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Forensic Odontology
Forensic OdontologyPrinciples and Practice
EditEd by
Jane A TaylorFaculty of Health and Medicine
University of Newcastle
Australia
Jules A Kieser (Deceased)Faculty of dentistry
University of Otago
New Zealand
this edition first published 2016 copy 2016 by John Wiley amp Sons Ltd
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Library of Congress Cataloging‐in‐Publication Data
Forensic odontology (taylor)Forensic odontology principles and practice edited by Jane taylor Jules Kieser p cm includes bibliographical references and index iSbN 978‐1‐118‐86444‐9 (cloth)i taylor Jane (Jane A) editor ii Kieser Jules (Jules A) editor iii title [dNLM 1 Forensic dentistry W 705] RA1062 614prime18ndashdc23
2015029796
A catalogue record for this book is available from the british Library
Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books
Set in 9513pt Meridien by SPi Global Pondicherry india
1 2016
v
Contents
Contributors xiv
Dedications xvi
Preface xviii
1 Foundation knowledge in forensic odontology 1Jules A Kieser Jane A Taylor Zaf Khouri and Maurice Churton
Introduction 1
A short history of forensic odontology 2
Forensic odontology in Australia 5
Forensic odontology in New Zealand 10
Working as an odontologist 19
References 20
2 Jurisprudence and forensic practice 23David L Ranson
Legal systems and the healthcare community 23
Types of law 28
The coronial system 32
The investigators within the coronerrsquos jurisdiction 38
Court procedures and the expert medical witness 41
Long‐term preparation 48
Medium‐term preparation 48
Short‐term preparation 49
Logistics of appearing as a witness 49
Refreshing memory 50
Revision of medical knowledge 51
Medico‐legal analysis 52
Pre‐trial conference 52
Entering the court 53
Conversations outside the court 53
Appearance and behaviour 54
Report writing 57
Reference 63
Recommended reading 63
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Forensic Odontology
Forensic OdontologyPrinciples and Practice
EditEd by
Jane A TaylorFaculty of Health and Medicine
University of Newcastle
Australia
Jules A Kieser (Deceased)Faculty of dentistry
University of Otago
New Zealand
this edition first published 2016 copy 2016 by John Wiley amp Sons Ltd
Registered OfficeJohn Wiley amp Sons Ltd the Atrium Southern Gate Chichester West Sussex PO19 8SQ UK
Editorial Offices9600 Garsington Road Oxford OX4 2dQ UKthe Atrium Southern Gate Chichester West Sussex PO19 8SQ UK111 River Street Hoboken NJ 07030‐5774 USA
For details of our global editorial offices for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at wwwwileycomwiley‐blackwell
the right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright designs and Patents Act 1988
All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise except as permitted by the UK Copyright designs and Patents Act 1988 without the prior permission of the publisher
designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names service marks trademarks or registered trademarks of their respective owners the publisher is not associated with any product or vendor mentioned in this book
Limit of Liabilitydisclaimer of Warranty While the publisher and author(s) have used their best efforts in preparing this book they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose it is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom if professional advice or other expert assistance is required the services of a competent professional should be sought
Library of Congress Cataloging‐in‐Publication Data
Forensic odontology (taylor)Forensic odontology principles and practice edited by Jane taylor Jules Kieser p cm includes bibliographical references and index iSbN 978‐1‐118‐86444‐9 (cloth)i taylor Jane (Jane A) editor ii Kieser Jules (Jules A) editor iii title [dNLM 1 Forensic dentistry W 705] RA1062 614prime18ndashdc23
2015029796
A catalogue record for this book is available from the british Library
Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books
Set in 9513pt Meridien by SPi Global Pondicherry india
1 2016
v
Contents
Contributors xiv
Dedications xvi
Preface xviii
1 Foundation knowledge in forensic odontology 1Jules A Kieser Jane A Taylor Zaf Khouri and Maurice Churton
Introduction 1
A short history of forensic odontology 2
Forensic odontology in Australia 5
Forensic odontology in New Zealand 10
Working as an odontologist 19
References 20
2 Jurisprudence and forensic practice 23David L Ranson
Legal systems and the healthcare community 23
Types of law 28
The coronial system 32
The investigators within the coronerrsquos jurisdiction 38
Court procedures and the expert medical witness 41
Long‐term preparation 48
Medium‐term preparation 48
Short‐term preparation 49
Logistics of appearing as a witness 49
Refreshing memory 50
Revision of medical knowledge 51
Medico‐legal analysis 52
Pre‐trial conference 52
Entering the court 53
Conversations outside the court 53
Appearance and behaviour 54
Report writing 57
Reference 63
Recommended reading 63
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Forensic OdontologyPrinciples and Practice
EditEd by
Jane A TaylorFaculty of Health and Medicine
University of Newcastle
Australia
Jules A Kieser (Deceased)Faculty of dentistry
University of Otago
New Zealand
this edition first published 2016 copy 2016 by John Wiley amp Sons Ltd
Registered OfficeJohn Wiley amp Sons Ltd the Atrium Southern Gate Chichester West Sussex PO19 8SQ UK
Editorial Offices9600 Garsington Road Oxford OX4 2dQ UKthe Atrium Southern Gate Chichester West Sussex PO19 8SQ UK111 River Street Hoboken NJ 07030‐5774 USA
For details of our global editorial offices for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at wwwwileycomwiley‐blackwell
the right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright designs and Patents Act 1988
All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise except as permitted by the UK Copyright designs and Patents Act 1988 without the prior permission of the publisher
designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names service marks trademarks or registered trademarks of their respective owners the publisher is not associated with any product or vendor mentioned in this book
Limit of Liabilitydisclaimer of Warranty While the publisher and author(s) have used their best efforts in preparing this book they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose it is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom if professional advice or other expert assistance is required the services of a competent professional should be sought
Library of Congress Cataloging‐in‐Publication Data
Forensic odontology (taylor)Forensic odontology principles and practice edited by Jane taylor Jules Kieser p cm includes bibliographical references and index iSbN 978‐1‐118‐86444‐9 (cloth)i taylor Jane (Jane A) editor ii Kieser Jules (Jules A) editor iii title [dNLM 1 Forensic dentistry W 705] RA1062 614prime18ndashdc23
2015029796
A catalogue record for this book is available from the british Library
Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books
Set in 9513pt Meridien by SPi Global Pondicherry india
1 2016
v
Contents
Contributors xiv
Dedications xvi
