Forensic dentistry

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Dental forensic examination to identify US soldiers in JPAC

Forensic dentistry (synonym: forensic odontology , forensic stomatology , also forensic odontostomatology from Latin: forum marketplace (formerly: court square )) is one of the three judicial sciences of humans, alongside forensic medicine and forensic anthropology . It is used in particular for the individual identification of corpses based on the comparison of their dentition ( teeth / jaw ) ante and post mortem (before and after death). It is used for victims of natural disasters, fire , aircraft , ship , train and traffic disasters as well as crimes . In addition, she deals with the allocation of bite marks, age diagnostics, gender determination, with victims of abuse and in the broadest sense with treatment errors .

Identification procedure

Jade-adorned teeth

The proportion of forensic odontology within the identification process is very high. In the 2004 tsunami disaster in Southeast Asia, 1,474 dead were identified. The dental comparison was the primary identifier in 79% of the cases through an odontological comparison of their dental status. In most countries, the rule applies that at least 12 similar characteristic elements of two fingerprint samples to be compared mean a positive identification. Applied to forensic dentistry, this means that at least 12 similar characteristic elements of two dental findings to be compared lead to an identification. Mathematically, with both methods the number of possibilities exceeds that of the earth's population . In total there are more than two trillion possible combinations. The individual characteristics of the teeth and dental therapy measures allow a very narrow definition of the person, which is comparable to the fingerprint or even the genetic fingerprint in terms of identification security . The method is therefore also known as “ dental fingerprinting ” ( English: “dental fingerprint”). The surviving teeth of the victims are compared with the dental status and X-rays of missing people.

Certain professions ( glass blower , confectioner ) or habits ( pipe smoker ) can be recognized from changes in the teeth, illnesses you have suffered ( rickets , syphilis ) from the shape of the teeth. Care of the teeth and the type of treatment provide information on the status and social position of the stranger.

The success of the prophylaxis has led to a reduction in caries in young people and periodontal damage in adults, thus reducing the number of dental treatments and the number of x-rays taken. This makes it difficult to compare information ante and post mortem. When establishing identity, the focus is increasingly placed on the examination of anatomical and morphological structures.

Dental assistance with identification

The criminal police regularly publishes the dental status of unknown victims in dental journals, such as the Zahnärztliche Mitteilungen , a specialist journal that is sent to all dentists in Germany every two weeks, so that dentists can compare the dental status with their records and help identify them. Likewise, the Joint POW / MIA Accounting Command (JPAC) should be mentioned, whose task it is to search for prisoners of war (English Prisoner of War , POW) and missing soldiers (English Missing in action , MIA) of members of the armed forces of the United States as well their identity verification . This is also possible with victims who have been burned beyond recognition: teeth, including dental fillings and implants, can withstand temperatures of up to 1200 ° Celsius. Dentists sometimes have a kind of photographic memory , whereby a set of teeth or a (more extensive) treatment can be (re) recognized. Otherwise, the findings can be compared with the patient records of a dentist. It would be desirable if the practice management software provided a comparison program with which entered findings could be automatically compared with the findings of all patients of a dentist, just as fingerprints can be compared with a database using an automated fingerprint identification system (AFIS) today.

Dental examination post mortem

Numerous features in one set of teeth

According to Wright, the post-mortem dental examination includes the determination of the following characteristics, which are recorded in a dental scheme . There are also special findings sheets for forensic dentistry. For documentation purposes, photo and video recordings , molds ( silicone , polyether ) and plaster models , including dating and labeling of the models, can be made. The investigation may be hampered by numerous factors, such as by the rigor mortis (lat .: rigor mortis ), giving access only after a post-mortem possible.

