|Year : 2016 | Volume
| Issue : 1 | Page : 39-43
Significance of Dental Records in Personal Identification in Forensic Sciences
Vagish Kumar L Shanbhag
Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
|Date of Web Publication||3-Feb-2016|
Vagish Kumar L Shanbhag
Senior Lecturer, Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Yenepoya Research Centre, Yenepoya University, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Forensic odontology is a branch that connects dentistry and the legal profession. One of the members in the forensic investigation team is a dentist. Dentists play an important and significant role in various aspects of the identification of persons in various forensic circumstances. However, several dentists and legal professionals are quite ignorant of this fascinating aspect of forensic odontology. A need was felt to fill this gap. The dental record is a legal document possessed by the dentist and it contains subjective and objective information about the patient. A PubMed search and Google search were done for articles highlighting the importance of dental records in forensic sciences using the key words "forensic odontology, forensic dentistry, forensic dentists, identification, dental records, and dental chart". A total of 42 articles relevant to the title of the article were found and reviewed. The present article highlights the role of dentists in forensic sciences, their possible contributions to forensics, and the various aspects of forensic dentistry, thus bridging the gap of knowledge between the legal and the dental fraternities.
Keywords: Dental records, dentists, forensic dentistry, forensic dentists, forensic odontology, identification
|How to cite this article:|
Shanbhag VL. Significance of Dental Records in Personal Identification in Forensic Sciences. J Forensic Sci Med 2016;2:39-43
| Introduction|| |
Even though the world is a beautiful place to live, crimes, violence, accidents, and disasters occur on an everyday basis. There is little we can do to stop them. However, identifying and bringing the culprit (s) to punishment and bringing solace to the relatives of the victim or the deceased by identifying the deceased is the best justice we can afford. Dentists play a significant role in forensic investigation. They are frequently insisted upon to identify the remains of individuals who cannot be identified visually. They are often part of the multimember team of forensic investigation.
Several dentists and legal professionals are quite ignorant of the importance of dental records in the identification of unknown persons in the field of forensics. A need was felt to fill this gap. A PubMed search and Google search were done for articles highlighting the importance of dental records in forensic sciences using the key words forensic odontology, forensic dentistry, forensic dentists, identification, dental records, and dental chart. A total of 42 articles relevant to the title of the article were found and reviewed.
| Teeth, Identification of Persons, and Dental Records|| |
A forensic investigation team may involve law enforcement officials, forensic pathologists, forensic odontologists, forensic anthropologists, serologists, criminalists, and other specialists depending on the circumstances. Personal identification may also be required to identify both a missing living individual with amnesia and the culprits committing crimes. Dental records are very important and often play a key role in the personal identification of persons who are beyond visual recognition. It is a member of the legal profession, frequently the police, who calls upon the dentist for the process of identification. ,
The identification of a person is required when the body is disfigured or mutilated beyond recognition as a result of barbaric crimes, workplace and motor vehicle accidents, aviation and navy disasters, wars, fire, flood, manmade and natural mass disasters and causalities, and in circumstances where the body is in an unrecognizable, decomposed state. When dental structures are the only source of information for the identification of human remains, the forensic odontologist plays a vital role in identification of the person. Teeth are hard stable unique structures with unique shapes and sizes. These are not easily decomposed as other body structures even after death. Teeth survive even disastrous environmental conditions, such as fire, which makes these a trusted source in the identification process. Variations in shape, color, position, age, wear patterns, caries, periodontitis, dental restorations, and prosthetic work render the dentition of an individual like that of fingerprints.  The Disaster Victim Identification (DVI) Guide: Interpol 2009 states that the primary methods of identification are fingerprint analysis, comparative dental analysis, and DNA analysis. It also states that accurate positive identification may be possible when the postmortem (PM) and the antemortem (AM) dental records obtained are from the same person.  The Interpol DVI Guide mentions that if a positive match is found using dental identification, it can be trusted as a stand-alone identifier.