Preface xviii
1 Foundation knowledge in forensic odontology 1Jules A Kieser Jane A Taylor Zaf Khouri and Maurice Churton
Introduction 1
A short history of forensic odontology 2
Forensic odontology in Australia 5
Forensic odontology in New Zealand 10
Working as an odontologist 19
References 20
2 Jurisprudence and forensic practice 23David L Ranson
Legal systems and the healthcare community 23
Types of law 28
The coronial system 32
The investigators within the coronerrsquos jurisdiction 38
Court procedures and the expert medical witness 41
Long‐term preparation 48
Medium‐term preparation 48
Short‐term preparation 49
Logistics of appearing as a witness 49
Refreshing memory 50
Revision of medical knowledge 51
Medico‐legal analysis 52
Pre‐trial conference 52
Entering the court 53
Conversations outside the court 53
Appearance and behaviour 54
Report writing 57
Reference 63
Recommended reading 63
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
this edition first published 2016 copy 2016 by John Wiley amp Sons Ltd
Registered OfficeJohn Wiley amp Sons Ltd the Atrium Southern Gate Chichester West Sussex PO19 8SQ UK
Editorial Offices9600 Garsington Road Oxford OX4 2dQ UKthe Atrium Southern Gate Chichester West Sussex PO19 8SQ UK111 River Street Hoboken NJ 07030‐5774 USA
For details of our global editorial offices for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at wwwwileycomwiley‐blackwell
the right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright designs and Patents Act 1988
All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise except as permitted by the UK Copyright designs and Patents Act 1988 without the prior permission of the publisher
designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names service marks trademarks or registered trademarks of their respective owners the publisher is not associated with any product or vendor mentioned in this book
Limit of Liabilitydisclaimer of Warranty While the publisher and author(s) have used their best efforts in preparing this book they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose it is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom if professional advice or other expert assistance is required the services of a competent professional should be sought
Library of Congress Cataloging‐in‐Publication Data
Forensic odontology (taylor)Forensic odontology principles and practice edited by Jane taylor Jules Kieser p cm includes bibliographical references and index iSbN 978‐1‐118‐86444‐9 (cloth)i taylor Jane (Jane A) editor ii Kieser Jules (Jules A) editor iii title [dNLM 1 Forensic dentistry W 705] RA1062 614prime18ndashdc23
2015029796
A catalogue record for this book is available from the british Library
Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books
Set in 9513pt Meridien by SPi Global Pondicherry india
1 2016
v
Contents
Contributors xiv
Dedications xvi
Preface xviii
1 Foundation knowledge in forensic odontology 1Jules A Kieser Jane A Taylor Zaf Khouri and Maurice Churton
Introduction 1
A short history of forensic odontology 2
Forensic odontology in Australia 5
Forensic odontology in New Zealand 10
Working as an odontologist 19
References 20
2 Jurisprudence and forensic practice 23David L Ranson
Legal systems and the healthcare community 23
Types of law 28
The coronial system 32
The investigators within the coronerrsquos jurisdiction 38
Court procedures and the expert medical witness 41
Long‐term preparation 48
Medium‐term preparation 48
Short‐term preparation 49
Logistics of appearing as a witness 49
Refreshing memory 50
Revision of medical knowledge 51
Medico‐legal analysis 52
Pre‐trial conference 52
Entering the court 53
Conversations outside the court 53
Appearance and behaviour 54
Report writing 57
Reference 63
Recommended reading 63
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
v
Contents
Contributors xiv
Dedications xvi
Preface xviii
1 Foundation knowledge in forensic odontology 1Jules A Kieser Jane A Taylor Zaf Khouri and Maurice Churton
Introduction 1
A short history of forensic odontology 2
Forensic odontology in Australia 5
Forensic odontology in New Zealand 10
Working as an odontologist 19
References 20
2 Jurisprudence and forensic practice 23David L Ranson
Legal systems and the healthcare community 23
Types of law 28
The coronial system 32
The investigators within the coronerrsquos jurisdiction 38
Court procedures and the expert medical witness 41
Long‐term preparation 48
Medium‐term preparation 48
Short‐term preparation 49
Logistics of appearing as a witness 49
Refreshing memory 50
Revision of medical knowledge 51
Medico‐legal analysis 52
Pre‐trial conference 52
Entering the court 53
Conversations outside the court 53
Appearance and behaviour 54
Report writing 57
Reference 63
Recommended reading 63
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
vi Contents
3 Anatomy and morphology 64Mark Leedham and Erin F Hutchinson
Dental anatomy and morphology 64
Morphogenetic fields 65
Additional teeth 66
Hypodontia 70
Shape anomalies 72
Peg lateral incisors 72
General head and neck anatomy 73
Temporomandibular joint (TMJ) 73
Infratemporal fossa 74
Pterygopalatine fossa 74
Mandibular nerve 75
Salivary glands 75
Oral cavity 76
Blood supply and lymphatic drainage of
the orodental tissues 77
Osteology of the juvenile and adult craniofacial complex 77
Neurocranium 77
Frontal bone 80
Parietal bone 84
Occipital bone 86
Temporal bone 95
Sphenoid bone 103
Viscerocranium 110
Zygomatic bone 110
Lacrimal bone 113
Ethmoid bone 114
Inferior nasal concha 116
Vomer bone 117
Nasal bone 119
Maxilla 119
Palatine 125
Mandible 126
References 130
4 Forensic pathology 134David L Ranson and Norman Firth
The role of the forensic pathologist 134
The medico‐legal autopsy 135
Post‐mortem changes in the deceased 139
Decomposition 140
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Contents vii
Radiological examination 140
External examination 141
Head 142
Trunk 143
Limbs 143
Internal examination 144
The face head and neck 145
The thorax 151
The abdomen and pelvis 153
The genitalia 154
The limbs 154
Post‐autopsy procedures 154
Injuries 155
Classification of injuries 156
Injury interpretation 164
Injury and cause of death 165
References 166
Recommended reading 166
5 Human identification 167Stephen Knott
Human identification 167
We have the right to our name when we die 167
Methods of identification 168
Human dentition 169
Teeth the last tissue to disintegrate 169
Role of the primary identifiers 171
Visual 171
Fingerprints 171
DNA 172
Medical and anthropological 173
Ante‐mortem dental data 173
Dental records or dental data 174
Dental prostheses 175
Oral implants 176
Orthodontics 176
Radiographic images facial sinuses and anatomical
features within the bone 176
Superimposition 178
Facial reconstruction 179
Standards for acceptance of identification 181
References 183
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
viii Contents
6 Mortuary techniques 185Alain G Middleton
The dental post‐mortem 185
What is the purpose of the dental post‐mortem 185
Components of a dental post‐mortem 186
Location 186
Facilities 186
Equipment ndash basic requirements 186
Ventilation 186
Lighting 187
Examination table 187
Oral health and safety ndash personal protection 187
