DENTAL POSTMORTEM EXAMINATION
The postmortem examination team you may be on is responsible for examining and charting the dental remains to include the presence or absence of teeth, restorations, pathology, and any other feature that might be useful in the ID process. The process starts with gentle cleaning of the dental remains with a tooth brush using sodium hypochlorite (bleach) and hydrogen peroxide. Remember that incinerated (burnt) teeth are brittle and will shatter if not handled carefully. Next, a team process including either a team of three dentists or a team of two dentists and a dental hygienist or a Dental Technician, chart all dental evidence on a postmortem dental record form.
The entire dental team must agree to be consistent in charting methods. This is a slow process and much attention must be paid to details. Remember to check and double check each step. The team will decide which charting system they will use. Other dental abbreviations used for charting., The use of a fiberoptic light is invaluable in the examination process. The examiner begins by evaluating tooth #1 and associated radiographs. The second dentist on the examination team evaluates tooth #1 and confirms the findings of the first dentist. The recorder charts the findings of tooth #1 and all three members confirm the charting. Tooth #2 is examined and the process is repeated until all 32 teeth have been charted. The approach is redundant, but errors are corrected as they are made. Charting should be done in pen, not pencil. Findings to be recorded during the postmortem examination are as follows:
Pathology Unique anatomy
References to possible gender and racial group
Teeth missing because of the trauma of the mishap should be specifically noted to avoid confusion over extracted or congenitally missing teeth. A prostho- dontist should be available to examine and describe dental prosthetic appliances. In some cases, the appliance may have been specifically marked for identification . It is wise to solicit from the victim’s family study models or extra prosthetic appliances that may be available. Such evidence is important in providing antemortem data regarding ridge shape/size, rugae, and general oral anatomy. The antemortem dental record will be covered next.
Since the dental tissues are the most resistant tissues of the human body their characteristics can last unchanged even after a long period of staying under water, being buried or in spite of putrefaction and unsuitable environmental conditions, and therefore they are more suitable for identification purposes than other tissue parts. And the uniqueness of dental structures enhance their value in identification studies.
The importance of dental identification has increased within the last years due to their successful applications in victim identification studies.
Dental identification is based on the comparison of postmortem data such as autopsy findings of the deceased and radiographic and photographic records of postmortem remains with antemortem dental records and radiographies. Radiographies showing dental restorations, borders of bones and other anatomical tissues, fillings and root fillings and dental records provided from the family or the dentist are compared with postmortem evidence and radiographies. In the case where antemortem and postmortem data is fitting, dental identification is reliable and very fast. Every concordant point is important, but every discrepancy has to be explained.
ANTEMORTEM DENTAL EXAMINATION
Another major section in forensic dentistry involves the antemortem dental record examination. Dentists, hygienists, and Dental Technicians can effectively operate this section. The task of this section will always be the most difficult in the entire forensic dentistry arena. They will be required to determine who was involved in the disaster, locate and procure all military or civilian dental records and radiographs, arrange for the delivery of these materials, and undertake the process of developing a composite antemortem record for each victim for the evidence supplied. You may not have all existing antemortem dental records for the victim from outside sources. This may lead to discrepancies in the antemortem record and postmortem record comparison. The quality, quantity, and variety of dental record documentation of this antemortem evidence present the major obstacles in this section. Clearly, all antemortem evidence must be compiled to a single antemortem dental record form. to provide a composite antemortem picture. Comparing dental records sent directly from dental offices with a postmortem record is a near impossible task. At least two members of the antemortem dental record staff should review each composite antemortem dental record as a quality control mechanism. The completed antemortem composite form should also be quality checked against antemortem dental radiographs.
