I took a continuing education course years ago that has stayed with me in a way that few others have. It wasn’t just the content; it was the realization that what we do every day in clinical practice can reach far beyond the operatory. The course was taught by Dr. Edward Pavlik, a respected voice in forensic dentistry. He didn’t just lecture; he told stories with real cases, real people, and real identifications. He connected the dots between the radiographs we take, the charting we complete, and the role those records can play when traditional identification methods are not possible. 

While most of us are walking into hygiene checks and preventive appointments, some dental professionals are being called into situations where their expertise helps return a name to someone lost. In those moments, they rely on something we create every single day: dental records. 

What is forensic dentistry?

Forensic dentistry, or forensic odontology, is the application of dental science in legal investigations, most commonly for human identification. Teeth are among the most durable structures in the body, often surviving conditions such as fire, trauma, and decomposition.¹ When fingerprints are not available and DNA is compromised or delayed, dental records frequently provide the most immediate and reliable means of identification. 

Dr. Pavlik’s most notable case was the investigation surrounding John Wayne Gacy. It is a case that reshaped how the forensic community understood the necessity of dental documentation.

When remains were recovered from Gacy’s property in the late 1970s, many were unrecognizable. Decomposition, time, and the conditions of recovery had eliminated nearly every other avenue of identification. With 33 victims, it remainsthe largest mass murder case in American history. Investigators turned to dental records for answers. Antemortem charts, radiographs, and restorative documentation were compared against postmortem findings one by one. In case after case, it was the dental record—and only the dental record—that provided a confirmed identity.² 

Dr. Pavlik also led the dental identification team for American Airlines flight 191, where 273 people lost their lives. These mass fatality events where the number of victims, the condition of remains, and the urgency of identification converge into something almost incomprehensible are the situations that push forensic dentistry to its outer limits. 

Why dental identification matters

In these scenarios, dental identification becomes a cornerstone of the disaster victim identification (DVI) process. Interpol’s DVI protocols—the international standard for multicasualty response—establish dental comparison as a primary identification method, alongside fingerprints and DNA.³ Postmortem teams document recovered dental structures. Antemortem teams gather records from dental offices. Comparison teams match the two. The process is methodical, but its success depends entirely on what those antemortem records contain. 

The British Dental Journal noted that comparative dental identification is one of the most reliable and efficient methods available when quality records exist.⁴ That phrase “when quality records exist” carries the full weight of what forensic dentistry requires of us. 

In mass casualty events, dental hygienists have also served onsite as part of organized response teams. Through the Disaster Mortuary Operational Response Teams (DMORT), trained dental professionals, including hygienists, assist in postmortem charting, radiographic documentation, and record comparison.³ The skills we use every day in the operatory translate directly to the field. 

How dental records identified 9/11 victims

No event has tested forensic dentistry on a larger or more demanding stage than the attacks of September 11, 2001. Remains were fragmented, commingled, and subjected to forces that destroyed nearly every conventional means of identification. Visual recognition was impossible. Fingerprints were largely unavailable. DNA analysis, while ultimately critical, required time and intact biological material that was not always present.⁵ 

Dental records stepped into that gap. At the New York City Office of the chief medical examiner, more than 140 dentists ultimately volunteered in the effort.⁶ Dental hygienists were part of that effort too. Winnie Furnari, MS, RDH, a member of the New York City Dental Identification Team, documented the contributions of hygienists who served in the response, some for a shift or two, others for hundreds of hours over weeks and months.⁷ Their clinical skills of charting, radiographic technique, and documentation were not peripheral. They were essential. 

Tooth enamel is the hardest substance produced by the human body. It survived the collapse of the towers when nearly nothing else did.⁵ The details captured during ordinary clinical appointments by hygienists became the evidence that returned names of the lost. Approximately 40% of those missing from the World Trade Center site remained unidentified.5 The identification effort has never fully closed.  

Dr. Pavlik said that quality of the antemortem record determines what is possible—not the skill of the forensic examiner, nor the technology available at the time of identification. Clarity and completeness of the record and documentation is what matters. 

This idea lands differently when you’ve just spent 30 years in the operatory rushing through charting when running behind, or skipping an x-ray on a squirmy patient, or simply writing “generalized recession.” Dr. Pavlik told us that even the smallest detail—a rotated tooth, a distinctive restoration contour, an unusual pattern of recession—could become the defining feature in an identification.²  

It is worth remembering that dental records are legal documents. They must be accurate, legible, and maintained with integrity. As the clinicians who often hold the most current and detailed record in a patient’s file, hygienists carry a share of that responsibility in every appointment. 

Dr. Pavlik was on his way to an identification the day I called him. Somewhere, a forensic team was about to open a case file. Somewhere, a family was waiting. And somewhere in a dental office, possibly one not so different from yours, arecord created during a routine appointment was about to matter in a way no one had anticipated. 

As hygienists, we are not removed from that world. We are foundational to it. The next time you pick up your explorer, your probe, or your sensor, remember this: your documentation has a voice, and one day, it may be the one that matters most. 

Editor's note: This article appeared in the October 2026 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References 

1. American Academy of Forensic Sciences. Forensic odontology: Role in human identification. 2023. https://www.aafs.org/forensic-odontology. Accessed 2025. 

2. Pavlik E. Forensic dentistry and the importance of dental records in identification [continuing education course materials]. 

3. INTERPOL. Disaster Victim Identification Guide. 2nd ed. INTERPOL; 2018. https://www.interpol.int/How-we-work/Forensics/Disaster-Victim-Identification-DVI. 

4. Pretty IA, Sweet D. A look at forensic dentistry—part 1: the role of teeth in the determination of human identity. Br Dent J. 2001;190(7):359–366. doi:10.1038/sj.bdj.4800943 

5. Inside the lab working to identify the remains of 9/11 victims. NPR. September 11, 2025. https://www.npr.org/2025/09/11/nx-s1-5526859/september-11-nyc-victims-identifying-lab-dna 

6. Berry J, Luz C, Furlong A, Palmer C. Forensic dentistry: Identifying the victims of 9/11. Oral Health Group. December 1, 2001. https://www.oralhealthgroup.com/features/forensic-dentistry-identifying-the-victims-of-9-11/ 

7. Furnari W. 9/11—Dental hygienists contributed to identification efforts. RDH Magazine. September 8, 2023. https://www.rdhmag.com/pathology/article/14207784/9-11dental-hygienists-contributed-to-identification-efforts.