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Resumen Introducción: En Costa Rica la elaboración del expediente odontológico o ficha clínica no se realiza de manera habitual en todos los pacientes como ocurre en muchos países donde es exigido por ley. La realización del expediente únicamente está normada en el Código de Ética del Colegio de Cirujanos Dentistas de Costa Rica, es decir que no realizarlo se considera una falta ético-disciplinaria con pocas repercusiones para la persona profesional; sin embargo, tiene consecuencias graves en los esfuerzos para identificar a un ser humano. Este estudio tiene como propósito describir el impacto de la ausencia o la mala calidad de datos odontológicos antemortem en los casos de identificación realizados por la Unidad de Odontología Forense del Departamento de Medicina Legal en un período de casi ocho años (2015-2022). Materiales y métodos: Se realizó una revisión detallada en la base de datos del Sistema de Medicina Legal (SIMEL) del Departamento de Medicina Legal del Organismo de Investigación Judicial de la totalidad de solicitudes de interconsulta de la Sección de Patología Forense desde enero de 2015 hasta agosto de 2022. La información recopilada fue tabulada en Excel e incluyó tanto los resultados del análisis pericial como las características de la información antemortem disponible. Resultados: El análisis de los datos permitió determinar que en un período de casi 8 años se realizaron 165 valoraciones con fines de identificación, de las cuales se identificaron positivamente 51 individuos, 9 casos presentaron información insuficiente y 105 no contaban con expediente odontológico. Conclusiones: el expediente odontológico completo es indispensable para lograr una identificación positiva, un expediente incompleto o inexistente anula la posibilidad de identificar a un ser humano. La necesidad de contar con legislación que convierta la realización y preservación de los expedientes odontológicos de forma obligatoria con fines de identificación es necesaria en Costa Rica.

Abstract Introduction: In Costa Rica the elaboration of dental records or clinical files is not performed routinely in all patients as it is required by law in many countries. The completion of the dental record is only regulated by the Code of Ethics of the Colegio de Cirujanos Dentistas de Costa Rica (Board of Dental Surgeons of Costa Rica), which means that failure to do so is considered an ethical-disciplinary offense with few consequences for the professional; however, it has serious consequences in the efforts to identify a person. This study aims to describe the impact of the absence or poor quality of antemortem data in identification cases performed by the Forensic Odontology Unit of the Department of Legal Medicine over a period of almost eight years (2015-2022). Materials and Methods: A detailed review was performed in the database of the Forensic Medicine System (SIMEL) of the Legal Medicine Department of the Judicial Investigation Organism of the totality of interconsultation requests of the Forensic Pathology Section from January 2015 to August 2022. The information collected was tabulated in Excel and included both the results of the expert analysis and the characteristics of the available antemortem information. Results: The analysis of the data made it possible to determine that in a period of almost 8 years 165 assessments were carried out for identification purposes, of which 51 individuals were identified, 9 cases presented insufficient information and 105 had no dental files. Conclusions: A complete dental record is indispensable for a positive identification; an incomplete or non-existent record nullifies the possibility of identifying a human being.

