The gander disaster: dental identification in a military tragedy

The authors record the contributions of dentistry to the identification of victims of one of the most significant disasters in aviation and U.S. military history--the December 1985 crash of a DC-8 charter airliner near Gander, Newfoundland (now known as Newfoundland and Labrador), Canada, which killed 248 Army personnel and 8 crewmembers. Most of the dental records of the military victims were destroyed in the crash, and, as a result, this loss hampered dental identification. Nevertheless, dental identification was the primary means of identification for many because a very high percentage of the bodies were severely burned and fragmented. Many phases of the U.S. identification efforts have been reported, but the dental-investigation aspects have been mentioned only in passing. Therefore, this article documents the dental team's organization, methodology, and a variety of remarkable problems that the team encountered.     

The USS Iowa disaster: success of the forensic dental team

The authors record the contributions of dentistry to the identification of the crew members who were in one of the most significant peacetime military accidents in U.S. Navy history-the April 1989 explosion in a gun turret on the battleship USS Iowa and the deaths of 47 U.S. Navy personnel. Dental identification was the primary means of identification for most because a very high percentage of the bodies were burned or fragmented. The dental-identification team's success was a direct result of its preparedness, its use of dental personnel with mass-disaster experience, and the overall excellent quality of the antemortem dental records. The dental-identification team's successful involvement in the USS Iowa tragedy was considered a model for success and therefore was instrumental in contributing to the development of the American Board of Forensic Odontology "Guidelines for the Development of a Disaster Dental Identification Team."     

Tenerife revisited: the critical role of dentistry

The authors record the contribution of dentistry to the identification of victims of one of the most significant disasters in the history of aviation-the March 1977 collision of two Boeing 747 jumbo jets in the Canary Islands, which resulted in 583 fatalities. Dental identification was the primary method of victim identification because a high percentage of the bodies were severely burned. Virtually all aspects of the U.S. identification efforts have been reported with the exception of the valuable role of dentistry. The dental team's organization, methodology, and significant contributions to forensic dentistry and a variety of remarkable problems that the team encountered are documented.     

Identification via dental remains: Pan American Flight 759

Pan American Flight 759 crashed on takeoff from New Orleans International Airport on 9 July 1982. One-hundred-and-fifty-four persons lost their lives making this the second worst air crash in the United States. A dental identification team was assembled and began working the next morning. Ninety-three victims were positively identified by dental means and twenty-three other victims had strong supporting dental evidence as to their identities. The organization, method used, planning, and problem resolution concerning the dental team for this crash are presented.     

A new algorithm for use in computer identification

On 9 May 1987, a Soviet-made IL-62M Polish airliner, LOT Flight 5055, crashed, exploded, and burned, killing the crew and 183 passengers. A forensic science team from the Armed Forces Institute of Pathology, comprised of 6 dental officers, 3 forensic pathologists, and 3 medical photographers, worked in concert with the Polish forensic science team. The small number of antemortem records and the extreme fragmentation of the remains presented a new scenario for computer use. Typically, the Computer-Assisted Postmortem Identification (CAPMI) software is used to compare remains against an antemortem database. Results are listed by the number of tooth-to-tooth matches based on restorative or other characteristics or both. The Polish disaster confounded this approach to some degree, however, and suggested a reconsideration of the theory on which the sort is made, that is, that the cases with maximum number of matches to preexisting dental records would be the most likely identification (ID) match. A hypothesis was constructed that, if searches were accomplished for fragments with a minimum number of mismatches, the correct matches would appear higher in the rank order. Six antemortem records (that had all dental information) were sorted against one hundred and twelve postmortem fragmented records. The resulting report was reordered so that records were listed by minimum number of mismatches. There was significant improvement in rank placement for all of the records. Thus it was accepted that in the situation of highly fragmented remains a different sorting based on the number of mismatches is indicated. Programming changes to make this option available have been implemented in the new version of CAPMI.     

