Lecture 6 - Disaster Victim Identification and Forensic odontology

Question 1

What do forensic dentists do?

Answer 1

Responsible for six main areas of practice:
Identification of found human remains

Identification in mass fatalities

Assessment of bite mark injuries

Assessment of cases of abuse (child, spousal or elder)
Living or deceased

Civil cases involving malpractice
Not as big in NZ, internationally big

Age estimation
Particularly in Europe, and specifically cases that involved illegal immigration

Question 2

When does dental identification assume a primary role …

Answer 2

Dental identification assumes a primary role in the iden- tification of remains when postmortem changes, traumatic tissue injury or lack of a fingerprint record invalidate the use of visual or fingerprint methods. The identification of dental remains is of primary importance when the deceased person is skeletonized, decomposed, burned or dismem- bered.

Question 3

dental record =

Answer 3

The dental record is a legal document owned by the dentist, and contains subjective and objective information about the patient.
Observations such as distinctive shapes of restoration, root canal treatment, buried root tips, bases under restorations, tooth and root morphology, and sinus and jawbone patterns can be identi- fied only by examination of radiographs.

Question 4

bite mark pattern is compared with the

Answer 4

dental characteristics of the dentition of a suspect.

Question 5

animal bites vs human bite marks

Answer 5

Animal bites often cause shear rather than impact injuries, producing lacerations of the skin and open wounds

Question 6

Three reasons why you look at teeth …

Answer 6

unique
durable
historical record

Question 7

Why teeth? - unique

Answer 7

dentition & teeth specific to an individual

32 teeth x 5 surfaces=160 unique surfaces

“Combined with restorative treatment, root anatomy and surrounding tissues, there are 2.5 billion possibilities in producing a dental formula”

Five surfaces including the top so lots of unique features

People often have either natural processes, disease or artificial things done by practitioners to those surfaces which changes them permanently and when you combine this with the shapes of the root and the surrounding anatomy then you can end up with a lot of possibilities, not quite as many as DNA but still enough to make it pretty unique to an individual

Question 8

Why teeth? - durable

Answer 8

Teeth are the last tissue to disintegrate
Teeth are very hard things

Remain intact in temps up to 1600°C
Can survive significant heat exposure

Last to be decomposed
About the last thing to decompose depending on the conditions they are found in such as the acidity of soil

DNA recovery from pulp ”secluded space”
In some cases are asked to retrieve the nerve or pulp from inside the teeth which is soft tissue, it is a secluded space and it is relatively protected from heat and decomposition but difficult to get access to

Question 9

Why teeth? - historical record

Answer 9

Most likely to have extant ante-mortem data

Permanent changes (eg:extractions) cannot be reversed

Anthropological indication of ethnicity
Identification only works if you can gather information from the deceased AND if you have antemortem data that you can reliably compare it to

Question 10

number of unique surfaces on teeth

Answer 10

32 teeth x 5 surfaces=160 unique surfaces

Question 11

forensic odontology =

Answer 11

Forensic odontology is the application of the science of dentistry to the field of law

Forensic odontology involves people who train clinically to do one job but actually are involved in a completely different area, it is a sub specialisation

What they do interacts with the legal system

Question 12

Forensic odontologist roles include…

Answer 12

identification of unknown remains,
bite mark comparison,
interpretation of oral injury,
dental malpractice.

Question 13

bite mark comparison …

Answer 13

Bite mark comparison is often used in criminal prosecutions, Bite mark comparison is the most likely to involve the criminal justice system, it is the most contentious one

Bite marks may be apparent on the victims skin or may be present on a variety of inanimate objects

Bite marks are potentially important as evidence because it may be possible, in some cases, to make a match between them and the teeth of a suspect

Individuality features of teeth include gaps between teeth, ridges on their biting edges, their relative positions within the mouth and whether any of the teeth are rotated, missing or broken. Analysis and comparisons are the realm of the forensic odontologists

