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REVIEW ARTICLE

Role of dentist in person identification

BR Chandra Shekar, CVK Reddy1

Department of Community
Dentistry, Kamineni
ABSTRACT
Institute Dental Sciences and To reinforce awareness among dentists about their role in person identification and the
Research Center, Sreepuram,
Narketpally, Nalgonda District, importance of maintaining dental records of all their patients. The article reviews basic
Andhra Pradesh, 1Department of procedures of dental identification and some cases where dental identification played a key
Community Dentistry, role in eventual identification of the person. Forensic odontology is an integral part of forensic
J S S Dental College and
sciences. Forensic dental identifications, especially in times of mass disasters, depend mainly
Hospital, S S Nagar,
Mysore - 15, Karnataka, India on the availability of ante mortem dental records. It is the social responsibility of each and
every dentist to maintain dental records of their patients for the noble cause of identification
Received : 15-12-08
Review completed : 25-04-09
in the event of mass disaster.
Accepted : 30-04-09
PubMed ID : 19884723 Key words: Ante mortem, forensic odontology, identification, mass disasters, post mortem,
DOI: 10.4103/0970-9290.57377 reinforce

Human being, has come a long way from the early
caveman age to the present day of covering nothing less
than astronomical heights to sea bed depths. His zeal to
conquer new heights has created a world full of scientiÞc
advancement and technology. However, his intelligence
has also led to a surge in crime rate, terrorism, wars, mass
disasters, road trafÞc accidents and dreadful diseases. In all
such incidents the identity of the deceased, assailant or the
cause of death becomes important as the core of various
investigations are based on these processes.[1]
All humans have an identity in life; compassionate societies
require that, this identity be recognized even after death.
When a person dies there may be consequences, often
Þnancial, that must be dealt with.[1] Forensic science plays
an important role that can be used in a judicial setting and
accepted by the court and the general scientiÞc community
to separate truth from untruth. Forensic identiÞcations,
by their nature, are multidisciplinary team efforts that
typically involve the coordination and cooperation of
law enforcement ofÞcials, forensic pathologists, forensic
odontologists, forensic anthropologists, serologists,
criminalists and other specialists as deemed necessary.[2]
Forensic odontology is a vital and integral part of forensic
science that is most widely utilized for identiÞcation of
the living and deceased persons. In recent times, forensic
odontology has evolved as a new ray of hope in assisting
forensic medicine. This is relatively a young science of
Address for correspondence:
Dr. BR Chandra Shekar,
E-mail: drchandrubr@yahoo.com
dentistry and still in its infancy state in India where as
in other developed countries it has acquired a recognized
branch of dentistry in medical forensicology.[3]
In India, qualiÞed forensic odontologists are very few. So,
an attempt should be made to reinforce awareness among
dental practitioners about the role of dentists in person
identiÞcation and to awaken the social responsibility of
maintaining dental records of all the patients. This is very
essential for identiÞcation of individuals in the event of
any disaster.
This article is an attempt to reinforce the awareness among
dentists about their role in person identiÞcation and the
importance of maintaining dental records of all their
patients.
REVIEW OF NOTABLE DENTAL IDENTIFICATION
CASES
People have long recognized that a person’s teeth are
unique. Although great attention was not paid to dental
identiÞcation until recent times, the process has been used
for more than 2000 years.[4]
Earliest dental identification
The earliest recorded case concerns a female associated with
Emperor Nero, who was identiÞed after her death through
the unique arrangement of her teeth. In the year 66 A.D,
Nero’s mistress Sabina got his wife killed by her soldiers
and demanded to see the head of the victim in a dish. She
recognized the head by a black anterior tooth.[5]

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Dentist in person identiÞcation
First dental identification
Luntz L and Luntz P presented a case of 1775 in 1972.
Paul Revere constructed a bridge for his friend Dr. Joseph
Warren. Eventually Warren was killed by a bullet that
pierced his head in the battle of Bunker Hill. His body was
buried by the British in a mass grave. A year later, when
the British forces withdrew from Boston, the people of
Massachusetts wished to give a proper burial to Dr. Joseph
Warren. However, they could not identify Warren’s body
as all the bodies in the mass grave were badly decomposed.
