Positive ID

Figure 2: Maxillary torus postmortem. Photo credit, Greg Golden, DDS, DABFO

The evidence is that hygienists have a home in forensic odontology

by Amber D. Riley-Burns, RDH, BA

I have the privilege of supporting my local county law enforcement jurisdictions in Southern California in forensic dental identifications. I also have the honor of serving the United States as a dental team member of DMORT – the Disaster Mortuary Operational Response Team of the U.S. Department of Health and Human Services' National Disaster Medical System.

Much of the care I give to my patients, living or dead, is the same. On a regular basis, I take meticulous intraoral and extraoral radiographs, documenting with photographs any unique findings such as tori (permanent bony structures within a person's mouth), microdonts, peg laterals, the 180 degree rotated premolar, the well-developed lingual cusp on an anterior tooth, or the unusual anatomy of a posterior tooth (see Figures 1-5).

Figure 1: Maxillary torus antemortem. Photo credit, Riley-Burns

These things are unique to each person and are not common to the population. These are the small findings we in the postmortem setting look for to support and confirm positive human identification. Our conclusions based upon dental records must be within the highest degree of medical/dental certainty.

The system only works when these findings are documented in life. They are meaningless to me in the morgue if I cannot support their presence before death. Needless to say, working on the postmortem side of dentistry makes me a much more conscientious record keeper, radiographer, and photographer, because I never know if the records I've created for my patients will someday be needed to confirm their identities.

Forensic odontology is a part of your professional environment every clinical day. Your receptionist, office manager, dentist, assistant, and YOU the hygienist perform it every time you seat a patient in the chair. Your office's collaborative teamwork, from the time your patient is scheduled for an appointment to the time the patient checks out, is the antemortem portion of forensic odontology. It is the most critical factor in accurate, scientifically supported, and efficient positive identification of an unknown person.

If you are fortunate enough to be practicing in a digitized office, be proud of the flawless radiographs you create. Even though we try every time for a perfect shot, we all make mistakes. Sometimes, we cone-cut or distort an image. With digital technology it takes only seconds to correct a flawed image. Since the radiation exposure is minimal for patients, it is the standard of care to accept nothing less than perfectly diagnostic radiographs. If the image isn't diagnostic for disease, it isn't useful for identification either.

Figure 3: Mandibular tori postmortem. Photo credit, Rick Cardoza, DDS, DABFO

In the event that your patient's record is requested by law enforcement to develop a missing person report, you need to act immediately. Make copies of the entire chart, including all radiographs and photographs. Give the complete original chart to law enforcement, and if you have models or scans from collaborating treatment providers, include those as well. Every single bit of data that you can provide to law enforcement will ensure the most accurate information is uploaded into the National Crime Information Center in the hope that the case will be resolved quickly.

Figure 4: Mandibular tori postmortem. Photo credit, Greg Golden, DDS, DABFO

The next of kin, parent, or legal guardian of the missing will have signed an authorization to release medical records at the time the case was initiated, and this form will be supplied to your office for the record. If this form is not given to you, it is important to note that Sections 45 CFR 164.512(f) and 45 CFR 164.512 (g) of HIPAA provide exemptions for law enforcement, medical examiners, and coroners when the individual is or is suspected to be the victim of a crime.

In February 2011, I was elected to the Board of Governors of the American Society of Forensic Odontology (ASFO), an organization I joined in 2006 after completing a weeklong course in forensic dental identification given by the Armed Forces Institute of Pathology. Prior to that I had taken introductory courses that prepared me enough to know that forensics was something I wanted to do.

The ASFO is an all-inclusive professional society. Our membership includes dentists, hygienists, and assistants, but also many members from supporting forensic science fields that have an interest in forensic odontology. So when I'm speaking to a group of hygienists or dentists, or when participating in my local meetings and I'm asked, "Where do I start?" I always recommend the ASFO. From there you will gain access to online CE credits, and information about upcoming courses in forensic odontology and related technologies. You will also be connected with the rest of the membership so you can find others in your area who participate in this field.

Attending the ASFO meeting each February, which coincides with the American Academy of Forensic Science's Annual Session, is a tremendous way to network with other professionals. The 2012 annual meeting will be in Atlanta on Feb. 21, 2012, and you do not have to be a member to attend. Go to http://www.asfo.org to learn more about the meeting and the ASFO or to join. Students are welcome and may join at a reduced rate. If you are interested in using your skills in forensic odontology at the national level, I encourage you to look into the National Disaster Medical System and DMORTs at http://www.phe.gov/ndms.

Figure 5: Well-developed buccal cusp of No. 2. Photo credit, Riley-Burns

Forensic odontology has brought such a rewarding addition to my private professional career. It is a unique way to serve my community and nation in an important and sensitive way. It was an initial interest in the topic that truly evolved into a calling for me. When I began my journey into forensic odontology in 2001, I have enjoyed every moment that I have participated in the field. I would encourage any hygienist that is interested in this field to do it! There is a place for you and you do have an important contribution to give to forensics. Get involved at any level you can and grow from there. "Grow where you are planted" truly exemplifies my story. Although my roots have been moved around a bit over the years, I still grow as a hygienist and professional within forensics, and welcome the opportunity to serve the public in this unique way.

Amber Dawn Riley-Burns, RDH, BA, works in private practice with the office of Cary Brown, DDS, in Murrieta, Calif. She is forensic dental consultant and forensic dental autopsy assistant for San Diego County, Calif., and the California Dental Identification Team (Cal-DIT). In addition to DMORT, she consults for worldwide disaster management and identification with Kenyon International. She is an associate member of the American Academy of Forensic Sciences and volunteers her training to translate dental records of the missing and unidentified into NCIC code for nationwide case management. Contact her at [email protected].