The identification of a person is very important to initiate any criminal investigation and identify the victim or the deceased person. Confirmation of one's partner being dead is essential for remarriage in many communities and religions. The payment of insurance, pension, and other financial benefits need positive identification of the deceased person. To preserve the social rights of the deceased person and before his/her burial, identification of the person is important. The identification of persons who are missing for long durations brings justice and relief to the survivors of the deceased. ,
| Dental Record|| |
A dental record is a legal document that contains all subjective and objective information about the patient and it is in the possession of the dentist.  The dental record is a document that contains the patient's chief complaint, the history of illness and associated systemic illness, clinical examination, dental charts, diagnosis, investigations, the treatment done, and notes on subsequent follow-up (s). A dental chart gives information about the details of all the teeth present in the mouth, such as the teeth present or absent, restorations, pathologies like caries, furcation involvement, root pieces, and periodontal health. Dental charts also give information about all of the five surfaces and four surfaces of the posterior teeth and anterior teeth, respectively. The dental charts should be recorded accurately. Any error in charting may render the record as unuseful.  The dental record also constitutes radiographs, including skull and panoramic radiographs, computed tomography (CT), study and treatment casts, impressions, laboratory investigation reports, clinical photographs, consultancy and referral reports, written notes, drug prescriptions, and patient identification information (including denture and implant labeling). , Any history or observance of child abuse or domestic abuse should be recorded appropriately. All records must be signed and dated by the person who records this. Any changes in the record should be struck off with a single line, so as to be readable and also to avoid suspicion of fraud. , All entry of dental records to the Interpol should be done by the dentist.  Every dentist has the legal obligation to maintain an accurate legible dental record of his/her patient. All the records should be maintained by the dentists in good condition. There is good progress in maintaining computerized digitalized electronic records. Dental records should be kept for at least 7-10 years. , Accurate dental records obtained frequently constitute a major factor in identifying an individual and have forensic applications. 
Defense organizations suggest that treatment records, radiographs, study models, and correspondence are to be retained for 11 years after the completion of treatment. In the case of children, records should be maintained until the patient is 25 years old. Original pre- and postoperative orthodontic models should be retained permanently. If there are any intermediates, it can be discarded after 5 years.  The registration of dental records is mandatory in several European countries. 
The procedures for collecting dental records should conform to the relevant laws of the state. It should be remembered that a dental record is a matter of professional confidentiality between the patient and the dentist. Even police officers cannot inspect or remove a patient's records without his/her consent except with the permission from the law of the state. All legal protocols should be maintained while releasing the records, the deviation of which may prove disastrous. ,, In case of mass disasters, the "Disaster Victim Register (DVR)" process is required. AM forms (yellow colored) and PM forms (pink colored) should be filled separately for later comparison.  AM data is collected from every suspected victim's family and his/her related family members, doctors, and dentists.  The electronic version of this form is called the "DVI System International" software program developed by Plass Data (Plass Data Software A/S,Taastrup Moellevej 12A, 4300 Holbaek, Denmark). , It helps to identify the victim manifest. 
Dostalova et al. in their study described a new electronic imaging called Dental Cross, comparable to dental records for positive identification. The program shows detailed dental examination, treatment history, dental chartings, and images, including x-ray and photo documentation, for example, root canal or implant picture in one screen in a concentrated, detailed manner. Facilities for color coding and special notes are also available in this program. They perceived Dental Cross as an alternative source of information for searching victims. 
An electronic or computer-generated dental record has the advantage of easy handling, transfer, and feasibility of rapid communication in forensic cases related to identification. Computer softwares such as WinID3 dental comparison software bridged with DEXIS digital radiography program (DEXIS:-DEXIS, LLC:1910 North Penn RoadHatfield, PA 19440 USA. WinID3:-http://www.abfo.org/winid/) have been proved to be valuable in assessing and comparing AM and PM dental record information in incidents like the World Trade Center disaster. Also, the digital form of radiograph and photograph can be superimposed and compared using softwares like Adobe Photoshop and Mideo Systems casePACS (Adobe Photoshop:-Adobe http://www.adobe.com/in/products/photoshop.html?promoid=KLXLS/. Mideo Systems casePACS:- Mideo Systems Inc.15177 Springdale StreetHuntington Beach, CA 92649Phone: 800-258-1066Fax: firstname.lastname@example.org). 
| The Role of Dental Record in Identifying Unknown Persons and its Benefits for Other Forensic Methodologies|| |
Dental records are more readily available than fingerprint database, especially in the European countries, the UK, the USA, North America, Sweden, Scandinavia, Australia, and Oceania. Also, identification using dental records is less time-consuming than fingerprint- or DNA-based identifications. ,,,
Dental identification is broadly performed by two means. The first is to examine previous dental records of the person suspected as deceased and look for these dental characteristics in the deceased person for similarity and confirmation. The second means entails that if no previous records are present, a PM dental profiling is done that will give clues to narrow the search required for AM materials to identify the deceased person. 