The diversity of adult dental patterns in the United States and the implications for personal identification

Few would argue about the individuality of dental radiographs for forensic identification, but when an antemortem/postmortem comparison is based strictly on dental treatment notes and/or charts it becomes less certain. In the past, attempts to validate the high diversity of dental patterns created by combinations of missing, filled, and unrestored teeth have been based on unfounded statistical assumptions. The goal of this research is to present a statistically valid method of assessing dental pattern diversity for the identification of missing individuals. Empirical observation of large reference datasets was found to be the best technique for assessing dental diversity. This technique is nearly identical to the procedure used for mitochondrial DNA casework. For the research presented in this paper, two large datasets were used, one composed of U.S. military personnel and one composed of U.S. civilians. Dental patterns were found to be very diverse on a scale that is comparable to mtDNA. In addition, it was found that the diversity values remain very consistent regardless of the level of detail present in the treatment records. Overall, combinations of missing, filled, and unrestored teeth were found to be very individualistic and an excellent source for forensic identification.     

Root Morphology and Anatomical Patterns in Forensic Dental Identification: A Comparison of Computer‐Aided Identification with Traditional Forensic Dental Identification*

Abstract: An online forensic dental identification exercise was conducted involving 24 antemortem–postmortem (AM–PM) dental radiograph pairs from actual forensic identification cases. Images had been digitally cropped to remove coronal tooth structure and dental restorations. Volunteer forensic odontologists were passively recruited to compare the AM–PM dental radiographs online and conclude identification status using the guidelines for identification from the American Board of Forensic Odontology. The mean accuracy rate for identification was 86.0% (standard deviation 9.2%). The same radiograph pairs were compared using a digital imaging software algorithm, which generated a normalized coefficient of similarity for each pair. Twenty of the radiograph pairs generated a mean accuracy of 85.0%. Four of the pairs could not be used to generate a coefficient of similarity. Receiver operator curve and area under the curve statistical analysis confirmed good discrimination abilities of both methods (online exercise = 0.978; UT‐ID index = 0.923) and Spearman’s rank correlation coefficient analysis (0.683) indicated good correlation between the results of both methods. Computer‐aided dental identification allows for an objective comparison of AM–PM radiographs and can be a useful tool to support a forensic dental identification conclusion.     

Dentists' qualifications affect the accuracy of radiographic identification

This study assessed the effects of forensic odontologists' training and experience upon the accuracy of their dental radiographic identifications. Forty participating odontologists with various levels of training and experience completed a Web-based survey of their qualifications and then completed nine Web-based radiographic identification cases. They made their identifications using the American Board of Forensic Odontology Categories and Terminology for Body Identification. The results indicate that odontologists with high levels of training and experience performed significantly more accurately than those with lower levels. We conclude that high levels of training and experience in forensic odontology should be developed, maintained, and required of dentists who participate in a forensic team dealing with challenging identification cases.     

The Teaching of Denture Marking Methods in Dental Schools in the United Kingdom and the United States*,†

Abstract: Forensic organizations worldwide have recommended that dental prostheses should be marked with, at a minimum, the patient’s name and preferably with further unique identifiers such as a social security number. The current study aimed to assess the denture marking practice of dental schools within the United States and the United Kingdom. A questionnaire‐based survey was employed to gain both quantitative and qualitative data on the methods, practices, and ethos behind denture marking in 14 U.K. and 32 U.S. dental schools. One hundred percent of U.K. and 87.5% of U.S. schools returned surveys and the results suggest that, for dental schools where there is no legal or legislative need for denture marking, the practice is inconsistently taught and appears to be reliant on internal forces within the school to increase awareness. Among those schools practicing marking, only 18% employ a technique likely to withstand common postmortem assaults; this is a concern.     

Intelligent dental identification system (IDIS) in forensic medicine

This study reports the design and development of the intelligent dental identification system (IDIS), including its efficiency and reliability. Five hundred patients were randomly selected from the Dental Department at Police General Hospital in Thailand to create a population of 3000 known subjects. From the original 500 patients, 100 were randomly selected to create a sample of 1000 unidentifiable subjects (400 subjects with completeness and possible alterations of dental information corresponding to natural occurrences and general dental treatments after the last clinical examination, such as missing teeth, dental caries, dental restorations, and dental prosthetics, 100 subjects with completeness and no alteration of dental information, 500 subjects with incompleteness and no alteration of dental information). Attempts were made to identify the unknown subjects utilizing IDIS. The use of IDIS advanced method resulted in consistent outstanding identification in the range of 82.61-100% with minimal error 0-1.19%. The results of this study indicate that IDIS can be used to support dental identification. It supports not only all types of dentitions: primary, mixed, and permanent but also for incomplete and altered dental information. IDIS is particularly useful in providing the huge quantity and redundancy of related documentation associated with forensic odontology. As a computerized system, IDIS can reduce the time required for identification and store dental digital images with many processing features. Furthermore, IDIS establishes enhancements of documental dental record with odontogram and identification codes, electrical dental record with dental database system, and identification methods and algorithms. IDIS was conceptualized based on the guidelines and standards of the American Board of Forensic Odontology (ABFO) and International Criminal Police Organization (INTERPOL).     

