When Disaster Strikes, Dentists Are Ready to Serve

When Dr. Richard Souviron heard that ValuJet’s Flight 592 had just crashed in the Everglades, the Coral Gables, Fla., dentist knew his schedule was about to become frantic.

Two days after the May 11 crash, the first remains of the 110 victims were retrieved and Souviron’s team of 26 began its painstaking work--comparing tiny tooth parts and fillings to dental records they had obtained after hasty calls to passengers’ dentists.

To date, four victims have been positively identified on the basis of dental characteristics. Two were simple cases of matching fillings with prior X-rays. A child was identified by comparing tooth growth and development with prior X-rays. A fourth was trickier, since the extent of the remains was the crowned part of a tooth and only one root.

Still, the team managed to make a match--and plans to press on until as many victims as possible are identified.

Souviron is a forensic odontologist--one of a select cadre of dentists who use their knowledge about teeth and bite marks to identify victims of mass disasters and abuse and to find criminals.

New computer programs and DNA-analysis techniques are adding scientific credibility to a field traditionally considered subjective. So, too, are professional conferences such as the second national symposium on “Dentistry’s Role and Responsibility in Mass Disaster Identification,” opening Friday at the American Dental Assn. in Chicago.

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Many dentists attending the symposium work full time in private practices, turning to forensics only when mass disaster or mayhem strikes. It’s far from a get-rich-quick sideline; many work pro bono or receive only expenses to cover their office overhead.

Dr. Bryan Chrz, who will be a speaker at the ADA conference, logged 15-hour days for nearly three weeks last year as a member of the dental forensic team helping to identify the 168 victims of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City. At workday’s end, he drove from the medical examiner’s office to his home in nearby Perry so he could be with his then-pregnant wife. Even during his one-hour commute, there was no respite, since news of the bombing filled the airwaves. “You could never escape the situation,” he says.

Souviron can relate. As of last week, he and his team had logged more than 370 hours and he’s continued to see patients at his Coral Gables office. So far, about 78 dental records of ValuJet passengers have been obtained, Souviron says, and team members often talk directly with the dentists, hoping to gather any additional shred of information that could point to a positive identification. Twelve dental samples have been retrieved from the crash site.

Even so, he predicts that the dental role in identification of ValuJet passengers will be very small because of the location of the crash site.

“It’s much harder to get dental remains [in this crash]. It’s marsh, it’s swamp. Someone described it like quicksand,” says Souviron, chief forensic odontologist for the Dade County Medical Examiner’s Office who served as an expert witness at the trial of serial killer Ted Bundy, executed in 1989.

The type of crash also dictates the role forensic dentistry plays in identification. When bodies are not badly fragmented, much more can be accomplished.

When Dr. Gerald Vale, chief forensic dental consultant for the Los Angeles County coroner’s office, began working in the field more than three decades ago, the pioneer recalls knowing of only about eight colleagues in the field. Now, 372 odontologists are members of the American Academy of Forensic Sciences, a Colorado Springs-based organization that also includes toxicologists, pathologists and other forensics professionals.

About 90 of those 372 are certified by the American Board of Forensic Odontologists, says president Ann Norrlander, a Minneapolis general dentist. Certification is based on the candidate’s personal and professional record of education, training, experiences and achievements along with the results on a formal exam.

Over the years, guidelines have evolved, says Dr. L. Thomas Johnson, dental consultant to the Milwaukee County medical examiner and the Wisconsin Department of Justice crime lab. There are now set procedures on how to put together a dental forensics disaster team, says Johnson, who organized the ADA conference. There are also extensive guidelines, developed by Vale and others, on how to evaluate bite marks, which can make or break a murder case.

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Teeth are ideal for identification because they are a rugged body part, says Dr. James McGivney, forensic odontologist at St. Louis University Center for Advanced Dental Education and another symposium speaker. “Fire will eventually burn teeth, but it takes a good hot fire a long time.”

In the Oklahoma City bombing investigation, “a lot of the people had fingerprints on file [since they were federal employees],” Chrz says, so finger-printing and dental records together were used on more than 40% of victims; dental information alone was used on 23%.

At the crux of dental identification are three steps, says McGivney: gathering remains, gathering dental records and comparing the two sets of information. Remains are photographed, X-rayed and charted. Traditionally, odontologists have used the “long-table” approach, spreading out dental records on a table and comparing them with post-mortem data.

Now, computer software programs are speeding up the process, says McGivney, who has developed one such program. After dental data are entered into the computer, he says, the computer can be instructed to search for the best match between the pre-death dental records and the post-disaster information. For instance, he might ask the computer to find an upper left first molar with a filling.

By closely examining an adult’s 32 permanent teeth and each tooth’s five surfaces, experts can even differentiate identical twins.

Even if a victim had dentures, matchups might be possible, McGivney says, by comparing bones beneath the gum with prior X-rays or by examining the dentures for identifying marks such as an imprinted name (required on new dentures in several states).

As McGivney and others fine-tune the comparison process, colleagues have been focusing on the analysis of saliva found on murder victims who have been bitten and on cigarette butts and food left at a crime scene. “We developed an improved way of extracting DNA from saliva,” says Dr. David Sweet, professor of oral diagnosis and a forensic dentist at the University of British Columbia, Vancouver, whose doctoral dissertation was on the topic. Analysis of the DNA, in turn, can point to the perpetrator.

In his research, Sweet has also found that saliva from a bite mark can be recovered from the skin of a victim even 48 hours after its deposit with no worry of it being contaminated by the victim.

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As gruesome as their work is, odontologists say it can be gratifying. Their identification of suspects or victims often provides closure to a tragedy for loved ones. Once odontologists are done examining the dental remains, they turn them over to a local funeral home, whose directors send them to a funeral home in the victim’s hometown. But the work also takes a psychological and emotional toll.

“Psychological counseling is offered routinely now after major disasters,” says Los Angeles County’s Vale. One veteran, usually adept at distancing himself, found it difficult when two victims closely resembled his own children.

After working at the site of a mass disaster, says Vale, involved in the investigation of the 1986 Cerritos crash of a DC-9 and a private plane, “you live with it for a long time afterward.” Most difficult to cope with after an airline crash, Vale finds, is the thought that many passengers were anticipating a reunion, vacation or other happy event just moments before the crash.

Many veterans echo Vale’s sentiments: “I don’t seek out mass disasters,” he says. But if asked, he would serve.