Head hair 187
Face 187
Hands 188
Body covering 188
Footwear 188
lsquoTools of the tradersquo 188
Photography 189
Capture device (camera and lenses) and media 189
Producing and processing images 189
Organising images 190
Using images 190
Backup 190
Archiving 190
Depth of field 191
Fragments and single teeth 191
Radiographic equipment 192
CT scanning equipment 192
Teeth for DNA analysis 192
The lsquowhat and howrsquo 193
Organisation 193
Permissions 193
Examination and recording of the findings 195
The investigative examination 196
The identification examination 196
Detail 196
Written observations and charting 197
Recording of the findings 197
Stress 197
Legibility 197
Language 197
Errors 198
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Contents ix
Abbreviations 198
Transcription 198
Charting 198
Clinical notes 198
Radiographic 199
Tissue thicknesses 199
Fragments and single teeth 199
Radiation safety 199
Photographic 199
Impressions 200
Age estimation 200
Condition of the remains 200
Complete body or a partial set of remains 200
Incomplete andor fragmented 201
Are all the teeth and bone sections present 201
Skeletal remains 201
Incinerated remains 201
Decomposed remains 202
Mummification 203
Immersion 203
Procedure ndash putting it all together 203
Initial examination 203
Photographic and radiographic examination 204
Access and reflection 204
Intact skulls and mandible 204
Fragmented skulls and mandible 205
Reflection technique 205
Floor of the mouth and tongue 205
Access the maxilla and the oral cavity 206
Resection 206
Bite mark and other pattern recording 206
Reporting recording of results 207
Reports 207
Summary 208
Reference 208
7 Age assessment 209Richard Bassed Jeremy Graham and Jane A Taylor
Introduction 209
Some history of age assessment 211
A brief review of dental development 212
Developments in dental‐age assessment 214
Current age‐estimation methods 215
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
x Contents
Australasian specific research in dental age estimation 217
Concluding remarks 221
References 224
8 Bite marks 228Alex Forrest and Alistair Soon
Introduction 228
Describing bite marks 229
Bite marks are physical evidence 229
Class characteristics 230
Individual characteristics 230
Anatomical locations of bite marks 231
Types of bite marks 231
Not everything is a bite mark 234
Conclusions based on the description of the injury 234
The process of biting and how it relates to bite marks 235
The individuality of the dentition and its transfer
to the bite mark 236
The individuality of the human dentition 236
Accuracy of transfer of dental features to bitten tissues 237
Imaging in bite mark cases 238
Avoiding distortions due to perspective 239
Avoiding distortions due to parallax 241
Photographic lighting 241
File format for image files 245
Using alternative light sources 245
Imaging the dental casts for comparison 245
A note on the use of the ABFO No 2 bite mark scale 248
Undertaking the case 249
Case selection 250
The clinical appointments 250
Bite mark analysis 257
Bite mark comparison 266
Presenting bite mark evidence in court 273
Sources of potential distortion and error in
bite mark cases 275
Distortions due to tissue properties and movement
of a bitten body part 275
Distortions due to evidence collection 276
Distortions due to poor imaging 276
Potentially controllable variables 277
Potentially uncontrollable variables 277
Limitations of bite mark analysis and reporting the
outcomes of bite mark comparisons 277
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Contents xi
Can we determine the age of the biter from the injury arch
dimensions 279
Can we visually age bite marks 280
Swabbing for DNA 280
Materials required 281
Method 281
Conclusion 281
Future directions 282
References 283
9 Forensic odontology in disaster victim identification 286Hugh G Trengrove
Disasters and disaster planning 286
Disaster victim identification 287
DVI planning and organisation 288
DVI and forensic odontology 290
Forensic odontology DVI planning 291
DVI operations 296
DVI documentation 297
Health and safety during DVI operations 297
DVI phase 1 the Scene phase 298
The role of the forensic odontologist at the scene 299
Human remains at the scene 299
Recovery of remains 301
DVI phase 2 the Post‐mortem phase 310
Mortuary 311
Post‐mortem process 311
Personal property and effects documentation 314
Skin friction ridge analysis 314
Forensic pathology examination 314
Post‐mortem radiography 315
Post‐mortem DNA 316
Anthropology 316
Post‐mortem odontology examination 316
Radiology and photography 318
Teeth for DNA 319
Age assessment 320
Odontology quality review 320
Staffing in the mortuary 321
Equipment and PPE in the mortuary 321
DVI phase 3 the Ante‐mortem phase 323
Missing persons database (list) 323
Ante‐mortem data collection 323
Ante‐mortem skin friction ridge records 324
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
xii Contents
Ante‐mortem DNA 324
Ante‐mortem dental records 325
Ante‐mortem equipment 327
DVI phase 4 the Reconciliation phase 327
Skin friction ridge comparison (reconciliation) 328
DNA reconciliation 328
Odontology reconciliation 328
Detailed reconciliation 330
Formalisation of identification 331
DVI phase 5 the Debrief 331
Administrative arrangements and information management 332
DVI and the people 333
Forensic odontology team organisation 333
Responsibilities 333
References 335
10 Forensic anthropology 336Denise Donlon Russell Lain and Jane A Taylor
The scope of forensic anthropology 336
Assessment of ancestry 336
Importance of assessment of ancestry 337
Approaches 337
Tooth size and non‐metric traits 338
Assessment of sex 339
Approaches 339
Sexual dimorphism in the dentition 342
Sexual dimorphism in juveniles 342
Assessment of age 343
Methods of ageing juvenile and young adults (lt30 years) 343
Ageing of middle‐aged to older adults (gt30 years) 343
Comparative anatomy 344
Historical remains 347
Conclusion 351
References 351
11 Applied forensic sciences 355David C Kieser Terry Lyn Eberhardt Gemma Dickson and
J Neil Waddell
Introduction 355
Crime scene protocols 356
Forensic entomology 358
Forensic microbial aquatic taphonomy 363
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Contents xiii
The use of energy‐dispersive spectroscopy in forensic investigations 369
References 375
12 Odontology opinions 377Denice Higgins and Helen James
Introduction 377
General principles 377
Types of opinions 379
Identification of dental structures 379
Injuries sustained to the teeth or other oral structures 383
Injuries caused by teeth 386
Child abuse 390
Anatomicalmorphometric comparisons 391
Age estimation 393
Tooth selection and sampling for DNA 394
Oral pathology 396
Dental malpractice 396
Report writing 399
References 400
13 Forensic odontology management 402Helen James and Denice Higgins
Introduction 402
Administration 402
Education 414
Research 415
Conclusion 416
References 417
14 Application of post‐mortem computed tomography to forensic odontology 419Richard Bassed and Eleanor Bott
Introduction 419
Computed tomography and medico‐legal death investigation 421
Application of PMCT to odontology 423
Computed tomography and Disaster Victim Identification (DVI) 428
Triage of multiple deceased in DVI 429
