Forensic Dentistry (I) Dr. Abdelmonem Altarhony Forensic Dentistry (I)

Objectives Students should be able to explain and discuss: Definition of forensic dentistry Responsibility of forensic dentists Common reasons for identification of found humans remains Main forms of Dental identification Cases

DEFINITION Branch of Dentistry concerned with proper handling, examination and evaluation of dental  evidence, which will be then presented in the interest of justice. forensic dentistry represents the overlap between the dental and the legal professions. FORENSIC is derived from latin ward which means court of law .

To assist with forensic dentistry, dental professionals need to be aware of the importance of keeping accurate, current, detailed and legible dental records for the use of identification

Responsibility of forensic odontology 1.Identification of found human remains 2.Identification in mass fatalities 3.Assessment of bite mark injuries 4.Assessment of cases of abuse (child, spousal, elder) 5.Civil cases involving malpractice 6.Age estimation

Common reasons for identification of found humans remains Criminal: An investigation to a criminal death cannot begin until the victim has been positively identified. Marriage: Individuals from many religious backgrounds cannot remarry unless their partners are confirmed deceased. Monetary: The payment of pensions, life assurance and other benefits relies upon positive confirmation of death. Burial: Many religious require that a positive identification be made prior to burial.

Social: Society’s duty to preserve human rights and dignity beyond life begins with the basic premise of an identity. Closure: The identification of individuals missed for prolonged periods can bring sorrowful relief to family members.

Dental identification takes two main forms: 1.Comparative identification 2.Post mortem (PM)dental profiling.

1. Comparative identification The postmortem (after-death) dental remains can be compared with antemortem (before-death) dental records

The forensic dentist produces the postmortem (PM) record by careful charting, written descriptions of the dental structures and radiographs. Then, a methodical, systematic comparison can be done between the PM and AM records. Each tooth and surrounding structures are examined. Individuals with many dental restorations are easier to identify than those with little or no rest. treatment.

Similarities and discrepancies should be noted during the comparison process.

Example of a comparative dental identification case The body depicted in the images is that of a sixteen-year-old female. She was found encased in a waterbed frame after being reported missing for over a year. A victim of homicide, she became mummified in the dry, cool conditions under the bed. The bed, used frequently, was removed when a lodger left the apartment and the body was discovered. Despite the condition of the soft tissues the teeth remain in perfect condition. The antemortem and postmortem radiographs are shown below. A positive identification, this case illustrates a nonrestorative case. Note the mesiodens

1. Positive identification When reporting dental identification, the conclusions should be limited to the following four: 1. Positive identification The AM and PM data match in sufficient detail to establish that they are from the same person. 2. Possible identification The AM and PM data has consistent features but, because of the quality of either the PM or the AM remains or the AM evidence, it is not possible to establish identity positively.

3. Insufficient evidence The available information is insufficient to form the basis for a conclusion. 4. Exclusion The AM and PM are clearly inconsistent.

Means of Identification There are three categories examined when comparing dental records (ante-mortem with post-mortem) for identification, which are: periodontal tissue, anatomical features, and the teeth.

Periodontal tissues: Trabecular pattern, tori and osseous anomalies. Gingival morphology and pathology. Periodontal ligament morphology. Alveolar process and lamina dura. Presence of foreign bodies: Implants, unretrieved amalgam particles, surgical instruments, bullets, …

2. Anatomical features: Sinus configuration: maxillary and frontal Anterior nasal spine Mandibular canal Condylar and coronoid process TMJ Skull sutures Soft tissues features: rugae (rugoscopy) and lip (cheiloscospy) prints.

3. Teeth: Abnormality Natural and synthetic (fixed and removable) Present Missed Type Position Crown / root morphology - pathology Pulp chamber / root canal morphology – pathology Periapical pathology Dental restorations

Teeth abnormalities Abnormalities of eruption patterns. Abnormalities of shape (morphology). Missing features, extra features, or atypical features. Dilacerations of crown or root anomalies in the number of cusps or roots, abnormal enamel deposition, etc. Abnormalities in the number of teeth. Adontia, Polydontia / partial adontia Supernumerary teeth.

More developmental abnormalities Abnormalities in the spacing or position of teeth. Crowded, Diastema rotated or misaligned. Abnormalities in the size of teeth. Microdontia macrodontia.

Age estimation You can tell age solely by teeth analysis: Require the extraction of teeth and histopathological examination, and Require radiographs. The third molar may provide reasonable accuracy for the likelihood that a person is at least 18 years of age

Eruption sequence and timing Permanent teeth Primary teeth

Help me to solve those cases?

What ´s the patient’s age? Around 3 to 4 years

Around 11 to 13 years

Around 6 to 9 years

Socio Economic Status The quality, quantity and presence or absence of dental treatment may give an indication of socio-economic status or likely country of residence.

Ancestry and Sex Ancestry can be assessed by studying the facial skeleton and comparing the features with the main characteristics of the three racial groups: Mongoloid Negroid Caucasoid

Sex estimation Male and Female Cranium Differences: The men cranial mass is more blocky and massive / females is rounder and tapers at the top. Temporal Ridge . More prominent in men than women. A woman’s supraorbital margin is sharper, while the males is rather round and dull. The Zygomatic bone is more pronounced on the male skull. The Mandible (lower jaw) bone of a woman is rounded, while the male’s is squared.

F. Frontal bone – woman forehead structure terminates at the brow F. Frontal bone – woman forehead structure terminates at the brow. The male forehead is lower and more slopping. G. Men have a deeper cranial mass. H. The supercilary arch is large and rounded in the man. I. A males gonion is more flared out and sharply angled. J. The teeth of men tend to be larger.

Sex determination is usually based on cranial appearance. Microscopic examination of teeth can confirm sex by the presence or absence of Y-cromatin from the teeth pulp ( Bar bodies) and DNA analysis from saliva and pulp can also reveal sex.

Cold case Analyzing the skull and teeth can you tell me the sex, age, some habits and maybe where did he live?

Skeletal pattern and dental characteristics suggested the following profile: Caucasian, male, aged 25–35 years at death, moderate adult periodontitis, nicotine stains, lack of recent dental treatment

Using this information, a forensic artist produced a facial reproduction. Subsequently, the body was identified as that of a 28-year-old missing white male smoker.

Thank you