The Odontology Victim Identification Skill Assessment System*,†

Abstract: Mass fatality identification efforts involving forensic odontology can involve hundreds of dental volunteers. A literature review was conducted and forensic odontologists and dental educators consulted to identify lessons learned from past mass fatality identification efforts. As a result, the authors propose a skill assessment system, the Odontology Victim Identification Skill Assessment System (OVID‐SAS), which details qualifications required to participate on the Antemortem, Postmortem, Ante/Postmortem Comparison, Field, and Shift Leader/Initial Response Teams. For each qualification, specific skills have been identified along with suggested educational pedagogy and skill assessment methods. Courses and assessments can be developed by dental schools, professional associations, or forensic organizations to teach and test for the skills required for dental volunteers to participate on each team. By implementing a system, such as OVID‐SAS, forensic odontologists responsible for organizing and managing a forensic odontology mass fatality identification effort will be able to optimally utilize individuals presenting with proven skills.     

Office of the Secretary; TRICARE; changes included in the National Defense Authorization Act for fiscal year 2005; TRICARE dental program. Final rule

The Department is publishing this final rule to implement sections 711 and 715 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA for FY05), Public Law 108-375. Specifically, that legislation makes young dependents of deceased Service members eligible for enrollment in the TRICARE Dental program when the child was not previously enrolled because of age, and authorizes post-graduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association to provide dental treatment to dependents who are 12 years of age or younger and who are covered by a dental plan established under 10 U.S.C. 1076a. This adopts the interim rule published on September 21, 2005 (70 FR 55251).     

TRICARE; changes included in the National Defense Authorization Act for fiscal year 2005; TRICARE Dental Program. Interim final rule

The Department is publishing this interim final rule to implement sections 711 and 715 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA-05), Public Law 108-375. Specifically, that legislation makes young dependents of deceased Service members eligible for enrollment in the TRICARE Dental Program when the child was not previously enrolled because of age, and authorizes post-graduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association to provide dental treatment to dependents who are 12 years of age or younger and who are covered by a dental plan established under 10 U.S.C. 1076a. This rule also corrects certain references in 32 CFR 199.13. The rule is being published as an interim final rule with comment period in order to comply with statutory effective dates. Public comments are invited and will be considered for possible revisions to the final rule.     

Searching for Kin Amidst Tragedy—Disaster Victim Identification Operations for US Bangla Flight 211

The nature of air disasters includes factors that exacerbate challenges in the identification process. Of the 49 deceased in the US Bangla air crash in Kathmandu, Nepal, four were intact, 11 presented with burn injuries, another 11 presented with partial charring, and 23 were completely charred. Personal belongings were useful in the identification phases for all types of victims. Fingerprints were obtainable and useful in intact victims and victims with less severe burn injuries; medical and surgical information was useful in bodies with burn injuries; finally, dental findings were useful in cases of extensive charring. Other useful methods in the process included marks of identification, physical features, and exclusion. In certain resource‐limited settings, especially in closed population disasters, where scientific identification (DNA, dental records, etc.) is not currently available, personal belongings, clothing, and physical findings analyzed by an identification team using a structured organization may be cautiously used as the primary means of identification.     

TRICARE; expansion of geographic scope of the TRICARE Retiree Dental Program. Final rule

This final rule expands the geographic scope of the TRICARE Retiree Dental Program (TRDP) to overseas locations not currently covered by the program. At this time, TRDP is applicable only in the 50 United States (U.S.) and the District of Columbia, Canada, Puerto Rico, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands. Expanding the geographic scope of the program will ensure that all TRICARE-eligible retirees are eligible for the same dental benefits, regardless of their location. There are no additional Government costs associated with this final expansion of TRDP overseas as TRDP costs are borne entirely by enrollees through premium payments.     

