Dental Forensics

Course Date: 11/06 Reviewed/Updated: 10/10 Expiration Date: 10/13

A briefing designed to help augment local dental readiness training requirements

Objectives
Provides an overview of dental forensics. Reviews the following identification techniques: visual, fingerprints/footprints, radiological/medical, DNA, and dental. Describes identification processes/procedures for a mass disaster.

Dental Forensics
Branch of science that applies dental knowledge in civil and criminal investigations Internationally described as Forensic Odontology Includes not only dental identification but also involves mass disaster procedural management

Identification Methods
Visual Fingerprints/footprints Radiological/Medical DNA Dental

Visual
May not be possible due to disfigurement or fragmentation due to disaster trauma Least reliable due to emotional stress and subjective assessment required of family member

Fingerprints/Footprints
Severe fires or prolonged submersion may eliminate postmortem samples Civil fingerprint data has dramatically reduced Latent finger prints from victim personal property can be obtained, but difficult & time consuming

Radiological/Medical
Useful if victim has antemortem medical radiographs for comparison Medical records may document serial numbers from implanted prosthetic devices (joint, heart valve, etc.)

DNA
Becoming standard in military Civilian sector lagging behind Different protocols for identification
Legal precedents? Expensive! Takes longer to get results than other methods

 Unique

Dental Identification
No two individuals have identical dentitions Dental care rendered is often unique Identification can sometimes be made from one tooth
Teeth most durable part of human body Remains after decomposition, fire, or trauma

Durable

Mass Disaster Management

Mass disasters can occur at any location!
Every facility needs a written plan Plan identifies
Team members Plan for team activation Primary & alternative facilities used Instruments & supplies (should be ready)

Mass Disaster Management

Identification areas must be isolated away from outside influences Confusion will attempt to rule Follow the chain of command No information released without Medical Group Commanders approval Do not be afraid to ask for outside qualified help!

Human Remains Identification

Begins at disaster site
Security cordon established Human remains found, tagged and staked with numbers or GPS coordinates Locations of remains charted on map of disaster area Photographs taken of area Removal of remains in human remains pouches

Human Remains Identification

Disaster site preparation
Proximity governs which body parts and personal effects are placed in one bag Body bags are then transported to storage or disaster identification center Body part intermingling of multiple victim accidents will be sorted out by scientific means

Human Remains Identification

A major task that should begin early after disaster is the establishment of a probable victim list so that antemortem records may be obtained as quickly as possible
Manifest lists Missing person reports Eyewitnesses

Identification Center Organization

Center Team Chief
Sections/Teams Registrar Communications Public Affairs Security

Sections/teams
In-processing Photography Fingerprints Personal effects Pathology/Lab Anthropology Forensic Dentistry Mortuary Storage/Shipping

Identification Center Flow Diagram

Fingerprints
Initial processing Radiology Personal effects Photography

Pathology

Mortuary Processing

Forensic Dentistry
Anthropology Laboratory Shipping

Forensic Dental Organization

Identification Center Chief
Forensic Dentistry Chief

Antemortem Dental Record Section

Postmortem Dental Exam & Radiology Section

Postmortem record & comparison section

Forensic Dental Organization

Forensic Dental Chief Antemortem records section Postmortem exam & radiology section Postmortem record comparison section

Forensics Dental Chief

Manager, coordinator, facilitator & spokesperson for dental section Responsible to ID center chief or on-scene commander Responsible for smooth data flow both within own section and between ID center sections

Antemortem Records Section

Determine who was possibly in disaster Locate & procure antemortem records, arrange for delivery to disaster center Develop composite antemortem record for each potential victim from evidence supplied

Dental Charting
Entire team must be consistent Charting standards should be provided to every member for reference Universal numbering system preferred
Simple in nature Easily computerized

Antemortem Dental Record

AF FORM 1802

AFIP FORM

Antemortem Charting

Antemortem Charting

AF FORM 1802

AFIP FORM

Antemortem Records Section

Quantity, quality, & varied documentation major obstacle
Civilian dental office records may not be uniform or informative Reduce antemortem dental evidence to single composite record

Two members of antemortem staff should review composite antemortem record as a QA check

Antemortem Records Section

Composite antemortem record with supporting evidence
Placed in large manila folder Identified with name Arranged alphabetically Kept in secure area