Examination grid

  1. Existing, missing and retained teeth and restorations
    • Type of restorations and treated tooth surfaces
    • periodontal condition, tartar and discoloration
    • Misalignments , rotations, impacts, incompletely erupted teeth
    • Determination of teeth lost after death has occurred;
  2. Fixed dentures, partial dentures , implants ;
  3. Traces of removable prostheses (pressure points);
  4. Occlusal and intermaxillary relationships;
  5. Characteristics of the dental arches , possible tori ;
  6. Properties of the individual teeth ( angle characteristic , bending characteristic , the root feature , crown flight , the tooth axis );
  7. Dental abnormalities
  8. Properties of the periodontium ;
  9. Pathological processes on teeth, periodontium, mucous membranes or bones ;
  10. Analysis of post-mortem x-rays :

  • Angular feature

  • Root feature

  • Curvature feature

  • Tooth axes

Examination of the jaw

A distinction is made between different jaw shapes based on the biogenetic classification according to Alfred Kantorowicz and Gustav Korkhaus (modified according to Reichenbach and Brückl).

  • Narrow jaw
  • Mismatch between tooth and jaw size
    • frontal crowding
    • primary crowding
  • Crossbite
  • Progenic circle of shapes
    • Progenic interlocking - anomaly in tooth position
    • frontal crossbite - anomaly of the shape of the jaw
    • progenous forced bite - anomaly of the jaw position
    • real progeny
    • spurious progeny - anomaly in jaw size
    • masked real progeny
  • Cover bite
  • Open bite
    • sucking bite
    • real open bite (gnathic)
    • tongue open bite (macroglossia)
  • Consequences of premature tooth loss
    • Jaw growth inhibition (false progeny or prognathy)
    • Tooth migration (raised canine teeth)
  • Other simply conditional anomalies
  • Diastema (any gap in the dentition)
    • Trema (gap between the central incisors)
      • real Trema
      • fake trema
  • Too many teeth (hyperdontia)
    • eutypical shape
    • dystypal form
  • Structural abnormalities of the teeth
  • Classification of dysgnathias
    • Angle class I - neutral occlusion
    • Angle Class II - Distal Occlusion, Groups 1 and 2
    • Angle Class III - Mesial Occlusion
  • Hereditary traits
    • Mismatch between tooth and jaw size
    • frontal crowding
    • primary crowding
    • progenic form circle (real progeny)
    • Cover bite
    • open bite (abnormal skull structure)
    • tongue open bite ( macroglossia )
    • Hyperdontia
    • Hypodontia
    • Cleft lip and palate

Bite wounds

Three-day-old bite wound from a dog

Bite marks and wounds can help identify a perpetrator. The traces can appear both with the victims and with the aggressors involved in a criminal act. In some cases the dentition leaves an impression, a kind of negative, in the human tissue, from which conclusions can be drawn about the tooth position, tooth shape and numerous other features. Bite wounds inflicted by adults also occur as a result of sexual abuse . A distance between the canines of more than 3 cm usually suggests an adult dentition. Bite wounds from animals must be excluded. According to a review from November 2014 with regard to the bite mark analysis, the uniqueness of the human dental impression has not yet been proven.

Classification of bite wounds
class 1 Bite with erythema
2nd grade Bite with contusion (contusio)
Class 3 Bite with abrasion
Grade 4 Bite with tear wound
Class 5 Bite with tearing of tissue

Identification marking

The dental technician can provide dental prostheses with identifiers when they are made, which can facilitate identification if necessary. The name or initials of a denture wearer can be invisibly engraved on the inside of the denture, as well as in hidden places on dental crowns or bridges. A microchip with the patient's data can also be built into the denture.

DNA analysis from teeth

Teeth can be used to extract deoxyribonucleic acid (DNA) from the pulp (the tooth pulp , popularly the "nerve") after the pulp is protected by the surrounding tooth enamel and dentin as if by armor . For this purpose, the pulp cavity can be opened and the pulp removed. After this, the risk of contamination is very large, the tooth by means of more recent process is cryogenic grinding (engl .: cryogenic grinding ) and triturated from the powder, the DNA to DNA analysis using the chain reaction polymerase obtained.