Morphometric Comparison of Clavicle Outlines from 3D Bone Scans and 2D Chest Radiographs: A Shortlisting Tool to Assist Radiographic Identification of Human Skeletons

This paper describes a computerized clavicle identification system primarily designed to resolve the identities of unaccounted‐for U.S. soldiers who fought in the Korean War. Elliptical Fourier analysis is used to quantify the clavicle outline shape from skeletons and postero‐anterior antemortem chest radiographs to rank individuals in terms of metric distance. Similar to leading fingerprint identification systems, shortlists of the top matching candidates are extracted for subsequent human visual assessment. Two independent tests of the computerized system using 17 field‐recovered skeletons and 409 chest radiographs demonstrate that true‐positive matches are captured within the top 5% of the sample 75% of the time. These results are outstanding given the eroded state of some field‐recovered skeletons and the faintness of the 1950's photofluorographs. These methods enhance the capability to resolve several hundred cold cases for which little circumstantial information exists and current DNA and dental record technologies cannot be applied.     

Forensic dental training in Australia

To facilitate in the identification of victims of a major disaster a trained dental manpower reserve is required. In the state of New South Wales, Australia, an annual three-day training course has been designed to familiarize dentists from both the public and private sectors with identification techniques. The course is aimed to preserve the flexibility of personnel so that they can be utilized in a variety of roles rather than rigidly structuring the make up of a team. It is envisaged though, that in a mass disaster situation teams would be specialized into dental autopsy, antemortem or comparison roles.     

Demographic change and forensic identification: problems in metric identification of Hispanic skeletons

The United States (U.S.) population structure is currently in a state of flux with one of the most profound changes being the increasing number of people referred to as Hispanic. In the U.S., much of the identification criteria for a biological profile are based on American Black and White individuals from anatomical collections. Using metric data from the Forensic Anthropology Data Bank (FDB), this paper will attempt to explore several issues that forensic anthropologists face when confronted with Hispanic remains. These will involve estimation of sex, height, and ancestry, the initial components of a biological profile. Discriminant function analyses indicate that American White criteria provide poor estimations of sex when applied to Hispanics and that ancestry estimation of Hispanic crania is difficult. Additionally, a new linear regression equation is presented that estimates stature for Hispanic individuals, although population specific criteria are still needed for Hispanic individuals from diverse geographical origins.     

对欧美“法律东方主义”的反思与超越

法律东方主义是欧美社会想象与误读中国法的结果,表现为欧美学者以西方法治标准来理解检验中国法。欧洲法律东方主义影响到美国,导致美国社会与学术界对中国法产生各种偏见与自负。1882年美国排华法案与民国时期美国驻沪法院"治外法权"的存在是美国法律东方主义的体现,是美国法制历史变迁中的阴影部分。美国学者络德睦对美国中国法研究中的传统思维定式进行了反思,指出美国法学学术界对中国法的认知存在很多偏见与自负。后殖民法学理论作为后现代法学理论的分支,依附与从属于美国的主流法学,美国学者反思法律东方主义是为了消除美国法律历史上的阴影,为主流法学的发展提供参鉴。中国法学面临的现实问题与美国有所不同,各自的司法背景也迥异,后殖民法学理论有其学术价值,但吸纳判例教义学体系的精髓才是学习美国法的优先选项。     

The design and assessment of mock mass disasters for dental personnel

Mass disasters represent a significant challenge for dental personnel who are frequently called upon to provide identifications. Recently-published materials have highlighted the need to prepare such groups for the disaster challenge and to report inadequacies in existing preparation methods with an emphasis on team integration, organization, and the psychological and emotional effects of such work. Many studies have retrospectively reported errors that have been made in disaster situations, but few have addressed the issues proactively. In an effort to provide a prepared team of dental members, a mock disaster exercise (Operation: DENT-ID) is conducted annually in Vancouver, Canada. The present study analyzes the effectiveness of this exercise in relation to team organization, assessment of preparedness, and the emotional and psychological issues. An index of preparedness is developed and described. This index, in the form of a questionnaire, can be given to participants in mock disasters to assess the effectiveness of such exercises. While the focus of this paper is on the assessment of dental personnel, the indices and methods used can be applied to any group working within the disaster team. Results indicate that the increase in preparedness as a result of the exercise was highly significant.