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Forensic Medicine > Forensic Odontology > Flashcards

Forensic Odontology Flashcards

1
Q

Who sets the standards for dentists in the UK

A

General Dental Council

Must be followed

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2
Q

What are the roles of a forensic odontologist

A

Bite marks - identification and analysis/comparison

Ageing victims from their dentition

Victim identification based on dentition - can be single or multiple body or individual teeth

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3
Q

Bite mark analysis has many limitations - true or false

A

True

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4
Q

How did forensic odontology start

A

FO started with a Cuban dentist who taught in Paris (end of 19th century)
There was a fatal fire at charity event in Paris in 1897
They were unable to recognise bodies by personal effects so a team of dentists compared dental records to identify them
The Cuban dentist followed this case and wrote a paper on human identification from teeth/dental records
He is known as the father of the specialty

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5
Q

Can forensic odontologists identify someone from a single tooth

A

Yes

Obviously more teeth makes it more accurate

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6
Q

When is comparative dental analysis used

A

When we have access to the dental records of the victim/potential victim

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7
Q

When is dental profiling used

A

When we don’t have access to the dental records

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8
Q

Enamel is the hardest material in the human body - true or false

A

True

High stability - therefore good for identification as resistant to damage

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9
Q

What is enamel composed of

A

98% mineral and some organic material

This makes it very resilient

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10
Q

How can you get a DNA from a dental sample

A

Can get DNA from the pulp of the tooth (pulp relatively protected by the rest of tooth)
You extract the tooth from body to collect this

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11
Q

When does dental DNA come in useful

A

Useful if comparative analysis isn’t available as it can be used for ID instead

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12
Q

Forensic odontology can be applied at any stage of death - true or false

A

True

Can analyse the teeth of recent corpses, mummies and decomposed bodies

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13
Q

How do dentists record dentition in life

A

They will take notes of everything that is in your mouth such as missing teeth, fillings
Recorded on a odontogram - diagram of mouth
Will also write down the treatment plan

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14
Q

What is the main difference between AM and PM dental records

A

The AM records will usually include the treatment plan

PM records do not require this - obviously

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15
Q

How are AM dental records used for identification

A

The suspected patient’s AM record can be compared to the dentition of the corpse
Can match missing teeth and dental work

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16
Q

Which forms do forensic odontologists use to record their findings

A

They use Interpol forms - allows international use
Pink form records all data and findings from the PM
Yellow form collects all ante-mortem data - i.e. collected from police or victims dentist

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17
Q

Which investigations may a forensic odontologist carry out on a body at PM

A

Full oral examination and record findings
Dental radiographs
Intra-oral photographs
May take casts of the teeth

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18
Q

How are PM dental X-rays taken

A

Using a portable x-ray machine

Sensor placed in oral cavity and portable machine can take a digital X-ray quickly

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19
Q

What equipment do forensic odontologists use

A

Pretty much the same equipment as normal dentistry
Use large forceps to extract teeth for DNA
Also work with portable X-ray machines

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20
Q

Why do forensic odontologists typically work in the back corner of the mortuary

A

Because they work with radiation

Far away from other to keep them safe

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21
Q

Why do forensic odontologists use UV light

A

Sometimes used to view the composite on teeth (white or tooth coloured materials)
Used as it doesn’t show up under poor mortuary lighting

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22
Q

What is an odontogram

A

It is the diagram of the teeth that the dentist records features on

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23
Q

What is the main limitation of odontograms

A

Not perfect - human error
You rely on their interpretation of the individual dentist and their records
(unlike x-rays or images where you can view and analyse yourself)
Dentists may miss something in life

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24
Q

Forensic odontologists prefer to receive records that have proper images of the oral cavity - true or false

A

True
X-rays and photos are very useful
Allows for their own interpretation rather than relying on the odontogram

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25
Q

How might someone cosmetically alter their teeth

A

Tooth gems, gold, oral piercings, gum tattoo, grills

These are considered secondary identifiers as have been added to the oral cavity and could be there artefactually

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26
Q

Can grills be used for identification

A

Not reliable enough for identification

However, can be evidence if it has been specially made to fit the teeth

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27
Q

How can retainers and whitening trays be used for identification

A

They can give an idea of teeth layout/shape as based on impressions/cast of real teeth
Some may have numbers on them
Therefore can be used for identification

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28
Q

How can selfies be used for dental identification

A

Can compare teeth from photos to the body
You superimpose the image onto the unidentified teeth and compare measurements and unique features
Useful as selfies have good proximity to the teeth (within arms reach) and often use different angles

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29
Q

If you don’t have ante-mortem data then comparative analysis isn’t possible - true or false

A

True

Must use other methods to identify such as dental profiling - not impossible but harder

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30
Q

Why are teeth reliable for age estimation

A

They are relatively protected from diet or hormonal changes (compared to other tissue like bones)
Therefore the main impact is age
Not a perfect method

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31
Q

What are the key features of dental profiling

A

Age - most important
Sex
Ancestry

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32
Q

Teeth are good for sex estimation - true or false

A

False
Can be used but not very reliable
More accurate if pelvis and skull are analysed by anthropologist