CT and dental identification in DVI 433
Logistics and infrastructure 434
Conclusion 435
References 435
Index 438
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
xiv
Contributors
Richard BassedVictorian Institute of Forensic Medicine Victoria and Monash University
Australia
Eleanor BottHealthscope Pathology Australia
Maurice ChurtonOral and Maxillofacial Surgeon (Retired) New Zealand
Gemma DicksonVictorian Institute of Forensic Medicine Australia
Denise DonlonDiscipline of Anatomy and Histology University of Sydney Australia
Terry Lyn EberhardtPestLab AsureQuality Ltd New Zealand
Norman FirthFaculty of Dentistry University of Otago New Zealand
Alex ForrestSchool of Natural Sciences Griffith University Nathan Campus and Health
Support Queensland Australia
Jeremy GrahamSchool of Dentistry and Oral Health La Trobe University Australia
Denice HigginsForensic Odontology Unit University of Adelaide Australia
Erin F HutchinsonSchool of Anatomical Sciences University of the Witwatersrand South Africa
Helen JamesForensic Odontology Unit University of Adelaide Australia
Zaf KhouriNew Zealand Society of Forensic Odontology New Zealand
David C KieserChristchurch Hospital New Zealand
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Contributors xv
Jules A Kieser (Deceased)Faculty of Dentistry University of Otago New Zealand
Stephen KnottQueen Elizabeth Medical Centre and Faculty of Medicine Dentistry and
Health Sciences University of Western Australia Australia
Russell LainOral Surgery and Diagnostic Imaging Department Sydney Dental Hospital
Australia
Mark LeedhamNorthern Territory Coronerrsquos Office Australia
Alain G MiddletonNSW Forensic Dental Identification Unit Westmead Hospital
Australia
David L RansonVictorian Institute of Forensic Medicine and Monash University Australia
Alistair SoonHealth Support Queensland Australia
Jane A TaylorFaculty of Health and Medicine University of Newcastle Australia
Hugh G TrengroveNew Zealand Society of Forensic Odontology New Zealand
J Neil WaddellFaculty of Dentistry University of Otago New Zealand
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
xvi
Dedications
Anthony (Tony) John HILL (251945ndash22122013)
Tony was born and educated in New Zealand and eventually settled as a private
practitioner in Melbourne Australia In 1992 he enrolled in the Diploma of
Forensic Odontology course at the University of Melbourne under the tutelage
of Professor John Clement and worked at the Victorian Institute of Forensic
Medicine (VIFM) on a volunteer basis for a number of years In 2004 he retired
from general dentistry to take up a position at the VIFM as Senior Forensic
Odontologist
Tonyrsquos empathy for those in our society who die with no one to mourn for
them or to care for their remains was always evident ndash he was a man who wore
his heart very much on his sleeve He spent many years working with the
Victoria Police long‐term missing persons unit attempting to identify the
remains of un identified people who would otherwise be buried in anonymous
graves Tony played a large role in the identification of the remains of Ned Kelly
Colin Ross and Ronald Ryan all of whom were exhumed from Pentridge Prison
in 2009
The contribution Tony made to the identification of people who died in tragic
circumstances in mass fatality incidents has been an enduring testament to his
professionalism He played a major role in the Disaster Victim Identification
teams deployed to identify the deceased following the 2002 Bali bombings the
2004 Boxing Day tsunami in Thailand and the Black Saturday bush fires in
Victoria in 2009 Throughout these physically and emotionally demanding oper-
ations Tony always maintained a sense of cheerfulness generosity and profes-
sional empathy that was an example for us all
The recipient of several awards including the Australian Federal Police
Operations Medal and a Premierrsquos Citation Tony will be sadly missed by all
who had the good fortune to work with him and benefit from the enormous
breadth of his knowledge and experience He was a compassionate and kind
person and despite spending so many years dealing with some of the more
difficult aspects of humanity always maintained his empathy and respect for
his fellow man
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Dedications xvii
Julius (Jules) August KIESER (20121950ndash1062014)
It takes a noble man to plant a seed for a tree that will someday give shade to people he
may never meet
(Chinese proverb)
Jules was a man with an insatiable appetite for knowledge that he loved to
share He was born in Pretoria South Africa and educated at the University of
the Witwatersrand in Johannesburg where he completed his BSc in 1971 and
qualified as a dentist in 1975 He practised in the outback of South Africa and
subsequently in London and Johannesburg He gained a PhD (Medicine) in
1989 and in 1991 was appointed as reader of craniofacial biology and in 1994 as
honorary professor of anatomy
In 1996 he moved to Dunedin with his wife Glynny and their four teenage
children where he assumed the position of chair and head of the department of
oral sciences and orthodontics at the University of Otago Jules was a well‐
respected and much‐loved teacher who was an extraordinary inspiration to all
those around him He had an extensive range of research interests which led to
many exciting PhD theses Jules assisted in police investigations ranging from
child abuse and trauma analysis to disaster victim identification He played a
leading role in the identification of victims of the Boxing Day tsunami in 2004
and the Christchurch earthquake in 2011 For these he was awarded a New
Zealand Special Services Medal a Canterbury Earthquake citation and a fellow-
ship of the Faculty of Maxillofacial Pathology from the Royal College of
Pathologists of Australasia
Jules obtained a DSc from his alma mater in 2001 and in 2004 was awarded
an ad hominem fellowship in dental surgery from the Royal College of Surgeons
Edinburgh In 2006 he was elected a professional fellow of the Forensic Science
Society (UK) and in 2009 was appointed as the inaugural director of the Sir John
Walsh Research Institute at the University of Otago
Through all his research and his academic life and his commitment to foren-
sic sciences Jules always remained a man for all and one who cared about each
and every individual in his life
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
xviii
Preface
The genesis for this book was the inclusion of forensic odontology as an inde-
pendent stream in the Faculty of Oral and Maxillofacial Pathology in the Royal
College of Pathologists of Australasia Jules and I thought it would be fantastic
to have a dedicated textbook to support the curriculum that had been devel-
oped Our vision was an awareness text rather than a didactic discourse After
John Wiley amp Sons kindly supported the initiative we then set about asking
fellows to contribute and I would like to thank each and every one of them for
their efforts and the timeliness of their contributions I would particularly like
to thank David Kieser Erin Hutchinson Terry Eberhardt and Gemma Dickson
who stepped in for Jules after his passing A text such as this can only ever be