AM records, such as case history sheet containing dental chart, written notes, study casts, full mouth impressions, dental radiographs,  and high quality photographs, can be used in the positive identification of the deceased when compared with PM findings.  AM dental records are particularly helpful in mass disasters.  Radiographic records such as bitewing is helpful in identifying children without restoration.  People who often visit dentists and get restorative and prosthetic treatments are more likely to be identified by this method. Identification records such as identity cards, bank cards, driving licenses, and vehicle registration numbers that are usually found beside the body often help to temporarily identify the person. In other cases, missing person database helps to presume the identity of the person. Based on these, AM dental records are obtained and compared with PM records. 
The dentist then records dental characteristics of the teeth and the surrounding structures in the PM record. Radiographs are also obtained. PM radiographs should be obtained at similar angles as those of the available AM radiographs. This helps to simulate and compare radiographs. The features examined are erupted teeth, missing teeth, impacted teeth, tooth malposition, diastemata, contour of dental arch, occlusion, dental restorations and their contours, root canal treatment, supernumerary teeth, dental anomalies,  deciduous and retained teeth, crown-root morphologies and pathologies, patterns of jaw bones, pulp chamber-root canal morphologies and pathologies, periapical pathologies, periodontal tissues (gingiva, periodontal ligament, alveolar bone, and lamina dura) morphologies and pathologies; anatomical features of the maxillary sinus, the anterior nasal spine, the mandibular canal, the coronoid and condylar processes, and the temporomandibular joint; and the presence of any other pathologies, torus, and foreign substances such as wires, implants, plates, etc.  Dental anomalies documented in the dental record sheet will prove helpful in identification of the unidentifiable person. 
There may be discrepancies when both radiographs are compared. Explainable discrepancies relate to the time elapsed between the AM and the PM records. Examples include teeth extracted or restorations that have been placed or enlarged. Unexplainable discrepancies lead to exclusion. According to the American Board of Forensic Odontology, identification reports can be (a) positive identification- records that match with no discrepancies, (b) possible identification- AM and PM records that have consistent features but there is doubt in the quality of evidence, (c) insufficient evidence- without sufficient evidence to arrive at a conclusion, and (d) exclusion- records that clearly do not match. Generally a single tooth with unique consistent features is enough to establish an accurate identification, but sometimes even a full mouth radiograph may be insufficient. ,
| PM Dental Profiling|| |
This is done to restrict the population pool to which the deceased is likely to belong and thus, may help in locating AM dental records. It is done by the dentist when AM dental records are not available. Information on the deceased person's age,  ancestral background, sex, socioeconomic status, occupation, dietary habits, habitual behaviors, and dental/systemic conditions may be obtained by this method.  The determination of sex and ancestry can be interpreted from the skull shape and form. Tooth characteristics, such as cusps of Carabelli, shovel-shaped incisors, enamel pearls, and dental pulp shaped and multicusped premolars, can also assist in determining the ancestry. , Microscopic examination of teeth can confirm the sex by the presence or absence of Y chromatin. DNA analysis can also reveal the sex. The individual's chronological age can be determined by using dental structures. The age of children, including fetuses and neonates, can be determined by the analysis of tooth development and subsequent comparison with developmental charts. Third molar development may be used to calculate the approximate age of young adults.  In general, age estimation is based on the use of radiographs showing root and crown formations, closure of the apical foramen, calcification changes, and the eruption pattern.  Also, the age can be assessed noting the closure of cranial sutures, fontanelle, coronoid process, and condylar head.  In some edentulous old persons, the presence, morphology, and position of the third molar in the bone may be useful in identification. Assessment of pulpal volume using cone beam CT and x-ray microfocus CT can also be a guide in the age estimation of adults. The coronal pulp ratio is a useful indicator of the age assessment of unknown individuals.  Metallic components of prosthesis that are unique can also be used in such cases.  Periodontal disease progression, excessive wear, multiple restorations, extractions, bone pathosis, and complex restorative work may indicate an older individual. Other methods such as Scanning Electron Microscopy with Energy Dispersive X-Ray Analysis (SEM-EDXA) spectroscopy, the presence of erosion and unusual wear patterns in teeth, aspartic acid racemization, and translucency of the dentine are helpful in PM profiling. The quality, quantity, and presence or absence of dental treatment may indicate the socioeconomic status or likely country of residence of the person.  AM photographs showing the teeth often help in facial reconstruction and facial superimposition of skeletal and teeth characteristics, eventually aiding in positive identification.  If the PM profile does not elicit the tentative identity of the deceased, facial reproduction with the help of forensic artists is done.
