What is Forensic Odontology?

Simply put, Forensic Odontology is the application of dental principles and knowledge to matters of law.

Forensic Odontology cases, both civil and criminal, include:

  • Identify human remains that cannot be identified using DNA, fingerprints or other means
  • Identify remains in mass fatalities, such as plane crashes and natural disasters
  • Determine the source of bite mark injuries in cases of assault or suspected abuse (human and animal)
  • Assist in investigation of child, partner, elder and animal abuse cases
  • Estimate the age of skeletal remains and determine legal age
  • Testify in cases of dental standards of care and fraud

Forensic investigation is not what you see on TV with CSI or NCIS. Case Investigations are not completed in 45 minutes with exotic equipment by attractive women in designer dresses. This phenomenon is called the CSI effect and does have an impact on jury outcomes. Sophisticated laboratory tests and unrealistic outcomes are expected in every investigation. If not, the investigation is perceived as flawed. News reports and social media likewise have the ability to direct investigations in certain directions by putting pressure on investigators, law enforcement and the legal system. High profile media coverage catapults the more notable and even bizarre cases to the forefront of public opinion. Generally, knowledge of the masses supersedes the individual but not universally. Due diligence must pervade in forensic investigations. One should not rush to judgment and avoid biases as much as possible. Scientific methodology must be followed and critical thinking engaged.

Dental Identification

Forensic Odontologists assist law enforcement, attorneys, medical examiners and investigators. The bulk of what we do is identification of human remains. There are two parts to the ID puzzle, the antemortem (before death) information and the postmortem (after death) data. There is no repository of dental information. This is not a problem where if a person’s identity is thought to be known and all that is needed is confirmation. Dental records can be collected from information provided by family, friends and the dentist of record. But what happens in the case of a decedent with no information, say just a skeleton found in the Ocala National Forest? This involves a team approach. The medical examiner will conduct a thorough autopsy to establish cause and manner of death, look for identifying information like artificial joints which have ID numbers and any other relevant information. A forensic anthropologist will be employed to collect physical characteristics like gender, height, weight, physical traits, race, age range, etc. These findings are not exact but provide a reference point for the unknown victim. The odontologist completes a dental autopsy including photographs, orofacial examination, x-rays and dental charting of the teeth and fillings. All the deceased data is entered into a national data bank for missing and unidentified individuals. Of course DNA and fingerprint data is relevant but may be too expensive as in the case of DNA or simply unavailable in severe decomposition for example.

The data bank is a resource used by investigators when following leads on missing and unknown individuals. When there is a potential “hit” on an ID based on dental or any other data the investigator contacts the dentist of the decedent to collect dental records. The odontologist is called in to compare the ante- and postmortem dental records. Once all the records are available using digital technology, an ID (or not), can be done almost instantly.

The entire process is exacting and can take some time to complete if there are no initial leads. There is no room for error or second guessing. The medical examiner has the final say confirming the identification.

FO investigations date back to the Roman Empire. One of the earliest recorded cases was In A.D. 49 when the sister of Emperor Caligula, Agrippina, who when presented the severed head of her nemesis Lollia, identified her by the unusual dentition.

Other notable Forensic Odontology identification cases include:

  • Paul Revere identified the remains the famous General Dr. J. Warren by dental work he had done.
  • The identification of John Wilkes Booth by irregular teeth and a gold metal bridge on his top teeth.
  • Czar Nicholas II and his royal family executed in 1918 were ultimately identified by teeth and DNA.
  • Some of the 912 people who committed suicide in 1978 in Guyana were identified by dental records.
  • Twenty -three of the twenty-five murder victims of John Wayne Gacy, the “clown killer”, were identified by dental remains.
  • Both flights AA 191, the largest airline crash on US soil to that date killing 274 people and Valujet 592 that crashed in the Everglades in 1996 with 110 fatalities, had many of the identifications done with dental records.

Other notable events were at the Waco, Texas siege, Oklahoma City Murrah Federal Building terrorist murders, Hurricane Katrina in 2005 and the 9-11 attacks.

Military remains from overseas are sent to Dover Air Force Base in Delaware for processing and then released to the families.

Not included here are the thousands of equally important cases involving vehicular accidents, homicides, drowning, animal attacks, etc.