seen as a group project and all authors have willingly given their time and
expertise to participate
Our first sadness came with the passing of our esteemed colleague Tony Hill in
December 2013 It was not a hard decision to decide to dedicate this text to Tony
as he epitomised everything we love about our profession Our next sadness was
the passing of Jules Kieser in June 2014 While potentially catastrophic for the
text once again the decision was not hard that Jules would remain as an editor of
the book For me personally Jules was someone I looked up to as a role model and
mentor as well as a good friend His enthusiasm for forensic work generosity of
spirit in sharing knowledge and commitment to teaching the next generation is
something I can only dream of emulating I know that since June I have mentally
consulted him frequently about content and progression of the book so I feel he
has well and truly earned his place on the front cover Some comments about
Jules from our authors are presented below
Of a legend I write an infinite intellect extraordinary mind and insatiable thirst for
knowledge Jules Kieser is best described as a gentle giant whose youthful enthusiasm
for everything around him endeared him to both colleague and student alike He was a
phenomenal supervisor colleague and friend who inspired those around him to strive
far beyond their own expectations or self‐imposed limitations (E Hutchinson)
Jules was one of the great enthusiasts and supporters of forensic medicine He was a
master of his subject and someone who could hold an audience in the palm of his hand
and leave them both awed and enthused Hugely respected by his peers he was a prac-
titioner researcher and teacher As a teacher he truly inspired his students and left them
with a desire to push the boundaries and commit to supporting the forensic sciences
(D Ranson)
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Preface xix
An outstanding academic with a heart of gold who always put his students and col-
leagues first (N Waddell)
I had the pleasure of meeting Jules for the first time in Darwin when he was keynote
speaker at a forensic odontology meeting He immediately impressed me as a great
speaker researcher and person I was looking forward to seeing Jules again when I heard
of his loss The scientific community and his family have lost a wonderful man
(M Leedham)
Jules was a true gentleman in every respect Slow to judge quick to support first to
honour and lead by example Those of us who were lucky enough to have worked with
him are better people for having known him (A Forrest)
Jules Kieser contributed mightily to the discipline of dental anthropology His research
into odontometrics was particularly valuable and an example of his great breadth of
research crossing over into palaeoanthropology and forensic anthropology (D Donlon)
Following the Asian tsunami in Thailand I fortunately found myself working with a very
committed and caring guy called Jules Since that time our friendship evolved and I
became aware of Julesrsquo dedication to his work and his drive to research the unknown
(S Knott)
An inspiration to both students and colleagues alike (D Kieser)
All that being said this book would not have been possible without the dedication
and ceaseless work of Julesrsquo wife Glynny She has kept me and the authors on
the straight and narrow and prodded and poked us to make sure we met
deadlines She has my unending admiration thanks gratitude and love
It is fitting to express our thanks and gratitude to the Office of the Dean
(Dentistry) at the University of Otago for editorial funding Further thanks go to
Rachael Ballard and Fiona Seymour who worked on the manuscript during its
infancy Audrie Tan who has been an unfailing support throughout Jenny
Cossham Janine Maer and all at John Wiley amp Sons Thank you to Caro McPherson
for her copyediting and to Sandeep Kumar at SPi Global for overseeing the
production of this book
Jane A Taylor2015
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Forensic Odontology Principles and Practice First Edition Edited by Jane A Taylor and Jules A Kieser
copy 2016 John Wiley amp Sons Ltd Published 2016 by John Wiley amp Sons Ltd
1
Irsquom not young enough to know everything
J M Barrie The Admirable Crichton Act I (1903)
Introduction
Forensic odontology has been variously described as lsquothe application of dental
science to the administration of the law and the furtherance of justicersquo [1] and
lsquothat branch of dentistry which in the interest of the law deals with the proper
handling and examination of dental evidence and the proper evaluation and
presentation of such evidencersquo [2] and lsquothe overlap between the dental and the
legal professionsrsquo [3]
The dates of these references show us that forensic odontology has been develshy
oping as a specialist discipline for the last 50 or so years Once the remit of the merely
interested or community minded and conscientious dentists now require rigorous
training and commitment to practise within the profession The discipline is recogshy
nised as a speciality of dentistry in a number of countries including Australia and
has a dedicated training stream within the Royal College of Pathologists of Australasia
To the general community forensic odontology is most frequently associated
with personal identification of the deceased and gains significant publicity at the
time of disasters natural or manmade that claim many lives at a single point in
time The actual scope of practice of forensic odontology is considerably broader
than this In addition to human identification forensic odontologists are also
involved in the examination and assessment of bite mark injuries orofacial injuries
following assault or trauma and child abuse injuries age assessment of both living
and deceased persons and civil cases involving malpractice and fraud allegations
Foundation knowledge in forensic odontologyJules A Kieser1 dagger Jane A Taylor2 Zaf Khouri3 and Maurice Churton4
1 Faculty of Dentistry University of Otago New Zealand2 Faculty of Health and Medicine University of Newcastle Australia3 New Zealand Society of Forensic Odontology New Zealand4 Oral and Maxillofacial Surgeon (Retired) New Zealand
Chapter 1
daggerDeceased
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
2 Chapter 1
Practitioners must also have a sound working knowledge of dental anatomy
and pathology comparative dental anatomy the natural sciences legal system
law and relevant legislation An understanding of the activities and interactions
of other forensic disciplines is also important in developing an appreciation of
the scope and practice of forensic odontology
On a personal level forensic odontologists should have broad dental experience
a methodical and analytical approach with considerable patience and attention
to detail Personal honesty and integrity and emotional stability are vital Good
communication and interpersonal skills and the ability to work as part of a team
as well as autonomously are important as is the ability to formulate and articushy
late well‐balanced views
This text will work its way through current best practice in a number of these
areas It aims to support those undertaking training in forensic odontology in the
