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REVIEW ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 356-360
Role of dentist in person identification


1 Department of Community Dentistry, Kamineni Institute Dental Sciences and Research Center, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh, India
2 Department of Community Dentistry, J S S Dental College and Hospital, S S Nagar, Mysore - 15, Karnataka, India

Click here for correspondence address and email

Date of Submission15-Dec-2008
Date of Decision25-Apr-2009
Date of Acceptance30-Apr-2009
Date of Web Publication30-Oct-2009
 

   Abstract 

To reinforce awareness among dentists about their role in person identification and the importance of maintaining dental records of all their patients. The article reviews basic procedures of dental identification and some cases where dental identification played a key role in eventual identification of the person. Forensic odontology is an integral part of forensic sciences. Forensic dental identifications, especially in times of mass disasters, depend mainly on the availability of ante mortem dental records. It is the social responsibility of each and every dentist to maintain dental records of their patients for the noble cause of identification in the event of mass disaster.

Keywords: Ante mortem, forensic odontology, identification, mass disasters, post mortem, reinforce

How to cite this article:
Chandra Shekar B R, Reddy C. Role of dentist in person identification. Indian J Dent Res 2009;20:356-60

How to cite this URL:
Chandra Shekar B R, Reddy C. Role of dentist in person identification. Indian J Dent Res [serial online] 2009 [cited 2014 Oct 25];20:356-60. Available from: http://www.ijdr.in/text.asp?2009/20/3/356/57377
Human being, has come a long way from the early caveman age to the present day of covering nothing less than astronomical heights to sea bed depths. His zeal to conquer new heights has created a world full of scientific advancement and technology. However, his intelligence has also led to a surge in crime rate, terrorism, wars, mass disasters, road traffic accidents and dreadful diseases. In all such incidents the identity of the deceased, assailant or the cause of death becomes important as the core of various investigations are based on these processes. [1]

All humans have an identity in life; compassionate societies require that, this identity be recognized even after death. When a person dies there may be consequences, often financial, that must be dealt with. [1] Forensic science plays an important role that can be used in a judicial setting and accepted by the court and the general scientific community to separate truth from untruth. Forensic identifications, by their nature, are multidisciplinary team efforts that typically involve the coordination and cooperation of law enforcement officials, forensic pathologists, forensic odontologists, forensic anthropologists, serologists, criminalists and other specialists as deemed necessary. [2]

Forensic odontology is a vital and integral part of forensic science that is most widely utilized for identification of the living and deceased persons. In recent times, forensic odontology has evolved as a new ray of hope in assisting forensic medicine. This is relatively a young science of dentistry and still in its infancy state in India where as in other developed countries it has acquired a recognized branch of dentistry in medical forensicology. [3]

In India, qualified forensic odontologists are very few. So, an attempt should be made to reinforce awareness among dental practitioners about the role of dentists in person identification and to awaken the social responsibility of maintaining dental records of all the patients. This is very essential for identification of individuals in the event of any disaster.

This article is an attempt to reinforce the awareness among dentists about their role in person identification and the importance of maintaining dental records of all their patients.


   Review of Notable Dental Identification Cases Top


People have long recognized that a person's teeth are unique. Although great attention was not paid to dental identification until recent times, the process has been used for more than 2000 years. [4]

Earliest dental identification

The earliest recorded case concerns a female associated with Emperor Nero, who was identified after her death through the unique arrangement of her teeth. In the year 66 A.D, Nero's mistress Sabina got his wife killed by her soldiers and demanded to see the head of the victim in a dish. She recognized the head by a black anterior tooth. [5]

First dental identification

Luntz L and Luntz P presented a case of 1775 in 1972. Paul Revere constructed a bridge for his friend Dr. Joseph Warren. Eventually Warren was killed by a bullet that pierced his head in the battle of Bunker Hill. His body was buried by the British in a mass grave. A year later, when the British forces withdrew from Boston, the people of Massachusetts wished to give a proper burial to Dr. Joseph Warren. However, they could not identify Warren's body as all the bodies in the mass grave were badly decomposed. Dr. Joseph Warren's body was later identified by Paul Revere by the ivory work which he had done for his friend when alive. This was thought to be the first case of identification by a dentist. [6]

First dental identification reported from India

Sansare K and Dayal PK in their review in 1995 have mentioned that according to Elphinstine, M. Raja Jayachandra Rathore of Canouj, died on the battlefield in 1191. His body was identified by his false anterior teeth. This was probably the first case of identification using dentition from India. [5]