ANTEMORTEM/POSTMORTEM RECORDS COMPARISON
The last section in the dental forensic ID process compares the antemortem and postmortem records. Here the results of all previous work are seen. The size of the section is dependent on the number of fatalities, since there is a requirement to place all postmortem dental records face-up on tables in numerical order for a comparison with the antemortem composite dental records. After all postmortem dental records have been placed as described, the staff can systematically compare- the antemortem dental composite records as they are received with the postmortem dental records placed on the table. This is done by hand carrying the composite antemortem record and walking alongside the tables viewing the postmortem dental records looking for a significant point of comparison, such as a crown on tooth #30. Once significant points of comparison are noted between the antemortem and postmortem dental record forms, the radiographs of the respective records can be reviewed and a possible match established. If it is possible to determine the gender of the disaster victims, it is possible to reduce the manual comparison task by placing the postmortem records in numerical order on table by gender. Postmortem time. To provide quality control, provide the team leader of the forensic dentistry section the antemortem and postmortem dental records of potential positive ID established by the staff. The leader must reconstruct the positive dental ID. A dental identification form that summarizes the ID data can be completed at this This form is a tool in the decision-making and documentation process. It is used to provide rapid answers to questions when the team leader of the forensic dentistry section meets with the Identification Center chief at which time evidence regarding each case is presented.
The Role of Forensic Odontology in the Identification of Remains:
A case report
Afsin H., Uysal C.,Çagdır S., Gunce M.E.
*National İnstituition of Forensic Medicine
Forensic Odontology in Istanbul
** National İnstituition of Forensic Medicine in Istanbul
*** Forensic Medicine in Kocaeli University
The importance of dental identification increases within the last years due to mass disasters as a result of natural phenomenons such as cyclones, earthquakes, floods and volcanic explosions and due to airplane accidents, industrial accidents and terror acts.
Dental tissues are the strongest tissues in the human body and therefore their characteristics can last unchanged even after a long period of staying under water, being burried or in spite of putrefaction and unsuitable environmental conditions. Dental identification is based on the comparison of postmortem data such as autopsy findings of the deceased and radiographic and photographic records of postmortem remains with antemortem dental records and radiographics. Radiographics showing dental restorations, borders of bones and other anatomical tissues, fillings and rootfillings and dental records provided from the family or the dentist are compared with postmortem evidence and radiographics. İn the case where antemortem and postmortem data is fitting, dental identification is reliable and very fast.
The presented case was found on the ridge of a high mountain as skeletal remains by the fellows of a near village. All remnants were carried down from the mountain by soldiers and delivered to the authorities. The presecutor sent all remnants and personal belongings to the State Institute of Forensic Medicine and notified the German Consulate in Istanbul of the identity card. The State Institute of Forensic Medicine asked the German Consulate to collect medical data and radiographs of the person named on the identity card. The provided antemortem dental records were compared to the postmortem dental data by the forensic dentists of the Forensic Odontology Unit of the Morgue Specialisation Department. After the identification by dental data, the now identified body were handed over to his relatives.
People, who lost their lifes in mass disasters, wars, terror acts and natural phenomenons need to be identified. The current law systems in each country require a death certificate for conditions like insurance, testament, business and commerce relations, marriage and other situations to legal designation of the death. A homicide would be remain as an unsolved case until the victim is identified.
The relatives of missing persons lost their trust in community, because they didn’t know where their beloved relative is, if she/he is still alive or dead. Even if the person is dead, the relatives need to know where the grave is and they wish to organize a funeral ceremony complying their traditions and beliefs to get over the lost of the beloved person more easily.
Identification studies are based on comparison of antemortem records and radiographs with the postmortem records, including fingerprints, foot and palm prints, dental records and the morphology of the teeth, DNA identification, radiographic superimpositions, visual identification, personal belongings, serology, anthropometric data and medical history. Each method has its own value and different methods should be used together to lead for a conclusion and result in identification studies.
Visual identifiction can be done in a time period between 24 hours and 3-4 months depending on environmental circumstances. Since the emotional conditions can make the relatives cofused, visual identification is not particularly a reliable method.
Even if the human dentition is changing during lifetime, their charasteristics remain unchanged as the strongest tissues in the human body after death. Dental restorations and dentitions are resistant to inappropriate physical and chemical conditions. Restorations, dentitions, missing teeth and cavities determined at the oral examination can provide endless kombinations, associated with the160 surfaces on a single tooth, which make the human dentition so unique.