development of their knowledge base which forms alongside their clinical skills
The text is designed at the awareness level rather than aiming to be an exhaustive
discourse Contemporary excellent references are provided to extend reading
beyond the introductory
Recent reviews into the scope and reliability of all forensic evidence have
seen an explosion of research and literature relating to improving the perforshy
mance and professionalism of practitioners [4ndash6] Recent rulings challenging
admissibility of specialist evidence recognition of specialist disciplines and the
evidentiary weight of forensic evidence also highlight the need for continued
research into aspects of practice and the need to establish and maintain high
professional standards [7ndash9]
a short history of forensic odontology
Although it was reported that forensic odontology was used to identify victims
of a fire in the Vienna Opera House in 1878 [1011] the modern era of forensic
odontology is said to have commenced with the identification of the victims of
the Bazar de la Chariteacute fire which occurred on 4 May 1897 in Rue Jean‐Goujon
Paris One hundred and twenty‐six members of the Parisian aristocracy perished
after an etherndashoxygen film projector ignited a rapidly destructive fire All but 30
of the victims were identified visually or by personal effects mainly jewellery on
the day after the fire
The honour of being the lsquofather of forensic odontologyrsquo is often bestowed
on Oscar Amoedo a Cuban dentist working in Paris at the time of the fire but
he did not in fact do any of the odontology work at this incident The author
of LrsquoArt dentaire en Medecine Legale [12] which was a considerable text on many
aspects of the use of teeth for legal purposes merely reported the outcomes of
the work done by other dentists after the fire The credit for the idea of using
dental information to assist the final identifications actually belongs to the
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Foundation knowledge in forensic odontology 3
Paraguayan Consul Mr Albert Haus With the identification of the last 30 vicshy
tims seeming almost impossible Mr Haus suggested consulting the dentists
who had treated the remaining missing persons One of the unidentified vicshy
tims was the Duchesse drsquoAlencon who was a daughter of the Duke of Bavaria
and sister of Elisabeth Empress of Austria and Anne Queen of Naples A Dr
Isaac B Davenport had provided dental services to the duchess and many of the
other victims He was apparently a trained botanist as well as a dentist and his
detailed notes included excellent drawings of the dentition He examined the
majority of the remaining unidentified bodies and was eventually able to identify
the duchess via her dentition Subsequently a number of other dentists were
invited to examine the remains of the deceased and eventually all but five of
the victims were identified The police accepted these dental identifications
and released the bodies to the families [1314]
Prior to the Bazar de la Chariteacute fire the most frequently cited examples of the
use of teeth and dental work in the identification of the deceased were those of
Lollia Paulina by Agrippina using visual recognition of lsquodistinctive teethrsquo in AD 49
Charles the Bold in 1477 General Joseph Warren by Paul Revere via a fixed wire
silver bridge in 1776 Dr Parkman by Nathan Keep from the fit of dentures on
study models in 1849 and Napoleon the IV in 1879 [1415]
In 1954 Strom [16] reported that the use of teeth to aid identification in the
modern understanding had in fact initially been proposed by Godon in 1887 but
a report by MrsquoGrath in 1869 [17] described the use of dental characteristics to
differentiate between two incinerated females
After the Bazar de la Chariteacute fire many authors published case studies on the
use of forensic odontology in both single and multiple fatality incidents
Rosenbluth [18] described a case in the United States in 1898 where dentistry
played a pivotal role in a murder case Ryan [19] mentioned the identification of
US Sailors from an accident in 1927 commenting on the high quality of the denshy
tal records kept by the Navy and Gustafson [11] recounted a fire in Oslo in 1938
where 29 people died Simpson [20] summarised a number of English cases of
the early 20th century Strom [16] and Gustafson [11] reported on the identificashy
tion of victims of the Second World War via forensic odontology Teare [21]
discussed the identification of 28 victims of a plane crash in 1950 Frykholm [22]
described a Swedish shipping accident in 1950 where 15 were killed and Mercer
Reid and Uttley [23] and Warren [24] a rail accident in New Zealand in 1953
where 151 perished Bradley and Miller [25] described the use of odontology in the
identification of victims of a plane crash in Canada The odontology aspects of the
identification of the 118 victims of a fire aboard the SS Noronic in Toronto
Harbour were described in detail by Grant Prendergast and White [26]
While these reports would appear to indicate that forensic odontology was
well recognised as a discipline Frykholm [22] did comment that both the
German and Swedish authorities involved in his case report lsquoreflected a certain
disbeliefrsquo about the value of forensic odontology and that the assisting dentists
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
4 Chapter 1
had no personal experience in forensic odontology prior to this case It would be
reasonable to assume that both appreciation of the value and experience in
forensic odontology were varied across the globe as can be expected with any
relatively new and emerging area of knowledge and investigation
Histories of forensic odontology acknowledge that the next significant
publication after Amoedo was that of Gustafson in 1966 [11] This compreshy
hensive text covered principles of identification in single and multiple death
situations information that can be ascertained from the dentition the
responses of teeth and restorations to various traumas and the investigation
of bite mark injuries Although more than 40 years old the text remains relevant
for contemporary practitioners Texts by Furuhata and Yamamoto [27] Luntz
and Luntz [28] Sopher [29] Cameron and Sims [30] and Harvey [31] and an
edition of the Dental Clinics of North America in 1977 soon followed marking the
arrival of a new specialist discipline within the field of dentistry Professional
associations relating to forensic odontology soon followed for instance the
Canadian Society of Forensic Odontology was formed in 1970 [32] the British
Association of Forensic Odontology in 1983 the New Zealand Society of
Forensic Dentistry in October 1985 and the Japanese Society of Forensic
Odontology in 1988 [33] thereby exposing the discipline to larger numbers of
interested dentists
The American Society of Forensic Odontology formed in 1970 as a group
open to any person with an interest in forensic odontology [15] In 1976 the
American Board of Forensic Odontology (ABFO) was incorporated under the
auspices of the American Academy of Forensic Sciences to lsquoestablish enhance
and revise qualifications and standardsrsquo and has developed a role as a certifying
