer bidrar till en ökad kariesrisk hos äldre. Flertalet studier redovisade ett samband mellan gingivala retraktioner och rotytekaries. Majoriteten av det granskade materialet visade att rotytan var känslig för kariesangrepp. Framförallt var molarerna utsatta för kariesrisk hos äldre. / As life expectancy increases and our teeth are retained to a higher age, there is an increased risk of caries in the elderly. The purpose was to describe risk factors that affect the caries situation in the elderly. Another purpose was to find out which teeth and tooth surfaces are mainly affected. This study was carried out as a general literature review; PubMed and Cinahl were used. Articles published 2000-2010 were used. A total of 15 articles were included. The results show that diet, medications, saliva, bacteria, gingival recession, self-care, smoking, removable prostheses, prosthetic crowns and the number of remaining teeth are various risk factors that can cause both crown and root surface caries in the elderly. Those surfaces that were mainly affected by caries were root surface, the occlusal surface and the lingual surface, as well as the surfaces that are directly related to fillings. The teeth most vulnerable to caries were the molars, premolars and canines. Several studies showed a relationship between gingival recession and root surfaces caries. The majority of the reviewed articles showed that the root surfaces were susceptible to caries. It was primarily molars that were exposed to caries in the elderly.

Darbo tikslas: įvertinti Kauno miesto odontologinių paslaugų teikėjų konkurencijos intensyvumą. Darbo uždaviniai: 1. nustatyti pagrindinius odontologinių paslaugų teikėjų konkurenciją įtakojančius veiksnius; 2. įvertinti Kauno miesto odontologinių paslaugų teikėjų konkurenciją įtakojančių veiksnių intensyvumą; 3. pateikti rekomendacijas skirtas konkurencinės situacijos pagerinimui Kauno miesto odontologinių paslaugų rinkoje ir padedančias šių paslaugų teikėjams priimti efektyvius veiklos sprendimus. Tyrimo metodika: atlikus mokslinės literatūros analizę buvo nustatyti pagrindiniai odontologinių paslaugų teikėjų konkurenciją įtakojantys veiksniai. Kauno miesto odontologinių paslaugų teikėjų konkurenciją įtakojančių veiksnių intensyvumo įvertinimas vyko dviem etapais: 1. ekspertų atranka (anketinė Kauno miesto odontologines paslaugas teikiančių įmonių vadovų ir odontologijos skyrių vadovų apklausa); 2. anketinė ekspertų apklausa. Viso tyrimui buvo atrinkti 36 ekspertai. Rezultatų analizės metu apskaičiuotas ekspertų nuomonių sutapimo koeficientas S. Rezultatai: esami konkurentai šiek tiek daugiau nei vidutiniškai įtakoja Kauno miesto odontologinių paslaugų teikėjų konkurenciją (odontologijos kabinetus ir klinikas atstovaujantys ekspertai esamų konkurentų įtaką vertino kaip didelę, šeimos klinikas ir poliklinikas atstovaujantys ekspertai esamų konkurentų įtaką vertino kaip vidutinę). Nauji konkurentai daro didelę, pacientai ir pakaitalai – vidutinę, o tiekėjai silpną įtaką... [toliau žr. visą tekstą] / Aim of the study: to evaluate the intensity of the competition of odontological services providers in Kaunas city Objectives: 1. to determine the main factors that affect the competition of odontological services providers; 2. to evaluate the intensity of such factors in Kaunas city; 3. to present the recommendations, how to improve the competitive situation in Kaunas odontologic market, and how to make the effective solutions on the activity for such services providers. Methods: the analysis of the scientific literature allowed determining the factors, which affect the competitiveness of odontologists. The intensity of the factors that affect the competition of odontological services providers in Kaunas city was evaluated in two stages: 1. selection of experts (questioning of the heads of odontologic companies in Kaunas city and heads of odontologic departments); 2. questioning of experts. In total, 36 experts were selected for the research. While analyzing the results, the coefficient of coincidence of expert opinions S was calculated. Results: the present competitors affect the competition of odontological services providers in Kaunas a little more than on the average (the experts, who represented odontologic offices and clinics, evaluated the influence of the present competitors as big; the experts, who represented family clinics and health care institutions, evaluated the influence of the present competitors as average). New competitors have big, patients and... [to full text]

