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 persons 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):4538

This article has been peer reviewed.

I
nterest in forensic dentistry was relatively dormant the status of a persons 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

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Figure 1a: Antemortem radiograph. Figure 1b: Postmortem radiograph of the same person as in Fig. 1a.

either source to prevent the establishment of a positive ethical issue about the maintenance of patients privacy.
identification. Additionally, potential for insurance fraud is associated
3. 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, but the suspected identity of graphs.6 Whether dental records are preserved in written
the decedent cannot be ruled out. The identification is form or on a computer database, following the principles of
then deemed inconclusive. record management ensures that all dental information that
4. 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.3
databases.
Sometimes explainable discrepancies are present, such as Radiographic Examination
changes in restorations related to the passage of time, 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, or additional treatments by a second party fying remains (Figs. 1a and 1b). Observations such as
that were not registered in the antemortem record. In distinctive shapes of restoration, root canal treatment,
all these cases, the discrepancies can be explained and buried root tips, bases under restorations, tooth and root
identification can still be made. morphology, and sinus and jawbone patterns can be identi-
fied only by examination of radiographs. In some instances
Dental Record as a Legal Document a single tooth may be all that remains, and upon compari-
The dental record is a legal document owned by the son of radiographs, a positive identification can be made.
dentist, and contains subjective and objective information
Original antemortem dental radiographs are of immense
about the patient. Results of the physical examination of
value for comparison; 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. In addition, the results of clinical
be adequately fixed and washed so that they remain view-
laboratory tests, study casts, photographs and radiographs
able years later. The best results are obtained when the
become components of the record, and should be kept for
7 to 10 years. 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.1
erased, but corrected with a single line drawn through the Identification becomes a problem when few restorations
incorrect material. This method permits the original entry are available for antemortempostmortem comparison.
to remain readable and removes any questions about fraud- Today, fewer people have dental restorations because of the
ulent intent to alter recorded information. success of preventative intervention. However, at some
Computer-generated dental records are becoming more stages of the development of human dentition, digital dental
common for dental records. The obvious advantage of the radiographic superimposition (Figs. 2a and 2b) can be used
electronic record is that it can be easily networked and for identification, 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. However, in antemortem and postmortem records.7 When an ante-
the use of electronically managed dental records creates an mortem record is unavailable, the postmortem chart of the

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 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. postmortem radiograph with cut and paste commands. 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.
comparison with the available antemortem records of others.
Age Determination Based on Dental Data and smoke have been deposited on the teeth. Generally,
Age estimation is a subdiscipline of the forensic sciences teeth and restorations are resistant to heat, unless they are
and should be an important part of the identification exposed directly to flame. Preservation is possible in most
process, especially when information relating to the cases.4
deceased is unavailable.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 most common meth-
determination for younger persons. Human dentition ods of identification include visual identification, finger-
follows a reliable and predictable developmental sequence, printing, serologic and DNA comparison, and anthropo-
beginning about 4 months after conception and continuing logic examination of bone. Each method has its advantages
to the beginning of the third decade of life when develop- and disadvantages. They all rely on the principle that iden-
ment of all the permanent teeth is completed.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- physical examination of the decedent.3
alization. Such determinations are also based on the degree of Forensic anthropologists and forensic odontologists may
formation of root and crown structures, the stage of eruption, work together to resolve problems associated with identifi-
and the intermixture of primary and adult dentitions. cation. Both disciplines are concerned with the analysis of
calcified structures of the body, namely the bones and the
Mass Disaster Identification teeth. The bones and teeth of the craniofacial complex, key
Transport accidents form the majority of cases in which identification tools for the forensic odontologist, effectively
dental identifications are needed, particularly aircraft acci- distinguish one person from others and one population
dents in which both fire and trauma are often severe. Fires from another and are used to determine the race, age and
in and collapse of heavily occupied buildings are another sex of a person.1
source of multiple problems of identification. The forensic This anatomic material can be used for identification
odontologist is usually a member of the investigating team, when the skull and facial bones are used as a foundation for
the composition of which varies, depending on the nature the reconstruction of facial soft tissues. With the use of
of the disaster. Generally, the team includes a coordinator or standard anthropologic thickness measurements at specific
head of the team, a pathologist and various specialists with points on the face, soft-tissue thickness points can be
experience related to the particular type of disaster, in addi- connected with sculpting clay and the reconstructed
tion to the forensic odontologist.2 features can sometimes be digitized on a computer screen.
In a situation involving fire or severe trauma, physical Because computers permit the addition of components
features are often destroyed. Because teeth are heavily calci- directly to cranial features, computers have been useful
fied, they can resist fire as well as a great majority of trau- for techniques involving facial superimposition. The
mas. Dental examination is significantly confounded when underlying skeletal structures can thus be viewed below the
heat and flames have fragmented tooth enamel, and soot soft tissue, providing a means to check its accuracy. The

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Figure 3a: Prosthetic teeth were custom fitted into the sockets. Figure 3b: A sketch of the decedent was completed before the
Figures 3a to 3c reprinted with permission from Wood and others.10 computer-aided reconstruction.

than impact injuries, producing lacerations of the skin and

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

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 Forensic Odontology: The Roles and Responsibilities of the Dentist

in the field of forensic odontology. 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, casework and graduate teaching.
Another excellent source of postgraduate forensic dental
training is the Armed Forces Institute of Pathology of
Washington, DC, which offers an annual week-long
program. The American Academy of Forensic Sciences
established the American Board of Forensic Odontology in
1976 and began certifying qualified dentists in the field of
forensic odontology.
Conclusion
Each practitioner has a responsibility to understand the
Figure 4: Bite mark inflicted on the right arm. forensic implications associated with the practice of his or
her profession. 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. They often appear in various stages of resolution.5,17 and legally acceptable records, and assist legal authorities in
Reporting an instance of human abuse to the proper the identification of victims and suspects. C
authorities is mandatory in most jurisdictions. 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. If oral injury is his recommendations and photographs.
involved, the dentist should maintain complete and precise
records of the findings for scrutiny by legal authorities. Dr. 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, Quebec City,
Quebec.
of the record. Photographs of the injury or injuries are often
helpful to document injuries. Although child abuse or
Correspondence to: Dr. Sylvie Louise Avon, Faculty of Dentistry,
abuse inflicted on people of any other age is not a frequent Laval University, Cit universitaire, Ste-Foy, QC G1K 7P4.
area of concern to the dentist, as a provider of primary E-mail: [email protected].
health care he or she is required by law to report such The views expressed are those of the author and do not necessarily
reflect the opinion or official policies of the Canadian Dental
instances to the proper authorities.1 Unfortunately, the Association.
incidence of dentists reports is low. Major reasons preventing
dental professionals from getting involved in cases of abuse
include ignorance about maltreatment, lack of awareness of References
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