Age diagnosis

Upper maxillary canine in which the Retzius stripes can be easily seen in the full image resolution

Another field of activity is forensic age diagnostics, also of living people whose date of birth cannot be proven otherwise. The tooth breakthrough times that Wurzeldentintransparenz , the racemization of aspartic acid in dentin and the degree of Zementannulation expand the range of methods. In Germany, the implementation of a forensic age estimation of the living requires a judicial decision. The age of children and adolescents can be determined relatively precisely. This is helpful, for example , if the date of birth is unclear to determine the age of majority or in criminal proceedings , whether the accused falls under juvenile law or is under the age of 14 as a child ( Section 19 StGB) or is considered an adolescent (18 to 20 years of age) . In adults, a purely odontological age estimate with an accuracy of ± 5 years, according to other authors, ± 10 years is possible. The Retzius stripes (perikymatia) show an individual pattern in each person and can therefore also be evaluated from a forensic point of view. More recent studies by Willems have revealed a new model for estimating tooth age: The Willems method is used on fewer than seven lower jaw teeth. In contrast, there is the so-called London Atlas. It is recommended to first determine the age according to the London Atlas method, then according to Willems, and to calculate the mean value.

Odontometric sex determination

In order to determine the sex of a corpse in the case of incomplete or poorly preserved skeletal parts and missing DNA traces, the possibility of an odontometric sex determination remains, possibly including the jaw. For example, the upper central incisor in women is wider than the canine , in men both teeth are the same width. The differences in width between the upper central and lateral incisors also differ, as do the differences in width between the lower lateral incisor and the canine.

In addition, the caninus mandibularis index can be used to refer to the relationship between the mesiodistal crown diameter (MDKD) and the width of the caninus mandibularis arch on a gender-specific basis. The separating function of a discriminant formula in the measurement of the lower jaw ( mandible ) is determined by three variables, the angular width between the horizontal and ascending branch of the mandible, the height of the ascending branch of the mandible and the height of the mental foramen, as well as the palatal fold relief and the measurement of the palatal arch .

Gender diagnoses can be made by the first lower molars, the first upper premolars, and especially the canini (canine teeth). The cervical features are more suitable than the crown diameters for sex determination, while the tooth root lengths are unsuitable for this.

Forensic anthropology

Wisdom tooth 28 ( Swedish : visdomstand) not yet fully erupted in the left upper jaw of the raspberry girl.
Teeth are the most enduring evidence of human development: molars from the Koenigswald collection in the Senckenberg Research Institute

The wife of Luttra is a 5000 year old Neolithic bog corpse that was found in 1943 in a bog in the municipality of Falköping , Västra Götalands län , Sweden . Because of the raspberries , her last meal, the young woman was nicknamed Hallonflickan (German: raspberry girl). The ossification of the cranial sutures together with the tooth structure, in particular the upper wisdom teeth that have not yet erupted , could be used for anthropological age determination. They suggest that she was around 20 to 25 years old. The exact cause of death could not be clarified. Fossil teeth are used in paleoanthropology to use the Retzius strips to reconstruct the speed of development of the juveniles of early species of hominini .

Forensic aspects of domestic violence

Dentists are increasingly devoting themselves to the detection and documentation of traces of violence in connection with a visit to the dentist in order to be able to convict the perpetrator in court later. This also includes securing DNA traces for a possible DNA analysis. A victim often decides to file a complaint long after the crime. It is precisely then that reliable documentation is important. Corresponding documentation sheets have been developed and are available to the dentists. In these cases too, dentists are bound by confidentiality . According to Section 1, Art. 14, Paragraph 6 of the GDVG ( Health Services and Consumer Protection Act ), however, the doctor is obliged to report this to the youth welfare office if there are “serious indications” of child abuse . In addition, the doctor is generally authorized to break the obligation to maintain confidentiality in order to avert danger to life and limb (“imminent danger”). The Institute for Forensic Medicine at the Ludwig Maximilians University in Munich , in collaboration with the Bavarian Association of Statutory Health Insurance Dentists, has developed a forensic dentistry examination sheet for the clinical examination of victims after an act of violence .

Medical malpractice

A dental malpractice is present if a dental treatment was not carried out taking into account the current state of knowledge of medical science at the time of the treatment, unless the patient and the treating person have agreed a different standard of treatment permissible and effective. It can result in the dentist being liable under civil, regulatory or criminal law. In the broadest sense, diagnosing the treatment error and assessing the treatment are part of forensic dentistry.