Due to the rising awareness of forensic sciences and forensic medicine and the improvements in uderstanding multidisciplinary approaches in Turkey, there is significant progress in the field of forensic anthropolgy and forensic odontology. National İnstitute of Forensic Medicine is the only expert witness institution for cases concerning forensic medicine Turkey. Forensic odontology, facial reconstruction and superimposition are some of the methods used in identification studies in the institution, applied successful to criminal cases. Annually an average number of 2800 authopsies are performed in the National İnstitution of Forensic Medicine, Department of Morgue Specialty. Approximately 300 cases are buried unidentified in the forlorn cemetery, after taken postmortem records and radiographs.
İssues related with forensic odontology such as oral trauma, bitemarks in child abuse and sexual offenses, malpractice and vehicle accident cases are sent from the courts all over the country to the Second Specialty Committee of the National İnstituition of Forensic Medicine in Istanbul for inspection and annually an estimated number of 520 files are solved by the Forensic Odontology Department.
Skeletal remains found on the ridge of a high mountain by the fellows of a near village were carried down from the mountain by soldiers and delivered to the authorities.The skeletal remains included skull including maxilla, mandibula, two iliac bones, scapula, two femur bones, vertebrae and pieces of vertebrae, humerus and costa bones, tibia- fibula in two boots, and foot bones in socks.
Personal Belongings consisted of a brown suede jacket, a red flask, a darkblue T-shirt, a pair of white socks, a pair of white socks, a screwdriver, scissors, glue and sandpaper in a brown leather purse, headphones of a walkman and a casette, a tooth brush, and sample of soil in a small plastic bag in a blue haversack. Another black haversack content canned food, foodpot, white soap, dish, watch, green pocket lighter, a compass in cover, a brown belt, needle, thread, knife, scissors, and İdentity Card given by German Authorities.
The presecutor Sent all remnants and personal belongings to the State Institute of Forensic Medicine and notified the German Consulate in Istanbul of the identity card. The State Institute of Forensic Medicine asked the German Consulate to collect medical data and radiographs of the person named on the identity card.
A regular autopsy was performed on the skeletal remains at the Morgue Specialization Department. The findings were reported as loss of almost entire soft tissue, fracture on tip of left femur, fracture on 1. cervical vertebrae, fracture on left collum tallus, fracture on right scapula , and defects on 5 of 10 ribs . Lower tip of left tibia, and lower and upper tip of left fibula were missing, and 35 bones of hands and feet were present.
The examination of upper jaw and teeth, performed by the forensic dentists of the Forensic Odontology Unit showed that the mandibula was broken in three pieces on the mesial of the left central tooth and the right premolars. An amalgam filling on the oclusal of the second molar and an amalgam filling on the buccal of the third molar on the left, and a composit filling on the oclusal of the second premolar, an amalgam filling on the ocluso-distal of the second molar, and defect on the oclusal of the first molar were determined on the right lower jaw.
An amalgam filling on the distal of the second premolar, an amalgam filling on the oclusal of the first molar, an amalgam filling on the oclusal and defect on the vestibule of the second molar, and defect on the vestibulo-oclusal of the first and second premolar were determined on the right, and amalgam filling on the ocluso-distal of the second molar, defects on the vestibulo-disto-mesial of the first and second premolar, and defects on the vestibulo-distal and mesial of the first molar were determined on the left upper jaw.
Antemortem dental records provided by the German Consulate in Istanbul included the dental chart dated 5. 5. 1993 prepared by Dr. Jan Novotny, which reported that all teeth were present, with amalgam fillings on 47-37-46-24-15-17-45-25-27-16.
The garments and personal belongings were examined by the Physical Examination Department. The personal belongings were given back to the Consulate and the family could identify some of them as the belongings of their missing son.
Data on antemortem dental records were compared with the postmortem findings.Fillings recorded on the antemortem dental chart and determined at the postmortem examination were fitting, so the remains could be identified as the missing person. After the identification by dental data, the remains were handed over to his relatives.
Race, sex, age, physical characteristics ( such as height, weight, colour of skin, hair and eyes ) are parameters used with priority in forensic sciences. Before defining this parameters, a person cannot be accepted as identified. This studies were performed multi directionally and focused on the best method and best structure for each parameter. It is suggested to use not only one of the structures, but to use combined methods involving all proper structures. But in cases where the remains are incomplete, damaged or purtefied, only the existing structures can be used in identification efforts. İt is clearly known that teeth are particullarly useful structures in identification studies, since they are resistant against physical factors and environmental conditions and found usually with the decomposed body.