Bite Mark Cases

Bite mark cases date back to William the Conqueror in the eleventh century. Since his teeth were distinctive, he was known to bite the wax seals on official documents. Or the Salem witch trials in the late 1600’s where people were executed based on claims of accusers who opined that they were bitten. A case in Norway started in 1958 still is unresolved as of 2012.

The landmark bite mark case in the US is the Ted Bundy case. Bundy was a serial killer who raped and murdered an estimated 40 women. This pivotal trial established the admissibility of bite mark evidence in the Florida court system. Bundy was finally executed in the electric chair in 1989.

Bite mark comparisons for both humans and animals is basically the same process. Digital images of the bite mark wounds are taken and imported in Photoshop and resized to life size. Then teeth impressions are taken from the suspect and those are scanned and also imported into Photoshop. Next, the images, teeth models and the bite mark are compared for similarities. The Forensic Odontologist renders an opinion of the likelihood of the suspect having made the mark.

Bite mark cases are not without controversy however. There have been exonerations of inmates convicted on faulty bite mark evidence and erroneous testimony. Perhaps the most famous case is that of Ray Krone who was convicted and spent 10 years on death row for the murder of a waitress. At the timethe biological evidence was inconclusive. However, in 2001 biological samples were retested and Mr. Krone was ultimately excluded. Another man who lived in the same neighborhood who was in prison for another offense was convicted for the murder.

A dentist in Mississippi became the poster boy for bad science because of egregious mistakes and fabricated evidence leading to false convictions. All forensic science, including bite mark evidence is being re-evaluated for scientific validity. As with any of the forensic sciences, bite mark evidence is an important evidentiary tool but needs to be used judiciously and not overstated.

Domestic Violence

In all 50 states, dentists are mandated by law to report suspected cases of child and adult abuse to social agencies or law enforcement. One of the commonalities of abuse is the inconsistency, vagueness, or contradictory history of physical signs of injury. The victim may be described as “clumsy” or “accident prone” leading to injuries. Victims’ behavior may be withdrawn, overly aggressive or inappropriate and demonstrate lack of eye contact. There are multiple physical and psychological indicators of abuse that forensic dentists are trained to look for during an examination.

Child Abuse

The Roman Laws of Twelve Tables, 450 BC, stated that a male child may only be sold three times. Spartan children with mental and physical defects were left to die in the wild. In 1871, the first child cruelty case in New York City was given the SPCA to get help. Today, there is a pervasive world-wide network in pornography, illegal sex trafficking and exploitation of children and young adolescents. The types of physical injuries indicative of abuse include fractures, bruises, lacerations, patterned injuries, orofacial and ocular injuries, bite marks, failure to thrive, healed fractures and dental trauma. Emotional abuse usually manifested as neglect or deprivation is also present. Children at risk are often seen as “different”, challenged mentally or physically, in drug or alcohol environments, isolated from others and often financially poor. Often the boyfriend or partner has no emotional commitment to the family becomes the primary abuser. Mental abuse consists of verbal assault, threatening, bullying, shaming and belittling and ridicule.


Intimate Partner Violence (IPV)

According to the CDC in 2010, eight million woman and men are victims of IPV annually and approximately 2000 die as a result. Categories of IPV include: verbal abuse, financial abuse, stalking or control, physical abuse and sexual abuse.

Statistics from a recent article disclose the following facts:

  • Woman are at a higher risk than men
  • Over half of spousal homicide victims had reported history of domestic violence
  • Childhood victimization more prevalent among spousal violence victims
  • Perpetrators if intimate violence also cause harm to others


Elder Abuse and Neglect – the hidden crime

There is no physical, social or demographic profile of the prototypical adult individual most likely to suffer abuse. Often they cannot live alone, are over 75 years old with one or more impairments. This generation is subject to passive and active abuse where caregivers fail to give adequate health care and living conditions. Other categories of elder abuse consist of financial or material care, psychological abuse, undue influence, physical abuse and sexual abuse. Failure to sustain

Determining the incidence and prevalence of elder abuse and neglect is very difficult, mainly because most cases are not known to anyone out-side of the situation. Also, differing definitions of abuse and neglect, reporting agencies not keeping adequate data. While the actual incidence and prevalence of elder mistreatment in domestic and institutional settings is unknown and can only be estimated, all of the studies clearly indicate that most cases are unreported in spite of mandatory reporting laws in all fifty states. (Encyclopedia of Aging | 2002 Hudson, Margaret.

