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J Forensic Sci, March 2007, Vol. 52, No.

Available online at:

Veronique F. Delattre,1,2 D. D. S.

Antemortem Dental Records: Attitudes and
Practices of Forensic Dentists

ABSTRACT: This study was designed to provide insight concerning the attitudes and practices of forensic dentists regarding antemortem dental
records reviewed for purposes of dental identification. Forensic dentists were invited to participate in a 10 item survey. The majority of the
respondents reported a considerable amount of experience in dental identifications of the deceased. Sixty-six percent reported having suspected
dental negligence or fraud in their antemortem record reviews. Only 17% believe that a forensic dentist should report suspected dental negligence,
while 31% agree that dental fraud should be reported. Their response to additional issues addressed in the study suggests diversity in the practices
and attitudes of forensic dentists in the use of antemortem dental records. In conclusion, opening a dialogue among practicing forensic dentists may
lead to a standardized set of recommendations by the appropriate societies in the forensic dental community.

KEYWORDS: forensic science, forensic dentistry, forensic odontology, human identification, dental identification, dental records

This study was designed to provide insight concerning the at- certificate in turn facilitates the funeral arrangements, burial or
titudes and practices of forensic dentists regarding antemortem cremation of the individual, life insurance benefits, social security
dental records they review for purposes of dental identification. benefits, disposition of instructions in the decedent’s last will and
The study assessed several areas of forensic dental practice, in- testament, and matters of inheritance. The need for complete and
cluding demographics of the respondents, such as years of foren- accurate antemortem dental records is especially evident when
sic dental experience and number of dental identifications dealing with large numbers of victims, such as in a busy metro-
performed over the course of their careers. Other topics assessed politan city or a mass fatality incident. Ultimately, it is only when
included the contact person to request antemortem dental records, forensic dentists receive a true picture of the antemortem dental
how often records were returned to the providing dental office, information to compare with the human remains that a satisfactory
and attitudes about dealing with the suspicion of dental negligence determination of identification can be declared, allowing the de-
or fraud discovered while reviewing antemortem records for the cedent to be returned to the family for closure (3–8).
purpose of dental comparisons.
There can be several aspects to the issue of acquiring antemor-
tem dental records for use by a forensic dentist in the identification Methods
of human remains. The first aspect is that of patient privacy, and
Forensic dentists, members of the Odontology Section of the
the second aspect is that of the dentist’s concern for his or her own
American Academy of Forensic Sciences and diplomates of the
self-protection when releasing dental records. In an effort to co-
American Board of Forensic Odontology (ABFO), were invited
operate with the dental identification of their patient, it is advis-
by e-mail to participate in an online survey designed to elicit in-
able for the private dentist to consider contacting the forensic
formation on their practices concerning the acquisition and return
dentist directly to clarify any discrepancies in the records or to
of antemortem dental records to the dental providers, and attitudes
voice their concern about potential negligence or fraud, rather
about reporting suspected cases of dental negligence or fraud dis-
than with-holding valuable dental information from the investi-
covered during review of antemortem dental records. Before im-
gation (1–2).
plementation, the research proposal had been reviewed and
Medical examiner and coroner offices may turn to the forensic
approved through the Committee for the Protection of Human
dental consultant to achieve the positive scientific identification
Subjects , which is the Institutional Review Board for the Uni-
that is necessary for the issuance of a death certificate. The death
versity of Texas Health Science Center at Houston.
The questionnaire was administered through an online survey
Department of Restorative Dentistry and Biomaterials, University of Texas website. A cover letter with the study’s web link was e-mailed to
Dental Branch at Houston, 6516 M.D. Anderson Blvd., #493, Houston, TX.
each dentist, inviting them to participate in the study. The cover
Harris County Medical Examiner’s Office, 1885 Old Spanish Trail, Hous- letter requested that the dentist complete and return the question-
ton, TX.
An oral presentation of this paper was made at the 58th Annual Meeting naire within a 4 week period. The initial mailing was followed by
of the American Academy of Forensic Sciences, February 2006, Seattle, a second e-mailing 4 weeks later.
WA. The online survey consisted of a cover page indicating the pur-
Received 24 June 2006; and in revised form 30 Sept. 2006; accepted 7 Oct. pose of the study, a reminder that all responses were to be grouped
2006; published 6 Feb. 2007. and that no individual would be identifiable to ensure confiden-