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33
Q

How do the police decide which dental records to request when an unidentified body is found

A

If a body is found, the police can consult the missing persons database and ask family for dentist or find dentist themselves to get the appropriate records for comparison

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34
Q

The more teeth you have the more information you can collect - true or false

A

TRUE - makes the case easier

If someone is missing most of their teeth it limits the analysis you can do

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35
Q

What must forensic odontologist record in their dental report

A

The date/location when body was received
Who called them
What examinations/procedures were performed - in a lot of detail
Where any ante-mortem records where collected from
Compare AM and PM in detail
Conclusion
Must sign it

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36
Q

What are the 3 primary identifiers

A

Fingerprints
Teeth
DNA

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37
Q

How many primary identifiers are required for indication

A

Only one is required for identification but some coroners ask for at least 2

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38
Q

How was forensic odontology used in the Grenfell fire

A

67% of Grenfell victims were identified positively via forensic odontology
7% were possible/probable IDs due to lack of evidence or poor ante-mortem records
When DNA was considered alongside this they became positive IDs

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39
Q

What effect can heat have on the teeth

A

Usually quite resilient to heat
Effect determines by temp and length of exposure (of significant teeth can turn to ash - long time needed)
Can cause separation of crown and root (due to dehydration)

40
Q

What is mixed dentition

A

When both milk teeth and permanent teeth present

41
Q

The presence of mixed dentition suggests what

A

That the remains are that of a child

42
Q

What tests can you do if you only have a single tooth to analyse

A

Must confirm it is a human tooth - macroscopic features

You then do microscopic analysis
Can then section the tooth and examine the dental histology

43
Q

Forensic odontologists need to be able to distinguish human teeth from what

A

Animal teeth
May get mixed up in mass victim samples
Otherwise bite marks and remains can be incorrectly classified

44
Q

In which age group is age estimation from teeth the most accurate

A

Children and adolescents
Lots of teeth to work with and lots of physiological changes occurring that can be staged - staging/scoring methods available
Assess and identify what stage of dental development the child is at

45
Q

When do teeth start to age

A

Our teeth start to age slightly from age of 21-25
Regressive changes occur
Becomes more severe as age increases

46
Q

Ageing from dentition is more challenging in adults - true or false

A

True

Only have the permanent dentition to work with and different features need assessed

47
Q

Regressive change in the teeth becomes more obvious/severe as age increases - true or false

A

True

48
Q

What happens to our teeth between the ages of 25-30

A

Start seeing transparency at end of root

This is due to dentine

49
Q

How does dentine change with age

A

From age 25-30 = start seeing transparency at end of roots

Its spreads to the dental crown as age increases

50
Q

How can third molar development be used in identification

A

It can be used to age/identify young adults
Will usually be developing between ages of 18-23 - can assess level of development
If absent = under 18
If fully developed = adult (harder to assess age)

51
Q

What are the third molars also known as

A

Wisdom teeth

These are the last teeth to develop - come in between ages of 18-23

52
Q

Which type of substrate makes bite marks easier to identify

A

Firmer substrates - hold shape of bite better (e.g. cheese and chocolate)
Those that do not decay - less likely for mark to be distorted
If part of tooth is left in substrate it’s very useful

53
Q

Is skin a good substrate for bite marks

A

NO

It comes with lots of factors that contribute to distortion such as different layers, movement of victim

54
Q

What can distort a bite mark left on skin

A

Primary factor is the skin itself - different layers, Langer’s lines, elasticity and movement/position of victim
Secondary distortion in photos

55
Q

How can bite mark evidence be used in court

A

You can now only state whether the bite mark excludes the suspect or doesn’t exclude - requires a lot of experience
As a technique it has many limitations so is not reliable to base a conviction on (many past ones have since been thrown out)

56
Q

Bite mark evidence has led to many wrongful imprisonments - true or false

A

TRUE

Experts didn’t acknowledge the limitations of the technique so this evidence was enough to convince the jury

57
Q

What is involved in bite mark identification

A

First identify whether the bite mark is human
Then it is compared to possible suspect
They are then only excluded or not excluded - no exact identification

58
Q

Why are some FOs reluctant to compare bite marks to a suspect

A

Due to limitations of the technique

59
Q

Case reports should be written in pairs - true or false

A

True
Should be completed by 2 FOs
Especially in bite mark cases

60
Q

What is dental neglect

A

When you get children with lots of decayed teeth
This suggests the parents are not taking care of their child’s hygiene - suggestive of general abuse/neglect

May also be seen in vulnerable elderly or disabled

61
Q

What signs of sexual abuse may be seen on dental examination

A

STDs in the oral cavity
Physical evidence of forced oral sex
Abused children may react negatively to oral examination - very personal and up close which they may not like (also a sign of emotional abuse)

62
Q

How can tooth decay suggest abuse

A

Tooth decay can be very painful so if you see a child with lots of it, it may suggest neglect
No seeing to the problem

