Berks County Medical Society Medical Record Spring 2020 - 28

M e d i c a l R ec o r d F e a t u r e

FORENSIC ODONTOLOGY:

Overview and Significance
by Tammy Balatgek, DDS, MS

A

ll humans have an identity in life.
Family members, compassionate
societies, religious beliefs, legalities,
investigations, and financial situations
demand this identity be recognized after
death. When visual identification is not
an option, several primary methods to
identify the deceased which are scientifically
trustworthy include fingerprint comparison
(dactyloscopy), comparative dental analysis,
and DNA analysis.1
Forensic odontology is an area of
dentistry focused on comparative dental
analysis for identification of unidentified
remains and for helping to solve crimes.
Dentists may also be asked by investigators
to assist with cases of missing and
unidentified persons by releasing dental
records to be uploaded to a database for
potential matching of information. There
are currently several databases used by
law enforcement including the Federal
Bureau of Investigation's (FBI) National
Crime Information Center (NCIC) and
the National Institute of Justice's (NIJ)
National Missing and Unidentified Persons
System (NamUS) to solve identities using
dental and non-dental information.2
Teeth and dental structures represent the
hardest and most resilient tissues in the body
and are therefore durable after a person's
death, making them extremely useful for
identification purposes. In cases of burned,
mutilated, decomposed or skeletal bodies
where visual identification or obtaining
post-mortem fingerprints is not viable, a
forensic dentist with ante-mortem dental
records may be able to offer an identity in
an accurate, timely and economical fashion
when compared to DNA analysis.
Comparative dental identification
involves charting tooth restorations
and missing teeth, taking radiographs,
photographs, and occasionally molds of the
teeth on the deceased and then comparing
that information to the ante-mortem dental
record. The odontologist will make a
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determination of a positive ID if the anteand post-mortem dental features match, or
if there are explainable discrepancies that
exist due to the progression of dental work,
and an exclusion if the dental features are
not possible such as a post-mortem victim
having a tooth present that is missing on the
ante-mortem record.2
Dental identification plays a large role in
mass disasters which may include: natural
phenomena such as floods, hurricanes,
tsunamis, earthquakes, epidemics and
pandemics; accidents such as transportation
mishaps, chemical spills, fires, explosions,
and radiation accidents; acts of terrorism
and armed conflicts. Identification in these
situations is challenging due to several
factors. Regarding the victims, there can be
high numbers, mutilated and fragmented
bodies, commingling of bodies, and missing
or completely destroyed bodies. Regarding
the teams made up of law enforcement,
first responders, forensic anthropologists,
physicians, nurses, pharmacists, coroner
or medical examiner personnel, radiology
teams, and forensic odontologists, they face
challenges of working in temporary morgue
locations with non-ideal conditions for long
hours, stress, inexperience, time pressures,
lack of ante-mortem information, legal,
jurisdictional, organizational and political
issues, internal and external documentation
and communication issues. Most disasters
require utilizing all accepted methods
of identification - fingerprinting, dental
comparison, and DNA typing. To aid in
the identifications, computer assisted patient
identification programs, such as Computer
Assisted Post Mortem Identification
(CAPMI), DVI System International, and
Win ID3 to name a few, are used to compare
ante-mortem and post-mortem records
and create a "best match" according to the
number of matching features.3
Other areas of forensic dentistry helpful
to the legal community include bite mark
analysis and age estimation. Bite mark

analysis includes comparison of bite marks
on the victim to the dentition of the
perpetrator via photographs, measurements,
and dental molds. Bite mark analyses
are extremely useful and powerful in
excluding certain suspects, protecting the
innocent, and ensuring justice is done. Age
estimation can assist in determining the
age of a decedent, illegal immigrant, and
criminal offenders who may lie about their
age for lesser punishment. Age estimation
methods include analysis of radiographs of
the developmental stage or pulp size of the
subject's teeth.2
Forensic dentists have a source of
valuable data that can be helpful during
death investigations and crime situations.
By examining, recording, and comparing
dental characteristics of bodies, it is possible
for the odontologist to satisfy a basic societal
need of corpse and victim identity.
Dr. Tammy Balatgek is the owner
and practicing dentist of Center
for TMJ & Sleep Disorders, LLC.
She is currently the appointed
Forensic Dentist through County
of Berks Coroner system and
Tower Health. Dr. Balatgek
has taken multiple continuing
education courses and a one year Master's level
class through McGill University on Forensic
Dentistry. She is also certified through the FBI
as a coder and interpreter of dental records for
missing and unidentified cases. She may be
contacted via: drtammy@tmjsleepcenter.com.
Bibliography
1. Gaglietti, N.M. and R.H.A. Silva, Primary
Identification Methods and their Effectiveness in Mass
Disaster Situations: A Literature Review. Arab Journal of
Forensic Sciences & Forensic Medicine (AJFSFM); Vol 1,
No 5 (2017), 2017.
2. Metcalf, R.D. and J. Klim-Lemann, Overview of
Forensic Odontology. J Calif Dent Assoc, 2015. 43(6): p.
295-301.
3. Brannon, R.B. and H.P. Kessler, Problems in massdisaster dental identification: a retrospective review. J
Forensic Sci, 1999. 44(1): p. 123-7.


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Berks County Medical Society Medical Record Spring 2020

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