420 Copyright r 2006 by American Academy of Forensic Sciences

with the their record reviews. while 63% disagreed. we should address any question to the turned to the providing dental office after being used in the dental treating dentist for clarification. in specific cases. with fraud and was awaiting trial.’’ and to indicate whether they agreed or disagreed agency in charge of the investigation was the entity that routinely with the statement. performing dental procedures that are unnecessary. to the investigative agency they are consulting with. it depends on my degree of suspicion contact the dental providers. while one-third did not report having these potential for the respondent to provide additional information in same suspicions. Interesting comments re- percent of the respondents indicated that they were currently certi. contacted the perienced between 251 and 500 cases. although need voluntary co-operation of the profession. Comments listed dental offices. it was an were not ABFO diplomates. it would have to be pretty blatant. investigator. it would have to be and another 6% reporting that both they and the agency would pretty blatant negligence. Of those responding forensic dentistry for over 15 years. or reported it to ment. 14% of respondents ex. and coding a simple Results procedure as a more complex one in order to charge more (11). and only 22% reported dentist to confirm findings first. Fraud is a deception deliberately tal identification are to be used only for that purpose. 29%. only if necessary to prove The study next queried whether those responding to the survey the decedent’s identification. Two-thirds of the ing 80% of the forensic dentists surveyed agreed with the . by respondents included statements such as: the philosophy of with 6% of the forensic dentists personally requesting the records. The next item on the survey asked what action the respondent Forensic Dental Experience of Respondents took as a result of her or his suspicion of dental fraud or negli- The majority of the respondents self-reported a considerable gence while comparing dental records during a dental identifica- amount of experience in dental identifications of the deceased. Some asked to consider this slightly different statement focusing on participants made the comment that they return the dental records dental fraud rather than dental negligence. reported that In the next and corollary survey question. without becoming an dental records reviewed for purposes of dental comparison. and only if it was the cause of the percent always return the records. walking in another’s moccasins applies here. and instructions for completing the survey. participants were they or their agency never return the records to the provider. and 15% chose the ‘‘other’’ response. ANTEMORTEM DENTAL RECORDS 421 tiality of responses. and 23% usu. The other 12% of respondents were equally split. ligence is the committing of an act which a person exercising And finally. the dentist was already charged o100 cases in their careers.’’ Thirty-one percent of responders they do not return the records to the providing dentist if they are agreed with the statement. needed to dental identification cases in their careers: 9% had experience with clarify the incorrect charting in order to establish identification. I might contact the insurer or state agency. A fairly large number. demise of the decedent. DELATTRE . 23% had unless it is a blatant fraud. as well as the results of a formal examination (9). the 22% who stated that they had reported their suspicions men- The ABFO offers certification based upon a dentist’s personal and tioned the following scenarios: contacted the treating dentist dir- professional record of education. ectly. Some examples of dental fraud could include: an additional ‘‘other’’ open-response field.’’ A resound- practiced to secure unfair or unlawful gain (10). it would depend most made a habit of returning the records some of the time. charging a fee for a service that was never actually rendered. ceived from other respondents included: I contacted the dentist to fied as diplomates of the ABFO. the responses were quite varied. 12% had between 1000 and 2000 cases. experience and achieve. or the and state whether they agreed or disagreed with the following failure to do what a person exercising ordinary care would do statement: ‘‘Antemortem records received for the purpose of den- under similar circumstances. there followed a series of 10 multiple choice items. if it is blatant processed between 501 and 1000 cases.’’ A chose the ‘‘other’’ response. Practices Attitudes Dental records from the presumed decedent’s dental practition- er must be obtained before a detailed comparison of antemortem In the next survey question. 39% sometimes. fraud. where it happened. 22% reported the suspicions while a large majority of ing over 10 years of experience. over 2000 cases. The remaining 34% of respondents clarify charting. As a reminder to the reader. and the blatancy of the suspected infraction. tion. and then Participants were asked to indicate whether they agreed or dis- leave the decision as to whether or not to return the records to the agreed with the following statement: ‘‘A forensic dentist should providing dentist up to the agency. to this item. ally return the records. participants were asked to consider a broader issue ordinary care would not do under similar circumstances. and the medical examiner was notified. this statement: ‘‘A forensic dentist should report suspected dental Participants in the study overwhelmingly (88%) reported that the negligence. participants were asked to consider and postmortem dental remains can be performed successfully. Comments listed by respondents in- few of the respondents indicated that records are returned to the cluded statements such as: who says that I am qualified to detect dental office only upon special request. with an additional 18% hav. dentists reported having suspected dental negligence or fraud in Next. The actions of forensic experience. 68% made the official request for release of the dental records from disagreed. as in the first statement. contacted federal law enforcement. but were members of the Odontology interstate case and was reported to the district attorney in the area Section of the American Academy of Forensic Sciences. fraud. not When asked to indicate how often the dental records are re. Sixty-six the State Board of Dental Examiners. Two respondents indicated that report suspected dental fraud. training. contacted Over half of the participants have completed more than 250 the dentist but not with reference to possible fraud. and one forensic dentist noted that had ever suspected dental negligence or fraud in the antemortem it would not be possible to verify fraud. do not ‘‘stir the pot’’. reported it to the local dental association. 69% had reported such Sixty-six percent reported that they had been actively practicing suspicions in the previous survey question. Nine upon the degree of negligence. Only 5% reported o5 years of 78% chose not to report the suspicion to anyone. Neg. this is a difficult issue that might comparison process. Only 17% agreed with the statement. but did not report the apparent fraud. without absolute proof. and only 6% the evidence upon which was based a ‘‘positive identification.