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Os objetivos desse estudo retrospectivo longitudinal tipo censo foram verificar o percurso dos pacientes entre consultas de manutenção preventiva e curativas, e avaliar a qualidade de preenchimento dos prontuários odontológicos nas disciplinas clínicas obrigatórias do Departamento de Saúde Bucal da Criança e do Adolescente (SCA), da Faculdade de Odontologia da Universidade Federal de Minas Gerais (FAO UFMG). A partir do banco de dados do projeto de extensão "Promoção de Saúde e Gerenciamento do Banco de Dados de Pacientes do SCA", que gerencia o fluxo dos pacientes nas clínicas do departamento, foram considerados elegíveis para a pesquisa, todos os prontuários odontológicos de pacientes atendidos na clínica de Odontopediatria, a partir do segundo semestre de 2013 até o segundo semestre de 2019. Para serem incluídos no estudo, os prontuários deveriam incluir o termo de consentimento livre e esclarecido (TCLE) assinado pelo responsável pelo paciente, serem de pacientes que tiveram a primeira consulta em uma das disciplinas obrigatórias do SCA, e terem ao menos uma alta após a primeira consulta, tendo também comparecido a pelo menos uma consulta de manutenção preventiva. Os prontuários foram avaliados por uma única pesquisadora previamente calibrada (Kappa intraexaminador: 0,888). O desfecho principal avaliado foi a probabilidade de encaminhamento dos pacientes ao tratamento curativo odontológico nas disciplinas obrigatórias da FAO UFMG. A avaliação do percurso dos pacientes entre as consultas de manutenção e curativas foi realizada através de análise de sobrevida, que analisou o intervalo de tempo entre as consultas, o tipo de consulta (se preventiva ou curativa), o sexo e a idade do paciente, enquanto a qualidade de preenchimento dos prontuários foi avaliada descritivamente. Os resultados da análise de Cox foram fornecidos em razão de risco (HR), intervalo de confiança de 95% (IC) e nível de significância p≤ 0,05. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG (CAAE: 44625221.4.0000.5149). Dos 1390 prontuários elegíveis, 296 corresponderam aos critérios de inclusão, sendo que 141 (47,6%) eram de pacientes do sexo feminino e 155 (52,4%), do sexo masculino. A idade média dos pacientes na primeira consulta foi de 5,97 anos (DP = 2,305). Dos 296 prontuários, nenhum deles apresentou o preenchimento adequado para todas as seções analisadas. Para avaliação do desfecho de encaminhamento ao tratamento odontológico, foram contabilizadas 972 consultas odontológicas, sendo que em 281 (28,9%), o paciente apresentou necessidade de tratamento curativo e em 691 (71,1%), o paciente não apresentou necessidade de tratamento curativo. A probabilidade de necessidade de encaminhamento para tratamento curativo na consulta de manutenção preventiva com intervalo de seis meses foi de 18,9%, de 42,6% com intervalo de 12 meses, e de 52,5% com intervalo de 18 meses. Não houve diferença na probabilidade de encaminhamento ao tratamento no tempo de seguimento entre pacientes do sexo feminino e masculino (HR = 1,13; [0,89 ­ 1,43]; p = 0,304). Pacientes com idade igual ou inferior a 9 anos tiveram 2,07 vezes mais chances de serem encaminhados ao tratamento curativo com o tempo de seguimento do que pacientes com 10 anos ou mais (HR = 2,07; [1,62 ­ 2,64]; p < 0,001). Desta forma, conclui-se que intervalos superiores a seis meses de acompanhamento aumentaram a chance do paciente necessitar de tratamento curativo, sendo que esta probabilidade foi maior entre crianças com idade igual ou inferior a 9 anos. A qualidade de preenchimento dos prontuários odontológicos pelos alunos de graduação é preocupantemente deficiente.

The aims of this census-type longitudinal retrospective study were to verify the patients' journey towards preventive and curative dental care clinics provided by the Department of Oral Health for Children and Adolescents (SCA) of the Faculty of Dentistry at the Federal University of Minas Gerais (UFMG). Clinical records evaluated in the present study came from the database of the university extension project called "Health Promotion and Management of the SCA's Patient Database" which manages the flow of patients in the pediatric dentistry department's clinics. It was considered eligible those dental records related to patients seen in the Pediatric Dentistry clinic, from the second half of 2013 to the second half of 2019. In addition, to be included in the sample dental records had to comprise the informed consent form signed by the person responsible for the patient, be related to patients who had their first clinical appointment in one of the mandatory subjects of the SCA, and had at least one discharge after the first oral health care appointment, having also attended at least one preventive maintenance oral health consultation. All dental records were evaluated by a single researcher, who had been previously calibrated (Kappa intra-examiner: 0,888). The main outcome evaluated was the probability of referring patients to curative dental treatment in the FAO UFMG mandatory subjects. The assessment of patients' journey between preventive/maintenance and curative care was performed through survival analysis, which analyzed the time interval between dental appointments, the type of clinical appointment (whether preventive or curative) and patient's sex and age. The quality of filling in the dental records was descriptively evaluated. The cox analysis results were provided in risk ratio (HR), 95% confidence interval (CI) and significance level p≤ 0.05. This study was approved by the UFMG Research Ethics Committee (CAAE: 44625221.4.0000.5149). Of the 1390 eligible dental records, 296 met the inclusion criteria, 141 (47.6%) referred to female patients and 155 (52.4%) to male patients. The mean age of patients at the first consultation was 5.97 years (SD = 2.305). Of the 296 eligible dental records, none of them were adequately filled in for all the analyzed sections. In order to evaluate the outcome 'referral to dental treatment', 972 dental appointments were counted, and in 281 (28.9%) the patients had a need for curative treatment and in 691 (71.1%) the patients had no need for curative treatment. The probability of needing a referral for curative treatment at six months of follow-up was 18.9%, 42.6% at 12 months, and 52,5% at 18 months. There was no difference in the probability of treatment referral in the follow-up time between female and male patients (HR = 1,13; [0,89 ­ 1,43]; p = 0,304). Patients aged 9 years or younger were 2.07 times more likely to be referred to curative treatment with follow-up time than patients aged 10 years or older (HR = 2,07; [1,62 ­ 2,64]; p < 0,001). Thus, it was concluded that follow-up intervals of more than six months increased the chance of the patient needing curative treatment, and this probability was higher among children aged 9 years or less. The quality of filling out dental records by undergraduate students is utterly deficient