Pink teeth

"Pink teeth" (Engl .: pink teeth ) may be about one to two weeks post mortem occur during life or. By hyperemia , blood congestion and leakage of red blood cells in the autolysis and humid conditions it can lead to seepage of hemoglobin , the red blood pigment in the dentinal tubules come, the tooth pink so discolored. The phenomenon can be observed in death by drowning , especially if the head was in a low position. However, pink teeth are not pathognomonic for any particular cause of death and remain a non-specific phenomenon.

history

Early days of forensic dentistry

Fire in the Vienna Ring Theater on December 8, 1881. Representation by Karl Pippich .

A few cases are reported, especially since the Middle Ages, of identifications based on dentition, including Charles the Bold , Louis XVII. and William the Conqueror .

In 1862 the Viennese Paul Pfeffermann , who called himself a doctor of medicine and surgery, ophthalmology and dentistry and was a member of the Viennese medical faculty and several learned societies, published a brief summary for the first time in the literature in his "Comprehensive presentation of the entire dentistry" Chapter “Forensic Dentistry”. It describes the benefits of special forensic dentistry, objects of dental examinations, complications in the event of injuries to the teeth, classification of injuries, criteria for assessing abnormal conditions in injuries, the drafting of dental judicial reports, complaints about any possible complaints against the dentist himself Complaints, formulas from expert opinions. In the four arranged forensic dental reports, there is talk of a syphilitic infection, an injury to the teeth in a brawl , serious injury to the face by being hit with a log and finally an opinion on the meaning and curability of bad breath .

Identity determinations

Fire in the Bazar de la Charité, cover of Le Petit Journal of May 10, 1897.

In 1881, after the fire in the Vienna Ring Theater , the method of identification based on the position of the teeth was practiced for the first time on the recovered and severely destroyed corpses, thus laying the foundation for the later renowned "Vienna School of Criminology". According to official information, the death toll was 384. Ludwig Eisenberg writes of almost 1,000 deaths.

Oscar Amoëdo y Valdes (1863–1945) from Cuba is known as the father of forensic dentistry . The occasion was a tragic fire disaster at a charity event in Paris , the Bazar de la Charité , in 1897 , at which 129 people were killed. Amoëdo was not involved in identifying the burn victims himself, but interviewed the people involved and published the results in the first book on forensic dentistry, L'Art Dentaire de Medicine Legale . He himself names Albert Hans, the Paraguayan consul, as the originator of forensic dentistry. He called the dentists treating the burn victims together in order to identify the victims.

The identity of the cremated corpse of Adolf Hitler was established by the fact that his dentist Hugo Blaschke had to reproduce Hitler's teeth out of plaster after a request from the Soviet military administration in order to identify Hitler during his imprisonment in the Allied internment camp for Nazi celebrities in Nuremberg- Langwasser . The plaster dentures made from memory matched those of Hitler's teeth that were in Soviet custody. Eva Braun's cremated corpse was also identified based on the complicated dental prosthesis, which the dental technician Fritz Echtmann recognized. During underground cable work by the Post on 7./8. December 1972, two skeletons were found near the Lehrter Bahnhof in Berlin, which based on their teeth could be assigned to the Reich Minister and important confidante of Hitler Martin Bormann and to Hitler's last personal or accompanying doctor, SS-Standartenführer Ludwig Stumpfegger . Splinters of glass from hydrocyanic acid vials were found between the teeth of both skulls . This invalidated rumors that Bormann had fled to South America.

When the identity of Lee Harvey Oswald , the assassin on John F. Kennedy , was questioned in 1963 and again in 1981 (it was alleged that a Russian spy was buried instead of him), his identity was confirmed on the basis of his dentition after his exhumation .

Forensic dentistry was also used after the attack on the World Trade Center and the Pentagon (2001), as well as after the hurricanes Katrina and Rita (2005) or after tsunami disasters such as the 2004 earthquake in the Indian Ocean with over 230,000 victims or the Tōhoku 2011 earthquake ( Fukushima ) kills 19,300. The victims were also identified with the help of forensic dentistry in aircraft accidents such as Air-Algérie flight 5017 (in Mali , 2014) or Germanwings flight 9525 (2015).

archeology

In archeology, finds are analyzed using DNA analyzes of the teeth. For example, a total of 25 skeletons were found during tunnel work in London. The bones come from a cemetery for plague victims from the early 15th century, which was proven by DNA analysis of the teeth. The plague bacterium Yersinia pestis could be detected in several teeth .

