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P R O F E S S I O N A L I S S U E S

Forensic Odontology:
The Roles and Responsibilities of the Dentist
• Sylvie Louise Avon, DMD, MSc •

A b s t r a c t
Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. Forensic
dental fieldwork requires an interdisciplinary knowledge of dental science. Most often the role of the forensic
odontologist is to establish a person’s identity. Teeth, with their physiologic variations, pathoses and effects of
therapy, record information that remains throughout life and beyond. The teeth may also be used as weapons and,
under certain circumstances, may leave information about the identity of the biter. Forensic odontology has an
important role in the recognition of abuse among persons of all ages. Dental professionals have a major role to play
in keeping accurate dental records and providing all necessary information so that legal authorities may recognize
malpractice, negligence, fraud or abuse, and identify unknown humans.

MeSH Key Words: dentists; forensic dentistry; dental records

© J Can Dent Assoc 2004; 70(7):453–8
This article has been peer reviewed.

I
nterest in forensic dentistry was relatively dormant the status of a person’s teeth changes throughout life and
until the 1960s when renewed interest was sparked by the combination of decayed, missing and filled teeth is
the first formal instructional program in forensic measurable and comparable at any fixed point in time.3,4
dentistry given in the United States at the Armed Forces The fundamental principles of dental identification are
Institute of Pathology. Since then the number of cases those of comparison and of exclusion. For example, dental
reported has expanded to such an extent that the term identification is used when antemortem records for the
“forensic odontology” is familiar, not only to the dental putative deceased person are available and circumstantial
profession, but also to law enforcement agencies and other evidence suggests the identity of the decedent, and when
forensic groups.1 antemortem records of other suspicious, unidentified
Forensic odontology involves the management, exami- persons are available and must be ruled out. Identification
nation, evaluation and presentation of dental evidence in requires a list of the possible persons involved so that appro-
criminal or civil proceedings, all in the interest of justice. priate antemortem records can be located. The availability
The forensic odontologist assists legal authorities by exam- and accuracy of these records determine the success of
ining dental evidence in different situations. The subject identification. Unfortunately, dentists often maintain poor
can be divided roughly into 3 major fields of activity: civil records, resulting in confusion that makes dental identifica-
or noncriminal, criminal and research.2,3 tion impossible.4
Identification Regardless of the method used to identify a person, the
Dental identification assumes a primary role in the iden- results of the comparison of antemortem and postmortem
tification of remains when postmortem changes, traumatic data lead to 1 of these 4 situations5:
tissue injury or lack of a fingerprint record invalidate the 1. Positive identification: Comparable items are sufficiently
use of visual or fingerprint methods. The identification of distinct in the antemortem and postmortem databases;
dental remains is of primary importance when the deceased no major differences are observed.
person is skeletonized, decomposed, burned or dismem- 2. Possible identification: Commonalities exist among the
bered. The principal advantage of dental evidence is that, comparable items in the antemortem and postmortem
like other hard tissues, it is often preserved after death. Even databases, but enough information is missing from

Journal of the Canadian Dental Association July/August 2004, Vol. 70, No. 7 453

identification.Avon Figure 1a: Antemortem radiograph. therefore it is essential that all routine the dentition and supporting oral and surrounding struc- radiographs exposed during the course of a dental practice tures must be recorded. potential for insurance fraud is associated 3.7 When an ante- the use of electronically managed dental records creates an mortem record is unavailable. Vol. root canal treatment. but the suspected identity of graphs. and sinus and jawbone patterns can be identi- fied only by examination of radiographs. Observations such as that were not registered in the antemortem record. either source to prevent the establishment of a positive ethical issue about the maintenance of patients’ privacy. success of preventative intervention. fewer people have dental restorations because of the ulent intent to alter recorded information. following the principles of then deemed inconclusive. Comparison of antemortem and postmortem radio- avulsion of a tooth or teeth secondary to the trauma at the graphs is the most accurate and reliable method of identi- time of death. However. and upon compari- The dental record is a legal document owned by the son of radiographs. tooth and root identification can still be made. at some Computer-generated dental records are becoming more stages of the development of human dentition. However. Results of the physical examination of value for comparison. In some instances Dental Record as a Legal Document a single tooth may be all that remains. a positive identification can be made. allowing comparison of the spatial rela- transferred for routine professional consultation or forensic tionships of the root and support structures of the teeth cases requiring dental records for identification. Today. The obvious advantage of the radiographic superimposition (Figs. such as Radiographic Examination changes in restorations related to the passage of time. All entries should be signed or initialled by angulation of the film to the x-ray tube is the same as that recording personnel. Changes in the record should not be of the original films. or additional treatments by a second party fying remains (Figs. study casts. and contains subjective and objective information Original antemortem dental radiographs are of immense about the patient. 7 Journal of the Canadian Dental Association . record management ensures that all dental information that 4. Additionally. in antemortem and postmortem records. In distinctive shapes of restoration.3 databases. photographs and radiographs able years later. Figure 1b: Postmortem radiograph of the same person as in Fig. Exclusion: Unexplainable discrepancies exist among may be required to resolve a forensic problem is properly comparable items in the antemortem and postmortem maintained and retrievable. the postmortem chart of the 454 July/August 2004. The best results are obtained when the become components of the record. and should be kept for 7 to 10 years. to remain readable and removes any questions about fraud. dentist.6 Whether dental records are preserved in written the decedent cannot be ruled out. bases under restorations. 1a. 2a and 2b) can be used electronic record is that it can be easily networked and for identification. Sometimes explainable discrepancies are present. 1a and 1b).1 erased. No. the discrepancies can be explained and buried root tips. This method permits the original entry are available for antemortem–postmortem comparison. morphology. digital dental common for dental records. but corrected with a single line drawn through the Identification becomes a problem when few restorations incorrect material. The identification is form or on a computer database. all these cases. 70. Insufficient identification evidence: Insufficient with the computer enhancement of dental lesions or supportive evidence is available for comparison and restorations on electronically generated dental radio- definitive identification. the results of clinical be adequately fixed and washed so that they remain view- laboratory tests. In addition.