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This paper describes the development and implementation of a Dental Record within an Electronic Health Record in the public Primary Health Care network of Buenos Aires City. In the five months of implementation, the adoption was progressively increasing but with a great deal of variability among the health facilities. Pediatric population was the most common assisted and the most frequent oral health problem was caries.

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Resumen Introducción: La identificación por métodos odontológicos ha demostrado su efectividad desde hace mucho tiempo, pero en los últimos años ha tenido un rol determinante en la identificación de víctimas de desastres masivos y en crímenes de lesa humanidad. Uno de los factores determinantes para efectuar una identificación positiva es la calidad de la información antemortem. La presente investigación tuvo como fin establecer la calidad de la información recopilada en los expedientes odontológicos durante el año 2018 en Costa Rica con respecto a la información contemplada en los protocolos de INTERPOL. Materiales y métodos: Estudio descriptivo de corte transversal, en el que se realizó un cuestionario basado en la información solicitada en los formularios antemortem y postmortem de INTERPOL para identificación de víctimas de desastres (DVI). Se realizó una cuestionario piloto y se aplicó a 10 odontólogos, posteriormente se realizó un cuestionario final calibrado, vía electrónica a través del Colegio de Cirujanos Dentistas de Costa Rica mediante la plataforma Google Docs; los resultados fueron analizados mediante las distribuciones de frecuencia, cruce de variables, comparación de medias con base en el análisis de variancia. El nivel mínimo de confianza para las comparaciones fue del 95%. El procesamiento estadístico de los datos se realizó en la base de datos llamada SPSS versión 17.0 y en Excel. Resultados: En total fueron respondidos 573 cuestionarios de los cuales el 76% son mujeres; la distribución es independiente de la edad(p=0,161). Un 90,2% de los odontólogos generalmente elaboran un expediente clínico odontológico para sus pacientes, un 8,4% a veces no lo hace y un 1.4% no siempre lo realiza. El 69% de los entrevistados indican que la información que recopila en el expediente clínico odontológico si puede ser útil para la identificación de una persona, 19% indica que no sabe que esta información puede ser utilizada para identificación y un 12% indica que no es útil. Conclusiones: El expediente clínico odontológico es de extrema utilidad para colaborar en el proceso de identificación de víctimas mortales, sin embargo existe una gran cantidad de información no odontológica que puede ser recopilada por los odontólogos para facilitar la identificación de seres humanos.

Abstract Introduction: The identification by dental methods has proven its effectiveness for a long time, but in recent years it has played a determining role in the identification of victims of mass disasters and crimes against humanity. One of the determining factors for positive identification is the quality of antemortem information. The purpose of the present investigation was to establish the quality of the information collected in the dental records during the year 2018 in Costa Rica with respect to the information contemplated in the INTERPOL protocols. Materials and methods: Descriptive cross-sectional study, in which a questionnaire was conducted based on the information requested in the INTERPOL antemortem and postmortem forms for identification of disaster victims (DVI). A pilot questionnaire was carried out and applied to 10 dentists, later a calibrated final questionnaire was done electronically through the College of Dental Surgeons of Costa Rica in the Google Docs platform; the results were analyzed by means of frequency distributions, crossing of variables, comparison of means based on analysis of variance. The minimum confidence level for the comparisons was 95%. The statistical processing of the data was done in the database called SPSS version 17.0 and in Excel. Results: A total of 573 questionnaires were answered, of which 76% are women; the distribution is independent of age (p = 0.161). 90.2% of dentists generally elaborate a dental clinical record for their patients, 8.4% sometimes do not and 1.4% do not always do it. 69% of the interviewees indicate that the information that they collect in the dental clinical file can be useful for the identification of a person, 19% indicate that they do not know that this information can be used for identification and 12% indicate that it is not Useful. Conclusions: The dental clinical file is extremely useful to collaborate in the process of identification of fatalities, however there is a large amount of non-dental information that can be collected by dentists to facilitate the identification of human beings.