Initial stage in the preservation of bite marks is to take photos using oblique lighting, if bite marks are sufficiently deep then this is usually followed by casting in an appropriate medium, make cast of suspects teeth, use computer technology to improve accuracy and use it to produce a detailed outline of the biting edges

Recovery of saliva from the vicinity of the victim’s injuries may lead to confirmation of the attackers identity through DNA profiling

Question 14

DVI vs criminal forensics

Answer 14

Differential though may overlap

Victim of crime vs accidental death or suicide

Coronial court vs Criminal court
Coroner court = inquisitorial
Criminal court = each side presents their case and tries to discredit the other side and witnesses are cross examined

Circumstances of death vs Guilt / innocence

Question 15

Forensic odontology and criminal forensics

Answer 15

Bite mark analysis
Maxillofacial trauma including GSW –> Injuries found in the head and neck region may be analysed by forensic odontology
Age estimation
Teeth from crime scene

Question 16

Forensic odontology useful when the

Answer 16

person cannot be identified visually therefore asked to confirm identity using dental records

Question 17

Why do you need to identify the victim?

Answer 17

So that those who are left behind have some explanation of what took place and if possible can get the remains of their loved ones back

Bodies change from being recognisable to unrecognisable very quickly, in some cases in a matter of a few days when it then becomes impossible to visually recognise someone

4Cs = certainty, closure, criminality, cash

Question 18

Certainty

Answer 18

accidental victim substitution (Erebus)

correct remains returned to relatives

Question 19

Closure

Answer 19

location & nature of death
begin grieving process

Closure on a personal level, but also on medicolegal level for wills etc

Question 20

Criminality

Answer 20

Gunshot/explosives residue, location of victim

Question 21

Cash

Answer 21

Medico-legal requirement for wills / insurance / business affairs

Question 22

Interpol DVI guide - primary methods of identification

Answer 22

Fingerprint analysis
Forensic dental analysis
DNA analysis

Question 23

Interpol DVI guide - secondary methods of identification

Answer 23

(these are other things that will support the primary identification methods)
Personal descriptions and medical findings
Evidence/clothing

Question 24

Forensic odontology practitioners must be knowledgeable in …

Answer 24

dental anatomy,

orofacial growth and development (tooth development and eruption)

dental treatment and materials,
Need to know this so that you can identify it in the victim but also need to be able to read forensically antemortem dental records

dental biomechanics,

dental radiography,

maxillofacial osteology
Need to know the bones of the face

Question 25

Forensic odontology is ______ analysis

Answer 25

pattern

Question 26

Patterns that forensic odontologists need to be able to analyse

Answer 26

Identify individual teeth

Bite problems - Also called malocclusions and the problem classifications include Healthy, overly crowded, overbite, underbite

Patterns of tooth eruption - age estimation
Age estimation more useful for young people, useful up to about age 17-18 after which it doesn’t really become useful again until the opposite end of the spectrum where maybe the loss of teeth provides some distinguishable features
Primarily age estimation is particularly useful for young people and this can be quite important because you are less likely to find fillings, dental treatment, extractions, restorations, and are less likely to find records particular\ly for young victims but what you might have is a pattern of eruption that at least provides you with supporting evidence for the age of the victim

Distinguish between human and animal bites

Match a bite to a bite mark

Match a bite to a person

Recognise dental restorative materials and restorations
Hard to recognise white plastic fillings, compared to the metallic ones such as gold, doesn’t really come up on X-ray and hard to distinguish visually

Dental radiographs - patterns

Recognise patterns using written documentation of dental treatment
Antemortem records need to be analysed, usually full of shorthand and jargon
Need to translate records to a language that all dentists and a layperson can understand
Reconciliation dental sheets show antemortem and postmortem records compared side by side
Needs to be able to be presented to coroner on specific paperwork

Question 27

Forensic odontology teams

Answer 27

Forensic Odontology is carried out by teams
The head of the team must be a qualified and registered dentist and who also has credentials as a forensic dentist, however the team itself can be made up of other dental professionals such as hygienists etc

Frequently include practitioners with auxiliary status (hygienists, therapists, technicians)

Two Forensic Odontologists (qualified dentists) must attend each case.
Allows for cross checking

One FO must have full accreditation with the NZSFO

Question 28

why does forensic odontology work?