board of forensic odontologists [34] This is the only international society to take
on such a formal role
The International Association of Forensic Odonto‐Stomatology (IOFOS) held
its inaugural meeting in Paris in June 1973 [35] Membership was initially open
to any individual with an interest in forensic odontology and was not limited
only to dentists It has since grown to be a group where membership is country
based having 32 member countries in 2015 and is the organisation representshy
ing the majority of forensic odontologists internationally
The only international journal dedicated to forensic odontology The
International Journal of Forensic Dentistry was published from 1973ndash1977 and was
the forerunner to the Journal of Forensic Odonto‐Stomatology which commenced
publication in 1982 [35]
In Australia The Australian and New Zealand Forensic Science Society was
formed in 1971 with the aim of bringing together scientists police pathologists
and members of the legal profession [36] Dentists were and still are members
of this group Dentists with a special interest in forensic odontology formed The
Australian Society of Forensic Dentistry now known as The Australian Society
of Forensic Odontology (AuSFO) in 1984
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Foundation knowledge in forensic odontology 5
Forensic odontology in australia
Pounder and Harding [37] reported that the first autopsies were conducted in
Australia in 1790 one on a victim of inanition (starvation) and the other on the
governorrsquos gamekeeper who was allegedly murdered by Aborigines Pounder [38]
reporting on death investigations in the early years (1839ndash1840) of South
Australia indicated that both the coroner and jurors were required to view the
body of the victim as part of the inquest procedures Although the stated purshy
pose was for the examination of marks of violence it could also be surmised that
it was also for the formal identification of the victim This practice remained
until 1907 Cordner Ranson and Singh [39] indicated that the first lectures on
forensic medicine were held in Melbourne in 1866
It is not really known when forensic odontology was first used in Australia
A report in the New South Wales Police News in 1943 reported the identification
in Melbourne Victoria of a murder victim Bertha Couphlin in 1923 and of
Norman List in 1924 using dental evidence [40] This article also mentioned
that the identity of three victims of a plane crash in the Dandenong Ranges in
1938 lsquocould only be established by means of the teethrsquo Cleland [41] mentioned
the identification of a New Zealand citizen in Western Australia in 1930 although
this identification appeared to rely more on circumstantial dental evidence than
true dental identification
The most famous identification case from that era occurred in New South
Wales in 1934 Colloquially known as the Pyjama Girl Case the outcome highshy
lights the value of dentistry in identification but also the pitfalls that can derail the
well intentioned but ill prepared dental practitioners and investigating police
officers It involved a murdered woman who remained unidentified for 10 years
ostensibly due to unreconciled dental information The badly burned remains of
the victim were discovered by a farmer in a road culvert near Albury in September
1934 The body was clothed only in pyjama remnants and revealed little other
identifying information A post‐mortem was carried out and a local dentist Dr
Francis Jackson was asked to complete a dental autopsy His unorthodox proceshy
dures can best be explained by his inexperience in forensic odontology but mitishy
gated by the fact that few people had any experience at that time At the subsequent
Supreme Court trial he admitted that this was his only experience of forensic
odontology and he found the process lsquorevolting and unnervingrsquo [42 43]
Dr Jacksonrsquos unconventional examination occurred over three visits On the
first he made some observations and extracted two teeth on the second he
extracted an additional four teeth and on the third he took upper and lower
impressions of the jaws The extracted teeth were then mounted into the stone
dental models made from the impressions lsquoin approximately the same position
as they were in the mouthrsquo During the course of these examinations Dr Jackson
incorrectly identified one tooth and failed to observe restorations in two other
teeth These inaccuracies proved pivotal in the inability to identify the remains
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
6 Chapter 1
for 10 years Photographs of the casts with the extracted teeth in situ were
distributed to dentists in Australia and New Zealand and every dentist in metshy
ropolitan Melbourne and Sydney was personally contacted by police
Information about this case including images of the extracted teeth was also
displayed as lsquoadsrsquo in movie theatres Unsurprisingly none of these activities
yielded any useful information
The police relied on public appeals to attempt to identify the victim
Apparently over 500 women who had been reported missing were located in the
course of the investigation Ultimately the remains were preserved in a formalin
bath and it became quite a social outing to visit lsquothe body in the bathrsquo at Sydney
University Many false identifications were offered to police from these viewings
About nine months after the victim was found police interviewed a man
Antonio Agostini whose wife Linda had been reported missing by a family
friend This gentleman indicated that he did not recognise the lady in the bath
but provided police with the details of his wifersquos dentist
The information provided by this dentist did not match the post‐mortem
information provided by Dr Jackson and the investigation continued
Interestingly the dental information provided by the treating dentist was also
somewhat unorthodox It transpired that he kept no formal clinical records and
the information he provided was an amalgamation of personal recollection and
ledger entries of fees paid This information would be legally inadmissible today
In 1944 new investigating officers decided to review all the information relatshy
ing to the case and asked another dentist Dr Magnus to re‐examine the body Dr
Magnus was more thorough in his work correctly identifying all the teeth and
locating previously unobserved restorations On comparison the new charting
matched the ante‐mortem dental information of Linda Agostini Antonio Agostini
subsequently admitted to having murdered his wife in 1934 [42 43]
This case highlights the importance of experience and procedure in forensic
odontology the value of comprehensive clinical records and attention to detail
during the collection of post‐mortem information Despite this recognition it still
took a number of years before formal services in forensic odontology were estabshy
lished in Australia Interestingly this development followed a similar path in
most states and territories From around the early 1960s there was spasmodic
use of dentists to assist police in identification procedures This was generally an
informal arrangement with little or no remuneration which meant that the
