Helen James

Forensic odontology involvement in disaster victim identification

Forensic odontology is one of three primary identifiers designated by Interpol to identify victims of mass casualty events. Forensic odontology is involved in all five phases—Scene, Postmortem, Antemortem, Reconciliation and Debrief. Forward planning, adequate funding, international cooperation and standardization are essential to guarantee an effective response. A Standard Operation Procedure should be utilized to maximize quality, facilitate occupation and health issues, maintain security and form a structure to the relief program. Issues that must be considered in the management of the forensic odontology component of disaster victim identification are given in “Appendix 1”. Each stage of the disaster, from initial notification to debrief, is analyzed and a comprehensive checklist of actions suggested.

Radiographic Recognition of Dental Implants as an Aid to Identifying the Deceased

Abstract:  This study was undertaken to determine if dental implants can be radiographically differentiated by company type to aid forensic identification of the deceased. Recognition of dental implants on intraoral radiographic images was assessed in a blind study using a radiographic examination guide to highlight differences between dental implants. Inter‐ and intra‐examiner comparisons were conducted and a computer program (Implant Recognition System®) was evaluated to see whether it improved the accuracy of implant recognition. The study found that dental implants could be radiographically differentiated by company type. The Implant Recognition System® in its current form was of little benefit for radiographic assessment of dental implants for forensic odontologists. Prior knowledge of implant types, with a McNemar’s statistical value of 92.9, proved to be most significant in identification.

Disaster victim identification: quality management from an odontology perspective

The desired outcome of the victim identification component of a mass fatality event is correct identification of deceased persons in a timely manner allowing legal and social closure for relatives of the victims. Quality Management across all aspects of the Disaster Victim Identification (DVI) structure facilitates this process. Quality Management in forensic odontology is the understanding and implementation of a methodology that ensures collection, collation and preservation of the maximum amount of available dental data and the appropriate interpretation of that data to achieve outcomes to a standard expected by the DVI instructing authority, impacted parties and the forensic odontology specialist community. Managerial pre-event planning responsibility, via an odontology coordinator, includes setting a chain of command, developing and reviewing standard operating procedures (SOP), ensuring use of current scientific methodologies and staff training. During a DVI managerial responsibility includes tailoring SOP to the specific situation, ensuring member accreditation, encouraging inter-disciplinary cooperation and ensuring security of odontology data and work site. Individual responsibilities include the ability to work within a team, accept peer review, and share individual members’ skill sets to achieve the best outcome. These responsibilities also include adherence to chain of command and the SOP, maintenance of currency of knowledge and recognition of professional boundaries of expertise. This article highlights issues of Quality Management pertaining particularly to forensic odontology but can also be extrapolated to all DVI actions.

Dentine and cementum as sources of nuclear DNA for use in human identification

Teeth are increasingly utilized as a source of nuclear DNA to aid identification of human remains. DNA extraction and the results of genetic analysis from these tissues are extremely variable and to some extent unpredictable. This study examines the availability of nuclear DNA in different areas of the dental hard tissues and explores the extent and nature of the variation within and between individuals. Results of this study indicate that nuclear DNA is available in widely variable quantities in dentine and cementum. This variation exists within teeth and between teeth, even between comparable teeth from the same individual. The quantity of DNA available in dentine is affected by age and dental disease, whereas that in cementum is not. Forensically useful genetic profiles were obtained from as little as 20 mg of tooth powder, thus avoiding the necessity for complete destruction of the tooth. A better understanding of why there is more DNA in one tooth tissue or region compared with another, and of the effects of disease and age, will aid in the selection of which tooth and tissue to sample and will increase the validity of the use of teeth as a source of nuclear DNA for human identification.

Bite Mark or Bottle Top

An alleged assault was reported by a 42-year-old female, with initial medical examination revealing an apparent bite mark on the right buttock. Odontological examination, including visual assessment, full history and photographs showed that the injury did not meet the class characteristics of a human bite. Subsequent digital overlay production showed that the injury pattern was consistent with a corrugated bottle top. This case highlights the need for careful assessment of injuries alleged to be caused by human teeth.

Australian oral health case notes: assessment of forensic relevance and adherence to recording guidelines.