to the investigator but not the dental office providing the records. editors. Dentists who drill for gold. suspicions. Stimson PG. province may vary slightly in their regulations and standards of 9. and be. The dental identification response team: preparation for mass from the investigating agency. The theory of human identification. Bell G. In: Bowers lieves that antemortem dental records received for the purpose of CM. Department of Restorative Dentistry and Biomaterials University of Texas Acknowledgments Dental Branch at Houston 6516 M. receives antemortem dental records cords.. Delattre January 2006. where each state or American Society of Forensic Odontology. 3rd ed. Office for their support. TX 77030 pated in this survey.tmc. #493 The author wishes to thank the forensic dentists who partici.D. The composite forensic dentist in this study Academy of Forensic Sciences. J Forensic Sci 1999. believes that a forensic dentist should not report sus. with this project. In conclusion. Mrs. Delattre VF. and only 3% chose the ‘‘other’’ cat.Delattre@uth. Opening a dialogue among practicing forensic dentists on ways to http://www. O’Shaughnessy PE. LDA J 2005. 3. http://www. National Post December 7. 5. Barsley R. 1994: may never be a complete consensus to the issues studied here. 11.D. New York: Dell . ABFO Diplomates Reference Manual. has practiced forensic dentistry for over 15 years. J Forensic Identification 2006.44(5):906–9. Proceedings of the 58th Annual Meeting of the American Acad- reveals an interesting composite view of the forensic dentists par. care. the data suggest that there is diversity in the 7. Dental identification: postmortem considerations. Self-assessment of the forensic value of dental practices and attitudes of forensic dentists on the issues addressed in records. ON: tice mainly in the United States and Canada. 1995. 6. Manual of forensic odontology. Dental identification after Hurricane Katrina. 8. 336. Discussion References A compilation of the most frequent responses to the survey items 1. 38. the survey. J Gt Houst Dent Soc 2005.abfo. Janine Delattre for her invaluable help E-mail: Veronique. Wright FD. Privacy issues related to the acquisition of antemortem dental records. This is not unexpected as the responding dentists prac. 17% disagreed. but did not report those 64(4):26–7. Forensic dental identifications in the greater Houston area. 558. 3rd ed. Bell G. editors. has performed Just as there is no one regulating agency for each nation. 1995.46(6):1379–84. dental identification are to be used only for that purpose. J pected dental negligence or fraud to a regulatory agency. Blackwell T. Additional information and reprint requests: Veronique F. Factors affecting the acquisition of antemortem dental re- over 250 dental identifications. Manual of forensic odontology.canada. Delattre. and the Harris County Medical Examiner’s egory as a response. Delattre VF. Forensic Sci 2001. WA: American ticipating in this study. there 10. 2006:200. manage the suspicion of dental negligence or fraud discovered in antemortem dental records may lead to a set of recommendations by the appropriate societies in the forensic dental community.F. Delattre VF. Seattle. ON: American Society of Forensic Odontology.56(6):945–9. Delattre VF. 4. 2005. has suspected dental negligence or fraud. Manticore. emy of Forensic Sciences. The american heritage dictionary. Houston. Anderson Blvd. and returns the antemortem records fatality incidents.76(7):23–6. D. Manticore.S.422 JOURNAL OF FORENSIC SCIENCES statement. 3rd ed. February 20–25 2006. In: Bowers CM.