First dental identification accepted by law

Dental evidence was first accepted in the United States in the Webster-Parkman case in 1849. [1] This happened in Boston, U.S.A. Webster, Prof. of Chemistry in Boston Medical School, borrowed money from his colleague Dr. Parkman who was relentless in demanding the repayment. Unable to cough up the amount, Webster plotted to kill Dr. Parkman. Webster invited Dr. Parkman to his lab, promising repayment, on 23 rd November in 1894. Dr. Parkman was never seen again after that. On receiving a complaint, the authorities thoroughly searched Webster's laboratory, where the trunk of a human body with a left thigh, few bones and some artificial teeth were found. When the mutilated remains were assembled, corresponded and fitted, it was concluded that they belonged to Dr. Parkman. Dr. Parkman's dentist, Dr. Nathan C Keep played a significant role in identifying Dr. Parkman. [1]

First dental identification in a mass disaster

According to Dr. Oscar Amoedo, Professor, Dental School at Paris, regarded as the father of forensic odontology, the first case of dental identification in which a great number of victims lost their lives occurred in Paris in 1897. A fire in a charity bazaar resulted in 126 deaths. Here, ante mortem dental records were compared with post mortem dental records for identification of the dead. [4]

Identification using prosthesis

The countess of Salisbury was burnt at Hatfield house in 1835. The body was charred beyond recognition by visual means. She was identified by her gold denture. [1]

Identification of Hitler

Bagi BS mentioned in 1977 that the bodies of Hitler and his mistress Eva Brauma were identified by his dentist, (Kathe Hensrman Fritz Echtmann) using dental records. [3]

Identification of general Zia-Ul-Haq

Sansare K mentioned in 1995 that General Zia-Ul-Haq, late president of Pakistan, died in 1988 in a plane crash. His body was identified by his dentition. [7]

Identification using tooth brush

Thousands of people lost their lives in the world trade center disaster in the U.S. on September 11, 2001. DNA extracts from tooth brushes of the victims were used in identification of some victims.

Identification of Saddam Hussain's sons

According to a U.S. website, (CNN NEWS) dental identification was used to confirm the identities of the bodies of Saddam Hussain's two sons.


   Dental Identification Procedures Top


Whenever a human body or the remains of a human body are found, the police are called for further investigation. The police in turn may make a formal request to the dental authorities to help them identify the individual. At this point in time, a tentative identification is possible by considering the geographical location where the body was found, the physical features, the available wallet or driving license or any other personal belonging of the deceased individual. This tentative identification may help in narrowing the search for ante mortem records with which a possible identification may be established with a degree of certainty. [8] Dental identification of an individual can be made mainly by two methods namely

  • Comparative method of dental identification
  • Post mortem dental profiling. [8]


Comparative method of dental identification

Comparative method of dental identification involves establishment to the highest degree of certainty that the remains of the decedent at the site of mishap or death and details in the ante mortem dental records are of the same individual to confirm identity of the individual. Here, the forensic dentist prepares a post mortem dental record by careful examination, charting and written descriptions of all the dental structures along with the radiographs as additional supportive evidence. Radiographs needs to be punched with rubber dam, indicating ante mortem or post mortem, to avoid any sort of confusion in future. [9] Once the post mortem record is complete, a systematic and methodical comparison has to be made between the ante mortem and post mortem dental records examining each and every tooth and surrounding structures. While dental restorations play a significant role in the identification process, other additional features may also be of help. The manual of American Society of Forensic Odontology (ASFO) and the guidelines for body identification by American Board of Forensic Odontology (ABFO) provide numerous such additional features to be looked for in the identification process. [10] The similarities and discrepancies should be carefully noted at the time of comparison of the records. [11] The discrepancies can be of two types - explainable or unexplainable. Explainable discrepancies are the ones for which an explanation can be reasonably accepted keeping in mind the time elapsed between the recording of ante mortem and post mortem findings. Example, a tooth noted to be present in the ante mortem records which is missing in the post mortem records (might have been extracted after ante mortem findings were recorded and before death), a restoration which is mesio occlusal (MO) in ante mortem records being mesio occluso distal (MOD) in the post mortem records (a further distal extension may have been made in the time elapsed between the noting of ante mortem and post mortem records). Unexplainable discrepancies are the ones for which the explanation cannot be provided for and hence, have to be excluded. Example, a permanent tooth recorded to be extracted in the ante mortem finding to be present in the post mortem record.