Bakalauro baigiamajame darbe nagrinėjamas pirminio lygio odontologijos paslaugų prieinamumas vaikams Šiaulių mieste. Nagrinėta pagrindinė Šiaulių miesto problema – vaikų prieinamumas pas gydytojus odontologus. Darbą sudaro dvi pagrindinės dalys: teorinė ir praktinė. Teorinėje darbo dalyje pateikta paslaugos samprata, savybės, klasifikacija, išskirti paslaugų teikimo sektoriai. Nagrinėta paslaugų kokybės esmė, veiksniai lemiantys paslaugos teikimo procesą, pateiktos 5 kokybės dimensijos, kurios nagrinėja paslaugų kokybę kaip bendrą paslaugos įvertinimą vartotojų atžvilgiu. Pateiktas vartotojų suvokimas apie teikiamą paslaugos procesą, išskirti klientų tipai, analizuotas klientų pasitenkinimo lygis, bei kaip skundai įtakoja vartotojo pasitenkinimą paslauga. Aprašyti vartotojų pasitenkinimą matuojantys kokybės modeliai: E. Gummesson 4 Q kokybės modelis, Gronroos ir Gummesson kokybės modelis ir Servqual modelis. Tinkamiausias modelis matuojantis prieinamumą – Servqual modelis. Plačiau teorinėje dalyje nagrinėjama prieinamumo sąvoka sveikatos priežiūros įstaigose, bei pateikti veiksniai ribojantys sveikatos priežiūros prieinamumą. Praktinėje dalyje pateikta tyrimo metodologija, bei Šiaulių odontologijos poliklinikos charakteristika. Atliktas kiekybinis ir kokybinis tyrimas. Anketą sudaro 33 klausimai, o interviu – 24 klausimai. Šiaulių miesto vaikų prieinamumas buvo tirtas remiantis paslaugos vertinimo kriterijais pagal Servqual metodiką: laikas, vieta, informacija, gydytojų... [toliau žr. visą tekstą] / Accessibility to primary level dental services for children in Siauliai City is analysed in the bachelor‘s thesis. Examined the main problem in the city of Siauliai – Children`s access to the dentist. The thesis consists of two main parts: a theoretical and practical one. A concept of the service, its characteristics, classification is provided and sectors of service provision are identified. The essence of service quality, factors determining the process of service provision were analysed, 5 quality dimensions analysing the service quality as a general service evaluation from the point of view of consumers were provided. A consumer perception of the service process is provided, client types were distinguished, client satisfaction level and how complaints influence the consumer satisfaction with the service were examined. The following quality levels measuring consumer satisfaction were described: E. Gummesson 4Q Quality Model, Grönroos and Gummesson Quality Model and Servqual Model. The most suitable model measuring accessibility is Servqual Model. The concept of accessibility in a health care institution is analysed in more detail and factors limiting the health care accessibility are provided in the theoretical part. Research methodology and characteristics of Siauliai Dentistry Clinic is provided in the practical part. A quantitative and qualitative research was made. The questionnaire consists of 33 questions and interview – 25 questions. Accessibility of Siauliai City... [to full text]

Aim of the study. To evaluate patients’ attitude towards the accessibility of primary odontology care and their satisfaction with the services in public health care institution. Investigation methods. The patients were questionared in Odontology department for primary health care of public institution Kaunas “Kalniečių“ policlinic. 230 questionnaires were delivered, 198 respondents answered the questions (response rate 86%). Statistical data analysis was carried out on the basis of program package SPSS 10.0. Correlation between peculiarities was estimated according to the Chi square criterion test (χ2). The hypothesis concerning the comparison of two independent variables average was tested on the basis of Stjudent ( t ) criterion. Correlation strength among range variables was tested on the basis of Spearman correlation coefficient. As the basis for hypotheses checking was chosen significance level equal to 0,05 or less. Results. The majority of respondents evaluated primary health care odontolgy department from the financial point of view, communication and organization as satisfactory. The bigger part of respondents did not face any problems in: fee for odontology materials (73,2%), arrival to doctor – odontologist (66,5%), 79,2% claimed having had a possibility to select a doctor, 42,8% of the respondents had to spend up to 10 minutes at the receptionists’, while 42,3% of them spent at the receptionists from 10 to 15 minutes. Some accessibility specimen had a primary... [to full text]

