Dental Forensics

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A briefing designed
to help augment
local dental readiness
training requirements

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
Finger/foot prints
Radiological
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

Finger/foot prints
Severe fires with disasters may
eliminate post-mortem samples
Civil fingerprint data has
dramatically reduced
Latent finger prints from victim
personal property can be obtained,
but difficult & time consuming

Radiological
Useful only if victim has ante
mortem medical radiographs

DNA
Becoming standard in military
Civilian sector lagging behind
Different protocols for identification
Has not been tested yet in mass disaster
situation
Legal precedents?
Expensive!

Dental Identification

Unique

No two individuals have identical dentitions

Dental care rendered is often unique
Identification can sometimes be made from
one tooth

Durable
Teeth most durable part of human body
Remains after decomposition, fire, or
trauma

Mass Disaster Management

Mass disasters can occur at any
location!
Every facility needs a written plan
Plan identifies
Team members
Plan for team activation
Physical & 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 Med
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 and tagged and
staked with numbers
Locations of remains charted on map of
disaster area
Photographs taken of area
Removal of remains in bags is next
accomplished

Human remains identification

Disaster site preparation
Body parts and personal effects are
attempted to be placed in one bag
Body part intermingling of multiple
victim accidents will add confusion to
identification
Body bags are then transported to
storage or disaster identification center

Human remains identification

Major task that should begin early
after disaster is the establishment
of probable victim identification so
that antemortem records may be
obtained as quick 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

Initial
processing

Fingerprints &
photography

Laboratory

Forensic
Dentistry

Mortuary
Processing

Storage

Radiology &
personal effects

Pathology &
Anthropology

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
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

ANTE
MORTEM
DENTAL
RECORD

AF FORM
1802

Antemortem charting

Antemortem charting

CAPMI
Computer Assisted Post
Mortem Identification
Facilitates rapid processing of
possible matches
Confirmation and final positive
identification is still a HUMAN
process

Antemortem Records Section

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

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
Required with rigor mortis
Allows exposure of oral cavity for exam
and radiographs
Removes all soft tissue surrounding
oral cavity
Does not remove maxilla or mandible
from the body

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
Removes extra oral
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

Post mortem charting

Process begins with tooth #1
Examiner makes statement of findings
Visually confirmed by recorder
Recorder charts the findings which is
visually confirmed by all

Redundancy involved provides

necessary quality control

Post mortem 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

Post mortem charting

Accomplished on AF Form 1801
Mirror image of Antemortem Dental
Record ( AF Form 1802)
Allows side-by-side comparison

Same charting and CAPMI symbols

as antemortem record

POST
MORTEM
DENTAL
RECORD

AF FORM
1801

Post mortem radiographs

Portable 50 kvp unit adequate
Practice safe shielding techniques
Automated processor
Produces dry films ready for mounting

Only process one case at a time

4 x 4 gauze packs to stabilize films
during exposure

Post mortem radiographs

Use double film packs
Reduce exposure time for
skeletinized remains
Use bisecting angle technique
Increase tubehead-film distance
Generalized view desired
More detailed & specific films may be
taken if necessary

Post mortem radiographs

ARE A MUST!
Provides objective legal evidence

Dental treatment and anatomy unique

Ante/post mortem 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

Post mortem dental records &

comparison
Compares ante/post mortem records
for possible matches
Once significant comparison point is
reached, radiographs of respective
records can be reviewed to help
establish identity.
Large disasters need computer
processing (CAPMI) of information

Post mortem 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!

Computer can provide lists of records

with similar dental data

Dentists must still make positive

identification!

Post mortem dental records &

comparison
Once positive dental ID is made,
proper documentation is accomplished
All of victims documents are placed
together and secured
Copies would be nice

All IDs are notified through dental

chief to ID Center Chief
DO NOT RELEASE INFORMATION
OUTSIDE OF THIS CHAIN

References
Mass Disaster Management.
William M Morlang. Armed Forces
Institute of Pathology 1984

If any questions . . .
About content of this lecture
Consultant in Oral & Maxillofacial
Pathology, 59 Dental Squadron (WHMC),
DSN 554-7633

About the format of this lecture

Lt Col Howard Roberts, USAF Dental
Investigation Service, DSN 792-7679