Dr. Joseph Warren’s body was later identiÞed by Paul
Revere by the ivory work which he had done for his
friend when alive. This was thought to be the Þrst case of
identiÞcation by a dentist.[6]
First dental identification reported from India
Sansare K and Dayal PK in their review in 1995 have
mentioned that according to Elphinstine, M. Raja
Jayachandra Rathore of Canouj, died on the battleÞeld in
1191. His body was identiÞed by his false anterior teeth.
This was probably the Þrst case of identiÞcation using
dentition from India.[5]
First dental identification accepted by law
Dental evidence was Þrst accepted in the United States
in the Webster-Parkman case in 1849.[1] This happened
in Boston, U.S.A. Webster, Prof. of Chemistry in Boston
Medical School, borrowed money from his colleague
Dr. Parkman who was relentless in demanding the
repayment. Unable to cough up the amount, Webster
plotted to kill Dr. Parkman. Webster invited Dr. Parkman
to his lab, promising repayment, on 23rd November in
1894. Dr. Parkman was never seen again after that. On
receiving a complaint, the authorities thoroughly searched
Webster’s laboratory, where the trunk of a human
body with a left thigh, few bones and some artiÞcial
teeth were found. When the mutilated remains were
assembled, corresponded and Þtted, it was concluded that
they belonged to Dr. Parkman. Dr. Parkman’s dentist,
Dr. Nathan C Keep played a signiÞcant role in identifying
Dr. Parkman.[1]
First dental identification in a mass disaster
According to Dr. Oscar Amoedo, Professor, Dental School
at Paris, regarded as the father of forensic odontology, the
Þrst case of dental identiÞcation in which a great number of
victims lost their lives occurred in Paris in 1897. A Þre in
a charity bazaar resulted in 126 deaths. Here, ante mortem
dental records were compared with post mortem dental
records for identiÞcation of the dead.[4]
Identification using prosthesis
The countess of Salisbury was burnt at HatÞeld house in
1835. The body was charred beyond recognition by visual
means. She was identiÞed by her gold denture.[1]
357
Chandra Shekar and Reddy
Identification of Hitler
Bagi BS mentioned in 1977 that the bodies of Hitler and his
mistress Eva Brauma were identiÞed by his dentist, (Kathe
Hensrman Fritz Echtmann) using dental records.[3]
Identification of general Zia-Ul-Haq
Sansare K mentioned in 1995 that General Zia-Ul-Haq, late
president of Pakistan, died in 1988 in a plane crash. His body
was identiÞed by his dentition.[7]
Identification using tooth brush
Thousands of people lost their lives in the world trade center
disaster in the U.S. on September 11, 2001. DNA extracts
from tooth brushes of the victims were used in identiÞcation
of some victims.
Identification of Saddam Hussain’s sons
According to a U.S. website, (CNN NEWS) dental identiÞcation
was used to conÞrm the identities of the bodies of Saddam
Hussain’s two sons.
DENTAL IDENTIFICATION PROCEDURES
Whenever a human body or the remains of a human body
are found, the police are called for further investigation.
The police in turn may make a formal request to the
dental authorities to help them identify the individual.
At this point in time, a tentative identiÞcation is possible
by considering the geographical location where the body
was found, the physical features, the available wallet or
driving license or any other personal belonging of the
deceased individual. This tentative identiÞcation may help
in narrowing the search for ante mortem records with which
a possible identiÞcation may be established with a degree
of certainty.[8] Dental identiÞcation of an individual can be
made mainly by two methods namely
• Comparative method of dental identiÞcation
• Post mortem dental proÞling.[8]
Comparative method of dental identification
Comparative method of dental identiÞcation involves
establishment to the highest degree of certainty that the
remains of the decedent at the site of mishap or death and
details in the ante mortem dental records are of the same
individual to conÞrm identity of the individual. Here, the
forensic dentist prepares a post mortem dental record by
careful examination, charting and written descriptions
of all the dental structures along with the radiographs
as additional supportive evidence. Radiographs needs to
be punched with rubber dam, indicating ante mortem or
post mortem, to avoid any sort of confusion in future.[9]
Once the post mortem record is complete, a systematic and
methodical comparison has to be made between the ante
mortem and post mortem dental records examining each
and every tooth and surrounding structures. While dental
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Dentist in person identiÞcation
restorations play a signiÞcant role in the identiÞcation
process, other additional features may also be of help.
The manual of American Society of Forensic Odontology
(ASFO) and the guidelines for body identiÞcation by
American Board of Forensic Odontology (ABFO) provide
numerous such additional features to be looked for in the
identiÞcation process.[10] The similarities and discrepancies
should be carefully noted at the time of comparison of
the records.[11] The discrepancies can be of two types –
explainable or unexplainable. Explainable discrepancies
are the ones for which an explanation can be reasonably
accepted keeping in mind the time elapsed between the
recording of ante mortem and post mortem findings.