Answer 28

Teeth are hardest structures in body
Teeth survive high temperatures up to 1200°C
Filling materials present after 600 – 800°C (fillings often fall out before the teeth so the teeth still remain)
Resistant to decomposition and trauma

Patterns of tooth eruption allow age estimation

Tooth morphology and eruption may indicate ethnicity
See some estimations of ethnicity

Patterns of eruption, extraction, and restoration (fillings) are distinctive to individual

Root form and “smile analysis” as secondary dental identifiers
Look on social media for pictures with smile to clarify

Teeth = secluded environment for DNA recovery after fire (<500°C) and terrestrial decomposition, but not marine decomposition

Question 29

Forensic odontology is a _____ ______ _____

Answer 29

scientific evidential process

Question 30

Forensic odontology is a scientific evidential process….

Answer 30

Scientific: logical protocol, independent of bias (this is why you have a second person verifying what you are doing), validated reproducible techniques, peer-reviewed.
Police sometimes call them in to confirm someones identity which is not actually their job because their job is to actually collect the evidence and make a decision rather than confirm anything

Evidential: chain of custody (ensure that the evidence can be traced), recording and documentation, avoid contaminating evidence, communication understood by lay people.

Process: logical steps, independent verification and quality assurance.

Question 31

Forensic odontology is a scientific evidential process - SCIENTIFIC

Answer 31

Scientific: logical protocol, independent of bias (this is why you have a second person verifying what you are doing), validated reproducible techniques, peer-reviewed.
Police sometimes call them in to confirm someones identity which is not actually their job because their job is to actually collect the evidence and make a decision rather than confirm anything

Question 32

Forensic odontology is a scientific evidential process - EVIDENTIAL

Answer 32

Evidential: chain of custody (ensure that the evidence can be traced), recording and documentation, avoid contaminating evidence, communication understood by lay people.

Question 33

Forensic odontology is a scientific evidential process - PROCESS

Answer 33

Process: logical steps, independent verification and quality assurance.

Question 34

primary identifiers need

Answer 34

antemortem comparators

Question 35

Antemortem comparators of primary identifiers …

Answer 35

Visual–relatives,Facebook

Fingerprints–home, criminal, military
In NZ there is not much of a record for it because it is not as routine as overseas

Dental-dentist
Rely on dentists for written records or X-rays and in the best case scenario you get both

Medical– medical records

DNA– home, relatives

Question 36

Identification process using dental steps

Answer 36

examination and charting –> antemortem –> postmortem –> reconciliation –> reporting

Need to collect antemortem data which the police generally does and then forensic odontologists need to interpret it, forensic odontologists do postmortem and then need to reconcile and put the two together and form a process and then report on it

Question 37

postmortem interpol form colour =

Answer 37

pink

Question 38

antemortem interpol form colour =

Answer 38

yellow

Question 39

Dental Interpol forms …

Answer 39

There is a missing person and a dead person form for dental records/analysis to be filled out on
On the dental forms you note what is there and what is not there, fillings present for postmortem and then doing the same with antemortem data and then reconciling the two together

Question 40

Documenting forensic odontology …

Answer 40

Pink …
PM: Examination and recording of all missing, damaged, decayed, impacted and filled teeth.
Filling location (tooth surfaces) and material can be unique.
Recording onto Interpol “Pink” F1 & F2

Yellow…
AM: Retrieval and interpretation of antemortem records & xray films
Recording onto Interpol “Yellow” F1 & F2

Green…
For DVI, transfer data to PLASS DATA software

No colour…
RECON: Dental radiographic films may allow match to AM films.
“Smile” photography may be of some assistance

Question 41

Radiography in forensic odontology

Answer 41

Antemortem records and X-ray films
Can get mislabelled or unlabelled records which prove problematic

Portable X-rays are $26000 and are used to take the postmortem X-ray films to compare to the antemortem X-ray films

Question 42

Training for forensic odontology

Answer 42

already a registered dentists, also requires regular involvement in coronial victim identification i.e. you should eb regularly involved in victim identification in your own area

Question 43

What are you looking for when inspecting postmortem and antemortem dental records ?