Darbo tikslas. Įvertinti kokybės vadybos sistemos diegimą Lietuvos odontologijos įstaigose. Uždaviniai. Įvertinti kokybės vadybos sistemos diegimo būklę odontologijos įstaigose. Identifikuoti kokybės vadybos sistemos diegimo odontologijos įstaigose esmines problemas. Įvertinti naudą, kurią gauna iš kokybės vadybos sistemos odontologijos įstaigos. Tyrimo metodika. Atlikta anoniminė Lietuvos odontologijos įstaigų atstovų apklausa. Išplatintos 350 anketų, sugrįžo 286, atsako dažnis 81,7%. Rezultatai apdoroti SPSS 13.0 versija ir MS Excel. Statistinis duomenų reikšmingumas buvo tiriamas naudojant chi kvadrato (χ2) kriterijų, laisvės laipsnių skaičių (lls) bei statistinį reikšmingumą (p). Rezultatai laikomi statistiškai patikimais, kai p<0,05. Rezultatai. KVS įdiegta tik 12,2% odontologijos įstaigų kuriose dirba 5 ir daugiau darbuotojų, 33,9% įstaigų dabar ją diegia. Svarbiausios priežastys, skatinančios odontologijos įstaigas diegti KVS – to reikalauja įstatymai ir kiti norminiai aktai (72,4%), išaugę pacientų reikalavimai (13,6%) ir didelis pacientų skundų skaičius (6,3%). Esminės priežastys dėl ko nediegiama KVS – žmogiškųjų išteklių (50%), informacijos apie KVS (20,7%), finansinių išteklių (17,9%) ir laiko (3,3%) trūkumas, apie KVS nieko nežino 8,2%. Pagrindinės problemos su kuriomis susiduria įstaigos diegiant KVS yra procedūrų aprašymai (45,2%), kokybės politikos apibrėžimas (27,1%), audito grupės sudarymas (12%), diagnostikos ir gydymo metodikų sudarymas (10,2%), kokybės... [toliau žr. visą tekstą] / Aim of the study. To evaluate the implementation of the quality management system in institutions of odontology in Lithuania. Objectives. To evaluate the situation of the implementation of the quality management system in institutions of odontology. To identify the essential problems of the implementation of the quality management system in institutions of odontology. To evaluate benefits of the quality management system which obtain institutions of odontology. Methods. The anonymous survey of representatives of institutions of odontology in Lithuania was carried out. As many as 350 questionnaires were distributed, 286 of them were returned, the rate of response being 81.7%. The results were computed using SPSS 13.0 version and MS Excel. The statistical data value was analysed using the criterion of Chi-square (χ2), number of degree of freedom (df) and statistical significance (p). Results were considered as statistically reliable if p<0.05. Results. The QMS has been implemented in just 12.2% of institutions of odontology, the staff of which consists of 5 and more members. 33.9% of institutions are implementing the system. The most important reasons motivating institutions to implement the QMS are legislation and other regulations (72.4%), increased demands of patients (13.6%) and a high number of patients‘ complaints (6.3%). The essential reasons for not implementing the QMS is the lack of manpower (50%), lack of information about QMS (20.7%), financial resources (17.9%)... [to full text]

Darbo tikslas Ištirti kserostomijos klinikos ypatumus ir juos lemiančius veiksnius sergant Šegreno sindromu, po radioterapijos kaklo ir galvos srityje bei vartojant triciklius antidepresantus ir pasiūlyti burnos sveikatos pagerinimo būdą. Darbo uždaviniai 1. Ištirti pagrindinius kserostomijos klinikos simptomus ir nustatyti juos įtakojančių veiksnių reikšmingumą. 2. Nustatyti kai kurių etiologinių kserostomijos veiksnių sąsają su pacientų amžiumi, lytimi ir pagrindiniais klinikos simptomais. 3. Ištirti didžiųjų ir mažųjų seilių liaukų funkcinę būklę sialometrijos ir sialoscintigrafijos metodais ir įvertinti jos įtaką klinikiniams simptomams. 