Example, a tooth noted to be present in the ante mortem
records which is missing in the post mortem records (might
have been extracted after ante mortem Þndings were
recorded and before death), a restoration which is mesio
occlusal (MO) in ante mortem records being mesio occluso
distal (MOD) in the post mortem records (a further distal
extension may have been made in the time elapsed between
the noting of ante mortem and post mortem records).
Unexplainable discrepancies are the ones for which the
explanation cannot be provided for and hence, have to
be excluded. Example, a permanent tooth recorded to be
extracted in the ante mortem Þnding to be present in the
post mortem record.
A range of conclusions can be drawn following a comparison
of ante mortem and post mortem records. The American Board
of Forensic Odontology (ABFO), however, recommends
these to be limited to four conclusions, viz.[12]
1. Positive identiÞcation: This may be given when the ante
mortem and post mortem Þndings match in sufÞcient
details, without any unexplainable discrepancy, to give
the impression that they are from the same individual.
2. Possible identiÞcation: Here ante mortem Þndings may
be consistent with post mortem Þndings, but a positive
identiÞcation with certainty may not be established
owing to the poor quality of either the post mortem
remains or ante mortem dental records.
3. InsufÞcient evidence: Information in the ante mortem
and post mortem dental records are insufÞcient to draw
a conclusion of any sort.
4. Exclusion: The Þndings in the ante mortem and post
mortem dental records are clearly inconsistent with
respect to many features.[12]
A fact to be kept in mind at the time of drawing up of
conclusion is that there are no set of minimum number
of features or concordant points required to be matching
to establish a positive identiÞcation. A single tooth with
sufÞcient unique details may be of great help in establishing
a positive identiÞcation, where as a series of full mouth
radiographs may not be of any use if they do not have the
required unique details.[12]
Indian J Dent Res, 20(3), 2009
Chandra Shekar and Reddy
Most of the times, where ever dental identiÞcation is sought,
this method of comparison between ante mortem and post
mortem records is used for identiÞcation with certainty.
At times this method may not be applicable for example,
when there are no clues to make a tentative identiÞcation
without which there is no way of searching for ante mortem
records or the ante mortem records may be unavailable in
spite of making a tentative or presumptive identiÞcation.
In these circumstances a method known as post mortem
dental proÞling is used.
Post mortem dental profiling
Here the forensic dentist will help the authorities narrow
down the search for ante mortem records by giving
information on the deceased individual’s race, age, sex,
socio economic status, occupation, dietary habits, dental
and some systemic diseases as well by careful examination
of the deceased or the left over human remains at the
site of disaster. The identity of the race and sex to some
extent can be made by careful examination of the skull
for its shape and form. These features of the skull may
enable a forensic dentist put the individual into one among
the three major racial groups, Negroid, Mongoloid or
Caucasoid. Along with shape and form of the skull, other
features like cusps of Carrabelle, Shovel shaped incisors,
multi cusped premolars; talon’s cusp, taurodonts, etc may
assist in determination of the race. Sex determination is
made most of the times with thorough examination of the
skull as the sex differences in the morphology of the teeth
are not very signiÞcant. The microscopic examination of
teeth for the presence/absence of Y-chromatin and DNA
analysis can reveal the sex with certainty.[13,14] The age of
the individual can be gauged by examination of the teeth
and surrounding dental structures and their subsequent
comparison with the developmental charts. The age can
be established with an accuracy of plus/minus 1.5 years
to the actual chronologic age of the child with this
method.[15] Some authors recommend the use of aspartic
acid racemization method for determination of the age,
which can reveal the age to an accuracy of plus/minus
four years.[16] The conclusion on the age of the individual
can also be drawn by using charts such as those developed
by Ubelaker which graphically give an illustration of the
dentition (deciduous, mixed or permanent) right from the
age of around Þve months in utero to 35 years after birth.
The Þndings on the teeth such as erosion, stains, or unusual
wear patterns can help in determining the habits as well
as their occupation. Erosions can be due to many factors
like alcohol or substance abuse, working in an industry
involving use of acids (because of continuous exposure
to acid fumes in the working environment), excessive
consumption of carbonated beverages or disorders like
anorexia nervosa/other eating disorder/hiatus hernia.
Stains on the teeth may suggest smoking, tetracycline
use, betel nut and chewing of smokeless tobacco or even
dental ßuorosis as well.[17-26] The notching of incisors
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Dentist in person identiÞcation
suggest habitual placement of nails in between the teeth
(carpenters and cobblers), opening of bobby pins and
cutting of threads (tailors) or because of placement of
pipe stems, cigarette holders, hair pins etc. The unusual
wear pattern of the teeth may give an indication of
previous orthodontic treatment as well.[27] The presence
or absence of dental treatment (which gives information
on the attitude and dental awareness of an individual) as
well as the quality and quantity of dental treatment (type
of restoration, type of prostheses or appliance) may give
some clues on the socio-economic status of the individual.
