Sorting through a disaster

March 1, 1998
We see it in the newspaper: "Airline crash kills 137." We hear it on the radio: "A badly decomposed body was discovered today in a remote area. . . ." We see it on the evening news: "Medical examiners were at work today to discover the identity of a homicide victim in the city ..." It always gets our attention; we feel concern for the victims and the families of those involved. But most of us don`t continue to think about it as we get busy with our own lives, unless we have the job of helping i

Hygienists on forensisic teams help identify victims, bringing closure to a mass tragedy.

Cathleen Terhune Alty, RDH

We see it in the newspaper: "Airline crash kills 137." We hear it on the radio: "A badly decomposed body was discovered today in a remote area. . . ." We see it on the evening news: "Medical examiners were at work today to discover the identity of a homicide victim in the city ..." It always gets our attention; we feel concern for the victims and the families of those involved. But most of us don`t continue to think about it as we get busy with our own lives, unless we have the job of helping identify the victims.

Dr. Allan Warnick, a dentist who practices in Livonia, Mich., has such a job. In addition to his private practice, he serves as the chief forensic odontologist in the medical examiners` offices of Wayne and Oakland counties and is the team leader for the Michigan Dental Association`s forensic dental identification team. He is a diplomate of the American Board of Forensic Odontology, a member of the American Society of Forensic Odontology and the American Academy of Forensic Sciences. When mass disaster strikes the Midwest or a body is found in the Detroit area, Dr. Warnick and his team may be called in to help identify victims.

Precise identification of victims is important for many reasons. "You need positive identification of a victim for a death certificate," says Dr. Warnick. "Insurance companies won`t pay unless the body is incontestably identified. And, psychologically, it is a closure for the family. Family members can know absolutely that this is their son, daughter, spouse, etc. This really is why we do this work."

Dental identification is the usual procedure when identifying bodies or body parts. "There are not many people with fingerprints on file," says Dr. Warnick, "But most people have been to the dentist. When a disaster strikes, a high percentage of the victims will be identified through their dental records. Of the last five mass disasters in this country, I`d say that at least 65 percent of the identifications were made using dental records. If it`s a plane crash on a hard surface, dental ID is the main thing. In the case of a water disaster, teeth don`t float, they sink. Then, DNA testing is used." Although very accurate, DNA testing takes longer and is more expensive than dental identification.

Dr. Warnick has been instrumental in creating mass-disaster planning for dental forensic teams around the country. He literally has written the book on the subject and has set up dental ID teams in many U.S. locations. "These teams put dentistry in a good light," he says. "The teams are set up and are prepared to react when disaster strikes."

Once a mass disaster happens, dental teams can be summoned quickly. Dr. Warnick is the first to be alerted that a disaster has happened in his area. He then calls the members of the state`s forensic team. He has 85 dentists in Michigan and another 20 members who are hygienists or other auxiliaries on the statewide forensic dental ID team. All have been specially trained. Twelve of these people are the "go" team. "These team members are all volunteers," he says. "The `go` team members are all dentists who work with medical examiners within the state and are very experienced. I can know in five minutes who will be alerted anywhere in the state. It`s very easy for me, as team leader, because it`s never hard to get anyone to come out. It`s a real commitment on their part."

The support team that arrives at the site has various duties. "Some of our support-team members do not want to be with the bodies at all," Dr. Warnick explains. "So they sort through the dental records and make sure everything is updated and put into the computer. I think the one area where dental hygienists are the most helpful is in radiography. Most dental hygienists who take the X-rays for us do a better job than the dentists do because they work at it every day. Developing the X-rays, helping with computers and reviewing records are important support-team jobs. Dental hygienists do not work with the bodies by themselves. Instead, they are part of a three-member team that examines a body and records observations."

Unfortunately, if a dental hygienist really enjoys forensic work, she can`t take the interest very far without returning to school for a dental or medical degree. Explains Dr. Warnick: "It is frustrating for hygienists because everything says you have to have a DDS or MD behind your name. Individuals who want to do something in the field can go only so far. And our group is very small. I have dentists calling me from all over the country who have been taking forensic courses and are frustrated because there are so many others ahead of them who want to do this work. And dental hygienists are behind all of these people."

Even if the idea of serving on a forensic dental team isn`t for you, there are ways you can support the work of a team. The need for thorough dental records is critical.

"When an air disaster happens, the airlines provide us with a list of who was on the plane," says Dr. Warnick. "We then contact family members and find out who their dentist is so records can be obtained. We prefer original records to copies. When a written record is copied, we sometimes lose information at the edge of the paper. Sometimes, X-rays aren`t marked right and left, or come out less than perfect."

Dr. Warnick says that most of the records he sees today are better than in the past. "Young people coming out of dental school today keep better records, probably due to increased litigation."

Not all of the identification jobs Dr. Warnick performs involve victims of mass disasters; sometimes it`s identifying a body or skeleton that has been found. He says that he`s called into such situations 40 to 70 times a year.

Dr. Warnick is called to do the work when an individual cannot be identified visually. If it`s an intact body and they can`t ID fingerprints, he`s asked to do a work-up. The medical examiner employs investigators who track down leads as to the person`s identity. Then Dr. Warnick examines the body and compares the dental records of possible victims until he gets a match. "When we ID someone dentally, we are 101 percent sure of who it is. There is no question."

Bite-mark identification is an area that is being investigated in forensic science. "Bite-mark identification is very subjective," says Dr. Warnick. "We usually can agree on whether it is a human bite or an animal bite. But which human is the problem. If we can get some saliva from the bite mark, we sometimes can ID it with DNA. Often, in abuse cases, for instance, the bite wound has been washed and all the evidence has disappeared."

How does he sleep at night after seeing a mass disaster up close? "Fine. I find the work challenging. I have a great interest in forensics. The only thing that bothers me is when I work with kids who are victims. You come away from it changed a little bit. Not everybody is crazy enough to do this work or is suited for it. It is a real team effort. I know it sounds trite, but the small things you worry about just don`t seem so important. It really puts your life into perspective."

Dental hygienists who want to get involved in forensic science may want to look before they leap. At least that`s the opinion of Linda Parker, a dental hygienist in California. She discovered that she had an interest in forensics in 1980 when she worked at the site of a hotel fire.

A few years later, she began to work for a dentist who was the chief odontologist in the area. Her experience was mixed. "I helped my employer with his cases for about seven years. It was fascinating work. I did it to help other people. If you have lost or are missing loved ones, you want to be able to find them and know if they`re dead or alive. You need that closure. It would tear me up if I were in this situation and I didn`t know what happened."

The problem was that, as a dental hygienist, Parker had no authority. OI would take the X-rays, chart and do the work, and he would sign off on it.O She was frustrated that her work in forensics wasn?t taking her anywhere. She left the dental practice and now is involved in aviation with a flying Samaritan group. Her advice to other dental hygienists who may seriously be considering forensics: be aware that you will have limited authority and probably will not be paid for any of the work you do.

Cathleen Alty is a consulting editor for RDH

Where to get more information about forensic odontology

1. The American Dental Association, Council on Dental Practice, sponsors programs about dental mass-disaster identification. Call or write the ADA for information.

2. The American Society of Forensic Odontology is an organization that encourages interest in forensic odontology for those who don`t have credentials to join the American Academy of Forensic Sciences. Contact: Susan K. Rivera, DDS, 11 Tiffany Place, Saratoga Springs, NY 12866.

3. Contact: Ms. Amy Fensom, The Michigan Dental Association-Forensic Dental Identification Team, (617) 372-9070, ext. 423.