63
Q

FO’s are sometimes consulted on intraoral injuries - true or false

A

True

Work with the pathologist

64
Q

Dentists are required to report any signs of suspected abuse - true or false

A

True

65
Q

Is oral and facial trauma common in abuse cases

A

Yes

Occurs in around 50% of physical abuse cases

66
Q

What is an endodontic procedure

A

Like root canal

Treatment of the dental canal

67
Q

What are the risks of an endodontic procedure

A

Uses very small instruments - can fracture in canal

More prone to malpractice due to complications (must inform patient of mistake and correct it to avoid this)

68
Q

List examples or dental negligence

A

Missing oral cancer diagnosis

Overlooking the soft tissues of the mouth and missing disease

69
Q

If a dentist suggests a further appointment to investigate a serious issue and they don’t attend, is the dentist still at fault if they come to harm

A

No the dentist is not at fault

However, they must document the non-attendance

70
Q

List examples of dental fraud

A

Using cheap materials for dental work

Dentists charging for more work than they actually do

71
Q

Is dental fraud common

A

No not these days

72
Q

Is it common to see bite marks in cases of sexual assault

A

Yes

Especially in ‘sexual areas’ such as breasts or close to genitals

73
Q

When might a dentist be asked to investigate oral trauma

A

May be for insurance claim - e.g. Car accident
May ask for dental costs to be covered so insurance may request a dentist opinion to prove the accident was the cause of the dental problems

74
Q

How was bite mark evidence used in the Bundy case

A

He had very unique, crooked teeth which were used for comparison
In general these days this would be only be used to rule in a suspect not convict

75
Q

Define forensic odontology

A

It is a branch of forensic medicine and dentistry and deals with the proper examination, handling and presentation of dental evidence in a court of law

76
Q

What is dental jurisprudence

A

A set of legal regulations set forth by each state’s legislature describing the legal limitations and regulations related to the practice of dentistry
General dental council in the UK

77
Q

Describe the process of identification using comparative dental analysis

A

Post-mortem records are developed by the FOs
Ante-mortem records are retrieved
These 2 sets are compared

78
Q

Which dental feature would suggest the deceased was Caucasian

A

Carabelli’s cusp

Small extra cusp on the first upper molars

79
Q

Which dental feature would suggest the deceased was of Mongolian descent

A

Shovel-shaped upper central incisors

80
Q

List secondary methods of identification

A

Personal data
Medical findings
Evidence and clothing

81
Q

What are the 6 parameters in the Gustafson

A 
Occlusal attrition
Periodontitis
Secondary dentine position - assess dentine/pulp ratio
Cementum apposition
Root resorption
Root transparency
82
Q

Which skin types tend to bruise more easily (i.e. from bite marks)

A

Females
Black skin
Infants and the elderly
Obese people

83
Q

List the types of child abuse

A

Neglect
Physical
Sexual
Emotional

84
Q

What is the most common site of oral injury

A 
The lips (54%)
Followed by oral mucosa, teeth, gingiva, and tongue
85
Q

What effect may gags have on the mouth

A

May result in bruises or scarring at the corners of the mouth

86
Q

What sign of abuse may be seen on oral examination of pre-mobile infant

A

Lacerations to the labial frenum
Considered an indicator of abuse

However, also seen in falls or trying to feed child (use a bit of force)

87
Q

What can direct trauma to the teeth result in

A

Pulpal necrosis

This leaves the teeth grey and discoloured

88
Q

How can dental work be used for identification

A

Ante-mortem imaging of dental bridges, fillings etc. can be compared to evidence
Especially useful if the dental work is unusual or identifiable
Used in the case of Hitler and Mengele

89
Q

FO’s work in both civil and criminal courts - true or false

A

True

90
Q

When might FOs need to identify multiple bodies

A

If there has been some sort of disaster and multiple victims need identified
Disaster victim recovery and identification

91
Q

How do FOs report comparison of dentition

A

Can positively identify
Can report as possible of probable
Can also report that the suspect/potential victim is excluded

92
Q

Which up and coming technique is expected to modernise dental records

A

Digital oral scans

Build a more accurate digital picture of the oral cavity

93
Q

When might dental identification not be sufficient

A

Lack of evidence or poor ante-mortem records

Would use DNA alongside it to confirm in these cases

94
Q

How can the cementum annuli be used for age estimation

A

The cementum is a dental tissue that surrounds the root and is laid down in layers
1 layer = approx 1 year of life
Invasive method

95
Q

What is malpractice

A

When the professional doesnt follow the proper guidelines

usually with negative consequence

96
Q

How can restorative procedures result in malpractice cases

A

If the dentist does not follow the natural anatomy of the tooth when reconstructing
This leads to many further dental issues = malpractice

97
Q

List innovations in FO created by Dundee students

A

Dental record checklist listing key features - aids communication between dentist, police and FO

Website listing features of dental charts from across the world

An atlas of dental anomalies - aids identification/recording of features (should be recorded as an identifier)

Anatomical chart of oral jewelry/piercings/tattoos

3D diagram of dental damage

Forensic Medicine (13 decks)

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