dentists providing the services frequently had to complete examinations and
prepare reports after hours and at weekends In the vast majority of cases a single
practitioner provided the entire service Limited training in forensic odontology
was available to these dental practitioners and it is a credit to their dedication
and professionalism that the discipline has developed to the high standard and
international reputation it enjoys today
Dr Gerald (Gerry) Dalitz provided the early forensic odontology services in
Victoria from the 1950s In 1961 he was awarded a Doctor of Dental Science for
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
Foundation knowledge in forensic odontology 7
a thesis entitled lsquoSome aspects of dental science ndash Identification of human
remainsrsquo by the University of Melbourne While collecting data for his research
his expertise came to the attention of the Victoria Police and they slowly began
utilising his services Dr Ross Bastiaan started working with Dr Dalitz in 1979
continuing until 1989 Professor then Dr John Clement arrived from the UK in
1989 to take up a position in the dental school at the University of Melbourne
Professor Clement had considerable experience in forensic odontology and had
worked on a number of mass fatality incidents including the Free Enterprise at
Zeebrugge in 1987 Upon arriving in Melbourne Professor Clement was instrushy
mental in establishing a broader and more professional forensic odontology sershy
vice in Victoria including the introduction of the first graduate training program
and the only Chair in Forensic Odontology in Australia [44]
In New South Wales the Chief Dental Officer Dr Norbert Wright together
with Drs Max Bullus John Wild Sydney Levine and Barry Barker provided the
odontology services on a similarly informal basis It was not until 1981 when
Associate Professor Griffiths completed a Masters in Public Health relating to
Disaster Victim Identification and took up a position at Westmead Hospital that
forensic odontology was formally recognised and funded through the New
South Wales Health Service [44]
In South Australia Dr Kenneth Brownrsquos interest in forensic odontology was
sparked in 1961 when he attended a lecture entitled lsquoDental aspects of forensic
medicinersquo presented by Professor Gosta Gustafson who was the Professor of Oral
Pathology at the University of Lund in Sweden In 1967 he responded to a
request by the South Australian Police Department who were looking for volunshy
teer dentists to provide them with dental expertise Dr Brown read widely but
as there were no formal training programs in Australia at the time he used a
Churchill Fellowship in 1976 to travel internationally to increase his knowledge
and experience in the field of forensic odontology His honorary work for the
South Australian Police continued until a formal post in forensic odontology the
first such position in Australia was created at the University of Adelaide in 1980
Drs Jane Taylor (2000ndash03) and Helen James (2004ndashpresent) have succeeded Dr
Brown as leaders of this unit [44]
Pocock in his 1979 paper on the provision of a forensic pathology service in
Western Australia [45] commented that a part‐time forensic odontologist was
lsquoavailable for consultation in any problem of identificationrsquo This position had been
established in the early 1960s and was held by Dr Frank Digwood and became a
formal part‐time position in the 1980s Dr Stephen Knott provided assistance to Dr
Digwood from 1991 and succeeded him on his death in 1993 [44]
Dr Kon Romaniuk moved from New Zealand to take up a position in the
dental school at the University of Queensland as an oral pathologist in the mid
1960s As appears typical for most developing services in Australia he provided an
honorary consultation service in forensic odontology later establishing a more
formalised arrangement that provided a modicum of remuneration Dr Alex
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including
8 Chapter 1
Forrest started working as an assistant to Dr Romaniuk in 1985 and became the
consultant forensic odontologist in 1994 after a traffic accident necessitated
Romaniukrsquos retirement [44]
Early forensic odontology services in Tasmania were by Dr Eric Canning MBE
a non‐practising dentist who worked in the anatomy department at the University
of Tasmania Dr Paul Taylor has provided these services since 1989 [44]
It is believed that early forensic odontology services in the Northern Territory
were provided by Dr T Paul Boyd who worked part time as an oral surgeon in
the public health system Dr John Plummer had an interest in forensic odontolshy
ogy from his undergraduate years but his first exposure came in the late 1970s
when he was the government dentist in Katherine and was asked to help identify
a family who had drowned after a flash flood had washed away their homestead
Dr Plummer continued his professional development in forensic odontology by
using a Churchill Fellowship awarded in 1985 to travel extensively and meet
and work with a number of forensic odontologists internationally As a health
service employee Dr Plummer continued his involvement in forensic dentistry
on an honorary basis until his retirement in 2002 which proved satisfactory as
the caseload in the Northern Territory was not large [44]
The Australian Capital Territory was the last of the Australian jurisdictions to
establish any regular service in forensic odontology and this occurred as a conseshy
quence of poor identification procedures in a murder that led local dentist Dr David
Griffiths to develop an interest undertake some training and offer his services [44]
Also quite interestingly all states and territories in Australia have experienced
major incidents which required the services of forensic odontology and which
served to increase the profile of the emerging discipline across the country
The Ash Wednesday bushfires of 1983 claimed 47 lives in Victoria 14 of the
22 (64) Victorian victims who could not be visually recognised were identified
via forensic odontology [46] Forensic odontology now forms a routine part of
single and multiple death investigations in Victoria including the Kew Cottages
Hostel fire in 1996 (nine deceased) the Linton bushfires in 1998 (five deceased)
a light plane crash at Myrrhee in 2002 (six deceased) the Mt Hotham plane
crash in 2005 (three deceased) a car accident at Donald in 2006 (eight deceased)
the Kerang train crash in 2007 (nine deceased) the crash in the Burnely Tunnel
in 2007 (three deceased) and in a major national Disaster Victim Identification
(DVI) incident the Black Saturday bushfires of 2009 that claimed the lives of
174 people [44]
The Grafton bus crash in 1989 highlighted the limitations of visual identifishy
cation and changed identification practices in New South Wales One of the 21
victims of this accident was initially incorrectly visually identified so when just
over two months later 35 people were killed in a collision between two buses
near Kempsey forensic odontology was used to identify the majority of the
victims Subsequently forensic odontology has been used as part of the identishy
fication repertoire in all mass fatality incidents in New South Wales including