In short, we can say, in post mortem dental proÞling, a
forensic dentist looks for all possible methods to narrow
down the identity of the deceased so as to enable search
for the ante mortem records. This as a method of forensic
dental identiÞcation is used when comparative and other
methods of identiÞcation are not sufÞcient to establish the
identity of the individual.
Other innovative methods in dental identification
Although comparative dental identification or post
mortem dental proÞling are the most frequently used
in forensic dental identifications, in many instances,
some innovative techniques such as labeled dentures or
orthodontic appliances, the unique restorative materials
can easily narrow down the search for identity of the
deceased. There have been many scientiÞc articles in
literature to show how the labeled prostheses (labeling
patient’s name or patient’s unique ID number) [28,29]
other dental appliances such as removable orthodontic
appliances,[30] unique composition of restorative material
or the presence of Kevlar Þbers in the denture have helped
in the ultimate process of establishing identity of the
individual. This method of labeling the prostheses or any
other appliance is a noble thought which will be of great
help in identiÞcation process especially at times of mass
disasters. So the concerned dental organizations through
out the world should insist that dentists get their patients
identity engraved or labeled in the respective appliance
or prostheses.
DNA in dental identification
The resistant nature of dental tissues and dental restorations
to changes brought about by environmental extremes such as
temperature and decomposition make them an ideal source
of DNA, which will be of great help in the identiÞcation of
a person.[31] With the advent of Polymerase Chain Reaction
technique that allows ampliÞcation of DNA at pre-selected
sites the biological material extracted even from a root Þlled
tooth will be sufÞcient to make a conclusion on the identity
of a person.[32] Here the DNA extracted from human remains
at the site of disaster is matched with the ante mortem
sample derived from any of the sources of DNA such as
a tooth brush, hair brush, blood sample, biopsy material,
clothing or any other personal belonging of the deceased.
If the genomic DNA is not in sufÞcient concentration to
359
Chandra Shekar and Reddy
draw a conclusion on the identity, then mitochondrial DNA,
present in high copy number in each cell and maternally
inherited, will be of great help.[33] The analysis of mtDNA
is a powerful tool in the forensic case work if there is no
ante mortem comparison sample owing to the maternal
inheritance pattern of mtDNA which can be matched with
parents or siblings of the deceased.[33]
Dental identification in mass disasters
Dental identifications have always played a key role
in natural and manmade disaster situations and in
particular mass casualties normally associated with aviation
disasters.[34-37] The identiÞcation process in a mass disaster
situation is fundamentally the same as that in a routine
comparative dental identiÞcation of a deceased individual,
but, the conditions under which the process is under taken
is more complex because of the physical and emotional
nature of the situation.[38-40] Lack of standardization in the
charting of dental records (because of which there will be
wide variations in the way in which details are recorded
in both ante mortem and post mortem records), the poor
working conditions, the psychological stress, decomposition,
mutilation of human remains at the site of disaster, all
confound the process of identiÞcation.[41] The fundamental
requisite for proper handling of these situations is disaster
preparedness.[41,42]
CONCLUSION
Forensic dental identifications play a vital role in the
identiÞcation of individuals when identiÞcation by visual
or any other methods like finger printing fail. Dental
identiÞcation of a person is based on unique individual
characteristics of the dentition and dental restorations,
relative resistance of the mineralized dental tissues and
dental restorations to changes resulting from decomposition
and harsh environmental extremes such as conditions of
temperature and violent physical forces.[43]
Dental identification can be used for identifying the
deceased or the assailant in a crime scene or for identiÞcation
of victims of a mass disaster. In the Asia paciÞc region,
because of its wide range of variations in topography
and climatic conditions, India is a disaster prone country
with an average of eight major natural calamities a
year. While ßoods, cyclones, droughts, earthquakes and
epidemic are frequent from time to time, major accidents
occur in railways, mines and factories causing extensive
damage to human life and property.[44] During all these
disasters the bodies of most of the victims are mutilated
beyond recognition by visual or any other methods. Under
these situations forensic dental identiÞcation is extremely
valuable.[43]
Forensic dental identification depends largely on the
availability of ante mortem records. So, it is the social
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Dentist in person identiÞcation Chandra Shekar and Reddy

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Indian J Dent Res, 20(3), 2009 360