Recent studies show that identification will still remain a favourite subject of forensic sciences. Within the last years there is a growing interest in identification topics in Turkey, too. Studies performed in the National Institute of Forensic Sciences, the only official expert witness institution in Turkey, are an important step in developing models and regration formulas for applying combined methods.
1.Dwight T., (1894) Methods of estimating the height from parts of the skeleton, Med.Rec.N.Y., 46: 293-296 (5’ten naklen).
2.Camps F.E. (1976) Identification by The Skeletal Structures, “Gradwohl’s Legal Medicine, (FE Camps, Robinson AE, Lucas BCD, Eds.), 3rd edition, s. 109-35, J. Wright and Sons Ltd, Bristol”içinde (20’den naklen).
3.Gustafson G. (1950) Age Determination on Teeth, Am. J. Dent. Assoc., (41): 45-54.
4.Cottone J.A., Standish M.S. (1982) Outline of Forensic Dentistry, The History Forensic Dentistry, s. 23-24, Yearbook Medical Publ., Chicago.
5.Haas L. (1954) The size of cella turcica by age and sex, Am. J. Roentgenol. Rad. Ther. Nucl. Med., (72): 754-61.
6.Francis CC. (1948) Growth of the human pituitary fossa, Human Biol., (20): 1-20.
7.Israel H. (1973) The dichotomous pattern of change in craniofacial structures, Am. J. Phys. Anthropol., (39): 111-28.
8.Steawart T.D. (1958) The rate of development of vertebral osteoartritis in American Whites and its significance in skeletal age identification, The Leech, 28: (3,4,5): 144-51(5’den naklen).
9.Mc Kern T.W., Stewart. (1957) Skeletal Age Changes in Young American Males analyzed from the stand point of identification, Headgu. QM Res. Dev. Command., Tech Report EP-45 Natick, Massachusels (2’den naklen).
10.Clark D.H. (1992) Practical Forensic Odontology, The chronology of dental development and age assessment, 3rd edition, pp. 22-42, Butterwordh Heinemann Ltd., Oxford.
11.Johnson C.C. (1968) Transparent dentine in age estimation, J.Oral Surg., 25: 834-8.
12.Bang G., Ram E.(1970) Determination of age in Humans from Root Dentine Transparency. Acta Odont. Scand., (28): 168-178.
13.Whittaker D.K., Kneale M.J. (1978) The dentine-predentine interface in human teeth. Br. Dent. J., 146(2): 43-46.
14.Whittaker D.K., Liewelyn D.R., Jones Rr.W. (1975) Sex determination from necrotic pulpal tissue, Br. Dent. J., 139(10): 403-405.
15.Whittaker D.K., Banbury I.R.., Burgess P.J. (1980) The use of tooth fragments in species determination. Br. Dent. J., 148(4): 105-106.
16.Averil D. C. (1991) Manual of forensic odontology, Age determination of decent 2nd edition pp. 49-54, American Academy of Forensic Sciences, Colorado Springs.
17.W.R Maples ve P.M. Rice (1978) Some difficulties in the Gustafson dental age, J. Forensic Sci., 168-172.
18. Barsley R.E. (1993) Forensic and legal issues in oral diagnosis, Dent. Clin. N. Am. 37: 133-156
19.Averill D.C. (1991) Manual of Forensic Odontology, Bite mark case workup 1st edition pp. 138-168 American Academy of Forensic Sciences, Colorado Springs
20.Ruskin J.D., Laney T.J., Wendt S.V., Markin R.S. (1993) Treatment of mammalian bite wounds of the maxillofacial region, J. Oral Maxillofac. Surg., 51(2): 174-176
21.Furness J. (1968) A new method for the identification of teeth marks in cases of assault and homicide, Br. Dental J., 124: 261- 266
22.Whittaker D.K. (1975) Some laboratory studies on the accuracy of bite mark comparision, Int. Dent J., 25: 166-171
23. Cameron J., Sims B.G. (1974) Forensic Dentistry, Bite marks, Churchill Livingstone, Edinburgh
24.Cottone J.A., Standish M.S. (1982) Outline of Forensic Dentistry, 120 Year book Medical Publ., Chicago
25.Pierce L.J., Strickland D.J., Smith S.E. (1990) The case of Ohio V. Robinson, Am. J. Forensic Med. Pathol. 11(2): 171-177
*Postmortem animal attacks; identification of animals and dead bodies. Four case reports.