A range of conclusions can be drawn following a comparison of ante mortem and post mortem records. The American Board of Forensic Odontology (ABFO), however, recommends these to be limited to four conclusions, viz. [12]

  1. Positive identification: This may be given when the ante mortem and post mortem findings match in sufficient details, without any unexplainable discrepancy, to give the impression that they are from the same individual.
  2. Possible identification: Here ante mortem findings may be consistent with post mortem findings, but a positive identification with certainty may not be established owing to the poor quality of either the post mortem remains or ante mortem dental records.
  3. Insufficient evidence: Information in the ante mortem and post mortem dental records are insufficient to draw a conclusion of any sort.
  4. Exclusion: The findings in the ante mortem and post mortem dental records are clearly inconsistent with respect to many features. [12]


A fact to be kept in mind at the time of drawing up of conclusion is that there are no set of minimum number of features or concordant points required to be matching to establish a positive identification. A single tooth with sufficient unique details may be of great help in establishing a positive identification, where as a series of full mouth radiographs may not be of any use if they do not have the required unique details. [12]

Most of the times, where ever dental identification is sought, this method of comparison between ante mortem and post mortem records is used for identification with certainty. At times this method may not be applicable for example, when there are no clues to make a tentative identification without which there is no way of searching for ante mortem records or the ante mortem records may be unavailable in spite of making a tentative or presumptive identification. In these circumstances a method known as post mortem dental profiling is used.

Post mortem dental profiling

Here the forensic dentist will help the authorities narrow down the search for ante mortem records by giving information on the deceased individual's race, age, sex, socio economic status, occupation, dietary habits, dental and some systemic diseases as well by careful examination of the deceased or the left over human remains at the site of disaster. The identity of the race and sex to some extent can be made by careful examination of the skull for its shape and form. These features of the skull may enable a forensic dentist put the individual into one among the three major racial groups, Negroid, Mongoloid or Caucasoid. Along with shape and form of the skull, other features like cusps of Carrabelle, Shovel shaped incisors, multi cusped premolars; talon's cusp, taurodonts, etc may assist in determination of the race. Sex determination is made most of the times with thorough examination of the skull as the sex differences in the morphology of the teeth are not very significant. The microscopic examination of teeth for the presence/absence of Y-chromatin and DNA analysis can reveal the sex with certainty. [13],[14] The age of the individual can be gauged by examination of the teeth and surrounding dental structures and their subsequent comparison with the developmental charts. The age can be established with an accuracy of plus/minus 1.5 years to the actual chronologic age of the child with this method. [15] Some authors recommend the use of aspartic acid racemization method for determination of the age, which can reveal the age to an accuracy of plus/minus four years. [16] The conclusion on the age of the individual can also be drawn by using charts such as those developed by Ubelaker which graphically give an illustration of the dentition (deciduous, mixed or permanent) right from the age of around five months in utero to 35 years after birth. The findings on the teeth such as erosion, stains, or unusual wear patterns can help in determining the habits as well as their occupation. Erosions can be due to many factors like alcohol or substance abuse, working in an industry involving use of acids (because of continuous exposure to acid fumes in the working environment), excessive consumption of carbonated beverages or disorders like anorexia nervosa/other eating disorder/hiatus hernia. Stains on the teeth may suggest smoking, tetracycline use, betel nut and chewing of smokeless tobacco or even dental fluorosis as well. [17],[18],[19],[20],[21],[22],[23],[24],[25],[26] The notching of incisors suggest habitual placement of nails in between the teeth (carpenters and cobblers), opening of bobby pins and cutting of threads (tailors) or because of placement of pipe stems, cigarette holders, hair pins etc. The unusual wear pattern of the teeth may give an indication of previous orthodontic treatment as well. [27] The presence or absence of dental treatment (which gives information on the attitude and dental awareness of an individual) as well as the quality and quantity of dental treatment (type of restoration, type of prostheses or appliance) may give some clues on the socio-economic status of the individual. In short, we can say, in post mortem dental profiling, a forensic dentist looks for all possible methods to narrow down the identity of the deceased so as to enable search for the ante mortem records. This as a method of forensic dental identification is used when comparative and other methods of identification are not sufficient to establish the identity of the individual.

