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Forensic Odontology Section: Review Article
Role of Dentists during Mass Disasters: A Review
Kiran Vallamchetla, Kotya N Maloth1, Vani Chappidi2, Stuti Goyal3, Sridevi Ugrappa4, Srikanth Kodangal2
Private Practice, Hyderabad, 1Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, 2Department of Oral Medicine and
Radiology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, 3Srinivas Institute of Dental Sciences, Mangaluru, Karnataka, India,
4
Faculty of Dentistry, AIMST Dental Institute, AIMST University, Semeling, Bedong, Malaysia
Abstract
Mass disasters cause damage, ecological disruption, and loss of human life on a massive scale. The reasons for these ranges from natural causes such
as volcanic eruptions and earthquakes to secondary human causes like wars. Such massive disruption of life demands help from people belonging to
various sectors of healthcare, providing pre‑identified, structured, and systematic aid to the victims of the disaster. This review article highlights the
role of a dentist in such massive disasters. The dentist not only provides first aid to the victims but also aids in the identification of human remains.
Keywords: Dentist, forensic odontology, mass disasters
Introduction of justice, deals with the proper handling and examination of
dental evidence and with the proper evaluation and presentation
Disasters are as old as human history, but the dramatic increase
of dental findings. Based on the major fields of activity, Avon
and the damage caused by them in the recent past have become
classified forensic odontology into civil, criminal, and research.
a cause of national and international concern; almost all of them
The civil field is the one concerned with mass disasters.[5]
resulting in high incidence of morbidity and mortality. Mass
disasters are highly unexpected events that cause alarming Following mass disaster, identification of an individual victim
loss of lives. A “disaster” can be defined as “any occurrence by dental means, is one of the most reliable methods. In
that causes damage, ecological disruption, loss of human life severe burn situations and/or following severe disintegration,
or deterioration of health and health services on a massive visual recognition of facial features and fingerprints is often
scale sufficient to warrant an extraordinary response from impossible due to extensive soft tissue destruction; this
outside the affected community or area.”[1] Major emergencies situation ensures the use of hard (calcified) tissue such as
and disasters have occurred throughout the history and the human dentition and jaw bones for human identification
incidence of disasters has increased in the recent past owing as they sustain severe form of insults with minimal loss of
to the rise in the world’s population. identification details. People who have been diseased for some
time before death and those drowned accidentally in water also
Mass casualty situations occur in an unpredictable manner
present unpleasant conditions with difficulty in identification of
with serious consequences. Disasters may be man‑made or
the victim.[6] Because of the lack of a comprehensive fingerprint
natural which include, earthquakes, cyclones, floods, tidal
database, dental identification continues to play a vital role in
waves, land‑slides, volcanic eruptions, tornadoes, fires,
mass disaster.[7]
hurricanes, snow storms, severe air pollution smog, heat waves,
famines, epidemics, building collapse, toxicologic accidents
(e.g., release of hazardous substances), nuclear accidents, and Address for correspondence: Dr. Kotya N Maloth,
warfare.[2] It is also caused by human activities such as mishaps Department of Oral Medicine and Radiology, Mamata Dental College and
involving mass transport by land, sea or air, and other causes Hospital, Khammam, Telangana, India.
E‑mail: dr.kotyanaik.maloth@gmail.com
include war, boundary disputes, ethnic, or religious conflicts.[3,4]
The Federation Dentaire Internationale (FDI) defines forensic
This is an open access article distributed under the terms of the Creative Commons
odontology as that branch of dentistry, which, in the interest Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
Access this article online creations are licensed under the identical terms.
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How to cite this article: Vallamchetla K, Maloth KN, Chappidi V, Goyal S,
Ugrappa S, Kodangal S. Role of Dentists during Mass Disasters: A Review.
DOI:
10.4103/jiaomr.jiaomr_91_17
J Indian Acad Oral Med Radiol 2017;29:371-3.
Received: 22-09-2017 Accepted: 06-01-2018 Published: 15‑02‑2018
© 2018 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer ‑ Medknow 371
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Vallamchetla, et al.: Role of dentists in mass disasters
Role of Dentists During an Emergency
The role of dentists in national emergencies has its origin
since the inception of forensic field. During periods of intense
military activity in Korea, as well as in World War II, dentists
in conjunction with medical fraternity participated in the
emergency care of the injured. The assignment of a specific
role to an individual dentist depends on the state of organization
of the Emergency Health Services at the community level.