Professional societies

In Germany, the Working Group for Forensic Odontology (AKFOS) of the German Society for Dental, Oral and Maxillofacial Medicine and the German Society for Forensic Medicine has been dealing with forensic odontology since 1976 . Werner Hahn (1912–2011), former director of the Clinic for Oral and Maxillofacial Surgery at Christian-Albrechts-Universität Kiel, founded the AKFOS in Germany - as a board member of the DGZMK - in 1976 and was his for more than 20 years Chairman. From the very beginning he campaigned for further training to become a "specialist dentist for forensic odontology", but without success. AKFOS is a member of the International Organization For Forensic Odonto-Stomatology (IOFOS). Rüdiger Lessig, Director of the Halle Institute for Forensic Medicine, was elected Vice President in 2017. The Association Française d'Identification Odontologique (AFIO) exists in France, the American Society of Forensic Odontology (ASFO) in the USA and the Asociación Española de Odontología Legal y Forense (AEOLF) in Spain . In Austria and Switzerland there are working groups in the respective societies for forensic medicine. Peter Freyberger described Graz as the cradle of Austrian dental forensics.

literature

Individual evidence

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  8. ^ The Munich criminal investigation department asks for help. ( Memento of March 13, 2017 in the Internet Archive ) In: Dental communications . March 1, 2017. Retrieved March 12, 2017.
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  26. ↑ RezwanaBegum Mohammed, PV Krishnamraju, PS Prasanth, Praveen Sanghvi, Masha Lata Reddy, S. Jyotsna: Dental age estimation using Willems method: A digital orthopantomographic study. In: Contemporary Clinical Dentistry. 5, 2014, p. 371, doi: 10.4103 / 0976-237X.137954 .
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  33. ↑ An example of this is: Tanya M. Smith et al .: Rapid dental development in a Middle Paleolithic Belgian Neanderthal. In: PNAS . Volume 104, No. 51, 2007, pp. 20220-20225. doi: 10.1073 / pnas.0707051104
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  36. ↑ Examination sheet for forensic dentistry for the clinical examination of victims after an act of violence . Institute for Forensic Medicine at LMU. Retrieved July 11, 2019.
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  44. ^ O. Amoëdo: The role of the dentists in the identification of the victims of the catastrophe of the “Bazar de la Charite”. In: Dental Cosmos. Volume 39, Paris, May 4, 1897, pp. 905-912.
  45. ^ Ulli Kulke : The second death of Adolf Hitler. In: Die Welt Online. October 25, 2006.
  46. ^ Forensic Dentistry . Springer, 2000, ISBN 3-642-50273-3 , pp. 140-146 ( google.com ).
  47. ↑ Katja Anslinger, Burkhard Rolf: The case of Martin Bormann . (PDF) Institute for Forensic Medicine at the Ludwig Maximilians University in Munich. Retrieved January 6, 2015.
  48. ↑ Bormann's skeleton clearly identified . In: Der Spiegel . No. 19 , 1998, pp. 230 ( online ). Retrieved January 6, 2015.
  49. ↑ C. Michael Bowers, Forensic Dental Evidence: An Investigator's Handbook , EPDF. Retrieved July 11, 2019.
  50. ↑ David R. Senn, Paul G. Stimson: Forensic Dentistry . 2nd Edition. CRC Press, 2010, ISBN 978-1-4200-7837-4 , pp. 21 ( books.google.com ).
  51. ↑ Claus Grundmann: ( Page no longer available , search in web archives: Dentists asked as reviewers. ) DZW, E-paper, 02/2016, p. 10. Retrieved on January 16, 2016.@1@ 2Template: Toter Link / digital.dzw.de
  52. ↑ Nina Sündermann, AP: The Black Death felt on the tooth. 20 minutes. Retrieved December 16, 2015.
  53. ↑ AKFOS website
  54. ^ Claus Grundmann: The dentist as an expert. In: Dental communications. Issue 24/2008. accessed on February 15, 2016.
  55. ↑ Forensic Dentistry: Forensic Medicine Becomes Vice President , ZWP online, October 27, 2017. Accessed July 11, 2019.