4. Nustatyti kserostomijos trukmės sąsają su pagrindiniais kserostomijos simptomais. 5. Nustatyti sergančiųjų pacientų dantų, apydančio ir burnos higienos būklės sąsają su kserostomijos etiologija ir klinika. 6. Pasiūlyti kserostomijos stadijų klasifikaciją ir jos diagnostikos kriterijus. 7. Patobulinti dirbtinių seilių sudėtį ir pasiūlyti sergančiųjų kserostomija burnos sveikatos pagerinimo būdą. Medžiaga ir metodai Tyrimų medžiagą sudarė dvi grupės: I. KMU dantų ir burnos ligų klinikoje 2003 – 2005 metais 64 pacientai, pirmą kartą besikreipę konsultuotis dėl sausos burnos, buvo įtraukti į studiją. Iš jų 34 atrinkti dirbtinių seilių poveikiui tirti iš kurių 27 pacientam atliktas sialoscintigrafinis tyrimas; II. Iš KMUK archyvo atsitiktiniu būdu buvo atrinktos 481... [toliau žr. visą tekstą] / There is a continuous discussion about the basic xerostomia etiology and clinic problems in literature. Still individual authors have no unified opinion on how and to what extent the etiological factor of hyposalivation is relevant to manifestation of various aspects of xerostomia (Jensen SB et al.). There is no final objective data about the relationship of subjective patient complains with age, sex, psychological status and duration of xerostomia. There is an on-going discussion among certain authors in medical literature on when salivation should be considered as deficient, and what level of hyposalivation causes clinical xerostomia. Proper treatment of xerostomia is one of the most relevant problem. At the present, there is no unified treatment strategy that is towarded to stage or severity degree of xerostomia. However, objective criteria are not developed yet to classify xerostomia severity. Most authors, independently of absence of clear indications, recommend anticariesogenic, antibacterial treatment and to compensate the lack of saliva with artificial ones. Currently, there are not available saliva substitutes as one of the most important xerostomia treatment component on the market in our country. The study is also needed to evaluate the effectiveness of the treatment. 2. THE AIM AND THE GOALS OF THE STUDY The aim of the study was to evaluate the pecularities of xerostomia etiology and clinic and the... [to full text]

In cases of forensic dental identification, a key factor in the comparison of the dental status of deceased persons with antemortem dental records is the matching of dental restorations in individual teeth. Many studies have been performed showing the prevalence of dental interventions. This has mostly been performed by counting the numbers of decayed, missing and filled teeth (DMFT) in each mouth without detailed data collection on a per-tooth basis. The purpose of this study was to investigate the research question: to what extent would data on the distribution and prevalence of restoration types in the human dentition facilitate forensic identification? A database program was developed to allow efficient collection and collation of dental trait information. Provision was made for storing information relating to a subject's individual teeth, such as restorative materials used and surfaces filled. Other data, such as missing teeth, caries status on a per-individual tooth basis and presence and details of types of prostheses may be stored. iii Data from patients attending a private group practice in Hobart was collected and a system was devised to enable the likelihood of dental trait occurrence to be calculated in cases of forensic dental identification. The capabilities of the system are demonstrated in a series of mock cases of dental identification. An opportunity to make use of the database for which it was designed arose in relation to the analysis of person identification evidence in a murder trial at the Tasmanian Supreme Court. The use of this reference database in evidence invoked lengthy debate involving the judge, crown prosecutor and defence barristers. The resulting voire dire was resolved in favour of conclusions drawn from the use of the database being admitted in evidence. The legal precedent set in the Marlow trial may possibly offer encouragement for practising odontologists to further the concept of establishing and using reference databases of dental traits in population groups in other parts of Australia.

