- Exercise 1 Age Estimation by Dentition
- Exercise 2 Age Estimation by Radiology
- Exercise 3 Skeletal Remains
- Exercise 4 Wound Certificate
- Exercise 5 Drunkenness Certificate
- Exercise 6 Sexual Offence Certification—Victim
- Exercise 7 Examination of Accused of Sexual Offence
- Exercise 8 Fetal Examination
- Exercise 9 Leave and Fitness Certificate
- Exercise 10 Death Certificate
- Exercise 11 Postmortem Certificate
PRACTICAL EXAMINATION
Introduction
The pattern of practical examination and the total marks differ for various universities. But all the universities adopt a standard set of exercises for practical exams. It may be in the form of major exercise with viva, short cases and spotters or in the form of OSPE (objective structured practical examination).
The common and most important sets of exercises and spotters would be discussed to help the students prepare for their practical examinations.
Age estimation
Whenever a conflict of age arises in the procedure of investigation, the help of the medical expert is sought for to determine the age of the individual. Each age has got a medicolegal importance and therefore, determination of age plays a crucial role in both civil and criminal cases. As far as possible, the age estimated should fall within a range of two years (up to 21 to 25 years) and the estimated age should be helpful for the court.
Example:
A victim of sexual offence is referred for age estimation, her alleged age is 16 years; after the radiological examination if the estimated age falls between 15 to 17 years; this age estimated by the medical expert is of no use to the court, rather weaken the case by giving a benefit of doubt that she can be less than 16 years also. Here the court wants to know whether she is above 16 years of age and whether she is less than 18 years or not. Hence, caution should be taken by the expert before arriving at the final opinion regarding the age.
To estimate the age of an individual, the following data are taken into consideration:
- General physical development: Height, weight, chest and abdominal measurements.
- Teeth eruption and completion of root calcification.
- Radiological examination of all the joints (more reliable).
- Secondary sexual characteristics.
- Closure of skull sutures and degenerative changes (after 25 years).
Age Estimation by Dentition
The eruption of teeth both temporary and permanent has a chronological order and is used for age estimation.
- At birth, there are 44 germ tooth present inside the jaw of a full term baby (20 + 24)
- By 3 years there are totally 20 teeth; all are temporary.
- By 6 to 7 years: There are 24 teeth (20 temporary + 4 permanent)
- From 6 to 12 years total number of teeth remains as 24 (mixed dentition).
From the germ tooth, the crown is formed and then erupts outside in the oral cavity; after the eruption of the teeth, the root formation takes place. In case of permanent teeth, the root calcification gets completed after 2 years of eruption of the respective teeth and it is 3 years for the 3rd molar tooth. While examining X-rays or OPG, the root of the last erupted tooth and the crown of the next to erupt tooth are taken into consideration to determine the age of an individual. There is wide variation in the eruption of 3rd molar and hence, not useful for age estimation.
Charting of teeth:
FDI (Federation Dentaire Internationale) system:
- Each tooth is identified by a two digit number in which, the proximal digit indicates the quadrant and the distal digit indicates the actual tooth. While numbering the permanent teeth 1, 2, 3, 4 are used for designating right upper, left upper, left lower and right lower quadrants, respectively. Whereas 5, 6, 7, 8 are used for the corresponding temporary teeth.
Permanent teeth
18 | 17 | 16 | 15 | 14 | 13 | 12 | 11 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 |
48 | 47 | 46 | 45 | 44 | 43 | 42 | 41 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 |
Temporary teeth
55 | 54 | 53 | 52 | 51 | 61 | 62 | 63 | 64 | 65 | ||||||
85 | 84 | 83 | 82 | 81 | 71 | 72 | 73 | 74 | 75 |
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SAMPLE EXERCISE 1
A dental charting or living individuals or OPG or mandibles wound be provided and asked to estimate the age of the individual from the eruption status of the teeth.
16 |
55 | 14 |
53 | 12 | 11 | 21 | 22 |
63 | 24 |
65 | 26 | ||||
46 |
85 | 44 |
83 | 42 | 41 | 31 | 32 |
73 | 34 |
75 | 36 |
Interference: The 1st permanent molar, central and lateral incisors and 1st premolar teeth have erupted. 2nd temporary molars and temporary canines are still present in the oral cavity. While calculating the age, the last erupted tooth and the next to erupt tooth are taken into consideration. 1st premolar erupted and 2nd premolar has not erupted, hence the age is above 9 years and below 11 years.
Fig. 1.1: OPG: 1st Permanent molar, central and lateral incisors have erupted; 1st premolar has erupted only in right lower quadrant. All temporary canines have fallen off (not normal)
SAMPLE EXERCISE 2
16 | 15 | 14 | 13 | 12 | 11 | 21 | 22 |
63 | 24 | 25 | 26 | ||||
46 | 45 | 44 |
83 | 42 | 41 | 31 | 32 |
73 | 34 | 35 | 36 |
Permanent canine has erupted in upper right quadrant and all other canines are temporary. All the other teeth are permanent in the oral cavity. The age is 10 to 12 years; since the eruption of canine has started we can even say 11 to 12 years. It is preferable to opine within a range of 2 years, as there are wide variations in the eruption of tooth and any age estimated by dental examination has to be confirmed by radiological examination.
I have seen babies with 2 and 4 teeth present at birth and 8 to 12 teeth by 6 months. Both tooth formation and bone development are directly dependent on genetic and the nutritional status of the individual. Age estimation by dentition is always used as corroborative finding. However it is very useful to narrow down the estimated age in the period of mixed dentition (6 to 12 years).