Answer 43

Look for points of cordance - Look for shapes that look the same, hard to reproduce exact shapes so it is good evidence to use to convince the coroner that it is that person

Account for differences - Not always on X-ray records, other stuff can be done subsequently to the X-rays that forensic odontologists have access to

Question 44

Issues faced in dental examination due to deceased victims for forensic odontologists

Answer 44

personal protection
lightning
access and visibility

Question 45

Forensic odontologists also do _____ and _____ work

Answer 45

military and anthropological

Question 46

Lockerbie 1988

Answer 46

no DNA

86% identified solely or with the aid of dental –> shows how powerful and useful it is

Question 47

Tangiwai disaster 1953

Answer 47

13 of the 22 victims buried in the common grave were identified using dental records (they were unable to be identified visually)

Question 48

Mount Erebus 1979

Answer 48

142 (66%) of IDs were done by dental means –> dental records in a forensic setting are very useful for victim identification

Question 49

Boxing Day tsunami 2004 (Indian Ocean)

Answer 49

No dental identification without antemortem records!

Dental indenificathion had ,little effectiveness for asian countries (therefore not useful for Thai citizens)
Use all identification techniques because one may not work/takes longer/isn’t possible to do, may give results in different time, you can map the effectiveness of the identification techniques over time and in looking at this timeline relatively early on you can see that dental identification was really good early on for identification of body
Along the timeline you see dental records being important early on and then you run out of antemortem records so you start to rely more on fingerprints and then over time DNA became really important, so all of these methods are really important but they may give results at different times in the time course of the DVI operation

Question 50

Operation earthquake - 22 February 2011 12:51pm Christchurch

Answer 50

Two layers of security

Logistics - protection, biological hazard, suitable physical location

cultural and spiritual sensitivity

work flow established

Temporary mortuary established at military camp

Question 51

Dental victim identification procedures

Answer 51

based on Interpol guidelines with 5 recognised phases

Phase 1 (the scene), phase 2 (post mortem), phase 3 (antemortem), phase 4 (reconciliation), phase 5 (debrief)

Phase 1: The Scene

• Crime scene, recording
• Remains labeled, recovered, transported to mortuary
• Forensic dentally-qualified and rescue- qualified person needs to be present

 Phase 2: Post Mortem
- Personnel
- Information
- Operational command and control 
 Logistics

Question 52

Five stages of post mortem ID used in Operation Earthquake

Answer 52

1. Property - usually cleaned first then photographed and linked to the owner
2. Pathology
3. Dental - Nomad portable digital xray unit, Digital radiographs , False teeth - useful if labelled, Specialists from other countries flew in to aid in the identification efforts of NZ
4. Fingerprints - and footprints were examined
5. Quality Management - look at paperwork and ensure that it is done correctly and to a high enough standard

Question 53

Summary of CHCH earthquake DVI

Answer 53

Involved 34 Forensic Odontologists, including five overseas dentists

> 400 working days

Considerable assistance provided by
dental technicians, dental hygienists and dental therapists
dental auxiliaries (assistants/nurses)

177 of 181 deceased were identified (98%)

Includes 70 foreign victims

94% of ID based on single or multiple primary identifiers

6% based on secondaries (property, visual/physical, circumstantial)

43% by fingerprints, 33% by dental, 4% by DNA, 14% combination.

Dental and DNA significantly more useful for fragmented remains

Question 54

How to become a forensic odontologist

Answer 54

Forensic Odontologists are qualified dentists

FO Auxiliaries are qualified in an oral health related field

Lead FO fully credentialed with New Zealand Society of Forensic Odontology (NZSFO)

Scope of Practice defined by experience & CPD