Forensic dentistry (odontology) is a vital branch of forensic science that involves the application of dental knowledge, primarily for the identification of hum
an remains. The forensic dentist’s work includes:
- the comparison of remains with dental records
- the comparison with dental records
- the evaluation of bitemarks (animal or human)
- the comparison with suspect dentitions;
- the aging of individuals by the dentition to determine chronological age both in the living and in the deceased;
- the evaluation of an individual’s dental/oral injuries to resolve civil (compensation, etc.) or criminal matters (assault, etc.); and,
- resolving dental malpractice or negligence issues.
All of these areas involve evaluation, report writing, and/or court testimony.
Natural and synthetic (crowns and bridges) dentition.
Scope of Work
Forensic dentists deal with a range of medicolegal problems, but the most common issue addressed is identification of human remains. Often no fingerprints are on file or are destroyed by decomposition, fragmentation, or by fire as occurred in 9-11 and in most air disasters. Natural disasters such as tsunamis, hurricanes, and volcanoes can involve an enormous number of deceased. Buried bodies may even need to be re-identified if caskets are washed out of the ground by flooding or avalanche.
Antemortem dental cast compared to the deceased’s dentition.
The identification of an unknown or confirmation of an identity is performed at the request of the coroner or medical examiner. Fragments of a jaw or a single tooth can be sufficient to make an identification providing antemortem (pre-death) dental X-rays are available for comparison. A postmortem (after-death) oral examination includes intraoral and extra oral photographs, dental X-rays, and dental charting. A “smiling” photograph of the suspected deceased can be used for comparison if the anterior teeth are still present in the remains. In the absence of a missing person match, the dental characteristics of an individual can give law enforcement clues to identity. Postmortem dental data can be rapidly compared to antemortem data using a database such as WinID (www.winid.com) to provide a list of the best matches for an odontologist to compare for a potential identification. In the case of an unknown deceased or a missing person, the data can be entered into NAMUS (National Missing and Unidentified Persons System) (www.namus.gov), a national centralized repository and resource center database maintained by the U.S. Department of Justice.
Another important area of forensic dentistry is bitemark analysis. Bitemarks can occur during a variety of human activity including assault, domestic violence, rape, elder abuse, self-defense, sports, accidents, infanticide, or other homicide. The American Board of Forensic Odontology (www.abfo.org) has developed rigorous guidelines and standards for analysis and Board Diplomates (DABFO) require additional education, training, and experience in this subject matter. New odontologists would be wise to work with experienced mentors certified by ABFO when doing their first few cases. Experience with digital imaging and Photoshop® is often a requirement during the evaluation and comparison phase of bitemark analysis. DNA collection at autopsy or in the living is part of the bitemark protocol.
Dental injuries or dental neglect may be critical information in the investigation of domestic partner, child, and elder abuse. Odontologists also evaluate, consult, and/or testify in civil litigation resolving malpractice, negligence, personal injury, immigration (aging issues), and workers’ compensation cases.
Excised transilluminated bitemark (upper left), color photograph (upper right), ultra-violet [UV] photograph (lower left), alternate light [ALI] photograph (lower right) of the same bitemark.
Education and Training
A graduate dental education leading to the DDS (Doctor of Dental Surgery), DMD (Doctor of Dental Medicine), or equivalent degree is a basic requirement. Some dental schools may offer electives or other continuing education courses in forensic dentistry. The American Academy of Forensic Sciences (AAFS) offers annual forensic dental programs in the form of workshops, presentations, and posters sessions. The AAFS-affiliated FSAB (Forensic Specialties Accreditation Board) and the recognized certifying body, the American Board of Forensic Odontology (www.ABFO.org), have a certification program in forensic dentistry that is based upon a candidate’s personal and professional record of education, training, experience, and achievement as well
as the results of a formal examination.
The American Society of Forensic Odontology (www.ASFO.org) meets during the AAFS Annual Meeting and holds a daylong course on forensic dental themes. It is the entry-levelorganization, and anyone with an interest in forensic odontology can apply for membership. There are week-long courses offered biennially at the University of Texas Health Science Center in San Antonio (Southwest Symposium on Forensic Odontology) and in alternate years at the University of Detroit Mercy School of Dentistry in conjunction with the Wayne County Medical Examiner’s office. There are longer and more extensive programs such as the fellowship program at the University of Texas HSC in San Antonio, the certificate program at McGill University in Montreal, and the Bureau of Legal Dentistry at The University of British Columbia in Vancouver. Other institutions in Europe and Australia also have programs available. These courses are highly recommended because they specifically concentrate on forensic dental education. The objective of these courses/ programs/fellowships/certificates is to provide advanced training in current approved techniques and methods in forensic dentistry taught by highly qualified and experienced mentor odontologists in real situations and providing subject matter for research.
Intra oral ultra-violet [UV] photograph. Note the fluorescent dental fillings.
Severely charred natural dental crowns.
There are opportunities for a forensic odontologist to have a formal appointment or consulting relationship with a coroner, medical examiner, state and/or local government agencies, the police and/or military services, and the insurance industry. Insurance companies, legal firms, hospitals, and child/senior protection agencies often seek additional private consultations. Reimbursement is usually on a fee-for-service or contractual basis.
Once a commitment is made to enter this field, the forensic dentist needs to be current in the most accurate methods available, be aware of ethical values and conflicts, and possess the dedication to render an impartial opinion in a timely and professional manner.