Identification of Victims Utilizing Forensic Odontology & Digital Imaging Technology

An interview with Dr. Adam J. Freeman

Read this article in its original format in the ETM Digital Edition.

Identifying Victims: The Forensic Odontologist’s Role

When human remains are found, the medical examiner may, as part of the effort to identify, contact a forensic odontologist. There are only 91 board-certified forensic dentists in the world, so not every forensic dentist is board certified.

When some indication of the victim’s identity exists, first we request antemortem X-rays from the person’s dentist. We hope that those X-rays will be in digital format, but even if they are traditional film X-rays, we can digitize them. These antemortem X-rays then will be compared to postmortem digital X-rays.

I arrive at the medical examiner’s office with a portable X-ray gun, a laptop computer, and a digital sensor. After taking a full mouth series of X-rays, I compare those to the antemortem X-rays.

If we don’t have a clue to the identity, we put the information into databases—either the FBI’s National Crime Information Center’s (NCIC) system for missing persons or the Department of Justice’s National Missing and Unidentified Persons System (NamUs) database. Those two databases contain information on 100,000 missing persons or unidentified decedents in the United States.

Facing Large Disasters

In a large disaster such as a hurricane, a terrorist attack, or other large tragedy, the state’s governor may choose to declare an emergency and request resources from the federal government. The national team—the Disaster Mortuary Operational Response Team (DMORT)—may be deployed, depending upon the circumstances. The federal team has three portable morgues throughout the United States, packed up and ready with NOMAD portable X-ray units, DEXIS digital sensors, and computers all networked into a main server.

Here again, digital X-ray technology is integral to identification. To collect antemortem information, a family assistance center is set up. We make contact with the victim’s dentist and request that the X-rays be emailed. We can even get information from insurance companies for records like what restorations have been done and what procedures they have paid for in the last few years. If the antemortem records are digital, we can obtain them literally in seconds. In a mass disaster, digital antemortem records are the key to the speed and success of the identification effort. In the case of a plane crash, people can come from all over the world. If film X-rays have to be sent to us through mail or courier, that takes time.

Again, even in the case of a mass disaster, postmortem radiographs may be captured digitally. We take a full mouth series on every single body. All information is input into a program that works by matching algorithms to compare antemortem and postmortem X-rays. We chart each person: we look at the shape of their fillings, filling placement, we check for root canals, crowns, root shapes, pulp shapes, and trabecular bone patterns… All of those things must match. Anything that does not match could potentially exclude an identification.

Of course, there are explainable discrepancies. A filling can appear deeper in the postmortem X-rays because it can go from shallow to deep over time. That would be explainable, but everything else must match up. We look for chart notes that tell of other possible procedures that may not appear on the antemortem X-ray—for instance, that the person had a crown done after the antemortem X-rays.

We then enter the information into a database. For disasters, we can use WinID software that is compatible with our system via a built-in link. There is also a program developed in New York City after 9/11 called UVIS (Unified Victim Identification System) UDIM (Unified Dental Identification Module), and our system integrates into that as well. We chart each person’s dentition, both ante- and postmortem, into the system for matching purposes.

Digital Imaging and the Discovery Process

Digital imaging significantly shortens the process of identification compared to taking film X-rays. When taking a full mouth series with film, you have to take the X-rays and then process them. You can’t ask a body to bite down on the X-ray holder a certain way for optimum placement. After the X-ray is processed, if I see that it is a cone cut, I can go back and take another X-ray and process it again. Here is a clear benefit of the digital modality. I take the X-ray and can look immediately and know if have the image I need. Also, if an antemortem film was taken poorly—for instance, if it was elongated, foreshortened, or at a bad angle—with digital, I can take a bunch of postmortem X-rays with points of concordance to compare. With a digital format, I can zoom in or enlarge a particular area of interest. Digital imaging surely makes us faster, more accurate, and allows us to store X-rays more easily.

Digital X-rays are also very easily and securely shared. For example, if law enforcement finds a body in the woods in Connecticut, and a woman is missing in North Carolina, with film I would have to duplicate the X-rays and physically mail them. With digital, they can be quickly and securely emailed—or, more importantly, I can upload the X-rays on databases that can only be seen by law enforcement or medical examiners’ offices so we are not violating HIPAA. With film, to put them on that website, they first must be converted to digital with a special scanner.

Having digital X-ray capability in a mass disaster significantly cuts down identification time. When we use film X-rays, for a body to go through the dental section of the morgue for a disaster like 9/11, it could take 1.5 hours or more for one body to go through the postmortem dental section. In comparison, during Hurricane Katrina, that time was reduced to approximately 15 minutes by using digital X-rays. We can be five-times more productive. The work gets done quicker, more accurately, with a smaller number of people doing the work.

Giving the Victims a Voice

People feel powerless to help in a disaster. This profession allows me to be literally on the ground, helping people. When there is an unidentified body, I want closure to be achieved, quickly and effectively, and I don’t want dollars to impede the process. I do all identification work in Connecticut for free in the spirit of public service.

I think the way we treat victims or dead people in society is a reflection of how we as a society should live. These people no longer have a voice to speak for themselves. It is up to us to treat them respectfully and get them back to their loved ones quickly.


About Adam J. Freeman

Adam J. Freeman, DDS, D-ABFO earned his dental degree from Columbia University’s College of Dental Medicine. He completed a fellowship in forensic odontology at the University of Texas Health Science Center at San Antonio and Center for Education and Research in Forensics (CERF) and is a diplomate and president of the American Board of Forensic Odontology. He is the founder and director of the State of Connecticut’s Disaster Identification Response Team (DIRT), and the deputy chair of Interpol’s Disaster Victim Identification Odontology Working Group. Freeman is a fellow of the American Academy of Forensic Sciences and a past president of the American Society of Forensic Odontology. He has no financial interests in DEXIS, LLC or NOMAD.

 
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