Hygienists help in forensics

Without a standing local identification team, matching dental records was a monumental task. The state of Connecticut took note of this tragedy and quickly formed the Dental Identification Response Team or DIRT for short. I was encouraged by my boss, Dr. Tom Brady, to become a member of the American Society of Forensic Odontology. Dr. Brady had many years of service as a police constable to add to our response team knowledge base. Each year, as members of one of the three teams (antemortem, postmortem, comparison), we continue our education in disaster preparedness.

The annual American Society of Forensic Odontology meeting is routinely held the third week in February and attracts dental professionals from around the world. During a course titled “Beyond IDs and Bitemarks,” I had the privilege to be seated next to the only forensic odontologist from the nation of Senegal.

This particular dentist, an army colonel, had made the trip for continuing education for the past five annual meetings. I noticed that several of his uniform insignias were against a purple velvet background. They reminded me of the purple velvet ribbon that graced my nursing cap from the Fones School of Dental Hygiene. I suppose some things dental are universal. During lunch I found myself sitting between a doctor who works hand-in-hand with the Canadian Mounted Police and a woman dentist from Korea.

While my focus was on community preparedness, there were other areas covered at the meeting as well. These specialties included preparation for court testimony in civil litigation, child or spousal abuse evidence and professional fraud.

The director of our state forensic team is on call 24/7 and works closely with the medical examiner. The initial response team is responsible for assessment, site evaluation and personnel planning. The substrata of individual teams are trained, but may or may not have experience in forensic dentistry. We are available on 48-hour notice. We need to be capable of augmenting or relieving the initial response team during mass disaster.

Training includes a familiarization of the WinID (www.winid.com) or standardized charting system used by the medical examiner’s office. It is not vastly different from those seen in any U.S. dental office. Most dental professionals catch on quickly. The software can be downloaded for home study. The Katrina response was the first time digital radiography was used by a U.S. identification team. A 12-pound, handheld radiation source, the Aribex Nomad, enabled easy access to victims. Its initial implementation by other teams was after the 2004 Indian Ocean tsunami. The manufacturer has responded to the needs of dental teams by making modifications. It has reduced the overall weight of the unit to five pounds and increased the battery life.

The American Dental Association is currently working on a common “language” to facilitate the translation of our routine Dentrix charting to the WinID system via a centralized computer base. There is federal mandate that all dental and medical records be computerized by 2017. This will greatly assist forensic teams in the future when comparison matches need to be made. Winnie Funari, a forensic dental hygienist who frequently lectures about her 9/11 experiences, was on the ADA committee charged with developing these important changes. She is immensely proud of the fact that 50 percent of the post-9/11 identification team members were dental hygienists.

Typically when dental remains are used in forensic identification via DNA, it is the molar that is used because of its large pulp. A noncarious molar is preferred to minimize compromised DNA. In a cataclysmic event, the molar is most likely protected by thick cheek tissues, thus less likely to have been damaged by extremes in temperature. The molar is the tooth class richest in DNA and the root body is the anatomical region with the highest concentration of DNA.

Standardization of dental charting greatly increases the likelihood that remains can be identified. Hygienists play a critical role in the documentation of a patient’s unique permanent oral characteristics. Meticulous record keeping and up-to-date quality radiographs are essential to assist law enforcement or disaster response teams. Beyond the charting of missing and existing dentition, dental hygienists need to document what makes each and every patient truly “different.” Is it their cusp of carabelli, rotated bicuspid, peg lateral or large tori? Is there an oddly positioned impaction, macrodontia or microdontia?

Hygienists can ease the burden of those working long hours, often in a difficult environment, by simply doing their day-to-day job well. Mass casualty situations are emotionally tiring and difficult times. Response teams should not have to waste precious hours trying to understand chart notations or searching for good radiographs. A decrease in the use of amalgam only augments the need for detailed patient records. Hygienists are ideally suited for assisting authorities with antemortem (predeceased) information on dentures, ortho appliances, or dental photographs.

All persons possess an identity during their lifetime, and the dignity of confirming and maintaining this identity after death is a strong compelling societal need. Hygienists, as compassionate health care workers, are ideally suited to play an integral role in forensic organization and record keeping. We are already trained, well-educated observers of the human condition.

Hygienists wishing to learn more about forensics can go to the following sites:

• American Society of Forensic Odontology (www.asfo.org): Continuing education credits; membership open to all dental professionals.
• American Board of Forensic Odontology (www.abso.org): Membership limited to dentists.
• Center for Education and Research in Forensics (www.utforensic.org): Weeklong training courses.
• Disaster Preparedness Response (www.ada.org/2390.aspx)
• National Disaster Medical System (www.phe.gov/preparedness/responders/ndms/Pages/default.aspx)

Note: This article was published in Hygiene Tribune U.S. Edition, Vol. 5, No. 4, May 2012. A complete list of references is available from the publisher.