Author describes experiences as a dental forensic team member
BY Kimberley Daly, RDH, BASDH
I have always been interested in gruesome things. Things such as automobile accident pictures, body deformities, and untreated diseases. Call it curiosity or call it twisted, but I find beauty in the macabre.
When I found out that dental hygienists could assist with dental autopsies, I decided to get my Bachelor's of Applied Science in Dental Hygiene degree from St. Petersburg College to go further in my profession. I wanted to complete my capstone course in dental forensics, so I contacted my local forensic odontologist who agreed to be my mentor. I went on two fascinating, but very different dental autopsies.
Missing woman in bathroom
For the first dental autopsy, I was warned that there was a very decomposed body and to be prepared for the smell. I arrived with my mentor (an ABFO board-certified dentist) alongside another dentist (who is currently working toward her boards), and we received a stack of papers that included antemortem dental radiographs and paperwork that disclosed the details of the scene where the body was found. The paperwork told us that the woman was found on the toilet in her bathroom; her family last heard from her about two months prior. She died sometime within that two-month time period. Even though investigators found her body in her home, they needed irrefutable, positive identification, which could not be done by viewing the body alone.
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After reviewing the paperwork, we suited up in protective gear, including a head-to-toe bodysuit, masks, double gloves with the first layer taped down at the wrists with duct tape, and eyewear. We entered the dental room where the body was already waiting for us in a black body bag. The smell hit me like a ton of bricks, and amazingly, my stomach contents stayed in my stomach; I'd been worried for days that it wouldn't. It was unlike anything I have ever smelled before; it had a strangely sweet smell.
After becoming accustomed to the smell, we needed to set up the room for the dental autopsy. My mentor explained to me that the longest part of the autopsy is setting up and breaking down the room, and that the actual autopsy part is fairly quick. The first thing we did was charge the batteries for the NOMAD (the portable, handheld X-ray system) while we set up the rest of the room. We put barriers on the NOMAD and the digital radiograph sensor. We also made a bleach and water solution that we would use later and gathered the necessary instruments for the autopsy, including a scalpel, loppers, and an old toothbrush.
We confirmed the case number from the paperwork to the tag on the body bag, which matched. We opened the bag; the body had an outer wrapping of cloth, the next layer was plastic, and next was the body. We exposed only the head area because that was the only part of the body from which we were collecting evidence, and to contain the smell. The first thing I noticed was how well preserved her skin appeared. The medical examiner said this was likely due to her air conditioning system being on, resulting in a drying effect on her skin. She also had long, beautiful, straight hair. My mentor took pictures of her teeth.
Now comes the fun part-the autopsy. Clear visuals of the teeth are needed for the radiographs. The dentist then had to separate the mandible from the mucosal tissues in order to remove the entire mandible from the skull. The dentist used a scalpel and made an incision from the commissure of the lip to the tragus of the ear, then from the TMJ along the vestibule, all along the mandible. This resulted in the mucobuccal fold being separated from the mandible.
Next they needed to separate the mandible from the skull. The dentist used the loppers, which basically look like large garden shears, to make a quick and hard chop at the ramus. The mandible was separated, and I was allowed to use the toothbrush and bleach/water solution to brush the teeth clean of debris. I was surprised by how quickly and nicely this solution worked. More photographs were taken and then we took radiographs using the NOMAD. With the guidance of my mentor, I held and placed the sensor and the other dentist aimed the NOMAD. My mentor was commanding at the computer, giving her the responsibility of letting us know if our radiographs were acceptable. We completed a full-mouth series of radiographs. We charted the postmortem information using WinID codes and software (you can obtain a free download of the WinID software for your practice from the American Board of Forensic Odontology website). I called out each tooth number in numerical order and related the condition, such as if it had a filling or a crown. My mentor confirmed the findings from the radiographs, and the other dentist wrote the codes down on paper.
We then compared our postmortem radiographs with the antemortem radiographs. There were enough unique restorations present to make a positive identification.
