As dental hygienists, much of our work revolves around biofilm management, disease prevention, and patient education. But occasionally, the records we create take on a purpose far beyond the operatory and serve as critical evidence in forensic investigations.
Recently, I experienced firsthand the gravity of this responsibility. Our office received a call from the local coroner’s office requesting dental records to assist in identifying human remains. These calls are often a result of mass disasters, criminal investigations, and unidentified persons. While this may feel outside our traditional scope of practice, the foundation of forensic odontology relies heavily upon the very records that we as hygienists create every day: clinical and periodontal charting, intraoral and extraoral radiographs, photographic images, and detailed clinical notes.
Forensic dentistry, or forensic odontology, is grounded in the principles that dental structures are highly durable and unique to each person. Enamel, the hardest substance in the human body, can withstand extreme conditions such as fire, decomposition, and trauma.1 As a result, dentition is a reliable means of identification when other methods such as fingerprinting and visual recognition are not possible. This durability makes the oral cavity a biological “black box” preserving identifying information that can survive environments where DNA and skin are lost.2
Understanding the process of dental identification reinforces the important reality that every record created in practice isn’t just for insurance or our records but has potential long -term forensic value. Identification typically follows a systemic process of comparison between antemortem (AM) and postmortem (PM) findings.
The process begins with the creation of a comprehensive postmortem dental record. This is similar to what we do clinically. The oral cavity is examined and documented in detail—missing teeth, restorations, prosthetics, and unique anatomical features. According to the Manual of Forensic Odontology, 5th edition, dental identification relies on the systematic recording and comparison of all oral findings, emphasizing that minor details can be critical in establishing identity.3
After charting, radiographs are taken, which are often the most reliable component of the entire process. They provide objective, reproducible evidence of anatomical structures. A PM bitewing can be superimposed over an AM radiograph to match trabecular bone patterns, sinus outlines, or precise contours of a distal- occlusal composite.4 This is where a slightly distorted bitewing in clinical practice could cause a missed match. Ensure proper angulation, minimal distortion, and complete anatomical capture.
Intraoral and extraoral photographs also provide visual confirmation of features described in charts and notes. Study models and digital scans capture a 3D relationship of teeth and occlusion, making them valuable forensic records. In addition, the pulp chamber may preserve DNA, providing an additional method of confirmation when combined with dental record comparison. This is helpful if the crown is shattered.5
Once all findings are evaluated, conclusions are categorized as: positive identification, possible identification, insufficient evidence, or exclusion. A positive identification requires multiple points of concordance and must meet scientific and legal thresholds. These findings are then compiled and used in legal proceedings, death certification, or disaster victim identification efforts.
It is important to note that there is no universal dental database. Identification typically depends on comparing postmortem findings to existing dental records from private practices, clinics, or insurance documentation. In most cases, forensic teams are confirming a suspected identity, not searching without direction.6
When transitioning your records from standard documentation to forensic -ready, consider these practical takeaways. Create detailed restorative mapping by not just documenting an MO, but including material used (composite, amalgam, ceramic) and any unique contouring or overhanging margins. Record meticulous periodontal findings such as recession, furcation involvement, probing depths, or bone loss patterns. These are especially valuable and fall directly within the hygienist’s expertise. These patterns can be just as helpful in identification as restorations.
Radiographs should be high quality, properly angulated, and clearly dated. Clinical notes should describe unique features such as attrition, rotations, diastemas, or occlusal wear patterns.1 These are the details that ultimately determine one individual from another.
If you find yourself fascinated by the investigative side of dentistry, opportunities for the hygienists are expanding in forensic dentistry. You can go beyond being a record provider to become an active participant. Dental hygienists can work with disaster victim identification teams by assisting in charting and radiographic evidence during mass casualty events. They can collaborate with dental boards or legal teams to evaluate accuracy and completeness of dental records for legal proceedings. Continuing education and involvement with organizations such as the American Society of Forensic Odontology can provide pathways into this field.
We often hear that hygienists are prevention specialists. That is true, but we are also meticulous record keepers of biological identity, observers of anatomical uniqueness, and contributors to legal and forensic systems. Forensic dentistry doesn’t ask you to learn something new. It asks you to realize the weight of what you already do.
When the call comes, will your records be ready?
References:
1. Pretty, I. A., & Sweet, D. (2001). A look at forensic dentistry- Part 1: The role of teeth in determination of human identity. British Dental Journal, 2001;190 (7), 359-366. https://doi.org/1038/sj.bdj.4800972
2. Vlasiadis, K., & Koutsamani, M. (2023). Forensic dentistry - The role of the dentist in human identification. Clin Med Health Res J. https://doi.org/10.18535/cmhrj.v3i4.200
3. Stimson PG, Mertz CA, editors. Manual of Forensic Odontology. 5th ed. CRC Press; 2013.
Mishra G, Singh A. Forensic odontology. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK540984/