Submitted by Maykon Nascimento (maykon.albani@hotmail.com) on 2016-05-09T19:10:21Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Approved for entry into archive by Patricia Barros (patricia.barros@ufes.br) on 2016-06-06T12:34:39Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Made available in DSpace on 2016-06-06T12:34:39Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertacao Grasiele Bonadiman.pdf: 3637833 bytes, checksum: 9c919dca44b71050b2c6cbe78d9a59a6 (MD5) / Possíveis associações entre doença periodontal (DP) e alterações cardiovasculares em cães, como a endocardite infecciosa (EI), são relatadas na literatura, apesar de ainda não comprovadas. Fármacos anestésicos, utilizados para a tratamento periodontal (TP), podem levar à hipotensão, redução do fluxo sanguíneo coronariano e isquemia miocárdica. A determinação de biomarcadores, especialmente a troponina I cardíaca (TnIc), pode ser utilizada para a detecção de lesão miocárdica tanto em casos de EI, quanto por efeitos de fármacos anestésicos. Objetivou-se avaliar os níveis séricos de TnIc em cães com DP, como um indicador de EI, anestesiados para TP, com e sem o uso de antibióticos. Utilizou-se 24 cães com DP, sem evidências de outras doenças sistêmicas, selecionados por meio de avaliação física, laboratorial e cardiovascular. Formou-se três grupos de 8 cães cada: grupo I (controle) – cães anestesiados; grupo II - cães anestesiados submetidos a TP, não tratados com antibióticos; grupo III - cães anestesiados submetidos a TP, tratados com antibióticos. Os cães foram sedados com meperidina e acepromazina, induzidos com propofol e mantidos com isoflurano em oxigênio. Dosagens de TnIc foram realizadas imediatamente antes e 24 horas após o TP, com kit comercial pelo método de ELISA. A análise estatística foi realizada por meio do teste de "D'Agostino & Pearson", teste t para comparação de duas médias e teste post hoc de comparação múltipla de Tukey, após a análise de variância. Não houve diferença significativa nas dosagens de TnIc entre os grupos, nem entre os momentos avaliados (p>0,05). Conclui-se que não há aumento de TnIc em cães com DP após o TP, submetidos ou não a antibioticoterapia, podendo sugerir que não houve o desenvolvimento de EI; e não há aumento de TnIc em cães saudáveis submetidos ao protocolo anestésico estipulado. / Associations between periodontal disease (PD) and cardiovascular changes in dogs, such as infeccious endocarditis (IE), are reported by literature, although no evidences between them are verified. Anesthetic drugs, used for periodontal treatment (PT), can lead to hypotension, reduction of coronary blood flow and myocardial ischemia. Determination of biomarkers, especially cardiac troponin I (cTnI) can be used for the detection of myocardial injury in both cases: endocarditis and the effects of anesthetic drugs. This study aimed to evaluate canine cTnI in dogs with PD, as an indicator of IE, after PT, with and without using antibiotics. It was used 24 dogs with PD, with no evidence of any other systemic diseases. They were selected by physical examination, laboratory and cardiovascular evaluation and were divided into three groups: group I (n=8; control) - anesthetized dogs, group II (n=8) - anesthetized dogs submited to PT, not treated with antibiotics, group III (n=8) - anesthetized dogs submited to PT, treated with antibiotics. The dogs were sedated with acepromazine and meperidine, induced with propofol and maintained with isoflurane in oxygen. Canine cTnI dosages were taken immediately before and 24 hours after PT, using commercial kit (ELISA). Statistical analysis were performed by using "D'Agostino & Pearson" normality test, unpaired t test to compare two samples and Tukey´s post hoc test for multiple comparisons. All tests were performed at a level of significance of 0.05 No significant differences were found between groups or in different moments (p>0.05). It was concluded that there is no increased cTnI in dogs with PD after PT, treated or not with antibiotics, suggesting that there was no development of IE, and there is no increase in canine cTnI in healthy dogs anesthetized using this protocol.