After making the positive dental identification, we put the tongue and mandible back in place and gently replaced the mucobuccal fold back into its proper position. We wrapped her back in the plastic wrap, then the blanket, and zipped up the body bag. My mentor filled out the paperwork confirming the body's identity and gave it to the investigator.
We disinfected the workspace and put everything back in its proper place. We escorted the body back to the cooler, where it will remain until her body is released to her family.
Skeleton underneath noose
The second autopsy was very different than the first. The investigator told us information about the scene where the body was found. Forensic odontologists are not always on scene during the recovery of the body, but it is important to have as much information as possible. The investigator explained that the body, now only a skeleton, was found in a wooded area near a canal, under a noose that was tied to a tree (an apparent suicide). After being led back to where we would conduct our dental autopsy and seeing the skull, my mentor recognized that the restorations were completed in a foreign country. The posterior teeth were all stainless steel crowns and bridgework (the anterior teeth were missing postmortem).
We took radiographs using the NOMAD and charted the teeth and restorations using WindID codes. My mentor studied the skull and was able to tell that this was likely an older, Asian male. Since the investigator did not know the identity of this person, we did not have any antemortem dental records with which to compare. The WinID program automatically translates its codes into NCIC database codes, making this process extremely simple. My mentor explained that NCIC coding is sent to a staff member whose job it is to input the information on the FBI website, where each morning, the FBI's NCIC computer program runs a comparison with missing persons (there are other databases that are used as well). It is now the responsibility of the police detectives to identify the deceased.
It is rewarding to be a part of this process and to help families by processing and identifying bodies so they can find peace and closure.
The lesson that I learned from my first autopsy (and one I learned the hard way) is to bring a change of clothes. It was a long and fetid ride home wearing the same clothes I wore during the autopsy. The smell clung to my scrubs like superglue, and the smell stayed in my nostrils for two days. It is fascinating how nonchalant I felt about seeing dead bodies. Maybe it was the cleanliness of the facility or the light-hearted demeanor of the clinicians. I don't know, but I didn't have an emotional breakdown like I imagined would have. It was a crazy experience, but I would do it again in a heartbeat ... with a fresh change of clothes! But in all seriousness, with the help of my mentor, I am able to appreciate the work that goes into identifying the deceased and the peace and closure a family receives from this work. I learned that a body can tell you a great deal about itself. It was rewarding to be a part of the process that relieves the worry of the unknown by giving a family peace of mind after a death. RDH
How to get involved in forensics
Dental hygienist involvement is limited, but there are still many ways to get involved in dental forensics.
• Contact your local medical examiner's office and forensic odontologists. Dental hygienists can volunteer their time to assist in collecting postmortem dental information.
• Join organizations such as the American Society of Forensic Odontology (asfo.org). Anyone with an interest in forensic odontology can join. ASFO holds an annual meeting with forensic seminars. Students receive a discounted membership rate.
• Subscribe to forensic magazines and journals. International Organisation for Forensic Odonto-Stomatology (iofos.eu) has current and archived journal articles available online. Forensicmag.com is a free subscription covering all aspects of forensics through its website and e-newsletters.
• Attend forensic courses. There are weeklong courses available at Southwest Forensic Science Symposium by the University of Texas, San Antonio. There are also shorter weekend courses available through dental schools and other organizations.
• Join mass disaster recovery organizations such as Disaster Mortuary Operational Response Teams (DMORT). Some states have their own response teams, such as Michigan Mortuary Response Team (mimort.org) and Florida Emergency Mortuary Operations Response System (femors.org).
• Connect with others with similar interests.
Interested in forensics but not the gore?
• Other duties within mass disasters for dental hygienists include computer work, records, and family assistance center.
• Age estimation
• Bite mark evidence
• Child abuse issues
• Antemortem charting. It is important to keep accurate and current dental records on all patients. Record unique anatomical findings.
Kimberley Daly, RDH, BASDH, practices clinical dental hygiene in a small, general dental practice. She graduated from Palm Beach State College in 2004 and earned bachelor's of applied science in dental hygiene degree at St. Petersburg College in May 2015. She is completing her capstone course in dental forensics. The author can be contacted at [email protected].