Habits can have effects on teeth. For example, pipe smokers keep the pipe in the same location that causes unique wear patterns in the teeth. Also, smoking and drinking of tea and coffee can cause external stains. Excessive use of cold drinks may cause erosion. The occupation of a person may have effect on his dentition. The teeth of a person who works in an environment filled with dust, such as cement factories, show abrasion. So, documented information of the habits and occupation of the patient in the dental records may help in identifying the unknown person in association with other factors. 
Dental techniques that compare the AM and PM records or radiographs are frequently used in mass disasters and single identification cases.  AM and PM records remain one of the most reliable and frequently applied methods of identification. Nowadays, when digital radiography is becoming more common, a PM digital radiograph can be compared with an AM digital radiograph from dental records by measuring the length-to-width ratio of teeth and root central angle for positive identification, especially in mass disasters.  However, care should be taken to orient the true "left" and "right" of the digital radiograph before starting any procedure of comparison to eliminate subsequent errors and confusions. When conventional radiographs are digitized, care should be taken that the radiograph is not scanned in the reverse order.  It should be remembered that DVI follows a body numbering system consisting of the international country telephone code, site number, and body number for each unknown body. This number is visible on all related documents like radiographs, photographs, casts, etc. 
Other forensic odontology methods that may be of help in the identification of unknown persons where dental records include the following:
Labeled dental prosthesis, especially that containing chrome cobalt cast framework and acrylic removable dentures and dental implants, ,, orthodontic wires, cementum annulations for age estimation, enamel rod end patterns, dentinal translucency,  and patterns of palatal rugae on dental casts-palatal rugae in human beings are permanent and unique in each person and also helps in sex differentiation. ,, Mandibular canine index in the identification of sex,  DNA finger printing,  and extracting DNA (genomic and mitochondrial DNA) from the teeth material with the help of polymerase chain reaction (PCR) may also help in positive identification. Also, DNA extraction from saliva and oral mucosal cells are helpful. , The comparison of DNA preserved in and extracted from the teeth of an unidentified individual can be compared with the AM sample such as stored blood, hairbrush, clothing, cervical smear, biopsy, etc., or compared to a parent or sibling. , Bite marks are helpful in identifying or excluding a suspect involved in a crime. Dental pulp that is enclosed uniquely by the hard and resistant enamel, dentin, is a precious source for extracting DNA.  Dental pulp DNA can also help in sex determination.  Incorporating radiofrequency identification tag in dentures can aid in tracing and identification in forensic sciences.  ABO blood grouping antigens present in dental soft and hard tissues provide an opportunity to identify the unknown person by blood group typing. 
Tooth print invented by Dr. David Tesni is an arch shaped thermoplastic dental impression wafer, which records the individual's dental characteristics, teeth position, and occlusion. Another advantage is that DNA in the saliva is collected simultaneously by this method. Tooth print record is very helpful in the identification of a missing child, especially when taken at the age of 3 years and subsequently updated at the age of 7 years or 6 years and at the age of 12 years or 13 years.  Microchips with a code can be engraved into children's permanent teeth. The code can be visible on x-ray examination. Trident Systems Inc (TDS, USA). has a computer database of these codes and publishes the codes bimonthly in dental magazines whenever a child goes missing. So if the dentist takes an x-ray of the missing child, he/she can match the code with that of the codes published in the journal and help in the identification of the missing child. Also, the Interpol can be informed of these codes. 
| Conclusion|| |
Forensic dentistry plays a major role in the identification of those individuals who cannot be identified visually or by other means. A dental record should contain the name, age, sex, location, occupation, the number of teeth present, medical conditions, filled teeth, dentures and other restorations, and morphological variations of teeth and mucosa with photographs and radiographs, etc., These records can be compared with PM findings and other relevant factors that will ultimately help in identification of the person.  Dental records are highly important and significant in the positive identification of victims in mass disasters, such as earthquakes, flood, cyclones, epidemic diseases, drought, and railway and aviation accidents. It also helps to identify victims in wars and terrorist acts. So it is the social responsibility of every dentist to safely maintain the accurate dental record of every patient. Also, the appropriate protocol of the state should be applied while releasing these records. It is also important that every government establishes a central identification agency in its country to expedite the identification process.
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