Made available in DSpace on 2014-06-11T19:31:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-20Bitstream added on 2014-06-13T18:42:03Z : No. of bitstreams: 1 alvarenga_fas_dr_arafo.pdf: 377423 bytes, checksum: a7234c966436d6d6884b3c3d929d03d0 (MD5) / Objetivo: O objetivo principal deste estudo foi verificar a reprodutibilidade e validade do diagnóstico de microinfiltração marginal visual e digital, estabelecendo, a priori, a resolução e magnificação mais indicadas para a modalidade digital. Métodos: Para o diagnóstico da microinfiltração marginal, os métodos utilizados foram o visual (estereomicroscópio) e o digital (Image Tool Software-ITS3.0), sendo as leituras realizadas por dois examinadores previamente calibrados. Foi estimada a concordância intra/interexaminador e foi estudada a validade da imagem digital para diagnóstico, tomando-se o esteremicroscópio como critério de validação. Para o uso da imagem digital, foram comparadas diferentes resoluções e magnificações. Resultados: A detecção da microinfiltração por meio digital (ITS3.0) deve ser feita na resolução 600 dpi, com diferença estatisticamente significativa entre as magnificações de 100%, 200%, 300% e 400% (H=13,34; p<0,05), sendo que as de 200% e de 300% apresentaram comportamento semelhante. Ambos os métodos visual e digital ofereceram altos níveis de reprodutibilidade intraobservador (visual: 1=0,87 e 2=0,76; digital: 1=0,99 e 2=0,99) e interobservador (visual: =0,84; =0,99). Tomando-se o estereomicroscópio como critério de validação, a acurácia do ITS3.0 foi verificada, com sensibilidade de 0,95 e especificidade de 0,92. Conclusões: Em relação à microinfiltração marginal: Ao se empregar o sistema digital ITS3.0, deve-se adotar as magnificações de 200% ou de 300% na resolução de 600 dpi. Os métodos de diagnóstico da microinfiltração marginal visual e digital mostraram-se reprodutíveis. Considerando o estereomicroscópio como critério de validação, o método digital ITS3.0 se mostrou sensível e específico / Objective: The main objective of this study was to evaluate the reproducibility and the accuracy of the marginal microleakage diagnosis, by means of visual and digital methods, establishing the ideal resolution and magnification for digital images. Methods: In relation to the marginal microleakage diagnosis, by means of visual (stereomicroscope) and digital (Image Tool Software-ITS3.0) methods, two observers previously calibrated did the diagnosis, independently. It was estimated the intra/interobserver agreement and it was studied the validity of the digital image (using the stereomicroscope as the validation criterion). Also, it was verified the ideal resolution and magnification for digital image diagnosis. Results: Using the Image Tool Software (ITS3.0), the magnification levels of 100%, 200%, 300%, and 400% showed to be different (H=13.34; p<0.05), and 200% and 300% were similar and are indicated to detect microleakage at 600 dpi. The visual method was reliable, with high levels of intraobserver agreement (1=0.87, and 2=0.76) as the interobserver agreement (=0.84); for ITS3.0, the intraobserver was almost perfect for both examiners (1=2=0.99) and so was the interobserver agreement value (=0.99). The accuracy of the ITS3.0 was verified, using the stereomicroscope as the validation criterion, with sensitivity of 0.95 and specificity of 0.92 Conclusions: In relation to microleakage, its detection by means of digital image (ITS3.0) showed that 200% and 300% magnification levels are indicated in the 600dpi resolution. The diagnosis of marginal microleakage using visual and digital methods presented high levels of intra- and interobserver agreement. Using the stereomicroscope as the validation criterion, digital diagnosis by ITS3.0 was sensitive and specific

No estudo das marcas de mordidas, os materiais biológicos relacionados à Odontologia, como o dente e saliva, são analisados por meio de evidências físicas (análise métrica e/ou emparelhamento físico) e evidências biológicas (análise de DNA). A partir de ambos os métodos pode-se estabelecer a identidade de um indivíduo, podendo assim, nas investigações forenses, apontar, ou mesmo identificar, um suspeito em uma cena de crime. O presente trabalho aplicou quatro métodos de análise física nas marcas de mordida produzidas em queijos e chocolates, bem como obter a recuperação de DNA, extraídos da saliva destes alimentos mordidos e de garrafas de água consumidas. Para tal, 20 participantes (10 do sexo masculino e 10 do sexo feminino) morderam cinco pedaços de queijo, cinco pedaços de chocolate e beberam em cinco garrafas de água, totalizando 15 amostras para cada um. As amostras produzidas foram armazenadas e analisadas em diferentes intervalos de temperatura (ambiente e geladeira) e tempo (imediato, três dias e sete dias). Na análise física, os métodos aplicados foram: análise métrica utilizando um paquímetro digital (Digital Caliper, Cixi Xinzheng Trade Co., Ltd., Zhejiang, China); análise