256 Forensic dentistry
In recent years the classic three-section team has become some-
what dated. With the widespread use of computerized radiography and
record handling, the postmortem and radiology sections have merged
into one. The entire dental section now runs as a real-time, integrated,
and networked system that allows all sections immediate access to all
information. Postmortem team members now can review and do quality
control on radiographs as they are taken. Once the postmortem record is
obtained, if antemortem information is already on site, the antemortem
section can begin to work on comparisons. This integration and access
allows for accurate construction of victim records, timely review of pos-
sible identifications, and more rapid information transfer to the waiting
family members of the victims.
The tracker brings a postmortem case to the dental section. The first
step is always digital photography to document the unique number and
the appearance of the victim. The initial and last photographs for the case
show the case number assigned to the unidentified victim. These two photo-
graphs bracket all other photographs of the case on the camera’s storage
media for easy distinction and separation when they are entered into the
digital case file. Once the photographs are finished the decision for surgi-
cal or nonsurgical dental examination is made. The decision to resect the
jaws is dependent on the viewablity of the victim’s body. For viewable bodies ,
all methods to break rigor and access the dental structures for examination
and radiographs are attempted short of surgical access. There should be a
rigid protocol available to address this question. Sometimes the medical
examiner or MFI commander will request to review all cases before surgi-
cal access is used. The chief odontologist may be empowered to make this
decision. The protocol used should document all actions on each case and
note who approved surgical access. Once the mode of access is determined,
the postmortem dental examination begins with digital radiographs. A full
mouth series is taken. In some forensic cases a single arch bitewing projec-
tion image is used on some periapical radiographs to allow comparisons to
ante mortem bitewings. Once the digital radiographs are completed the post-
mortem visual examination is carried out, with the radiographs available for
review whenever necessary. The postmortem examination team is made up
of three individuals. The leader performs the visual examination and places
the digital sensor or film to assist with radiographs. The assistant operates
and aims the handheld x-ray source and assists the leader with the visual
examination. The third member of the team is the computer operator, who
verifies correct radiographic images, controls the progress through the visual
examination and radiographs, and enters the dental data into the electronic
chart as the examination progresses. Figure 12.1 shows the DMORT dental
morgue with workers in full personal protective equipment (PPE) and all
three workstations in operation in Louisiana following Hurricane Katrina.