Age Determination Based on Dental Data and smoke have been deposited on the teeth. Vol. especially when information relating to the cases.3 alization. unless they are and should be an important part of the identification exposed directly to flame. printing. work together to resolve problems associated with identifi- and the intermixture of primary and adult dentitions. Preservation is possible in most process. soft-tissue thickness points can be experience related to the particular type of disaster.8 Small variations in tooth forma- tion and eruption among persons has made dental estima- Anthropologic Examination tion of chronological age the primary method of age In addition to analysis of teeth. The Journal of the Canadian Dental Association July/August 2004. Each method has its advantages to the beginning of the third decade of life when develop. and anthropo- beginning about 4 months after conception and continuing logic examination of bone. computers have been useful fied. The horizontal cut consisted of a viewable section across the roots of a group of teeth from the posterior area and shows a high degree of deceased may be used to exclude his or her identity upon concordance between dentitions. Generally. distinguish one person from others and one population dents in which both fire and trauma are often severe. comparison with the available antemortem records of others. Fires from another and are used to determine the race. cation. namely the bones and the Mass Disaster Identification teeth. in addi. connected with sculpting clay and the reconstructed tion to the forensic odontologist. Because teeth are heavily calci. 70. finger- follows a reliable and predictable developmental sequence.9 The use of tification is derived from a positive correlation between radiographs is characteristic of techniques that involve known information about a person and findings from a observation of the morphologically distinct stages of miner. Human dentition ods of identification include visual identification. Generally. Both disciplines are concerned with the analysis of calcified structures of the body. 7 455 . Age estimation is a subdiscipline of the forensic sciences teeth and restorations are resistant to heat. physical examination of the decedent. effectively dental identifications are needed. the stage of eruption. for techniques involving facial superimposition. No. key Transport accidents form the majority of cases in which identification tools for the forensic odontologist. Such determinations are also based on the degree of Forensic anthropologists and forensic odontologists may formation of root and crown structures. directly to cranial features. depending on the nature the reconstruction of facial soft tissues. physical Because computers permit the addition of components features are often destroyed.2 features can sometimes be digitized on a computer screen. a pathologist and various specialists with points on the face. age and in and collapse of heavily occupied buildings are another sex of a person. The mas. when the skull and facial bones are used as a foundation for the composition of which varies. the team includes a coordinator or standard anthropologic thickness measurements at specific head of the team. particularly aircraft acci. postmortem radiograph with cut and paste commands. they can resist fire as well as a great majority of trau. serologic and DNA comparison. providing a means to check its accuracy. and disadvantages. In a situation involving fire or severe trauma. With the use of of the disaster. and soot soft tissue. The bones and teeth of the craniofacial complex. Dental examination is significantly confounded when underlying skeletal structures can thus be viewed below the heat and flames have fragmented tooth enamel.1 source of multiple problems of identification. the most common meth- determination for younger persons.4 deceased is unavailable. The forensic This anatomic material can be used for identification odontologist is usually a member of the investigating team. They all rely on the principle that iden- ment of all the permanent teeth is completed. Forensic Odontology: The Roles and Responsibilities of the Dentist Figure 2a: Digitized images showing a horizontal section of the roots Figure 2b: The horizontal section of the roots is superimposed on the randomly selected from the antemortem radiograph.