Postmortem Identification
Nature of disaster determines amount of time involved with postmortem dental examination Depending upon condition of victim, usually involves
Preparation/dissection & cleansing Radiographs Exam & charting

Postmortem Identification
Facial dissection (note ** below)
Infrequent, but may be required with burned or traumatized remains Allows full access to oral cavity for exam and radiographs Reflects soft tissue surrounding oral cavity Does not remove maxilla or mandible from the body ** Dissection approved by Identification Center Chief before procedure **

Postmortem Identification
Facial dissection
Perioral incision & tissue removal Mandible sectioned & submylohyoid incisions Separate ramus and incise pterygoids Floor of mouth incision connecting all external incisions

Facial Dissection
Perioral incision
Reflects extraoral tissue over teeth

Facial Dissection
Perio oral incision
Will allow exposure of facial surfaces of teeth and posterior surface of mandible

Facial Dissection
Mandible sectioned & submentalmylohyoid incisions

Facial Dissection
Separate ramus and incise pterygoid musculature
Frees mandible from rigor mortis musculature tetani

Facial Dissection
Floor of mouth incision
Connects to all external incisions Frees mandible for manipulation to facilitate exam and radiographs

Postmortem Charting
Process begins with tooth #1
First examiner makes statement of findings Recorded by second examiner After completion of exam the process is repeated with examiner roles reversed

Redundancy involved provides necessary quality control

Postmortem Charting
Factors to be considered/recorded
Restorations Missing teeth
Antemortem or due to trauma

Prosthetic appliances
Note any unique features

Pathology/unique anatomy Age estimate, possible gender, or racial group

Postmortem Charting
Accomplished on AF Form 1801 or AFIP Postmortem Form Mirror image of Antemortem Dental Record (AF Form 1802/AFIP Antemortem Form) Same charting and CAPMI/WinID symbols as antemortem record
Allows side-by-side comparison

POSTMORTEM DENTAL RECORD

AF FORM 1801

AFIP FORM

Postmortem Radiographs
Use digital radiography if available Portable 50 kvp unit adequate Practice safe shielding techniques If film-based, automated processor
Produces dry films ready for mounting

Only process one case at a time 4x4 gauze packs & Play-Doh to stabilize film/sensor during exposure

Postmortem Radiographs
Use double film packs Reduce exposure time for skeletinized remains Try to reproduce standard FMX All apices and occlusal/incisal edges represented in at least 1 image
More detailed & specific films/images may be taken if necessary

Postmortem Radiographs
Digital radiographs should be used if available All radiographs placed on one labeled CD for each postmortem record

Postmortem Radiographs
ARE A MUST!
Provides objective legal evidence
Dental treatment and anatomy unique Antemortem/postmortem comparison invaluable Unique alveolar/dental anatomy can establish identification if no restorations exist ID can be made on as little as one fragment or one tooth if unique anatomy or restoration present

Postmortem Dental Records & Comparison

Compares antemortem/postmortem records for possible matches Once significant comparison point is reached, radiographs of respective records are reviewed to help establish identity. Large disasters need computer information processing (WinID III)

Postmortem Dental Records & Comparison

Computer processing
Jonestown-Guyana (913 Fatalities)
Comparison of only one antemortem record against 913 postmortem records (assuming 2 min/record) would take over 30 hours!

Pentagon 9/11/01
WinID III program used on networked computers

Computer can provide lists of records with similar dental data

Postmortem Dental Records & Comparison

Dentists must still make positive identification! Once positive dental ID is made, proper documentation is accomplished
Dental Identification Summary Report (AF Form 1803 or AFIP Summary Report Form) or Computer Generated Summary with digital x-rays

Postmortem Dental Records & Comparison

All of victims documents are placed together and secured All IDs are notified through dental chief to ID Center Chief DO NOT RELEASE INFORMATION OUTSIDE OF THIS CHAIN

References/Additional Resources
Cottone JA, Bernstein ML, Forensic Odontology, Boca Raton: CRC Press, 2010. Senn DR, Stimson PG, Forensic Dentistry, 2nd Edition. Boca Raton: Taylor & Francis, 2010. Stavrianos C, Kokkas A, Andreopoulos E, Eliades A, Applications of forensic dentistry: Part 1, Research Journal of Medical Sciences. 2010;4:179-186.