métrica utilizando o software ImageJ (National Institutes of Health, Bethesda, Maryland); sobreposição manual; e a sobreposição digital por meio do software Adobe Photoshop (Adobe Systems, Inc., Mountain View,California, USA). Na análise biológica foram realizadas as seguintes etapas do exame de DNA: coleta da saliva pela técnica de duplo swab, extração do DNA utilizando Kit QIAamp (Qiagen, Hilden, Germany), quantificação do DNA recuperado através do equipamento espectofotômetro Nanodrop (Thermo Scientific&trade;, Wilmington, DE, USA), amplificação dos marcadores utilizando o Kit de identificação humana AmpFLSTR Identifiler PCR Amplification (Applied Biosystems&reg;, Carlsbad, CA, EUA) e a eletroforese em gel de agarose. De acordo com os resultados encontrados, não houve diferença significativa entre os dois métodos de análise métrica. Na análise de emparelhamento físico, o método manual obteve o maior número de identificados, com 58% para ambos os sexos, enquanto o método Adobe Photoshop apenas 32% das amostras foram identificadas para o sexo feminino e 44% no sexo masculino. O valor do índice de concordância intraobservador foi classificado como substancial para os métodos manuais em ambos os sexos e para o método Adobe Photoshop para o sexo masculino; e como moderado para o método Adobe Photoshop para o sexo feminino. Nas evidências biológicas, as amostras de DNA coletadas a partir da saliva depositada em queijos e chocolates mordidos e garrafas de água bebidas tiveram valores de concentração variando entre 28,52 ± 14,00 a 8,99 ± 2,20 ng/&mu;l, e estas foram suficientes para amplificação. Com isso, conclui-se que amostras de águas, queijos e chocolates nas condições estudadas, que simularam alimentos mordidos e bebidas consumidas encontrados em cenas de crime ou armazenadas em geladeiras a espera da análise pericial, podem ser utilizadas nas investigações de identificação em marcas de mordida tanto para métodos de evidências físicas quanto para métodos de evidências biológicas. / In the study of bite marks, the biological materials related to dentistry, such as teeth and saliva, are analyzed by means of physical evidence (metric analysis and / or physical pairing) and biological evidence (DNA analysis). From both methods can establish the identity of an individual, thus allowing, in forensic investigations, point, or even identify a suspect in a crime scene. This study aimed to apply four methods of physical analysis in bite marks produced in cheeses and chocolates, as well as obtain recovery the DNA extracted from the saliva of bitten food and bottled water consumed. The sample was comprised of 20 volunteers, 10 males and 10 females. Each volunteer was instructed to bite five pieces of cheese, five pieces of chocolate and drink five bottles of water, producing 15 samples of each from the 20 participants. The produced samples were stored and analyzed in different temperature ranges - temperature (25°C) and refrigerator (4-8°C), and time (immediately, three days, seven days). The methods used were: metric analysis by using a digital caliper, digital metric analysis using ImageJ software (National Institutes of Health, Bethesda, Maryland); manual overlay of the plaster model of the dental arches versus plaster model of chewed food, and overlapping images using Adobe Photoshop software (Adobe Systems, Inc., Mountain View,California, USA). In biological testing, saliva collecting was done using the double swab technique, DNA extraction according to the extraction protocol of the QIAamp kit (Qiagen®, Hilden, Germany), quantification of recovered DNA using equipment Nanodrop spectrophotometer (Thermo Scientific&trade;, Wilmington, DE, USA); amplification of the markers was performed by human identification kit Identifiler PCR Amplification AmpFLSTR (Applied Biosystems&reg;, Carlsbad, CA, EUA) and agarose gel electrophoresis. According to the results, there was no significant difference between the two methods of metric analysis. In the physical pairing analysis, the manual method had the highest number of identified subjects with 58% for both sexes while with the Adobe Photoshop method only 32% of the samples were identified for females and 44 % males. The index value for intraobserver agreement was rated substantial for manual methods in both sexes and for Adobe Photoshop method for males; and as moderate for Adobe Photoshop method for females.In biological evidence, samples of DNA from saliva deposited in cheese and bitten chocolate, beverage and water bottles had concentration values ranging from 28,52 ± 14,00 a 8,99 ± 2,20 ng/&mu;l, and these were sufficient for amplification. Thus, it was concluded that samples of water, cheeses and chocolates under the conditions studied, simulating bitten foods and beverages found at crime scenes or stored in refrigerators waiting for the forensic analysis can be used for investigations in identifying bite marks using both physical methods evidence as to biological method evidence.