the forensic odontologist can use contribution to forensic science.10 computer-aided reconstruction. producing lacerations of the skin and open wounds. The bite-mark pattern is numerous methods. For evaluation of a pattern mark.14 For children. elderly or spousal than those of domestic violence. To Comparison of bite marks represents dentistry’s vital accomplish these goals. They are opinion. Animal bites often cause shear rather bruised or scarred lips.1 On occasion.12 or upon the victim of an assault or homicide. Figure 3b: A sketch of the decedent was completed before the Figures 3a to 3c reprinted with permission from Wood and others. and does not represent any kind of cutaneous lesion.15 historical and chronological explanation of their origin.11. Suspicion is further aroused if. the particular method a suspect. nonhuman bite injuries are found on Abusive trauma to the face and mouth includes fractured victims. espe- biting can represent a form of expression that occurs when cially in cases of persons with accompanying head or body verbal communication fails. 4). the teeth and specific anatomical charac- Bite-Mark Evidence teristics can create a representative pattern (Fig. perhaps the most common nonhuman bite. than impact injuries. or physical or sexual abuse.16 Dog bites. instrument or piece Figure 3c: The sketch formed the template for the final drawing. Biting injuries can result from injuries.13 Bite-mark evidence inflicted by a deceased victim may also Family Violence be seen on a living assailant. the pattern can be compared result of these techniques is a recreation of the contour of with the suspect’s dentition for inclusionary or exclusionary the soft-tissue features that permits visual identification purposes. fractures of the maxilla and mandible.10 of the dentition. in the dentist’s playground altercations or sports competition. No. 70. Animal bites are usually distinguished from human teeth. Cat bites are small and round with pointed cuspid-tooth impressions caused by the conical shape of these teeth. Various versions can then be stored and tics must be recognizable and distinguishable. the forensic odontologist has to first determine whether the pattern is truly the result of biting. A dog (or other carnivorous mammal) is more likely than a human to cause avulsion of human tissue during violent biting. Depending upon the circumstances. the nature of the injuries is inconsistent with the also common in daycare centres. The shape reproduced for comparison. of clothing.Avon Figure 3a: Prosthetic teeth were custom fitted into the sockets. its characteris- (Figs. Because there is no single method for compared with the dental characteristics of the dentition of the analysis of bite-mark evidence. laceration of the labial or lingual frenum. 3a to 3c). other on the preference and ability of the analyst. in cases other The dentist should be aware of child. infection or injury.4 From the evidence. objects. a bite-mark used would depend on the circumstances of each case and pattern may be deposited within foodstuffs. are characterized by a narrow anterior dental arch and consist of deep tooth wounds over a small area. 7 Journal of the Canadian Dental Association . missing or bite injuries by differences in arch alignments and specific displaced teeth. and tooth morphology. Other characteristics of human- 456 July/August 2004. Vol. abuse when confronted with unusual oral injuries. Once he or she has established that the pattern is related to the teeth and was not made by a tool.

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Wood RE. 29(4):195–203. area of concern to the dentist. 70. Appreciation of the forensic field should abuse injuries are related to their multiplicity and repetitive give the dental clinician another reason to maintain legible nature. C authorities is mandatory in most jurisdictions. Forensic dentistry. of the record. therapeutic counselling for victims of violence is beyond the 7.16 The primary role of a dentist intervening in any 3. as a provider of primary E-mail: sylvie-louise. p. which offers an annual week-long program. not to attempt W. 1993. DC. Spitz and Fischer’s medicolegal investigation of death: victims. 1974. 7 457 . The Bureau is a forensic odontology laboratory and is the first and only laboratory in North America that is dedicated to full-time forensic dentistry research. History of forensic dentistry.ca. parent. 130(9):1325–9. 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A review of the most commonly used dental age estimation Education techniques.17 and legally acceptable records. Dr.. Douglas D. incidence of dentists’ reports is low. Combined physical school by integrating the subject into their oral pathology and computer-aided facial reconstruction in human skeletal remains. The dentist must also understand that his or her testimony may be Acknowledgements: The author wishes to thank Dr. Robert Wood for needed for future legal proceedings. They often appear in various stages of resolution. Edinburgh: Churchill abusive or neglectful. If oral injury is his recommendations and photographs. 2nd ed. Bouquot J. Cameron JM. Guidelines for bite mark analysis. Neville B. Attempting to provide advice or 6. Avon is a specialist in oral pathology and oral medi- Necessary radiographic studies should be retained as a part cine and professor at Laval University. confronted with violence. Ill: Charles C. 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