Other innovative methods in dental identification

Although comparative dental identification or post mortem dental profiling are the most frequently used in forensic dental identifications, in many instances, some innovative techniques such as labeled dentures or orthodontic appliances, the unique restorative materials can easily narrow down the search for identity of the deceased. There have been many scientific articles in literature to show how the labeled prostheses (labeling patient's name or patient's unique ID number) [28],[29] other dental appliances such as removable orthodontic appliances, [30] unique composition of restorative material or the presence of Kevlar fibers in the denture have helped in the ultimate process of establishing identity of the individual. This method of labeling the prostheses or any other appliance is a noble thought which will be of great help in identification process especially at times of mass disasters. So the concerned dental organizations through out the world should insist that dentists get their patients identity engraved or labeled in the respective appliance or prostheses.

DNA in dental identification

The resistant nature of dental tissues and dental restorations to changes brought about by environmental extremes such as temperature and decomposition make them an ideal source of DNA, which will be of great help in the identification of a person. [31] With the advent of Polymerase Chain Reaction technique that allows amplification of DNA at pre-selected sites the biological material extracted even from a root filled tooth will be sufficient to make a conclusion on the identity of a person. [32] Here the DNA extracted from human remains at the site of disaster is matched with the ante mortem sample derived from any of the sources of DNA such as a tooth brush, hair brush, blood sample, biopsy material, clothing or any other personal belonging of the deceased. If the genomic DNA is not in sufficient concentration to draw a conclusion on the identity, then mitochondrial DNA, present in high copy number in each cell and maternally inherited, will be of great help. [33] The analysis of mtDNA is a powerful tool in the forensic case work if there is no ante mortem comparison sample owing to the maternal inheritance pattern of mtDNA which can be matched with parents or siblings of the deceased. [33]

Dental identification in mass disasters

Dental identifications have always played a key role in natural and manmade disaster situations and in particular mass casualties normally associated with aviation disasters. [34],[35],[36],[37] The identification process in a mass disaster situation is fundamentally the same as that in a routine comparative dental identification of a deceased individual, but, the conditions under which the process is under taken is more complex because of the physical and emotional nature of the situation. [38],[39],[40] Lack of standardization in the charting of dental records (because of which there will be wide variations in the way in which details are recorded in both ante mortem and post mortem records), the poor working conditions, the psychological stress, decomposition, mutilation of human remains at the site of disaster, all confound the process of identification. [41] The fundamental requisite for proper handling of these situations is disaster preparedness. [41],[42]


   Conclusion Top


Forensic dental identifications play a vital role in the identification of individuals when identification by visual or any other methods like finger printing fail. Dental identification of a person is based on unique individual characteristics of the dentition and dental restorations, relative resistance of the mineralized dental tissues and dental restorations to changes resulting from decomposition and harsh environmental extremes such as conditions of temperature and violent physical forces. [43]

Dental identification can be used for identifying the deceased or the assailant in a crime scene or for identification of victims of a mass disaster. In the Asia pacific region, because of its wide range of variations in topography and climatic conditions, India is a disaster prone country with an average of eight major natural calamities a year. While floods, cyclones, droughts, earthquakes and epidemic are frequent from time to time, major accidents occur in railways, mines and factories causing extensive damage to human life and property. [44] During all these disasters the bodies of most of the victims are mutilated beyond recognition by visual or any other methods. Under these situations forensic dental identification is extremely valuable. [43]

Forensic dental identification depends largely on the availability of ante mortem records. So, it is the social responsibility of each dentist to maintain dental records of their patients for the noble social cause of identification in the event of any disaster.


   Suggestions Top


The concerned authorities (IDA and DCI) are requested to

  • evolve an approach so as to make record maintenance mandatory for all practicing dentists
  • introduce the subject of forensic odontology as a separate branch in the field of dentistry.



   Acknowledgment Top


My profound thanks to Dr. Shobha Sridhar, Professor, Department of Community Dentistry, Shyamala Reddy Dental College and Hospital, Bangalore and Dr. Veeresh D J, Professor, Department of Community Dentistry, PMN Dental College and Hospital, Bagalkot for their continuous supervision, academic excellence and help during the preparation of this article.

 
   References Top

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Correspondence Address:
B R Chandra Shekar
Department of Community Dentistry, Kamineni Institute Dental Sciences and Research Center, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh
India
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DOI: 10.4103/0970-9290.57377

PMID: 19884723

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