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Introdução: o prontuário odontológico é a documentação obtida durante o tratamento, oferece dados sobre anamnese e condições pré-existentes do paciente, bem como planejamento e trabalhos executados. Objetivo: coletar informações, através da análise de prontuários, do perfil dos pacientes e serviços de prótese dentária de um centro de especialidades odontológicas em uma cidade do interior da Bahia entre os anos de 2016 e 2017. Metodologia: este estudo se refere a uma observação retrospectiva de corte transversal, descritiva e analítica, com a finalidade de realizar uma análise dos prontuários de pacientes atendidos em um Centro de Especialidades Odontológicas na Bahia. Resultados: os resultados mostraram uma maior frequência de sexo feminino, faixa etária de 61 a 65 anos, com patologias sistêmicas. Foi mais frequente o edentulismo total superior e inferior, e o tempo médio para conclusão da reabilitação foi de 6 meses. Conclusão: a análise dos prontuários odontológicos é a maneira mais eficiente de se obter todas as informações dos usuários e da qualidade dos serviços prestados. Um prontuário bem preenchido oferece ao profissional as especificidades de cada paciente, garantindo um excelente trabalho clínico individualizado.

Introduction: the odontological records are the documents kept during the treatment. It offers data about both the patient's anamnesis and theirs pre-existing conditions, as well as the planning and all the work already done. Objective: identify, by way of analysis of the records, all information obtained about the patient's profiles and the work offered in dental prosthetics in a center dedicated to odontological specialties in a city in the countryside of Bahia State both in 2016 and 2017. Methodology: this study refers to a retrospective observation of cross-sectional cuts, descriptive and analytic, with the purpose of making a full analysis of the patients' records of the patients treated at the Centro de Especialidades Odontológicas na Bahia (Center of Odontological Specialities at Bahia). Results: the results showed a higher frequency of female, age from 61 to 65 years, with systemic pathologies. The upper and lower total edentulism was more frequent, and the mean time to complete rehabilitation was 6 months. Conclusion: the analysis of the odontological records is the most efficient way of obtaining all the needed information of the users and the quality of the services provided. A file well-filled offers to the professional every detail of each patient, ensures an excellent and tailored clinical work.

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Resumen:El presente documento expone el caso del cadáver de un masculino desconocido en cuya autopsia se observó el fenómeno de "Diente Rosado",según la historia médico legal este sujeto había sido arrastrado por la corriente mientras nadaba en el mar y su cadáver fue hallado tres días mástarde.Al momento del levantamiento del cuerpo, este se encontraba en avanzado estado de descomposición sin datos evidentes de trauma, sus dientes se encontraban intactos y con una coloración rosada que llamaba la atención al examen externo del cadáver y se determinó que la causa de la muerte fue asfixia por sumersión.Este fenómeno ha sido vinculado con un posible mecanismo asfíctico, ya que ha sido observado en casos de estrangulación, sofocación y asfixia por sumersión principalmente, sin embargo ha sido tema de discusión y refutado por muchos autores en el tema.

Abstract:This document sets out the case of the corpse of an unknown male in whose autopsy was observed the phenomenon of " Pink teeth", according to the legal medical history this subject had been dragged by the current while swimming in and his body was found three days later.At the time of the first forensic valuation, this was in an advanced state of decomposition without obvious facts of trauma, their teeth were intact and with a important pinkness to the external examination of the body and them was determined that the cause of death was asphyxiation by drowning.This phenomenon has been linked with a possible legal consecuences, since it has been observed in cases of strangulation, suffocation, and drowning mainly.

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