However, it is considered that the immediate needs in terms
of professional personnel will be more critical in relation to
primary treatment services, irrespective of the fields they are
concerned with.[8] Apart from the routine duties, additional
functions for dentists under mass casualty conditions would
comprise of [Figure 1]:
(a) First‑aid, including artificial respiration, emergency Figure 1: Role of dentists during mass disasters
treatment of open chest wounds, relief of pain, treatment
of shock and the mobilization of casualties towards the the deceased and the person represented by ante‑mortem dental
disastrous events records are of the same individual. In most of the developing
(b) Control of hemorrhage countries, comprehensive fingerprint data base and complete
(c) Attainment and maintenance of patent airway, and ante‑mortem dental records are not maintained properly,
intra‑tracheal intubation including tracheotomy thus making comparative dental identification sometimes
(d) Proper and adequate cleansing, debridement, and critical. The second investigation is for cases without previous
treatment of wounds ante‑mortem records and no clues of positive identity exist.
(e) Bandaging and splinting Under these circumstances, postmortem dental profiles
(f) Triage of facial and oral injury cases completed by the forensic dentists suggesting characteristics of
(g) Administration of anesthetics under medical supervision the individual result in narrowing the search of the ante‑mortem
(h) Assisting in surgical procedures apart from oral procedures material.[14]
(i) Insertion of naso‑gastric tubes for lavage, as instructed The advent of advanced analytical computer with inbuilt
(j) Administration of whole blood and intravenous solutions, software packages, dental biometrics (the matching of
as directed ante‑mortem and postmortem dental radiographs for human
(k) Administration of parenteral medication identification) has come into existence in situations where
(l) Urethral catheterizations information regarding fingerprint or facial features is
(m) Administration of immunizing agents to avoid future unavailable.
complications as directed.
The American Board of Forensic Odontologists[15] recommends
Role of a Dentist in Identification of Human only four conclusions when reporting dental identification:
(1) Positive identification: the ante‑mortem and postmortem
Remains records match in details with no unexplainable
The important role of dentists in the identification process discrepancies
is reflected from the event where high percentage of victims (2) Possible identification: ante‑mortem and postmortem data
were identified via dental examination (61%) in the Tsunami have consistent features but due to poor quality, identity
disaster of 26th of December in 2004, north of Sumatra cannot be positively established
Island.[9] Forensic dentists usually have a leading role in the (3) Insufficient evidence: available information is insufficient
forensic team when dental structures are the only source of to form basis for the final conclusion
information for the identification of human remains. The (4) Exclusion: the ante‑mortem and postmortem data are
resistance of teeth and their supporting tissues, even to fire and clearly inconsistent.
decomposition, makes them extremely useful for identification
Quality of ante‑mortem dental records was categorized as
purposes. [10,11] For the identification of human remains,
follows:
anything that distinguishes one person from another, such as a
• Grade 0: No information
tattoo, or a variation from normality, becomes very important to
• Grade 1: Information without written records
the forensic team, greatly assisting the identification process.[12]
• Grade 2: Written records only
These variations, analyzed by dental examiners, can potentially
• Grade 3: Record combined with unsystematic radiograph
lead to a positive identification.[13]
• Grade 4: Record combined with bitewings
The most frequent investigation performed, is the comparative • Grade 5: Record combined with full mouth survey or an
examination used to establish with certainty that the remains of orthopantomograph.
372 Journal of Indian Academy of Oral Medicine & Radiology ¦ Volume 29 ¦ Issue 4 ¦ October‑December 2017
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Vallamchetla, et al.: Role of dentists in mass disasters
Postmortem Dental Profiling education, and training, dentists can play a significant role in
responding to mass disaster or other unforeseen events.
Postmortem dental profiling is the process by which forensic
dentists limit the likely population to which a deceased belongs, Financial support and sponsorship
in the absence of ante‑mortem dental records. Postmortem Nil.
dental profile will provide information on age of the
deceased,[16] ancestral background,[17] sex, and socioeconomic Conflicts of interest
status.[18] Age of children (including fetuses and neonates) There are no conflicts of interest.
can be determined by analysis of tooth development and
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Journal of Indian Academy of Oral Medicine & Radiology ¦ Volume 29 ¦ Issue 4 ¦ October‑December 2017 373