¹Bulent Sam, ²Huseyin Afsin, ¹Cafer Uysal, ¹Oguz Polat
¹MD, Forensic Medicine Specialist, ²Dentist, PhD, Forensic Odontologist
¹,²National Institute of Forensic Medicine, Istanbul/TURKEY
*Has been presented orally in The 10th Biennial Scientific Meeting of International Association of Craniofacial Identification, September 11-14, 2002-Bari, Italy.
Postmortem animal bitemarks are often detected in forensic autopsies. Remains can be attacked by a large number of different animals. The shape and size of tooth, jaw and claw marks can lead to a conclusion of the structure of the species.
In our cases, three of them damaged by dog or dogs for nutrition from their head, neck and arms and one of them damaged by mice or mices from his periorbital tissues. So they needed identification; at first identification of animals which attacked and identification of dead bodies. The postmortem marks of the teeth and claws resulting from dogs and mice and the tissue loss depending on the nutritive attacks of these animals on cases prepared for presentation are very demonstrative.
The cases are described for the crime scene, cause of the death, localisation of teeth and claw marks of the animals on dead bodies, confusing lesions and other characteristics for presentation.
Key words: forensic science, identification, postmortem animal attack, autopsy
Animal bites may occur both, antemortem or postmortem, and are occasionally mixed in origine. Postmortem animal bitemarks are often detected in forensic autopsies.
Remains can be attacked by a large number of different animals. Usually, remains found in a house or an office may be damaged by mice, dogs and cats. Remains found on an open field may be attacked by small mammals like cats, dogs, mice, hyenas, foxes, wolfes and pigs. Bodies stood in water for a long time are damaged by marine creatures.
Crime scene investigation may help to identifying the animal. Lions always possess 3 lobes on the rear of the heel pad but dogs two lobes at rear of concave heel pad (17).At the autopsy, marks of teeth and jaws of the animal, tissue loss, marks of the claws and single tooth marks may be observed. The size and shape of these marks are depending on the build of the animals, which attack the body for nutrition. Shark attacks characterise with large gouges from the wound edges, punctures from teeth and extensive tissue loss.
Bites of a mouse are often found on areas of a small diameter such as lips, ears, nose, eyelids and fingers. Bites of a cat are mostly localised around the mouth. Bites of a dog are found commonly on regions with relative small diameter, eg neck, arms and legs and sometimes on heads.
The shape and size of these marks can lead to a conclusion of the structure of the species. Mice bites are shovel-shaped and reflect the small form of the teeth and jaws. Bite marks of cats and dogs are reflecting the archial arrangement of the teeth.
Dog bites, a common cause of traumatic injury, tend to be a greater source of morbidity and mortality in children than in adults. The greatest cause of morbidity in these children was the penetrating component of the dog bite. Pit bulls, the most commonly reportedbreed, were involved deaths; the next most commonly reported breedswere rottweilers and German shepherds.
For the dogs, full adult complement of teeth is forty two. This number is made up of twelve incisors (six in the upper and size in the lower jaw), four canine teeth (two each in the upper and lower jaw), sixteen premolars (eight each in both the upper and lower jaw) and ten molar teeth (four in the upper and six in the lower jaw). The most significant marks of a dog bite are the marks of the canins, left and right as a pair and with a distance of 4-7 cm. depending on the kind of the dog. Most breeds of dogs have a scissor bite, that is, the incisors must connect like scissors, so that the incisors of the upper jaw cut scissor-like over those of the lower jaw.