Recognizing the Abuser:

  • 47% of abuse cases were committed by the spouse.
  • 19% of abuse cases were committed by the adult child.
  • Malesabuse more often than females.
  • Caregiver dependence on the victim for financial assistance, housing, or other needs increases the risk for abuse.
  • Alcohol abuse is the most common risk factor for physical abuse.
  • A poor premorbid relationship between caregiver and care recipient is a predictor of stress that leads to abuse.

Other populations subject to abuse include the disabled, pregnant woman, the institutionalized, informed, disabled and pets.

Animal Forensics

Most of the same principles used in human forensics apply to animal criminal and civil cases as well. However, as one might expect, animal cases present with their own unique challenges. Animal bites typically are more destructive and the crime scenes difficult to manage.

There may be criminal and civil liability and incarceration for the dog owner who refuses to protect the public from a vicious animal. Dog bites and abuse are the most common cases with civil settlements reaching as much as $5 million.

Arguably the most famous dog criminal case involved two Presa Canarios dogs in the brutal mauling death of a popular female lacrosse coach in the hallway of her apartment building in San Francisco in 2001. She died from massive blood loss from the 77 bite wounds. One of the owners, an attorney, was found guilty of second degree murder which was upheld on appeal. Knoll, the owner, showed no remorse and was sentenced to 15 years to life.

Dr. Cohrn has specilaized expertise in animal forensics and has a chapter in a book on Forensic Odontology on animal bites. Locally, Dr. Cohrn was involved in two cases involving death by alligator. One involved a young woman killed in the Ocala National Forest and another case involving a teenage boy in Leesburg who died while swimming with friends. Using bite mark analysis, the alligators responsible were identified. A tragic criminal case involved a pack of dogs who were responsible for the mauling death of an elderly woman while getting out of her car. Through bite mark analysis each individual dog was shown to had bitten the woman.

The dogs belonged to a neighbor who was convicted of manslaughter and sentenced to 15 years in jail.

Dr. Cohrn, an Associate Professor at the University of Florida is a consultant to the School of Veterinary Medicine as a animal bite mark expert.
Mass Disasters

A mass disaster means different things to different people. Webster defines it as “a sudden calamitous event producing great material damage, loss and distress”. It can also be described as loss of life and/or property that exceeds a community’s resources and it’s ability to respond.

Natural disasters locally have included tornadoes, hurricanes, wildfires and flooding. Unintentional man-made disasters include transportation accidents, chemical spills, fire and an explosion of a propane facility with 53,000 gas tanks. Terrorism threats are always in the forefront of potential disasters.

We are members of both the State (FEMORS) and Federal (DMORT) disaster teams. Dr. Cohrn has been deployed to several hurricanes including Katrina, a tornado and a vehicular accident and fire where 11 people lost their lives.

The Florida disaster team has been in existence for 10 years and trains yearly . It is considered the best trained state team in the country often serving as a model for other agencies. Once activated, the team will be deployed within hours and fully operational with a complete morgue within two days. The entire operation is fully digital and computerized allowing for faster and more accurate identification of the victims. This is critical in order to reunite loved ones and family members.

Both the State and Federal disaster teams are modeled after each other operationally. Each have a portable morgue cache at a designated site(s) that can be activated within hours of notification. We work at the request of the medical examiner who always is in charge of the operation.

The morgue is transported to the disaster site and set up. Simplistically, the operation is set up with a command and logistics structure and morgue operations. The morgue has a number of sequential forensic stations: dental, anthroplogy, pathology, DNA, finger printing, etc., at which the victims are seen. Each postmortem section performs their expertise and the person is moved to the next station. On the antemortem side, team members collect data from relatives including medical and dental records, DNA samples, photos, etc. that will be beneficial in the identification of their loved one. Part of the antemortem tean is responsible for comparing the ante- and postmortem information and to make an ID from all the sources available. Once an identification is tentatively made it is verified, cross checked and reverified so that a misidentification is highly unlikely. The medical examiner is responible the final disposition and once approved the deceased is released to the family.

Disaster response is certainly the most physical and emotional roles of the Forensic Odontologist. Yet, to help grieving families in their time of immense emotional need provides a useful service and is good for the soul.

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