BACKGROUND Dental case notes record clinical diagnoses and treatments, as well as providing continuity of patient care. They are also used for dento-legal litigation and forensic purposes. Maintaining accurate and comprehensive dental patient records is a dental workers ethical and legal obligation. METHODS Australian registered specialist forensic odontologists were surveyed to determine the relevance of recorded case note items for dental identification. A dental case notes sample was assessed for adherence with odontologist nominated forensic value and compiled professional record keeping guidelines of forensic relevance. Frequency of item recording, confidence interval, examiner agreement and statistical significance were determined. RESULTS Broad agreement existed between forensic odontologists as to which recorded dental items have most forensic relevance. Inclusion frequency of these items in sampled case notes varied widely (e.g. single area radiographic view present in 75%, CI = 65.65-82.50; completed odontogram in 56%, CI = 46.23-65.33). Recording of information specified by professional record keeping guidelines also varied, although overall inclusion was higher than for forensically desired items (e.g. patients full name in 99%, CI = 94.01 - >99.99; named treating practitioner in 23%, CI = 15.78-32.31). CONCLUSIONS Many sampled dental case notes lacked details identified as being valuable by forensic specialists and as specified by professional record keeping guidelines.

A study of osseointegrated dental implants following cremation.

BACKGROUND The comparison of dental morphology and restorative work for human identification has been well documented. This case study involved documentation of osseointegrated and clinically restored dental implants following cremation. METHODS The mandible and the maxilla were excised from a head containing implants and cremated. The remains were retrieved, digital and radiographic images were taken and elemental analysis undertaken. The brand of implants was identified utilizing web based search engines. A prosthodontist, known to commonly use this implant system, was approached to ascertain possibilities that matched the data given. RESULTS Following cremation the implants were identified and a prosthodontist was able to identify the deceased. Two implants in the maxilla had dehiscences on their buccal surfaces, which could not be detected by periapical radiographs. CONCLUSIONS Dental implants osseointegrated and restored with a prosthetic superstructure were recognizable following severe incineration. It was possible to trace back the identity of the unknown victim to a prosthodontist. Bone dehiscences discovered in this study highlighted how two-dimensional radiographs may not reveal lack of bone support.

Cochlear implants in the forensic identification process

PurposeDecedents who are severely decomposed, skeletonized or incinerated present challenges for identification. Cochlear implants aid hearing and bear unique serial numbers that can be used to assist with identification of bodies that are not visually identifiable. The purpose of this paper was to highlight companies that have or had manufactured cochlear type implants and demonstrate the appearance of the implants to assist crime scene investigators, pathologists, anthropologists and odontologists.MethodInvestigation of cochlear implants was conducted on the internet and companies were contacted for information regarding their implants.ResultsThe functional appearance of a cochlear implant is explained, brands of implants are tabulated and pre and post-incineration images are presented.ConclusionThe prevalence of cochlear implants is predicted to increase, thus they are likely to become relevant to the identification process. Company brand and serial markings can be retrieved from post-incineration implants making them a valuable aid in identification when other identifiers that may be present are not useful because they are heat-sensitive.

Locard's Principle of Exchange, Dental Examination and Fragments of Skin

The transfer of materials between victim and perpetrator was first reported by Locard in the nineteenth century. While in recent years DNA testing has been very successful in matching biological material from crime scenes to perpetrators, the following cases demonstrate that other more time‐honored methods remain useful. Two cases of lethal assault are reported where the victims had bitten their assailants resulting in fragments of the perpetrators’ skin being wedged between their teeth which were discovered during post mortem oral examinations. As the fragments were able to be matched to injuries in the perpetrators, identification was established prior to confirmatory DNA testing. In case 1 a criminal conviction for manslaughter resulted, and in case 2 the identity of the assailant was confirmed. Examination of a properly exposed and illuminated oral cavity may provide useful evidence in assault cases. These cases represent an unusual dental variant of Locards principle.

Historical perspective: retention of human organs and the dismissal of ramsay smith

(2001). HISTORICAL PERSPECTIVE: RETENTION OF HUMAN ORGANS AND THE DISMISSAL OF RAMSAY SMITH. Pathology: Vol. 33, No. 2, pp. 172-173.