Case 1 : Death due to blunt trauma to the skull. The body was found on the border of a road near the forest. The findings indicated that the person was murdered at the crime scene. The body was attacked by wild dogs. Autopsy findings: On the left side of the face, neck and hairy skin soft tissue loss due to postmortem nutrition of dogs. Skull, face bones, mandibula and vertebrae of the neck could be seen. Superficial laserations due to canin teeth on the defect on the left side of the neck (Fig-1). The front and lower margins of the defect are parallel. Tissue loss on right ear, probably produced by the lateral incisors of the animal. Single tooth marks on the right side of the mandibula. Lesions on the scalp with regular margins with an average size of 5.5 cm. extending to the occipitale region. Lesions on the forehead and scalp were considered as scissor bites (Fig-2). The relatives could identify the person from the undamaged part of the face, denture (there was total prosthesis on the upper and lower jaws) and the rest of the body.
Case 2: Death due to mechanical asphixy with a ligature and blunt trauma to the skull. The body was found in a forest, upper part of the body naked and positioned on the face. The findings indicated that the person was murdered at the crime scene. The body was thought to be attacked by wild dogs. The autopsy displayed that entire head area beside the mentum and entire neck area beside the mandibular region had lost soft tissue due to postmortem nutrition of the dogs (Fig-3). The outer sides of the chest and the abdomina, the entire back and upper extremities extending to the wrists had lost sotf tissue. The bones could be seen. Defects on tips of both scapula and tooth marks on the defect margins. On the margins of the defects on the chest area, arch shaped scissor bites reflecting the structure of the jaws of the dog and just over these injuries, on the undamaged skin arch shaped bite marks with an average size of 4 cm were determined (Fig-6). The body remains unidentified, because no relatives could be found and no missing person could be matched with the existing data (including dental findings and DNA profiles).
Case 3: Stabbed woman, was found in a forest. The findings indicated that the body was transported. Numerous knife injuries on chest, abdomina, neck, back, left arm and left thigh were found at the autopsy. Soft tissue loss extending to the bones on head, neck and entire right arm due to postmortem nutrition of dogs (Fig-5). Tooth marks on injury margins. Loss of tissue starting from upper one third of right radius and ulna due to gnawing and tooth marks on the defect margins. The relatives could identify the remains from the general stature of the body and the garments.
Case 4: Death due to liver cancer. The body was found in bed. Complete loss of soft tissues of both orbita due to postmortem nutrition of mice (Fig-6). Typical mice tooth marks could be identified at the defect margins and the ridge of the nose. The identity is known.
Animals start with postmortem nutrition from the parts of the body like head, neck or hand which they can easily reach (6,13,14,18). The body of Case 1 was found laying on his right and therefore the animals began to nutrition from the left side.
In all cases, tissue loss due to postmortem dog or mouse nutrition is typical in its location, weight and tooth, claw and bite mark characteristics. Arch shaped defects, reflecting the form of the dog’s jaws.
It is important to stress, that in the second case the animal attacked the body from the neck and this is a very important aspect in the medico-legal investigation. If the body would be found later, probably the entire soft tissues of the neck would be lost and the cause of death might be remain undiscovered.
In the first case, lesions on the forehead and scalp seemed to be resulting from a stab, but actually they were scissor bites.
In cases where the characteristics leading to identification were damaged to hide the identity, identification may result in finding the murderer. Bodies found on open ground were totally damaged, so that visual identification was impossible. In all three cases, the crime scene investigation reports indicated that wild dogs were living in these areas. No identity cards were found and the investigators considered, that the murderer didn’t want the victim was identified. In case 1 and 3, identification of the victim resulted in identifying the perpetrator.
In identification efforts, first step should be age determination. Detailed dental records and panoramic radiographs are very important. If the soft tissues of the skull are lost total or partial, superimpositions of photos and skull, comparison of frontal sinuses on radiographs and facial reconstruction are to recommend. Mice are eating mostly the characteristic features of the face. When the loss of soft tissue is limited, it would be enough to complete the missing tissues on photos for identification.
In forensic autopsies of animal attacks most important points are to elucidate if bites are antemortem or postmortem, thus if contributing to death, to understand the species and breeds of the animal(s) that bite or feed on the corpse and also identification of bodies.